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Home My WebLink About17- Challenge Cost Share Agreement Modification - USDA, Forest Service, Custer Gallatin National Forest - Mystic Lake Beaver Dam Removal tl�s USDA Forest Service OMB 0596-0217 FS-1500-19 MODIFICATION OF GRANT OR AGREEMENT PAGE OF PAGES 1 2 1 U S FOREST SERVICE GRANT/AGREEMENT NUMBER: 2 RECIPIENT/COOPERATOR GRANT or 3 MODIFICATION NUMBER: 1 8-CS-1 1 0 1 1 1 00-008 AGREEMENT NUMBER,IF ANY: 001 M stic Lake Beaver Dam Removal 4 NAMEIADDRESS OF U S FOREST SERVICE UNIT ADMINISTERING 5.NAME/ADDRESS OF t1.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): Charlie Boucher, Custer Gallatin National Forest Jonathan Kempff, Custer Gallatin National Forest 3710 Fallon Street, Suite C, Bozeman, MT 59715 PO Box 130, Bozeman,MT 59771 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): City of Bozeman PO Box 1230, Bozeman,MT 59771 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: ® CHANGE IN FUNDING:Additional funds in the amount of$6,000 ® ADMINISTRATIVE CHANGES:See Block 9 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 purpose of this modification is to add additional funds in order to meet the intent of the originally negotiated cost-share match. The U.S.Forest Service has determined it is prohibitive to provide helicopter support,therefore,additional funds will go towards the added contract cost for delivery of pipe. See Mod 1 Financial Plan. Original Financial Plan-FS Non-Cash Contribution for Helicopter Support and related Salary costs have been removed. The new cummulative Match Determinations follows: Matching Costs Determination Total Forest Service Share=53.78% Total Cooperator Share=46.22% Total =100.00% Provision IV.THE FOREST SERVICE SHALL. Remove section IV.D.Provide helicopter support for the delivery of pipe to the pra'ect site. 10. ATTACHED DOCUMENTATION (Check all that apply): Revised Scope of Work Revised Financial Plan ® Other:Mod 1 Financial Plan 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 LA.CIT 01'BOZEMA GNATURE I I B.DATE 1 LC U.S R ZVEGN 1 LD.DATE ! SIGNED SIGNED Si nature of Signatory Official l�• 4 Si nature o i ato fficial) L l I I E NAME(type or print):ANDREA SURRATT 11 F NAM/(type or pr t t):MARY C. ERICKSON 1. [1�S USDA Forest Service OMB 0596-0217 FS-1500-19 1 I.G.TITLE (type or print):Interim City Manager 11.H. TITLE(type or print):Forest Supervisor 12. G&A REVIEW 12.A.The authority and format of this modification have been reviewed and approved for signature by: 12.8.DATE SIGNED -- November 3, CHARLENE BOUCHER 2018 U.S.Forest Service Grants&Agreements Specialist ^ m N � 98 W O O LO O ch O -' O m O O O O O O O O O O O LL 69 69 69 64 6R O 69 O 69 69 O N O 69 64 EA N t= O O O O O O O O O p - O O O O O O O O 7 (� Z Q z 69 69 69 69 69 69 69 O O Z o o �o 0)o o CD �- . Cm o00000 00 0 0L L o � � o o � o c C z Q o 0 o O 00 eC cLLIc (L o m m cn UO Z '♦3 +�+ a "O 0 0 0 0 0 0 0 0 O fq y t 4) O O O O O O O O O N y N Z O O O O O O O O O C U) 0 bs 6s s9 sA o0 0o ss o 3 V U C t�C 0 1- co tc K.� LL m CNO E d L +y.+ 4) U W Q Z U 0 G cc 21 p a m c Li E c 0 a L E w L m >,0 � �a o L y W 0 0 cv o 0 0 0 0 0 0 o 0 0 N - r y E U o 0 0 0 0 0 0 0 0 U U) Q � CD 0 0 0 6 0 6 6 Z Z «s O c E �, o c w c� � ssssr� s9 ss sAss N 0 a) N LL z- Q. W U) N b1J N 0) s p O y O v II 0 II I I N cn ~ 0 0 0 Q W v Z LL � U s t �- QQ ZI- F-o aO o � + mo a+ U) 2 o -QL �• " ♦- N p X O U r ea In Z U U W p ) i ca a W t� m � � m m -J o � � -E w O � E T > = a� C V ' N Q Q O Q m U) N@ > 7 Q C O m Q CT =3O (6 LL OU o U) l- W co LL O O U) U LL - it (3) r U y 4) O Q LL WORKSHEET FOR FS Cash to the Cooperator Cost Analysis, Column b Use this worksheet to perform the cost analysis that supports the lump sum figures provided in the matrix. NOTE: This worksheet auto populates the relevant and applicable matrix cells. Cost element sections may be deleted or lines may be hidden, if not applicable. Line items may be added or deleted as needed. The Standard Calculation sections provide a standardized formula for determing a line item's cost, e.g. cost/day x#of days=total, where