HomeMy WebLinkAboutCDN 2018-04-10 Item 2C - Grant Agreement - King Conservation District for Green TukwilaCity of Tukwila
Allan Ekberg, Mayor
INFORMATIONAL MEMORANDUM
TO: Community Development & Neighborhoods Committee
FROM: Rick Still, Parks & Recreation Director
BY: Robert Eaton, Parks & Recreation Manager
CC: Mayor Ekberg
DATE: April 10, 2018
SUBJECT: King Conservation District Jurisdictional Funds Grant
ISSUE
Contract agreement with King Conservation District for expending jurisdictional funds on the
Green Tukwila program via their grant process.
BACKGROUND
Every year, Tukwila receives approximately $10,000 from King Conservation District (KCD) in
jurisdictional funds. If these funds are not expended, they roll over to the next year. Currently,
Tukwila has approximately $51,000 in jurisdictional funds. The city's Green Tukwila (GT)
management team (comprised of staff from Parks & Recreation, Public Works, and Department
of Community Development) agree it could benefit the city to utilize the jurisdictional funds to
implement the Green Tukwila program by increasing staff capacity. Currently, Olena Perry, .75
FTE Recreation Specialist, dedicates .25 FTE of her job to GT and the jurisdictional funds could
be used to temporarily increase her hours another ten hours a week to focus on implementing
the Green Tukwila plan. Additional funds are included in the proposal for supplies and
contracted professional crews as well. KCD is in support of the funds being used this way and
other local agencies have expended their jurisdictional funds on Green Cities work as well.
DISCUSSION
KCD uses a grant process to track and monitor the expenditures of jurisdictional funds. Staff
met with KCD personnel and were encouraged to submit a project workplan defining how the
jurisdictional funds would be used (attachment A). The KCD Board approved this project and
requires the city to sign an agreement (attachment B). The project scope will allow for the
dedicated staff time required to implement the GT program.
The grant project is for a two-year scope of work and will include the temporary increase in staff
hours (10hrs/week), supplies, and contracted professional crews. Funds from Parks
Maintenance ($20,000) and the Recreation division ($10,000) budgets along with staff time
(10hrs/week) will be used for the matching portion of the grant. With the approval of this
agreement, Tukwila will be allocating a total of 20hrs/week (.5FTE) of time over the next two
years for implementing the Green Tukwila program.
FINANCIAL IMPACT
The total expense of the grant project is $117,400 apportioned over 2018 and 2019. The Parks
& Recreation general fund budget will cover $70,000 of the expense as the matching portion of
the grant (60%). This is comprised of staff time already allocated to the program and contracted
professional restoration crews. The remaining $47,400 are grant funds that will be reimbursed to
the city by KCD over the next two years. Below is a table summarizing this.
67
INFORMATIONAL MEMO
Page 2
Tukwila P&R Budget
KCD Funds
$ 70,000
$ 47,400
PROJECT TOTAL $ 117,400
Below is a table categorizing the grant funds and how they will be expended and reimbursed.
2018
2019
Salaries & Benefits I $ 20,000
$ 20,000
Field Supplies
$ 1,000
$ 1,000
Professional Services
$ 2,700
$ 2,700
Annual Totals
$ 23,700
$ 23,700
GRANT TOTAL
`-
474nn
KCD Reimbursement
$ 23,700 $ 23,700
TOTAL REIMBURSEMENT
$ 47,400
This is a reimbursement grant; therefore, the initial expenditures will have to be from the Parks
& Recreation general fund budget then be reimbursed by the King Conservation District
jurisdictional funds. Although there is no net increase to the budget because of the
reimbursement, due to accounting procedures, the P&R budget will be overspent by the grant
amount in 2018. Therefore, staff is seeking permission to overspend the Parks & Recreation
budget by approximately $23,700 in 2018 which will be reimbursed by the KCD Jurisdictional
Funds. This will be included in the 2018 year-end budget amendment and included in the 2019
budget.
RECOMMENDATION
The Council Committee is being asked to consider forwarding this item to the April 16, 2018
Regular Meeting Consent Agenda authorizing the Mayor to sign the grant agreement with King
Conservation District for $47,400.
