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DocuSign Envelope ID:El D3838B-8A07-4875-8535-3468EBC6493A <br /> State of Washington Department of Ecology Page 12 of 23 <br /> Agreement No: SPPREG-2123-EverFD-00005 <br /> Project Title: City of Everett Response Capacity Building <br /> Recipient Name: Everett city of-Fire Department <br /> Funding Distribution Summary <br /> Recipient/Ecology Share <br /> Funding Distribution Name Recipient Match % Recipient Share Ecology Share Total <br /> City of Everett Response 0.00 % $ 0.00 $ 33,000.00 $ 33,000.00 <br /> Capacity Building <br /> • <br /> Total $ 0.00 $ 33,000.00 $ 33,000.00 <br /> AGREEMENT SPECIFIC TERMS AND CONDITIONS <br /> N/A <br /> SPECIAL TERMS AND CONDITIONS <br /> GENERAL FEDERAL CONDITIONS <br /> If a portion or all of the funds for this agreement are provided through federal funding sources or this agreement is <br /> used to match a federal grant award,the following terms and conditions apply to you. <br /> A. CERTIFICATION REGARDING SUSPENSION,DEBARMENT,INELIGIBILITY OR VOLUNTARY <br /> EXCLUSION: <br /> 1. The RECIPIENT/CONTRACTOR,by signing this agreement, certifies that it is not suspended, debarred,proposed for <br /> debarment, declared ineligible or otherwise excluded from contracting with the federal government, or from receiving <br /> contracts paid for with federal funds. If the RECIPIENT/CONTRACTOR is unable to certify to the statements <br /> contained in the certification,they must provide an explanation as to why they cannot. <br /> 2. The RECIPIENT/CONTRACTOR shall provide immediate written notice to ECOLOGY if at any time the <br /> RECIPIENT/CONTRACTOR learns that its certification was erroneous when submitted or had become erroneous by <br /> reason of changed circumstances. <br /> 3. The terms covered transaction,debarred, suspended, ineligible, lower tier covered transaction, participant, person, <br /> primary covered transaction,principal, proposal, and voluntarily excluded, as used in this clause,have the meaning set <br /> out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact <br /> ECOLOGY for assistance in obtaining a copy of those regulations. <br /> 4. The RECIPIENT/CONTRACTOR agrees it shall not knowingly enter into any lower tier covered transaction with a <br /> person who is proposed for debarment under the applicable Code of Federal Regulations, debarred, suspended, <br /> declared ineligible, or voluntarily excluded from participation in this covered transaction. <br /> 5. The RECIPIENT/CONTRACTOR further agrees by signing this agreement,that it will include this clause titled <br /> "CERTIFICATION REGARDING SUSPENSION,DEBARMENT,INELIGIBILITY OR VOLUNTARY <br /> EXCLUSION"without modification in all lower tier covered transactions and in all solicitations for lower tier covered <br /> transactions. <br /> 6. Pursuant to 2CFR180.330,the RECIPIENT/CONTRACTOR is responsible for ensuring that any lower tier covered <br /> transaction complies with certification of suspension and debarment requirements. <br /> Template Version 12/10/2020 <br />