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Docusign Envelope ID:66D49F3C-3724-802E-81 D1-F5B0D633F6F8 <br /> ARTICLE II <br /> AWARD INFORMATION <br /> 2.1. Term.This Agreement is effective on July 1,2025 and expires on June 30,2027(the Term),unless <br /> terminated pursuant to this Agreement. <br /> 2.2. Amount of Agreement.Grant Funds(check one) must not exceed or❑are estimated to be <br /> $ 24,850.00 ,of which$0 are federal funds.Grantee accepts Grantor's payment as specified in this ARTICLE. <br /> 2.3. Payment. Payment will be made as follows(see additional payment requirements in ARTICLE IV; <br /> additional payment provisions specific to this Award may be included in PART TWO or PART THREE): Payment is <br /> to be made in one lump sum upon execution of the Agreement. <br /> 2.4. Award Identification Numbers. If applicable,the Federal Award Identification Number(FAIN)is <br /> N/A,the federal awarding agency is N/A,and the Federal Award date is N/A. If applicable,the Assistance Listing <br /> Program Title is N/A and Assistance Listing Number is N/A. The Catalog of State Financial Assistance(CSFA) <br /> Number is 592-01-0504 and the CSFA Name is Small Fire-fighting and Ambulance Service Equipment Grant <br /> Program. If applicable,the State Award Identification Number(SAIN)is N/A. <br /> ARTICLE III <br /> GRANTEE CERTIFICATIONS AND REPRESENTATIONS <br /> 3.1. Registration Certification. Grantee certifies that:(i)it is registered with SAM and <br /> HCL3MP6L8XV5 is Grantee's correct UEI;(ii)it is in good standing with the Illinois Secretary of State,if <br /> applicable;and(iii)Grantee has successfully completed the annual registration and prequalification through the <br /> Grantee Portal. <br /> Grantee must remain current with these registrations and requirements. If Grantee's status with regard to any of <br /> these requirements changes,or the certifications made in and information provided in the uniform grant <br /> application changes,Grantee must notify Grantor in accordance with ARTICLE XV. <br /> 3.2. Tax Identification Certification.Grantee certifies that: is Grantee's correct <br /> federal employer identification number(FEIN)or Social Security Number.Grantee further certifies,if applicable: <br /> (a)that Grantee is not subject to backup withholding because(i)Grantee is exempt from backup withholding,or <br /> (ii)Grantee has not been notified by the Internal Revenue Service(IRS)that Grantee is subject to backup <br /> withholding as a result of a failure to report all interest or dividends,or(iii)the IRS has notified Grantee that <br /> Grantee is no longer subject to backup withholding;and(b)Grantee is a U.S.citizen or other U.S.person. <br /> Grantee is doing business as a(check one): <br /> ❑Individual ❑Pharmacy-Non-Corporate <br /> ❑Sole Proprietorship ❑Pharmacy/Funeral Home/Cemetery Corp. <br /> ❑Partnership ❑Tax Exempt* <br /> ❑Corporation ❑Limited Liability Company(select <br /> ❑Medical Corporation applicable tax classification) <br /> Governmental Unit P=partnership <br /> ❑Estate or Trust C=corporation <br /> *Grantee must select"Tax Exempt"if Grantee is doing business as a corporation that is tax exempt. <br /> If Grantee has not received a payment from the State of Illinois in the last two years,Grantee must submit a W-9 <br /> State of Illinois <br /> GRANT AGREEMENT FISCAL YEAR 2027 <br /> Page 5 of 29 <br />