ATTACHMENT
Project Workplan Application
KCD Grant Agreement
68 W 12018 Info Memos\KCD_Junsdictional_Funds_Green_Tukwila_(4-4-18)-FINAL.doc
Robert Eaton Tukwila
Green Tukwila Implementation - 2018 & 2019
Member Jurisdiction Grant Program
Tukwila
6200 Southcenter Blvd
Tukwila, WA 98188
Robert Eaton
13900 Interurban Ave S Robert.Eaton@TukwilaWA.gov
Tukwila, WA 98168 0: 206-433-7157
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Robert Eaton Tukwila
Application Form
Summary Information
Project Title*
Green Tukwila Implementation - 2018 & 2019
Principal Partners (if any)
Amount of KCD Funding Requested*
You will need to upload a detailed budget document before you submit your application. Please make sure the
amount requested and total project cost amounts you list here match the amounts in the uploaded budget
document.
$47,400.00
Total Project Cost*
$117,400.00
Total Matching Funds (optional)
$70,000.00
Project Start Date*
01/01/2018
Project End Date*
12/31/2019
Close Date
Project Location*
Address, Parcel #, OR L&L Points, for site specific projects only.
If more than two locations, state "multiple" and explain.
Multiple Sites:
- Tukwila Park, 15460 65th Ave S
- Crystal Springs Park, 15832 51st Ave S
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Robert Eaton Tukwila
- S. 128th Parcel, corner of S. 128th St & 37th Ave S, Parcel #7345600722 (recently acquired vacant
parcel, still unnamed)
Jurisdiction
If the applicant is not a city or jurisdiction, please type in the city or jurisdiction this project is located in.
Is your project on public or private Land?*
Public
State Legislative District #*
Click here to find it on the web. If your project resides in more than one district, type in the primary district or type
in zero.
11
King County District #*
Click here to find it on the web. If your project resides in more than one district, type in the primary district or type
in zero.
8
Natural Resource Improvement Actions- Criteria Checklist
Please only select "yes" below the action that your project directly addresses
Direct Improvement of Natural Resource Conditions*
To improve landscape and natural resource conditions as a result of direct action that enhances water quality,
protects and conserves soils, implements ecosystem restoration and preservation projects (examples include
supporting private property owners with land stewardship, water quality, aquatic and wildlife habitat resources,
removal of invasive weeds, stewardship on public land)
Does your project directly address this issue?
Yes
Education and Outreach*
To raise awareness, deepen knowledge, and change behaviors of residents, landowners, and other land managers
and organizations to practice exemplary stewardship of natural resources (examples include education about
stormwater management; the value of farmland, local farms and food systems, shorelines, salmon habitat, forests
and other ecosystems)
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Robert Eaton Tukwila
Does your project directly address this issue?
Yes
Pilot and Demonstration Projects*
To test and/or improve concepts and/or approaches in natural resource management that can be replicated by
others (examples include low impact development or green infrastructure demonstration projects, development of
new best management practices, distribution of local farm products, urban agriculture (e.g. farmers markets and
backyard food production to promote or support social economic independence and healthy living); technological
innovation for natural resource conservation)
Does your project directly address this issue?
Yes
Capacity Building*
To enhance the ability of organizations, agencies, residential landowners and other land owners and managers to
have knowledge, skills, tools, support systems and technical resources to implement exemplary best management
practices and deliver natural resource management actions on the ground (examples include urban agriculture
development, assistance to and inclusion of private property owners, preservation, restoration, and/or expansion of
urban and/or rural agricultural lands, rural and urban forest lands, riparian restoration and stewardship on private
and public lands)
Does your project directly address this issue?
Yes
Project Type
Education
Forestry, Urban
Narratives, Budget, & Attachments
Project Description - Short
Provide a short, concise description of the project no more than two or three sentences.
Project Description- Member Jurisdiction*
Provide a description of the project that summarizes what you will do, how you will do it, and why you will do it.
Describe target audience, outcomes, objectives and general timelines.
The Green Tukwila Program was recently adopted by the Tukwila City Council on March 6, 2017. A 20 -
Year Stewardship Plan was developed to guide the overall program. The first step in implementation is
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Robert Eaton Tukwila
recruiting and developing Forest Stewards that will adopt parks or areas of parks and be the volunteer point
person for that site. Although there is currently no staff time or funding allocated to this new program, it has
risen to become a priority for the city. So much so, that the Parks & Recreation Department has reallocated
workloads to enable an existing .75 Full -Time Employee to dedicate .25 FTE of time to this project beginning
in 2018. The city is also desiring to utilize the KCD Funds to add an additional .25 FTE to this existing staff
member for a total of .50 FTE dedicated to this project for the next two years. KCD Funds and existing city
budget funds will also be used to contract professional crew days to support and augment this project. There
is great need for this as well as developing the stewardship program. As this is a new program to the city, this
grant project will focus on outreach, supporting and developing stewards, and beginning the boots on the
ground work through volunteer events.