the total is calculated automatically. The Non-Standard Calculation sections provide a write-in area for line items that require a calculation formula that is other than the standardized formules, e.g. instead of salaries being calculated by cost/day x#of days, costs may be calculated simply by a contracted value that is not dependent on days worked, such as 1 employee x$1,200/contract= $1,200. Be sure to review your calculations when entering in a Non-Standard Calculation, and provide a brief explanation of units used to make calculation, e.g. '1 month contract,'on a line below the figures. Salaries/Labor Standard Calculation Job Description Cost/Day 1#of Days I ITotal $0.00 $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Salaries/Labor 1 $0.00 Travel Standard Calculation Travel Expense lEmployees Cost/Trip 1#of Trips I ITotal $0.00 $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Travel I 1 $0.00 Equipment Standard Calculation Piece of Equipment 1#of Units Cost/Day 1#of Days I ITotal $0.00 $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Equipment $0.00 Supplies/Materials Standard Calculation Supplies/Materials 1#of Items Cost/Item ITotal $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Supplies/Materials $0.00 Printing Standard Calculation Paper Material 1#of Units Cost/Unit I ITotal $0.00 Non-Standard Calculation $0.00 Total Printing $0.00 Other Expenses Standard Calculation Item 1 1#of Units Cost/Unit I ITotal MOD 1 -ALTERNATE PLAN $6,000.00 $6,000.00 Added Mystic Lake Beaver Dam Removal Contract Cost $0.00 Non-Standard Calculation Total Other $6,000.00 Subtotal Direct Costs $61000.00 Cooperator Indirect Costs Current Overhead Rate J Subtotal Direct Costs ITotal $6,000.00 $0.00 Total Coop. Indirect Costs F $0.00 TOTAL COST $6,000.00 WORKSHEET FOR Cooperator Non-Cash Contribution Cost Analysis, Column c Use this worksheet to perform the cost analysis that supports the lump sum figures provided in the matrix. NOTE: This worksheet auto populates the relevant and applicable matrix cells. Cost element sections may be deleted or lines may be hidden, if not applicable. Line items may be added or deleted as needed. The Standard Calculation sections provide a standardized formula for determing a line item's cost, e.g. cost/day x#of days=total,where the total is calculated automatically. The Non-Standard Calculation sections provide a write-in area for line items that require a calculation formula that is other than the standardized formules, e.g. instead of salaries being calculated by cost/day x#of days, costs may be calculated simply by a contracted value that is not dependent on days worked, such as 1 employee x$1,200/contract= $1,200. Be sure to review your calculations when entering in a Non-Standard Calculation, and provide a brief explanation of units used to make calculation, e.g. '1 month contract,' on a line below the figures. Salaries/Labor Standard Calculation Job Description Cost/Day 1#of Days I ITotal $0.00 $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Salaries/Labor Travel Standard Calculation Travel Expense lEmployees Cost/Trip 1#of Trips I ITotal $0.00 $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Travel I I $0.00 Equipment Standard Calculation Piece of Equipment 1#of Units Cost/Day 1#of Days I ITotal $0.00 $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Equipment $0.00 Supplies/Materials Standard Calculation Supplies/Materials 1 1#of Items Cost/Item ITotal $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Supplies/Materials $0.00 Printing Standard Calculation Paper Material 1 1#of Units Cost/Unit I ITotal $0.00 Non-Standard Calculation $0.00 Total Printing $0.00 Other Expenses Standard Calculation Item 1#of Units Cost/Unit I ITotal MOD 1 -ALTERNATE PLAN $6,000.00 $6,000.00 Added Mystic Lake Beaver Dam Removal Contract Cost $0.00 $0.00 $0.00 Non-Standard Calculation Total Other I $6,000.00 Subtotal Direct Costs $67000.00 Cooperator Indirect Costs Current Overhead Rate ISUbtotal Direct Costs I IT'otal $6,000.00 $0.00 Total Coop. Indirect Costs $0.00 TOTAL COST $6,000.00