HomeMy WebLinkAboutAddendum - 1NOTICE OF AWARDU.S. Small Business Administration
2. Grant/Cooperative Agreement No.:1. AUTHORIZATION
(Legislation/
Regulation)
From Through
(Mo./Day/Yr.)5. BUDGET PERIOD (Mo./Day/Yr.)
From Through
6. FEDERAL CATALOG NO. 7. ADMINISTRATIVE CODES
(Mo./Day/Yr.)4. PROJECT PERIOD (Mo./Day/Yr.)
3. RECIPIENT: (Name, Organizational Unit, Address)
8. TITLE OF PROJECT/PROGRAM (limit to 53 spaces)
9. AWARD AMOUNT
Amount of SBA Financial
Assistance
10.DIRECTOR OF PROJECT (Program or Center Director,
Coordinator or Principal Investigator)
11.RECOMMENDED FUTURE SUPPORT (Subject to the availability offunds and satisfactory progress of the
project)
NAME BUDGET
YEAR
TOTAL
DIRECT COST
BUDGET
YEAR
TOTAL
DIRECT COSTLastFirstInitial
ADDRESS:a. b.
Yes No(Other Terms & Conditions Attached)
SBA Funds
Only
Total project costs including all other financial
participation.
FederalShare Non-FederalShare
a. Personal Service
b. Fringe Benefits
c. Consultants
d. Travel
e. Equipment
g. Contractual
14. THIS AWARD IS SUBJECT TO THE FOLLOWING
COST PRINCIPLESAND OMB UNIFORM
ADMINISTRATIVE REQUIREMENTS:
2 CFR Chapter 1, Chapter II, Part 200, et al,
uniform Administrative Requirements, Cost
Principles, and Audit Requirements for Federal
Awards.
Part 180 - OMB Guidelines to Agencies on
government debarment and suspension (Non
Procurement)
In-KindNon-Federal Program Inc.Non-Federal
i. TOTAL DIRECT COSTS
j. Indirect cost
(Rate).
13. REMARKS
12. Approved Budget (Excludes SBA Direct Assistance)
f. Supplies
h. Other
k. OTHER APPL. COSTS
l. TOTAL APPROVED BUDGET
subject to adjustment in accordance with SBA
policy
15. THIS AWARD IS SUBJECT TO THE TERMS AND CONDITIONS ON THE REVERSE SIDE
18.CONGRESSIONALDISTRICT NO.
16. CRS - EIN 17. COUNTY NAME
19a. CITY CODE b. COUNTY CODE c. STATE CODE d. PROGRAM CODE
BUDGET CODE DOCUMENT NO.AMT. ACTION FIN. ASST.TYPE OF ORGANIZATION
20a.b.c.d.
21. AGENCY OFFICIAL (Signature, Name and Title)22. DATE ISSUED (Mo./Day/Yr.)
23. RECIPIENT OFFICIAL (Signature, Name and Title)24. DATE 2/16/2024
SBA FORM 1222 (4-15) Previous editions obsolete
OMB Approval No.: 3245-0140
Expiration Date 7/31/2018
PURPOSE: This form is used to notify grant recipients of award reporting and record keeping requirements. Grantees are
required to review and sign the form and return to SBA at the address: SBDC- SBA/OSBDC, 409 Third Street, SW 6th Floor,
Washington, DC 20416All other SBA/OGM, 409 Third Street, 5th Floor, Washington, DC 20416
*Must meet all matching or cost participation
requirements
PHUC NGUYEN Digitally signed by PHUC
NGUYEN
Date: 2023.12.13 07:55:17 -05'00'
CAG-23-142, Adden #1-24
City of Renton Mayor Armondo Pavone
Attest:
Jason A. Seth, City Clerk
SBA FORM 1222 (4-15) Previous editions obsolete
Note: The estimated burden completing this form is 80 hours per response. You will not be required to respond to any collection
of information unless it displays a currently valid OMB approval number. Comments on the burden should be sent to
U.S. Small Business Administration, Chief, AIB, 409, 3rd St., S.W., Washigton, D.C. 20416 and Desk Office for Small Business
Administration, Office of Management and Budget, New Executive Office Building, room 10202 Washington, D.C. 20503. OMB
Approval (3245-0140).
PLEASE DO NOT SEND FORMS TO OMB.