With this allocation of staff time to the program, the city will be able to better implement an intentional
plan, beginning with this project. This project will focus on three sites initially Tukwila Park, Crystal Springs
Park, and S. 128th Parcel. It has just been confirmed in the last couple of months that there is now a local
resident to steward the S. 128th St Parcel, a non-profit (Student Conservation Association) to steward
Tukwila Park, and a local company, McKinstry, to steward Crystal Springs Park.
The goal of the on site work is to take portions of all three sites (Tukwila Park, Crystal Springs Park, and S.
128th Parcel) through the four phases of restoration: All three sites are currently in crisis due to English ivy,
Himalayan Blackberry and Knotweed. In 2018, the Green Tukwila Partnership lead by Tukwila Parks &
Recreation will also start educating the public and inviting volunteers to participate in restoration of these
three sites. Volunteers will be working in phase 1, invasive removal and phase 2, planting, of the 4 phases of
restoration. Volunteers will be taught the impact of invasive species of plants on native plants, recognizing
the invasive species, removal of invasive species, how to use tools, safe practices with equipment and why it
is important to have healthy, sustainable forests in the urban landscape.
Throughout this project, staff will continue to develop and grow the stewardship program and train
actual stewards which promotes community and a sense of ownership. This program is the future of the
Green Tukwila Partnership.
Project Activities and Measurable Results*
List specific project activities to be completed with KCD grant funds and the associated outcomes or measurable
results, and timeline.
1. Hosting three main Green Tukwila events each year: MLK Day of Service/January, United Way Day of
Caring/September, Green Tukwila Day/October that will focus on restoration work and stewardship
development. Funds will be used to promote the events, provide supplies and tools.
2. Develop and strengthen partnerships with Green Tukwila Stewards. Provide support for them and the
sites they adopt within this project. Help promote events, provide tools and outreach support, crew Lead on
volunteer events with and for them. This is an on-going aspect of the project.
3. Contract professional crew work days at the various sites for the more difficult and technical work that
cannot be done by volunteers. This work will be coordinated with the stewards throughout the year.
4. As project progress is made it will be evident by the physical change in the sites or areas of the sites.
There will be observable change in the work areas. The initial observable differences will be obvious in the
specific work areas after volunteers events mentioned above.
5. Develop and grow stewardship program and train actual stewards: As volunteers become more
invested in the Green Tukwila Partnership through restoration work parties, Forest Stewards will emerge.
The Green Tukwila Partnership will be creating a Forest Steward program that will consist of:
• What does it mean to be Forest Steward
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Robert Eaton Tukwila
• Leading volunteers and volunteer groups
• Using worklogs and reporting
• Invasive and best practices
• Basic native plant ID
• Safety with tools
• How the city can support Forest Stewards
Each Forest Steward will be unique with scheduling volunteer work parties and transiting into a event
lead. This program is the future of the Green Tukwila Partnership and is on-going throughout this project.
Project Budget and Expenses*
Fill out and upload separate Application Budget Form also available on the KCD Member Jurisdiction Grant
Program website. Budget must be detailed with footnotes, appropriate and reasonable, meeting state
auditor/GAAP guidelines. Please do not use forms from previous applications. Please only upload the form linked
above. Thank you!
Budget Form (1-2-18) - FINAL.xlsx
Member Jurisdiction Authorization Letter
If you are a nonprofit organization seeking Member Jurisdiction funding, you must upload written authorization
from the Member Jurisdiction to apply for funding. This can be in the form of a letter or scanned copy of an email.
Additional Attachments
Upload any photos or maps of your project here. Only one file will be accepted. Please combine multiple files into
one if possible.
Support Materials (1-2-18) - FINAL.docx
KCD Acknowledgement and Signature
By signing below, the applicant agrees to acknowledge King Conservation District funding by placing the KCD-
provided logo on signs, materials, and documents produced as part of the above proposal. In addition, the
applicant will notify KCD of public events and activities funded by the KCD.
