Washington State Military Department 11/20/2018

FFATA FORM Subrecipient Agency: City of Everett Office of Emergency Management Grant and Year: EMPG FFY18 Agreement Number: E19-125 Completed by: Name Title Telephone Date Completed: STEP 'I YES STOP, no further NO Is your grant agreement less than $25,000? analysis needed, / GO to Step 2 GO to Step 6 STEP 2 In your preceding fiscal year, did your YES NO STOP, no further organization receive 80% or more of its annual GO to STEP 3 analysis needed, GO to gross revenues from federal funding? Step 6 STEP 3 In your preceding fiscal year, did your YES NO STOP, no further organization receive$25,000,000 or more in GO to STEP 4 analysis needed, GO to federal funding? Step 6 STEP 4 Does the public have access to information about YES STOP, no further NO the total compensation*of senior executives in analysis needed, GO to STEP 5 your organization? GO to step 6 STEP 5 • Executive#1 Name: Total Compensation amount: $ Executive#2 Name: Total Compensation amount: $ Name: Executive#3 Total Compensation amount: $ Executive#4 Name: Total Compensation amount: $ Executive#5 Name: Total Compensation amount: $ STEP 6 If your organization does not meet these criteria, specifically identify below each criteria that is not met for your organization: For Example: "Our organization received less than $25,000." The city received less than $25M in federal funding, which was less than 1% of gross revenues. ` Z/ y Signature: Ll " Date: � *Total compensation refers to: • Salary and bonuses • Awards of stock, stock options, and stock appreciation rights • Other compensation including, but not limited to, severance and termination payments • Life insurance value paid on behalf of the employee Additional Resources: http://www.whitehouse.gov/omb/open http://www.hrsa.gov/grants/ffata.html http://wvvw.gpo.gov/fdsys/pkg/FR-2010-09-14/pdf/2010-22705.pdf http://www.grants.gov/ Page 1 of 3