COOPERATIVE AGREEMENT AMENDMENT 7 30 14.PDF

$ USDA Forest Service OMB 0596-0217
FS-1500-49
PAGE OF PAGES
MODIFICATION OF GRANT OR AGREEMENT 5
1. U.S. FOREST SERVICE GRANT/AGREEMENT NUMBER: 2. RECIPIENT/COOPERATOR GRANT Or 3. MODIFICATION NUMBER:
11-RO-11031200-013 AGREEMENT NUMBER, IF ANY: 1
C-91-12-020-M-00
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, Grants Management Specialist Thomas Torres, Forest Engineer
Tonto National Forest Tonto National Forest
Supervisor's Office 2324 E McDowell Road
2324 E. McDowell Rd. Phoenix, AZ 85006
Phoenix, AZ 85006
6. NAME/ADDRESS OF RECIPIENT/COOPERATOR (street, city, state, and zip + 7. RECIPIENT/COOPERATOR'S KM SUB ACCOUNT NUMBER (For FITIS
4, county): payment use only):
John Hauskins, Transportation Director
Maricopa County Department of Transportation
2901 W. Durango Street
Phoenix, AZ 85009-6357
S. 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:
I- CHANGE IN FUNDING:
1 ADMINISTRATIVE CHANGES: See revised Principal Contact List to replace Paragraph 10 of agreement.
ri 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):
The Annual maintenance meeting was held on May 23 11 2012. Attached is the revised Principal Contact List.
10. ATTACHED DOCUMENTATION (Cheek all that apply):
n Revised Scope of Work
1-1 Revised Financial Plan
El Other: Revised Contact List

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USDA Forest Service FS-1500-19
PRINCIPAL CONTACTS. Individuals listed below are authorized to act in their respective areas for matters
related to this agreement.
Principal Cooperator Contacts:
Cooperator Program Contact Cooperator Administrative Contact
Name: John Hauskins, Transportation Dir. Name: Lynne Hilliard
Address: 2901 W. Durango Street Address: 2901 W. Durango Street
City, State, Zip: Phoenix, AZ 85009 City, State, Zip: Phoenix, AZ 85009
Telephone: 602.506.4644 Telephone: 602.506.1791
FAX: 602.506.4858 FAX: 602.506.4882
Email: johnhauskins@mail.maricopa.gov Email:lynnehilliard@mail.maricopa.gov
Principal U.S. Forest Service Contacts:
U.S. Forest Service Program Manager U.S. Forest Service Administrative
Contact Contact
Name: Thomas Torres, Forest Engineer Name: Sherry Smith, G&A Specialist
Tonto National Forest Address: 2324 E. McDowell Road
Address: 2324 E. McDowell Road City, State, Zip: Phoenix, AZ 85006
City, State, Zip: Phoenix, AZ 85006 Telephone: 602.225.5383
Telephone: 602.225.5375 FAX: 602.225.5295
FAX: 602.225.5295 Email: sherrysmith@fsfed.us
Email: ttores@fs.fed.us

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,
I 1.A. MARICOPA COUNTY SIGNATURE 1 LB. DATE . 11.C. U.S. FOREST SERVICE SIGNATURE SIGNED 13.D. DATE
SIGNED
(Signature of Signatory Official) , (Signature of Signatory Official) _
1 I.E. NAME (type or print): I I.F. NAME (type or print): NEIL BOS WORTH,
See Attached
11.G. TITLE (type or print): I LH. TITLE (type or print): FOREST SUPERVISOR
See Attached
12. G&A REVIEW
.. 12.A. The authority and format of this modification have been reviewed and approved for signature by: SIGNED 12.B. DATE
SHERRY'. SMITH
U.S. Forest Service Grants & Agreements Specialist

MARICOPA COUNTY
Recommended by:
John B. Hauskins, RE. Date
Transportation Director
Approved and Accepted by:
Denny Barney, Chairman Date
Board of Supervisors
Attest by:
Fran McCarron Date
Clerk of the Board
APPROVAL OF DEPUTY COUNTY ATTORNEY
I hereby state that I have reviewed the proposed Intergovernmental Agreement and declare the
Agreement to be in proper form and within the powers and authority granted to the Parties by their
respective governing bodies under the laws of the State of Arizona.
Deputy County Attorney Date

Burden Statement
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response, including the time for reviewing instructions, searching existing data sources,
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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.