Common use of ADDITIONAL GRANT INFORMATION Clause in Contracts

ADDITIONAL GRANT INFORMATION. System Agency Data Universal Numbering System (DUNS) Number: 807391511 Federal Award Identification Number (XXXX): NH75OT000045 Assistance Listing Name and Number: Activities to Support State, Tribal, Local and Territorial (STLT) Health Department Response to Public Health or Healthcare Crises; 93.391 Federal Award Date: May 26, 2021 Federal Award Project Period through May 31, 2023 Name of Federal Awarding Agency: Centers for Disease Control and Prevention Awarding Official Contact Information: Xx. Xxxxxxxxx Xxxxx Email: xxx0@xxx.xxx Signature Page Follows Signature Page for System Agency Contract No. HHS001057600002 System Agency Grantee Signature Signature Printed Name: Xxxx Xxxx Printed Name: Xxxxx Xxxxxx Title: _Deputy Commissioner Title: Assistant City Manager/CFO Date of Execution: August 12, 2021 Date of Execution: August 12, 2021 The following Attachments to System Agency Contract No. HHS001057600002 are incorporated by reference: Attachment A: Statement of Work Attachment B: Budget Attachment C: HHS Uniform Terms and Conditions - Grant Attachment D: HHS Contract Affirmations Attachment E: Federal Assurances and Certifications Attachment F: FFATA Form Attachment G: Indirect Cost Rate Letter Attachments Follow ATTACHMENT A: STATEMENT OF WORK I. GRANTEE RESPONSIBILITIES To ensure community engagement in targeted communities disproportionately impacted by COVID-19 and the building of sustainable relationships in those targeted communities, Grantee will conduct the following activities:

ADDITIONAL GRANT INFORMATION. System Agency Data Universal Numbering System (DUNS) Number: 807391511 Federal Award Identification Number (XXXX): NH75OT000045 Assistance Listing Name and Number: Activities to Support State, Tribal, Local and Territorial (STLT) Health Department Response to Public Health or Healthcare Crises; 93.391 Federal Award Date: May 26, 2021 Federal Award Project Period through May 31, 2023 Name of Federal Awarding Agency: Centers for Disease Control and Prevention Awarding Official Contact Information: Xx. Xxxxxxxxx Xxxxx Email: xxx0@xxx.xxx Signature Page Follows Signature Page for System Agency Contract NoSIGNATURE PAGE FOLLOWS SIGNATURE PAGE FOR SYSTEM AGENCY CONTRACT NO. HHS001057600002 System Agency Grantee Signature HHS001057600012 SYSTEM AGENCY GRANTEE Signature Printed Name: Xxxx Xxxx Title: Date of Execution: Signature Printed Name: Xxxxx Xxxxxx Xxxx Title: _Deputy Commissioner Title: Assistant City Manager/CFO Date of Execution: August 12, 2021 Date of ExecutionTHE FOLLOWING ATTACHMENTS TO SYSTEM AGENCY CONTRACT NO. HHS001057600012 ARE INCORPORATED BY REFERENCE: August 12, 2021 The following Attachments to System Agency Contract No. HHS001057600002 are incorporated by reference: Attachment ATTACHMENT A: Statement of Work Attachment STATEMENT OF WORK ATTACHMENT B: Budget Attachment BUDGET ATTACHMENT C: HHS Uniform Terms and Conditions UNIFORM TERMS AND CONDITIONS - Grant Attachment GRANT ATTACHMENT D: HHS Contract Affirmations Attachment CONTRACT AFFIRMATIONS ATTACHMENT E: Federal Assurances and Certifications Attachment FEDERAL ASSURANCES AND CERTIFICATIONS ATTACHMENT F: FFATA Form Attachment G: Indirect Cost Rate Letter Attachments Follow FORM ATTACHMENTS FOLLOW ATTACHMENT A: STATEMENT OF WORK I. GRANTEE RESPONSIBILITIES To ensure community engagement in targeted communities disproportionately impacted by COVID-19 and the building of sustainable relationships in those targeted communities, Grantee will conduct the following activities:

