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USDA Forest Service OMB 0596-0217 FS-1500-19 PAGE OF MODIFICATION OF GRANT OR AGREEMENT PAGES 1 1. U.S. FOREST SERVICE GRANT/AGREEMENT 2. RECIPIENT/COOPERATOR GRANT or 3. MODIFICATION NUMBER: NUMBER: AGREEMENT NUMBER, IF ANY: 002 16-LE-11031200-005 4. NAME/ADDRESS OF U.S. FOREST SERVICE UNIT ADMINISTERING 5. NAME/ADDRESS OF U.S. FOREST SERVICE UNIT ADMINISTERING GRANT/AGREEMENT (unit name, street, city, state, and zip + 4): PROJECT/ACTIVITY (unit name, street, city, state, and zip + 4): Sherry Smith, Grant & Agreement Specialist Bray Addison, Patrol Captain Tonto National Forest, Supervisor's Office Tonto National Forest, Supervisor's Office 2324 East McDowell Road 2324 East McDowell Road Phoenix, AZ 85006 Phoenix, AZ 85006 6. NAME/ADDRESS OF RECIPIENT/COOPERATOR (street, city, state, and zip 7. RECIPIENT/COOPERATOR’S HHS SUB ACCOUNT NUMBER (For HHS + 4, county): payment use only): Maricopa County on behalf of the Maricopa County Sheriff’s Office 550 West Jackson Street, 4th Floor Phoenix, AZ 85003 8. PURPOSE OF MODIFICATION CHECK ALL This modification is issued pursuant to the modification provision in the grant/agreement THAT APPLY: referenced in item no. 1, above. CHANGE IN PERFORMANCE PERIOD: CY2018 Annual Operating Plan & Financial Plan (AOP) estimated dates January 1, 2018 through December 31, 2018. CHANGE IN FUNDING: Add funding in the amount of $100,400.00 for work to be performed in CY2018 AOP, attached as Exhibit A. ADMINISTRATIVE CHANGES: Add additional language to the Cooperative Law Enforcement Agreement (see 9. below) OTHER (Specify type of modification): Except as provided herein, all terms and conditions of the Grant/Agreement referenced in 1, above, remain unchanged and in full force and effect. 9. ADDITIONAL SPACE FOR DESCRIPTION OF MODIFICATION (add additional pages as needed): Note: 2018 CY AOP will be incorporated as Exhibit A to this agreement. Update Program Contact for Maricopa County Sheriff's Office to: Captain George Hawthorne Update Administrative Contact to: Cindy Kenney. (see attached AOP). 10. ATTACHED DOCUMENTATION (Check all that apply): Revised Scope of Work Revised Financial Plan Other: Exhibit A, CY2018 AOP 11. SIGNATURES AUTHORIZED REPRESENTATIVE: BY SIGNATURE BELOW, THE SIGNING PARTIES CERTIFY THAT THEY ARE THE OFFICIAL REPRESENTATIVES OF THEIR RESPECTIVE PARTIES AND AUTHORIZED TO ACT IN THEIR RESPECTIVE AREAS FOR MATTERS RELATED TO THE ABOVE-REFERENCED GRANT/AGREEMENT. 11.A. MARICOPA COUNTY, ARIZONA SIGNATURE 11.B. DATE 11.C. U.S. FOREST SERVICE SIGNATURE 11.D. SIGNED DATE SIGNED (Signature of Signatory Official) (Signature of Signatory Official) 11.E. NAME (type or print): 11.F. NAME (type or print): NEIL J. BOSWORTH 11.G. TITLE (type or print): Chairman Board of Supervisors 11.H. TITLE (type or print): Forest Supervisor USDA Forest Service OMB 0596-0217 FS-1500-19 ATTEST: FRAN MCCARROLL Date Date Clerk of the Board of Supervisors Special Agent in Charge, Southwestern Region PAUL PENZONE Date Sheriff 12. G&A REVIEW 12.A. The authority and format of this modification have been reviewed and approved for signature by: 12.B. DATE SIGNED ______________________________________ SHERRY J. SMITH U.S. Forest Service Grants & Agreements Specialist USDA Forest Service OMB 0596-0217 FS-1500-19 APPROVED AS TO FORM THIS ________DAY OF _____________, 201 BY: ______________________________ DEPUTY MARICOPA COUNTY ATTORNEY USDA Forest Service OMB 0596-0217 FS-1500-19 Burden Statement According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0217. The time required to complete this information collection is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at 202-720-2600 (voice and TDD). To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call toll free (866) 632-9992 (voice). TDD users can contact USDA through local relay or the Federal relay at (800) 877-8339 (TDD) or (866) 377-8642 (relay voice). USDA is an equal opportunity provider and employer. USDA Forest Service OMB 0596-0217 FS-1500-19 INSTRUCTIONS FOR FORM FS-1500-19 1. Enter the orginal U.S. Forest Service agreement number. 2. Enter the cooperator’s agreement number, if applicable. 3. Enter the number for this Modification, i.e. 01, 02, or 03. The first modification to an instrument is ‘01’, subsequent modifications receive a subsequent modification number (for example, the fourth modification is ’04’). 4. Enter the address of the G&A Specialist/Signatory Official responsible for this agreement. 5. Enter the address of the U.S. Forest Service Program/Project Manager or Lead Scientist responsible for this agreement. 6. Enter the cooperator’s address. 7. Enter the cooperator’s HHS Sub-Account numbers, if funding is provided on this modification (for example: G2412345003) (Only used by NA/S&PF and NRS) 8. Select all boxes that apply: - Change in Performance = updated performance period agreed to. - Change in Funding = obligation OR de-obligation amount and new totals. - Administrative = change in pay address, administrator address, correcting typing errors, etc. - Other = any other modification not described, such as update new objective to study plan, change the Principle Investigator, etc. 9. Insert changes such as updated provision, tasks, or any other data needed by the modification, add additional pages as needed. 10. Check all boxes that apply and ensure to attach these documents to the modification. Other attachments could include SF-424 forms. 11. A – D, self explanatory. 11. E – H, Type or print the names of signatory officials. 12. G&A Specialist signs and dates before sending to the individuals in block 11, if all modification data are approved for signature.