Authorized Applicant Electronic Signature*
Please enter your full name to sign and agree to the above.
Robert Eaton
Title
Parks & Recreation Manager
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74
Robert Eaton Tukwila
Date*
01/02/2018
Printed Om 24 January 2018 Member Jurisdiction Grant Program 7
75
Robert Eaton Tukwila
File Attachment Summary
Applicant File Uploads
• Budget Form (1-2-18) - FINAL.xlsx
• Support Materials (1-2-18) - FINAL.docx
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76
King Conservation District
Member Jurisdiction Grant Program
Grant Application Project Budget Form
Promoting sustainable uses of natural resources through
responsible stewardship
Project Name
Green Tukwila Implementation - 2018 & 2019
Total Match
Applicant
City of Tukwila - Parks & Recreation Department
$47,400
Contact
Robert Eaton
Mailing Address
12424 42nd Ave S, Tukwila WA 98168
E-mail
Robert.Eaton@TukwilaWA.gov
'Project Start Date: 1 -Jan -18
Phone
206-767-2332
'Project End Date: I 31 -Dec -19
Please provide detailed budget information below. Itemize categories
footnotes and detailed descriptions
such as supplies, contracted services with
below
Budget Item rKCD Funds
Other Funds
Other Funds
Total
(identify source and status'
of matching funds here ex.
Rose Foundation -
Pending)
(identify source and status
of matching funds here ex.
DON Small and Simple -
Secured)
Salaries & Benefits
$40,000
$40,000
$80,000
Travel/ Meals/ Mileage
(for - volunteers. staff)
'
_
$0
$0
Office Supplies,
$0
$0
$0
Field Supplies
$2,000
$2,000
Contracted/
Professional Services
$5,400
$30,000
$35,400
Permits
_ $0
Other: (specify)
_
$0
Other: (specify)
$0
Other: (specify)
$0
Other: (specify)
$0
Other: (specify)
$0
TOTAL
$47,400
$70,000
$01 $117,400
Total Project Cost
$117,400
Total Match
$70,000
Amount of KCD Funding
Requested
$47,400
77
Match Percentage
60%
According to the newly adopted 20 -Year Green Tukwila Stewardship Plan, the estimated project expenses for 2018 are $88,704 and for 2019 are $104,077 totalling
$192,781. We will not likely be able to implement the project at the that level but have made a modified and intentional implementation plan given our resources. This
is defined above. Part of this includes reallocating .25 FTE of an existing ,75 FTE staff member to this project (520K Salaries in Other Funds) and by adding an additional
.25FTE to their time (5201<Salaries KCD Funds) for a total of .50 PTE (.50 FTE of this staff members total time now) dedicated to this project per year. In 2017 there was
nothing allocated to this.
$21( Field Supplies: purchasing necessary hand tools & supplies for this new program. Currently nothing is allocated.
535,400 Professional Services: contracted crew days at the various sites. Currently limited city budget funds are allocated for crew days that will be intentionally used for
this project and will be mathcing funds, however more days are needed as well.
78
Green Tukwila Implementation — 2018 & 2019 January 2, 2018
Tukwila Parks & Recreation
Green Tukwila
Map of all 138 acres and sites within the City of Tukwila included within the 20 -Year Stewardship Plan
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79
Green Tukwila Implementation - 2018 & 2019
Tukwila Parks & Recreation
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Green Tukwila Implementation - 2018 & 2019
Tukwila Parks & Recreation
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81
Green Tukwila Implementation — 2018 & 2019
Tukwila Parks & Recreation
— - m _
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January 2, 2018
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82
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Green Tukwila Implementation - 2018 & 2019
Tukwila Parks & Recreation
Project Budget from 20 -Year Stewardship Plan
January 2, 2018
3reen Tukwila Partnership projections of program costs and volunteer match value for figure 1.4 on page
52 of the draft 20 -Year Plan
Year
Estimated number
of NEW acres to
enroll each year
Total Estimated
Program and
Field Costs
Volunteer
Match Value
($28.99/h4
Estimated number
of volunteer hours
each year
2017
1.50
$76,932
$86,970
3,000
2018
2.00
$88,704
$86,970
3,000
2019
3.00
$104,077
$92,765
3,200
2020
3.00
$113,161.
