IGA RE BLM FIRE PLAN RURAL ASSISTANCE.PDF
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Page 1 of2 CHOOSE ONE: Grant and Cooperative Agreement gi COOPERATIVE AGREEMENT 0 GRANT CHOOSE ONE EDUCATION El FACILITIES U RESEARCH 0 SDCR 0 TRAINING 1, GRANT/COOPERATIVE AGREEMENT NUMBER 2. SUPPLEMENT NUMBER 3, EFFECTIVE DATE 4. COMPLETION DATE L09AC15613 0003 07/28/2011 08/31/2014 5. ISSUED TO NAME/ADDRESS OF RECIPIENT (No., Street, City/County, State, ZIP) 6. ISSUED BY ELM AZ -STATE OFC ADMN SVCS (AZ 951 COUNTY OF MARICOPA Mailing Address: ONE N. CENTRAL AVE , SUITE 800 Attn: UNKNOWN PHOENIX AZ 85004 301 W. JEFFERSON ST., SUITE 960 PHOENIX 7. TAXPAYER IDENTIFICATION NO. (TIN) 9 PRINCIPAL INVESTIGATOR/ORGANIZATION'S PROJECT OR PROGRAM MGR. (Name & Phone) 8. COMMERCIAL 8, GOVERNMENT ENTITY (CAGE) NO, Sara Latin, 602 -275 - 1638 10. RESEARCH, PROJECT OR PROGRAM TITLE Maricopa County Emergency Management CWPP Implementation 11, PURPOSE Bee Schedule 2. PERIOD OF PERFORMANCE (Approximately) 08/01/2009 throu01 08/31/2014 13A. AWARD HISTORY 138. FUNDING HISTORY PREVIOUS $70 000.00 PREVIOUS 70 000.00 THIS ACTION 30,000.00 THIS ACTION ..-CASH SHARE $ 0,000.00 1.00 TOTAL $100,000.00 NON-CASH SHARE $0.00 RECIPIENT SHARE $0.00 TOTAL $I00000.00 114. ACCOUNTING AND APPROPRIATION DATA 01 P URCHASE REQUEST NO JOB ORDER NO. AMOUNT STATUS ,0020003605 15. POINTS OF CONTACT NAME MAIL STOP TELEPHONE E-MAIL ADDRESS TECHNICAL OFFICER Brian Achziger 623 -580 - 5622 Brian_AchzigerthIm.gov NEGOTIATOR ADMINISTRATOR Paul Stout 602 -417 - 9268 •aul _ stoutOblm.gov PAYMENTS IIIIIIIIIIIIIIIIIMIIIIIIIIOIN 11111111111.1.1111 16. THIS AWARD IS MADE UNDER THE AUTHORITY OF: Federal Land Policy and Management Act of 1976 17. APPLICABLE STATEMENT(S), IF CHECKED: 18. APPLICABLE ENCLOSURE(S), IF CHECKED: El NO CHANGE IS MADE TO EXISTING PROVISIONS 0 PROVISIONS SPECIAL CONDITIONS 0 FDP TERMS AND CONDITIONS AND THE AGENCY-SPECIFIC 0 REQUIRED PUBLICATIONS AND REPORTS REQUIREMENTS APPLY TO THIS GRANT UNITED STATES OF AMERICA COOPERATIVE AGREEMENT RECIPIENT CONTRACTING/GMNTII - [ DATE AUTHORIZED REPRESENTATIVE Paul Stout DATE 07/28/2011 Page 2 of 2 Grant and Cooperative Agreement ESTIMATED COST ITEM (A) NO. ITEM OR SERVICE (Include Specificallans and Special Inst=dons) QUANTITY UNIT 'until. PRICE AMOUNT (8) (C) (IX (C) (F) CFDA Number: 15.242 DUNS Number: 077535144+0000 LO9AC15613 11. PURPOSE: Request made by ELM Program Officer, Dolores arcia. The Terms and Conditions are revised to allow for annual reporting of the SF 425 Federal Financial eports and Performance Reports. Both reports should be reported at the end of each year of the agreement or every August 31st due to the Grants anagement Officer no later than 90 calendar days .fter that date. Delivery: 09/01/2011 Delivery Location Code: 0004276223 LM-AZ ARIZONA STATE OFFICE* ONE NORTH CENTRAL AVENUE PHOENIX AZ 85004-4424 US ccount Assignment: X G/L Account: 6100.411C0 Business Area: L000 Commitment Item: 411000 Cost Center: LLAZP00000 Functional Area 310100A.000000 Fund: XXXL1125AF Fund Center: • LLAZP00000 Project/WBS: LF.HF.P.1-020000 PR Acct ssign Line: 01 Period of Performance: 09/01/2009 to 08/31/2014 1 aricopa County Emergency Management 00010 Community Assistance 30,000.00 Obligated Amount: $30,000.00