Agenda - Environmental Policy Board - 01/13/2020

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EXHIBIT C Revision # METROPOLITAN COUNCIL ENVIRONMENTAL SERVICES 2019 CLEAN WATER FUND WATER EFFICIENCY GRANT PROGRAM GRANT AMENDMENT FORM NOTICE TO GRANTEE: Submission of this form is required to modify your city's agreement with Metropolitan Council Environmental Services (MCES) 2019 Clean Water Fund Water Efficiency Grant program (Grantee Program). After determination of your city's initial grant amount, completion and submission of this form is necessary when 1) you are requesting additional grant funds to meet unexpected rebate or grant demand, or 2) when your city has determined that the previously approved program's rebate or grant demand will not be met, requiring less grant funds than anticipated when the agreement was signed. The process for modifying your agreement is as follows: 1. Your City's designated authorized representative submits 2 signed copies of Exhibit C to MCES, with an attachment itemizing requests for changes to prior granted amounts. 2. Upon receipt of signed Exhibit C, MCES Program Administrator obtains Council authorized signatures that modifies the agreement and returns a fully signed copy of Exhibit A indicating new grant amount to City's designated authorized representative. Instructions: Indicate the date of your change request in #1 box. Indicate the number of this particular change request in #2 box (and in box at top of page — must match). Enter the current grant agreement amount (as MCES approved) in #3 box. If you wish to increase your municipality's grant amount, enter the amount you are requesting in #4 box. If you wish to decrease your grant amount due to less demand than anticipated, enter the amount in #5 box. Enter in #6 box the amount derived from adding #3 to #4 or derived from subtracting #5 from #3. Grant Agreement # 1. Date of change request: 2. Change request number: 3. Current Grant Agreement Amount (as MCES approved): 1