$1.01,465
3,500
2021
4.00
$127,639
$110,162
3,800
2022
5.00
$161,336
$115,960
4,000
2023
6.00
$1811,709
$1.15 560
4,000
2024 '
7.00
$200,675
$1.15,960
4,000
2025.
8.00
_ $225,466
$115,960
4,000
202E
8.00
$235,964
$1.15,960
4,000
2027
8.00
$243,596
$115,960
4,000
2028
8.00
$249,366
$115,960
4,000
2029
8.00
$253,559
$1.15,960
4,000
2030
8.00
$255,,944
$115,960
4,000
2031
6.00
$240,997
$11.5,960
4,000
2032
2.00
$198,583
$86,970
3,000
2033
4.00
$157,178
$86,970
3,000
2034
0.00
$133,380
$86970
3,000
2035
0.00
$118,942
$86,970
3,000
203E
0.00
$108,653
$86,970
3.000
Total
87.50
$3474,859
$ ,98.5,815
71,500
Overall cost to maintain all 87 acres and a smaller volunteer program beyond the 20 years is estimated
at $75,000 to $80,000/year.
83
84
AGREEMENT FOR AWARD
OF KING CONSERVATION DISTRICT MEMBER JURISDICTION GRANT
City of Tukwila
This Agreement is made between the King Conservation District Number 9, a municipal corporation in
King County, Washington, located at 1107 SW Grady Way, Suite 130, Renton, WA 98057 (referred to herein as
"District"), and the City of Tukwila, a municipal corporation in King County, Washington, located at 13900
Interurban Ave S. Tukwila, WA 98168 (referred to herein as "Recipient"), for the purposes set forth herein.
SECTION 1. RECITALS
1.1 Whereas, the District is a special purpose district organized and existing under authority of Chapter
89.08 RCW which engages in certain activities and programs to conserve natural resources, including soil and
water, which activities are declared to protect and promote the health, safety, and general welfare of the people
of the state of Washington; and
1.2 Whereas, pursuant to RCW 89.08.400 and/or RCW 89.08.405, King County has authorized and
imposed a system of assessments and/or a system of rates and charges to finance the activities and programs of
the District; and
1.3 Whereas, pursuant to RCW 89.08.220 and RCW 89.08.341 the District is authorized to enter into
agreements with, or to furnish financial or other aid to, municipal entities and agencies (governmental or
otherwise), or their designees, or any occupier of lands within the District, in order to carry out and facilitate the
activities and programs of the District to conserve natural resources; and
1.4 Whereas, the District has reviewed the grant application submitted by Recipient and has
determined that the application meets the requirements of Chapter 89.08 RCW and the District's policies and
procedures for awarding grants; and
1.5 Whereas, the District and Recipient desire to enter into this Agreement for the purpose of
establishing the terms and conditions relating to the District's award of a grant to Recipient.
SECTION 2. AGREEMENT
2.1 The District agrees to award Recipient a grant in the total amount Forty -Seven Thousand Four
Hundred and No/100 Dollars ($47,400.00) from KCD-Tukwila 2012-2017 Collections. Grant funds shall be used
by Recipient solely for the performance of the work described in Exhibit A which is attached hereto and
incorporated herein by this reference. The District shall pay the grant funds to Recipient in accordance with the
District's policies and procedures, or as otherwise provided herein, including but not limited to, the policies and
procedures contained in the grant program guidelines, provided that such funds have been collected and received
by the District.
2.2 Recipient represents and warrants that it will only use the grant funds for the work described in
Exhibit A, which may be amended by the parties pursuant to Paragraph 3.3 of the Agreement. Recipient shall
be required to refund to the District that portion of any grant funds which are used for unauthorized work. Further,
Recipient agrees to return to the District any grant funds that are not expended or remain after completion of the
work covered by this Agreement.
Page 1 of 4
85
2.3 Recipient acknowledges and agrees that the grant funds may only be expended on work which
shall be entirely within the District's jurisdictional boundaries. The following municipal entities are not within
the District's jurisdictional boundaries: Enumclaw, Federal Way, Milton, Pacific, and Skykomish. Recipient
shall be required to refund to the District that portion of any grant funds which are used for work performed
outside the District's jurisdictional boundaries.
2.4 In the event the scope of work authorized by this Agreement includes the use of grant funds to
purchase houses located on real property within a flood hazard area, Recipient acknowledges and agrees that grant
funds may only be used for such purposes if the houses to be purchased were constructed before floodplain
mapping or sensitive areas regulations were in place for that area. Recipient shall be required to refund to the
District that portion of any grant funds which are used for unauthorized purposes.
2.5 Recipient shall be required to provide the District with regular financial and project progress
reports for the duration of the project. Grant funds are remitted to the Recipient on a reimbursement payment
basis. Project progress reports must be submitted with each reimbursement request. Project progress and financial
reports, along with the final narrative and financial summary reports shall be submitted through the District's
online grant portal.The Recipient shall be required to submit to the District a final report which documents the
Recipient's completion of the work in conformance with this Agreement within thirty (30) days after the
completion of the work. The final report shall, among other things, summarize the project's successes and shall
address the regional benefits accomplished by the work. The final report shall also identify any obstacles or
challenges which were encountered during the work, along with general recommendations regarding ways to
avoid such obstacles or challenges in the future. If requested, Recipient agrees to provide the District with
additional financial or progress reports from time to time, at reasonable intervals.
2.6 Recipient's expenditures of grant funds shall be separately identified in the Recipient's accounting
records. If requested, Recipient shall comply with other reasonable requests made by the District with respect to
the manner in which project expenditures are tracked and accounted for in Recipient's accounting books and
records. Recipient shall maintain such records of expenditures as may be necessary to conform to generally
accepted accounting principals and to meet the requirements of all applicable state and federal laws.
2.7 If the Recipient is a Washington municipal agency, Recipient shall be required to track project
expenses using the Budget Accounting and Reporting System for the State of Washington ("BARS").
2.8 The District or its representative shall have the right from time to time, at reasonable intervals, to
audit the Recipient's books and records in order to verify compliance with the terms of this Agreement. Recipient
shall cooperate with the District in any such audit.
2.9 Recipient shall retain all accounting records and project files relating to this Agreement in
accordance with criteria established in the Revised Code of Washington and the Washington State Archivist.
2.10 Recipient shall ensure that all work performed by Recipient or its employees, agents, contractors
or subcontractors is performed in a manner which protects and safeguards the environment and natural resources
and which is in compliance with local, state and federal laws and regulations. Recipient shall implement an
appropriate monitoring system or program to ensure compliance with this provision.
2.11 Recipient agrees to indemnify, defend and hold harmless the District, its elected or appointed
officials, employees and agents, from all claims, alleged liability, damages, losses to or death of person or damage
to property allegedly resulting from the negligent or intentional acts of the Recipient or any of its employees,
agents, contractors or subcontractors in connection with this Agreement.
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2.12 Recipient agrees to acknowledge the District as a source of funding for this project on all literature,
signage or press releases related to said project.
2.13 Recipient shall notify the District if Recipient intends to sell, salvage, or otherwise dispose of any
equipment purchased with grant funds. The proceeds received by Recipient from any sale, salvage or disposition,
or the value of the equipment if proceeds were not received from any such action, must be: (a) re -invested back
into the originally awarded project; (b) invested in a similar project with District approval; or (c) returned to the
District.
SECTION 3. GENERAL PROVISIONS
3.1 This Agreement shall be binding upon and inure to the benefit of the parties hereto and their
respective successors and assigns.
3.2 This Agreement constitutes the entire agreement between the parties with respect to the subject
matter hereof. No prior or contemporaneous representation, inducement, promise or agreement between or among
the parties which relate to the subject matter hereof which are not embodied in this Agreement shall be of any
force or effect.
3.3 No amendment to this Agreement shall be binding on any of the parties to this Agreement unless
such amendment is in writing and is executed by the parties. The parties contemplate that this Agreement may
from time to time be modified by written amendment which shall be executed by duly authorized representatives
of the parties and attached to this Agreement.
3.4 Each party warrants and represents that such party has full and complete authority to enter into
this Agreement and each person executing this Agreement on behalf of a party warrants and represents that he/she
has been fully authorized to execute this Agreement on behalf of such party and that such party is bound by the
signature of such representative.
DISTRICT: RECIPIENT:
By By
Name Name
Title Title
Date Date
Approved as to Form: Approved as to Form:
DISTRICT LEGAL COUNSEL: RECIPIENT'S ATTORNEY:
By r t k r By
Name a Name
Date j .�3 Date
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