HomeMy WebLinkAboutCAG2024-514 - Other - Environmental Protection Agency - Brownfields clean-up assistance, multiple Kent locations - 11/13/24 FOR CITY OF KENT OFFICIAL USE ONLY
Sup/Mgr:
Agreement Routing Form DirAsst:
• For Approvals,Signatures and Records Management Dir/Dep:
KENT This form combines&replaces the Request for Mayor's Signature and Contract Cover (optional)
WASHINGTON Sheet forms. (Print on pink or cherry colored paper)
Originator: Department:
Bill Ellis ECD
Date Se Date Required:
c 11/13/2024 11/14/2024
Q Mayor or Designee to Sign. Date of Council Approval:
Q Interlocal Agreement Uploaded to Website n/a
Budget Account Number: Grant? Yes[Z] NoE]
Budget? Yes Type: Federal
Vendor Name: Category:
Environmental Protection Agency Grant: Non-Real Property
Vendor Number: Sub-Category:
Original
0
Project Name: Brownfields clean-up assistance, multiple Kent locations
OProject Details:
C
40
C
(11.111 Agreement Amount: $0
Basis for Selection of Contractor:
E *Memo to Mayor must be attached
i Start Date: Termination Date:
a Local Business? Yes F]No*If meets requirements per KCC 3.70.100,please complete"Vendor Purchase-Local Exceptions"form on Cityspace.
Business License Verification: ❑Yes In-Process F1 Exempt(KCC 5.01.045) Authorized Signer Verified
Notice required prior to disclosure? Contract Number:
Yes❑No CAG2024-514
Comments:
1 This form is required by the EPA to advance to CoK a final award agreement
for $500,000 in community brownfield assessment funds. Mayor can sign
since this certification does not yet bind the City to acceptance of funds per
conversation with Law.
0
°C The final award agreement will be taken to Council as require by KCC
40
3.70.240(C).
cDate Received:City Attorney: 11/13/24 Date Routed:Mayor's Offic�11/13/24 City Clerk's Office 11/13/24
adccW22373_7_20 + ✓6 cuments.KentWA.gov to obtain copies of all agreements
rev.20221201
A United States OMB Control No.2030-0020
EPA ENVIRONMENTAL PROTECTION AGENCY Approval expires 06/30/2024
Washington, DC 20460
This collection of information is approved by OMB under the Paperwork Reduction Act,44 U.S.C.3501 et seq.(OMB Control No.2030-0020).
Responses to this collection of information are required to obtain an assistance agreement(40 CFR Part 30,40 CFR Part 31,and 40 CFR Part 33 for
awards made prior to December 26,2014,and 2 CFR 200,2 CFR 1500,and 40 CFR Part 33 for awards made after December 26,2014).An agency may
not conduct or sponsor,and a person is not required to respond to,a collection of information unless it displays a currently valid OMB control number.
The public reporting and recordkeeping burden for this collection of information is estimated to be 0.25 hours per response.Send comments on the
Agency's need for this information,the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden to the
Regulatory Support Division Director,U.S.Environmental Protection Agency(2821T),1200 Pennsylvania Ave.,NW,Washington,D.C.20460.Include
the OMB control number in any correspondence.Do not send the completed form to this address.
EPA Project Control Number
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS,
LOANS AND COOPERATIVE AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with the awarding of any Federal
contract, the making of any Federal grant, the making of any Federal loan, the entering
into of any cooperative agreement, and the extension, continuation, renewal,
amendment, or modification of any Federal contract, grant, loan, or cooperative
agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress in connection with this Federal contract, grant, loan, or
cooperative agreement, the undersigned shall complete and submit Standard Form-LLL,
"Disclosure Form to Report Lobbying," in accordance with its instructions.
(3)The undersigned shall require that the language of this certification be included in the
award documents for all sub-awards at all tiers (including sub-contracts, sub-grants, and
contracts under grants, loans, and cooperative agreements) and that all sub-recipients
shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making
or entering into this transaction imposed by section 1352, title 31 U.S. Code. Any person who fails
to file the required certification shall be subject to a civil penalty of not less than $10,000 and not
more than $100,000 for each such failure.
Dana Ralph, Mayor
Typed Name &Title of Authorized Representative
11/13/2024
Signature and Date of Auth)rized epresentative
EPA Form 6600-06 (Rev. 06/2014) Previous editions are obsolete.