ADDITIONAL GRANT INFORMATION. System Agency Data Universal Numbering System (DUNS) Number: 807391511 Federal Award Identification Number (XXXX): NH75OT000045 Assistance Listing Name and Number: Activities to Support State, Tribal, Local and Territorial (STLT) Health Department Response to Public Health or Healthcare Crises; 93.391 Federal Award Date: May 26, 2021 Federal Award Project Period through May 31, 2023 Name of Federal Awarding Agency: Centers for Disease Control and Prevention Awarding Official Contact Information: Xx. Xxxxxxxxx Xxxxx Email: xxx0@xxx.xxx Signature Page Follows Signature Page for System Agency Contract No. HHS001057600002 HHS001057600011 System Agency Grantee Signature Signature Printed Name: Xxxx Xxxx Grantee Signature Printed Name: Xxxxx Xxxxxx Xxxxxxx X. Xxxx Title: _Deputy Commissioner Title: Assistant City Manager/CFO Executive Director Date of Execution: August 12October 6, 2021 Date of Execution: August 12October 4, 2021 The following Attachments to System Agency Contract No. HHS001057600002 HHS001057600011 are incorporated by reference: Attachment A: Statement of Work Attachment B: Budget Attachment C: HHS Uniform Terms and Conditions - Grant Attachment D: HHS Contract Affirmations Attachment E: Federal Assurances and Certifications Attachment F: FFATA Form Attachment G: Indirect Cost Rate Acknowledgement Letter Attachments Follow ATTACHMENT A: STATEMENT OF WORK I. GRANTEE RESPONSIBILITIES To ensure community engagement in targeted communities disproportionately impacted by COVID-19 and the building of sustainable relationships in those targeted communities, Grantee will conduct the following activities:

ADDITIONAL GRANT INFORMATION. System Agency Data Universal Numbering System (DUNS) Number: 807391511 Federal Award Identification Number (XXXX): NH75OT000045 Assistance Listing Name and Number: Activities to Support State, Tribal, Local and Territorial (STLT) Health Department Response to Public Health or Healthcare Crises; 93.391 Federal Award Date: May 26, 2021 Federal Award Project Period through May 31, 2023 Name of Federal Awarding Agency: Centers for Disease Control and Prevention Awarding Official Contact Information: Xx. Xxxxxxxxx Xxxxx Email: xxx0@xxx.xxx Signature Page Follows Signature Page for System Agency Contract No. HHS001057600002 HHS001057600021 System Agency Grantee Signature Signature Printed Name: Xxxx Xxxx Printed Name: Xxxxx Xxxxxx Title: _Deputy Commissioner Title: Assistant City Manager/CFO Director of Health Date of Execution: August 12September 16, 2021 Date of Execution: August 12September 16, 2021 The following Attachments to System Agency Contract No. HHS001057600002 HHS001057600021 are incorporated by reference: Attachment A: Statement of Work Attachment B: Budget Attachment C: HHS Uniform Terms and Conditions - Grant Attachment D: HHS Contract Affirmations Attachment E: Federal Assurances and Certifications Attachment F: FFATA Form Attachment G: Indirect Cost Rate Letter Attachments Follow ATTACHMENT A: STATEMENT OF WORK I. GRANTEE RESPONSIBILITIES To ensure community engagement in targeted communities disproportionately impacted by COVID-19 and the building of sustainable relationships in those targeted communities, Grantee will conduct the following activities:

ADDITIONAL GRANT INFORMATION. System Agency Data Universal Numbering System (DUNS) Number: 807391511 Federal Award Identification Number (XXXX): NH75OT000045 Assistance Listing Name and Number: Activities to Support State, Tribal, Local and Territorial (STLT) Health Department Response to Public Health or Healthcare Crises; 93.391 Federal Award Date: May 26, 2021 Federal Award Project Period through May 31, 2023 Name of Federal Awarding Agency: Centers for Disease Control and Prevention Awarding Official Contact Information: Xx. Xxxxxxxxx Xxxxx Email: xxx0@xxx.xxx Signature Page Follows Signature Page for System Agency Contract NoSIGNATURE PAGE FOLLOWS SIGNATURE PAGE FOR SYSTEM AGENCY CONTRACT NO. HHS001057600002 System Agency Grantee HHS001057600013 SYSTEM AGENCY GRANTEE Signature Signature Printed Name: Xxxx Xxxx Co1e Printed Name: Xxxxx Judge Xxxxxxx Xxxxxx Title: _Deputy Depuky Commissioner Title: Assistant City Manager/CFO Counky Judge Date of Execution: August 12Augusk 27, 2021 Date of Execution: August 12Augusk 26, 2021 The following Attachments to System Agency Contract NoTHE FOLLOWING ATTACHMENTS TO SYSTEM AGENCY CONTRACT NO. HHS001057600002 are incorporated by referenceHHS001057600013 ARE INCORPORATED BY REFERENCE: Attachment ATTACHMENT A: Statement of Work Attachment STATEMENT OF WORK ATTACHMENT B: Budget Attachment BUDGET ATTACHMENT C: HHS Uniform Terms and Conditions UNIFORM TERMS AND CONDITIONS - Grant Attachment GRANT ATTACHMENT D: HHS Contract Affirmations Attachment CONTRACT AFFIRMATIONS ATTACHMENT E: Federal Assurances and Certifications Attachment FEDERAL ASSURANCES AND CERTIFICATIONS ATTACHMENT F: FFATA Form Attachment G: Indirect Cost Rate Letter Attachments Follow FORM ATTACHMENTS FOLLOW ATTACHMENT A: STATEMENT OF WORK I. GRANTEE RESPONSIBILITIES To ensure community engagement in targeted communities disproportionately impacted by COVID-19 and the building of sustainable relationships in those targeted communities, Grantee will conduct the following activities:

ADDITIONAL GRANT INFORMATION. System Agency Data Universal Numbering System (DUNS) Number: 807391511 Federal Award Identification Number (XXXX): NH75OT000045 Assistance Listing Name and Number: Activities to Support State, Tribal, Local and Territorial (STLT) Health Department Response to Public Health or Healthcare Crises; 93.391 Federal Award Date: May 26, 2021 Federal Award Project Period through May 31, 2023 Name of Federal Awarding Agency: Centers for Disease Control and Prevention Awarding Official Contact Information: Xx. Xxxxxxxxx Xxxxx Email: xxx0@xxx.xxx Signature Page Follows Signature Page for System Agency Contract No. HHS001057600002 HHS001057600019 System Agency Grantee Signature Printed Name: Title: Date of Execution: Signature Printed Name: Xxxx Xxxx Printed Name: Xxxxx Xxxxxx Title: _Deputy Commissioner Title: Assistant City Manager/CFO Date of Execution: August 12, 2021 Date of Execution: August 12, 2021 The following Attachments to System Agency Contract No. HHS001057600002 HHS001057600019 are incorporated by reference: Attachment A: Statement of Work Attachment B: Budget Attachment C: HHS Uniform Terms and Conditions - Grant Attachment D: HHS Contract Affirmations Attachment E: Federal Assurances and Certifications Attachment F: FFATA Form Attachment G: Indirect Cost Rate Letter Attachments Follow ATTACHMENT A: STATEMENT OF WORK I. GRANTEE RESPONSIBILITIES To ensure community engagement in targeted communities disproportionately impacted by COVID-19 and the building of sustainable relationships in those targeted communities, Grantee will conduct the following activities:

ADDITIONAL GRANT INFORMATION. System Agency Data Universal Numbering System (DUNS) Number: 807391511 Federal Award Identification Number (XXXX): NH75OT000045 Assistance Listing Name and Number: Activities to Support State, Tribal, Local and Territorial (STLT) Health Department Response to Public Health or Healthcare Crises; 93.391 Federal Award Date: May 26, 2021 Federal Award Project Period through May 31, 2023 Name of Federal Awarding Agency: Centers for Disease Control and Prevention Awarding Official Contact Information: Xx. Xxxxxxxxx Xxxxx Email: xxx0@xxx.xxx Signature Page Follows Signature Page for System Agency Contract NoSIGNATURE PAGE FOLLOWS SIGNATURE PAGE FOR SYSTEM AGENCY CONTRACT NO. HHS001057600002 System Agency Grantee HHS001057600025 SYSTEM AGENCY GRANTEE Signature Signature Printed Name: Xxxx Xxxx Co1e Printed Name: Xxxxx Xxxxxxx X. Xxxxxx Title: _Deputy Depuky Commissioner Title: Assistant City Manager/CFO Hida1go Counky Judge Date of Execution: August 12Augusk 30, 2021 Date of Execution: August 12Augusk 27, 2021 The following Attachments to System Agency Contract NoTHE FOLLOWING ATTACHMENTS TO SYSTEM AGENCY CONTRACT NO. HHS001057600002 are incorporated by referenceHHS001057600025 ARE INCORPORATED BY REFERENCE: Attachment ATTACHMENT A: Statement of Work Attachment STATEMENT OF WORK ATTACHMENT B: Budget Attachment BUDGET ATTACHMENT C: HHS Uniform Terms and Conditions UNIFORM TERMS AND CONDITIONS - Grant Attachment GRANT ATTACHMENT D: HHS Contract Affirmations Attachment CONTRACT AFFIRMATIONS ATTACHMENT E: Federal Assurances and Certifications Attachment FEDERAL ASSURANCES AND CERTIFICATIONS ATTACHMENT F: FFATA Form Attachment G: Indirect Cost Rate Letter Attachments Follow FORM ATTACHMENTS FOLLOW ATTACHMENT A: STATEMENT OF WORK I. GRANTEE RESPONSIBILITIES To ensure community engagement in targeted communities disproportionately impacted by COVID-19 and the building of sustainable relationships in those targeted communities, Grantee will conduct the following activities:

ADDITIONAL GRANT INFORMATION. System Agency Data Universal Numbering System (DUNS) Number: 807391511 Federal Award Identification Number (XXXX): NH75OT000045 Assistance Listing Name and Number: Activities to Support State, Tribal, Local and Territorial (STLT) Health Department Response to Public Health or Healthcare Crises; 93.391 Federal Award Date: May 26, 2021 Federal Award Project Period through May 31, 2023 Name of Federal Awarding Agency: Centers for Disease Control and Prevention Awarding Official Contact Information: Xx. Xxxxxxxxx Xxxxx Email: xxx0@xxx.xxx Signature Page Follows Signature Page for System Agency Contract NoSIGNATURE PAGE FOLLOWS SIGNATURE PAGE FOR SYSTEM AGENCY CONTRACT NO. HHS001057600002 System Agency Grantee HHS001057600019 SYSTEM AGENCY GRANTEE Signature Signature Printed Name: Xxxx Xxxx Printed Name: Xxxxx XX Xxxxxx Title: _Deputy Commissioner Title: Assistant City Manager/CFO County Judge Date of Execution: August 12September 10, 2021 Date of Execution: August 12September 7, 2021 The following Attachments to System Agency Contract NoTHE FOLLOWING ATTACHMENTS TO SYSTEM AGENCY CONTRACT NO. HHS001057600002 are incorporated by referenceHHS001057600019 ARE INCORPORATED BY REFERENCE: Attachment ATTACHMENT A: Statement of Work Attachment STATEMENT OF WORK ATTACHMENT B: Budget Attachment BUDGET ATTACHMENT C: HHS Uniform Terms and Conditions UNIFORM TERMS AND CONDITIONS - Grant Attachment GRANT ATTACHMENT D: HHS Contract Affirmations Attachment CONTRACT AFFIRMATIONS ATTACHMENT E: Federal Assurances and Certifications Attachment FEDERAL ASSURANCES AND CERTIFICATIONS ATTACHMENT F: FFATA Form Attachment G: Indirect Cost Rate Letter Attachments Follow FORM ATTACHMENTS FOLLOW ATTACHMENT A: STATEMENT OF WORK I. GRANTEE RESPONSIBILITIES To ensure community engagement in targeted communities disproportionately impacted by COVID-19 and the building of sustainable relationships in those targeted communities, Grantee will conduct the following activities:

ADDITIONAL GRANT INFORMATION. System Agency Data Universal Numbering System (DUNS) Number: 807391511 Federal Award Identification Number (XXXX): NH75OT000045 Assistance Listing Name and Number: Activities to Support State, Tribal, Local and Territorial (STLT) Health Department Response to Public Health or Healthcare Crises; 93.391 Federal Award Date: May 26, 2021 Federal Award Project Period through May 31, 2023 Name of Federal Awarding Agency: Centers for Disease Control and Prevention Awarding Official Contact Information: Xx. Xxxxxxxxx Xxxxx Email: xxx0@xxx.xxx Signature Page Follows Signature Page for System Agency Contract No. HHS001057600002 HHS001057600012 System Agency Grantee Signature Signature Printed Name: Xxxx Xxxx Grantee Signature Printed Name: Xxxxx Xxxxxx Xxxx Title: _Deputy Commissioner Title: Assistant City Manager/CFO County Judge Date of Execution: August 12September 27, 2021 Date of Execution: August 12September 27, 2021 The following Attachments to System Agency Contract No. HHS001057600002 HHS001057600012 are incorporated by reference: Attachment A: Statement of Work Attachment B: Budget Attachment C: HHS Uniform Terms and Conditions - Grant Attachment D: HHS Contract Affirmations Attachment E: Federal Assurances and Certifications Attachment F: FFATA Form Attachment G: Indirect Cost Rate Letter Attachments Follow ATTACHMENT A: STATEMENT OF WORK I. GRANTEE RESPONSIBILITIES To ensure community engagement in targeted communities disproportionately impacted by COVID-19 and the building of sustainable relationships in those targeted communities, Grantee will conduct the following activities:

ADDITIONAL GRANT INFORMATION. System Agency Data Universal Numbering System (DUNS) Number: 807391511 Federal Award Identification Number (XXXX): NH75OT000045 Assistance Listing Name and Number: Activities to Support State, Tribal, Local and Territorial (STLT) Health Department Response to Public Health or Healthcare Crises; 93.391 Federal Award Date: May 26, 2021 Federal Award Project Period through May 31, 2023 Name of Federal Awarding Agency: Centers for Disease Control and Prevention Awarding Official Contact Information: Xx. Xxxxxxxxx Xxxxx Email: xxx0@xxx.xxx Signature Page Follows Signature Page for System Agency Contract NoSIGNATURE PAGE FOLLOWS SIGNATURE PAGE FOR SYSTEM AGENCY CONTRACT NO. HHS001057600002 System Agency Grantee HHS001057600015 SYSTEM AGENCY GRANTEE Signature Signature Printed Name: Xxxx Xxxx Co1e Printed Name: Xxxxx Xxxxxx Xxxx Xxxxxxxxx Title: _Deputy Depuky Commissioner Title: Assistant City Manager/CFO Medica1 Direckor Date of Execution: August 12Augusk 26, 2021 Date of Execution: August 12Augusk 26, 2021 The following Attachments to System Agency Contract NoTHE FOLLOWING ATTACHMENTS TO SYSTEM AGENCY CONTRACT NO. HHS001057600002 are incorporated by referenceHHS001057600015 ARE INCORPORATED BY REFERENCE: Attachment ATTACHMENT A: Statement of Work Attachment STATEMENT OF WORK ATTACHMENT B: Budget Attachment BUDGET ATTACHMENT C: HHS Uniform Terms and Conditions UNIFORM TERMS AND CONDITIONS - Grant Attachment GRANT ATTACHMENT D: HHS Contract Affirmations Attachment CONTRACT AFFIRMATIONS ATTACHMENT E: Federal Assurances and Certifications Attachment FEDERAL ASSURANCES AND CERTIFICATIONS ATTACHMENT F: FFATA Form Attachment G: Indirect Cost Rate Letter Attachments Follow FORM ATTACHMENTS FOLLOW ATTACHMENT A: STATEMENT OF WORK I. GRANTEE RESPONSIBILITIES To ensure community engagement in targeted communities disproportionately impacted by COVID-19 and the building of sustainable relationships in those targeted communities, Grantee will conduct the following activities:

ADDITIONAL GRANT INFORMATION. System Agency Data Universal Numbering System (DUNS) Number: 807391511 Federal Award Identification Number (XXXX): NH75OT000045 Assistance Listing Name and Number: Activities to Support State, Tribal, Local and Territorial (STLT) Health Department Response to Public Health or Healthcare Crises; 93.391 Federal Award Date: May 26, 2021 Federal Award Project Period through May 31, 2023 Name of Federal Awarding Agency: Centers for Disease Control and Prevention Awarding Official Contact Information: Xx. Xxxxxxxxx Xxxxx Email: xxx0@xxx.xxx Signature Page Follows Signature Page for System Agency Contract No. HHS001057600002 HHS001057600032 System Agency Grantee Signature Signature Printed Name: Xxxx Xxxx Printed Name: Xxxxx Xxxxxx Xxxxxxxxx, Medina County Judge Title: _Deputy Commissioner Title: Assistant City Manager/CFO County Judge Date of Execution: August 12September 1, 2021 Date of Execution: August 12September 1, 2021 The following Attachments to System Agency Contract No. HHS001057600002 HHS001057600032 are incorporated by reference: Attachment A: Statement of Work Attachment B: Budget Attachment C: HHS Uniform Terms and Conditions - Grant Attachment D: HHS Contract Affirmations Attachment E: Federal Assurances and Certifications Attachment F: FFATA Form Attachment G: Indirect Cost Rate Letter Attachments Follow ATTACHMENT A: STATEMENT OF WORK I. GRANTEE RESPONSIBILITIES To ensure community engagement in targeted communities disproportionately impacted by COVID-19 and the building of sustainable relationships in those targeted communities, Grantee will conduct the following activities:

ADDITIONAL GRANT INFORMATION. System Agency Data Universal Numbering System (DUNS) Number: 807391511 Federal Award Identification Number (XXXX): NH75OT000045 Assistance Listing Name and Number: Activities to Support State, Tribal, Local and Territorial (STLT) Health Department Response to Public Health or Healthcare Crises; 93.391 Federal Award Date: May 26, 2021 Federal Award Project Period through May 31, 2023 Name of Federal Awarding Agency: Centers for Disease Control and Prevention Awarding Official Contact Information: Xx. Xxxxxxxxx Xxxxx Email: xxx0@xxx.xxx Signature Page Follows Signature Page for System Agency Contract No. HHS001057600002 HHS001057600001 System Agency Grantee Signature Signature Printed Name: Xxxx Xxxx Printed Name: Xxxxx Xxxxxx Xxxxxxxxx Title: _Deputy Commissioner Title: Assistant Deputy City Manager/CFO Manager Date of Execution: August 1226, 2021 Date of Execution: August 1225, 2021 The following Attachments to System Agency Contract No. HHS001057600002 HHS001057600001 are incorporated by reference: Attachment A: Statement of Work Attachment B: Budget Attachment C: HHS Uniform Terms and Conditions - Grant Attachment D: HHS Contract Affirmations Attachment E: Federal Assurances and Certifications Attachment F: FFATA Form Attachment G: Indirect Cost Rate Letter Attachments Follow ATTACHMENT A: STATEMENT OF WORK I. GRANTEE RESPONSIBILITIES To ensure community engagement in targeted communities disproportionately impacted by COVID-19 and the building of sustainable relationships in those targeted communities, Grantee will conduct the following activities:

ADDITIONAL GRANT INFORMATION. System Agency Data Universal Numbering System (DUNS) Number: 807391511 Federal Award Identification Number (XXXX): NH75OT000045 Assistance Listing Name and Number: Activities to Support State, Tribal, Local and Territorial (STLT) Health Department Response to Public Health or Healthcare Crises; 93.391 Federal Award Date: May 26, 2021 Federal Award Project Period through May 31, 2023 Name of Federal Awarding Agency: Centers for Disease Control and Prevention Awarding Official Contact Information: Xx. Xxxxxxxxx Xxxxx Email: xxx0@xxx.xxx Signature Page Follows Signature Page for System Agency Contract No. HHS001057600002 HHS001057600039 System Agency Grantee Signature Signature Printed Name: Xxxx Xxxx Printed Name: Judge Xxxxx Xxxxxx Xxxxx Title: _Deputy Commissioner Title: Assistant City Manager/CFO County Judge Date of Execution: August 1226, 2021 Date of Execution: August 1225, 2021 The following Attachments to System Agency Contract No. HHS001057600002 HHS001057600039 are incorporated by reference: Attachment A: Statement of Work Attachment B: Budget Attachment C: HHS Uniform Terms and Conditions - Grant Attachment D: HHS Contract Affirmations Attachment E: Federal Assurances and Certifications Attachment F: FFATA Form Attachment G: Indirect Cost Rate Letter Attachments Follow ATTACHMENT A: STATEMENT OF WORK I. GRANTEE RESPONSIBILITIES To ensure community engagement in targeted communities disproportionately impacted by COVID-19 and the building of sustainable relationships in those targeted communities, Grantee will conduct the following activities: