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DocuSign Envelope ID: 15618600-A4AD-4A44-9D7C-33BAA62043F3 <br />OMB 096-0217 <br />Expiration Date: 11/30/2017 <br />ReN.(12-13) <br />planning, management, and completion of the project, which includes funds sufficient <br />to pay the non -Federal share of project costs, when applicable. <br />B. PRINCIPAL CONTACTS. Individuals listed below are authorized to act in their <br />respective areas for matters related to this award. <br />Principal Cooperator Contacts: <br />Cooperator Program Contact <br />Cooperator Administrative Contact <br />Name: Kristen Hebebrand <br />Name: Heather Elmer <br />Address: 38238 Glenn Ave, P.O. Box 229 <br />Address: 38238 Glenn Ave, P.O. Box 229 <br />City, State, Zip: Willoughby, OH 44096 <br />City, State, Zip: Willoughby, OH 44096 <br />Telephone: 440-975-3870 x 1004 <br />Telephone: 440-975-3870 x 1001 <br />Email: khebebrandAa crwp.org <br />Email: helmerAcrwp.org <br />Principal Forest Service Contacts: <br />Forest Service Program Manager <br />Contact <br />Forest Service Administrative Contact <br />Name: Donna Foster <br />Name: Midori Raymore <br />Address: 180 Canfield Street <br />Address: 626 E. Wisconsin Ave. <br />City, State, Zip: Morgantown, WV 26505 <br />City, State, Zip: Milwaukee, WI 53202 <br />Telephone: 304-285-1547 <br />Telephone: 414-297-1894 <br />Email: donna. m.foster cAusda.gov <br />Email: midori.raymoreAusda.gov <br />C. ASSURANCE REGARDING FELONY CONVICTION OR TAX DELINOUENT <br />STATUS FOR CORPORATE APPLICANTS. This award is subject to the provisions <br />contained in the Department of the Interior, Environment, and Related Agencies <br />Appropriations Act, 2012, P.L. No. 112-74, Division E, Section 433 and 434 as <br />continued by Consolidated and Further Continuing Appropriations Act, 2013, P.L. No. <br />113-6, Division F, Title I, Section 1 101(a)(3) regarding corporate felony convictions <br />and corporate Federal tax delinquencies. Accordingly, by entering into this award The <br />Recipient acknowledges that it: 1) does not have a tax delinquency, meaning that it is <br />not subject to any unpaid Federal tax liability that has been assessed, for which all <br />judicial and administrative remedies have been exhausted or have lapsed, and that is not <br />being paid in a timely manner pursuant to an award with the authority responsible for <br />collecting the tax liability, and (2) has not been convicted (or had an officer or agent <br />acting on its behalf convicted) of a felony criminal violation under any Federal law <br />within 24 months preceding the award, unless a suspending and debarring official of <br />the U.S. Department of Agriculture has considered suspension or debarment is not <br />necessary to protect the interests of the Government. If The Recipient fails to comply <br />with these provisions, the Forest Service will annul this award and may recover any <br />funds The Recipient has expended in violation of sections 433 and 434. <br />Page 2 of 18 <br />