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Federal Funding Accountability and Transparency Act(FFATA) l
<br /> ..1113111 Data Collection Form
<br /> -W Federal funds that require compliance with the Federal Funding Accountability and Transparency Act
<br /> DEPARTMENT OF support this agreement between The Department of Ecology(ECY)and your organization.The purpose
<br /> ECOLOGY of the Transparency Act is to make information available online so the public can see how recipients
<br /> State of Washington spend federal funds.
<br /> Your organization must have a Data Universal Numbering System(DUNS®) number to comply with the act and be eligible
<br /> to enter into this agreement.If you do not already have one, you may get a DUNS number free of charge by contacting
<br /> Dun and Bradstreet at www.dnb.com. ECY also encourages registration with the Central Contractor Registration(CCR)to
<br /> reduce data entry by both ECY and your organization.You may register with CCR free of charge at www.ccr.gov. ECY will
<br /> report information about your organization and this agreement to the federal government as required by Title 2 CFR, Part
<br /> 25.The public can view this information on the federal government website www.USASpending.gov. .
<br /> ECOLOGY AGREEMENT# C I,)-O 0 1 Mb
<br /> Recipient Information — For Recipient Use Only
<br /> 1. Legal Name 2. DUNS Number
<br /> •
<br /> City of Everett 608-909-156
<br /> 3. Principle Place of Performance -
<br /> 3200 Cedar Street
<br /> 3a. City 3b. State
<br /> Everett WA
<br /> 3c. Zip+4 3d. Country
<br /> 98201-4516 USA
<br /> 4. Are you registered in CCR? DYES. Skip to signature block. Sign, date and return. LINO. Continue with 5.
<br /> 5. In the preceding fiscal year did your organization:
<br /> a. Receive 80%or more of annual gross revenue from federal contracts,subcontracts,grants, loans,
<br /> subgrants,and/or cooperative agreements;.and
<br /> b. $25,000,000 or more in annual gross revenues from federal contracts, subcontracts, grants, loans,
<br /> subgrants, and/or cooperative agreements; and
<br /> c. The public does not have access to information about the compensation of the executives through periodic
<br /> reports filed-with the IRS or the Security and Exchange Commission per 2 CFR Part 170.330.
<br /> ® NO. Skip to signature block:Sign, date and return.
<br /> ❑YES.You must report the following information for the five(5) most highly compensated executives in your
<br /> organization. Sign, date and return.
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<br /> 1.
<br /> 2.
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<br /> 5.
<br /> •
<br /> *Note:"Total compensation” means the cash and noncash dollar value earned by the executive during the
<br /> subrecipient's past fiscal year. (For more information, see 17 CFR 229.402(C)(2)).
<br /> By signing this document,the Authorized Representative attests to the information above.
<br /> Signature of • t/•�/ d Re. ---ntative Print Name w D--`46.4- ate
<br /> I ic.,, .--D.N.A11) -k
<br /> Please sign and return this .ocument with the signed agreement.The Department of Ecology it°not pay
<br /> • any invoices until it receives this completed and signed form.
<br /> If you need this document in a format for the visually impaired, call Leann Ryser at(360)407-7054. Persons with hearing
<br /> loss can call 711 for Washington Relay Service. Persons with a speech disability can call 877-833-6341.
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