Common use of FEDERAL AWARD IDENTIFICATION Clause in Contracts

FEDERAL AWARD IDENTIFICATION. Subgrantee Name: GHC of Auburn, LLC dba Siena Skilled Nursing & Rehabilitation Center Subgrantee DUNS Number: N/A Federal Award Identification Number (XXXX): Federal Funds Obligated to the Subgrantee under this Agreement: $_ Federal Awarding Agency: Pass Through Entity: County of Placer, Health and Human Services Department Catalog of Federal Domestic Assistance (CFDA) Name: Medi-Cal CFDA Number: 93.778 Research and Development Grant: Indirect Cost Rate: Should the Subgrantee be determined to be a Subrecipient, pursuant to the criteria of 2 CFR Part 200 (the “Uniform Guidance”), the Subrecipient shall be subject to the Subrecipient Monitoring requirements outlined in the Uniform Guidance. Per 2 CFR Section 200.331, all pass-through entities must ensure that every sub-award is clearly identified to the subgrantee as a sub-award. As part of the Subrecipient Monitoring requirements, additional information will be provided to CONTRACTOR at the time of the of the subaward or when modified. Authorized Federal, State and County representatives shall have the right to monitor and evaluate the Subrecipient’s administrative, fiscal and program performance pursuant to this Agreement. The Subrecipient agrees to cooperate with monitoring and evaluation processes and will make any administrative program and fiscal staff available during scheduled monitoring processes including but not limited to administrative processes, policies, procedures and procurement, audits, inspections of project premises, and interviews of project staff and participants. The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the making, awarding or entering into of this Federal contract, Federal grant, or cooperative agreement, and the extension, continuation, renewal, amendment, or modification of this Federal contract, grant, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency of the United States Government, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, or cooperative agreement, the undersigned shall complete and submit Standard Form LLL, “Disclosure of Lobbying Activities'' in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontractors, subgrants, and contracts under grants and cooperative agreements) of $100,000 or more, and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S.C., any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. GHC Of Auburn, LLC Dba Siena Skilled Nursing & Rehabilitation Center Name of Contractor Printed Name of Person Signing for Contractor HHS000333 Contract/Grant Number Signature of Person Signing for Contractor Date Title Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 Approved by OMB 0348-0046 1. Type of Federal Action: [ ] a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. Status of Federal Action: [ ] a. bid/offer/application b. initial award c. post-award 3. Report Type: [ ] a. initial filing b. material change For Material Change Only: Year quarter date of last report 4. Name and Address of Reporting Entity: Prime Subawardee Tier _, if known: Congressional District, If known: 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: Congressional District, If known:

FEDERAL AWARD IDENTIFICATION. Subgrantee Name: GHC of Auburn, LLC dba Siena Skilled Nursing & Rehabilitation Center Granite Wellness Centers Subgrantee DUNS Number: N/A Federal Award Identification Number (XXXX): 2020VDBX0620 Federal Funds Obligated to the Subgrantee under this Agreement: $_ 198,895 Federal Awarding Agency: Department of Justice Pass Through Entity: County of Placer, Health and Human Services Department Catalog of Federal Domestic Assistance (CFDA) Name: Medi-Cal Coronavirus Emergency Supplemental Funding Program CFDA Number: 93.778 #16.034 Research and Development Grant: Yes (Project Grant) Indirect Cost Rate: Not Applicable Should the Subgrantee be determined to be a Subrecipient, pursuant to the criteria of 2 CFR Part 200 (the “Uniform Guidance”), the Subrecipient shall be subject to the Subrecipient Monitoring requirements outlined in the Uniform Guidance. Per 2 CFR Section 200.331, all pass-through entities must ensure that every sub-award is clearly identified to the subgrantee as a sub-award. As part of the Subrecipient Monitoring requirements, additional information will be provided to CONTRACTOR at the time of the of the subaward or when modified. Authorized Federal, State and County representatives shall have the right to monitor and evaluate the Subrecipient’s administrative, fiscal and program performance pursuant to this Agreement. The Subrecipient agrees to cooperate with monitoring and evaluation processes and will make any administrative program and fiscal staff available during scheduled monitoring processes including but not limited to administrative processes, policies, procedures and procurement, audits, inspections of project premises, and interviews of project staff and participants. The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the making, awarding or entering into of this Federal contract, Federal grant, or cooperative agreement, and the extension, continuation, renewal, amendment, or modification of this Federal contract, grant, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency of the United States Government, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, or cooperative agreement, the undersigned shall complete and submit Standard Form LLL, “Disclosure of Lobbying Activities'' in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontractors, subgrants, and contracts under grants and cooperative agreements) of $100,000 or more, and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S.C., any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. GHC Of AuburnGranite Wellness Centers Xxxxxxxx Xxxxxxxxxx, LLC Dba Siena Skilled Nursing & Rehabilitation Center MS Name of Contractor Printed Name of Person Signing for Contractor HHS000333 HHS000279 Contract/Grant Number Signature of Person Signing for Contractor Chief Executive Officer Date Title Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 Approved by OMB 0348-0046 1. Type of Federal Action: [ ] a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. Status of Federal Action: [ ] a. bid/offer/application b. initial award c. post-award 3. Report Type: [ ] a. initial filing b. material change For Material Change Only: Year quarter date of last report 4. Name and Address of Reporting Entity: Prime Subawardee Tier _, if known: Congressional District, If known: 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: Congressional District, If known:

FEDERAL AWARD IDENTIFICATION. Subgrantee Name: GHC of Auburn, LLC dba Siena Skilled Nursing & Rehabilitation Center Nevada Sierra Connecting Point Public Authority Subgrantee DUNS Number: N/A Unique Entity Identifier (UEI): Federal Award Identification Number (XXXX): Federal Funds Obligated to the Subgrantee under this Agreement: $_ $ Federal Awarding Agency: Name of Agency Pass Through Entity: County of Placer, Health and Human Services Department Assistance Listing Name (formerly Catalog of Federal Domestic Assistance (CFDA) Name: Medi-Cal CFDA ): Assistance Listing Number: 93.778 Research and Development Grant: Yes (Project Grant) / No (Formula Grant) Indirect Cost Rate: 10% / Not Applicable Should the Subgrantee be determined to be a Subrecipient, pursuant to the criteria of 2 CFR Part 200 (the “Uniform Guidance”), the Subrecipient shall be subject to the Subrecipient Monitoring requirements outlined in the Uniform Guidance. Per 2 CFR Section 200.331, all pass-through entities must ensure that every sub-award is clearly identified to the subgrantee as a sub-award. As part of the Subrecipient Monitoring requirements, additional information will be provided to CONTRACTOR at the time of the of the subaward or when modified. Authorized Federal, State and County COUNTY representatives shall have the right to monitor and evaluate the Subrecipient’s administrative, fiscal and program performance pursuant to this Agreement. The Subrecipient agrees to cooperate with monitoring and evaluation processes and will make any administrative program and fiscal staff available during scheduled monitoring processes including but not limited to administrative processes, policies, procedures and procurement, audits, inspections of project premises, and interviews of project staff and participants. The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the making, awarding or entering into of this Federal contract, Federal grant, or cooperative agreement, and the extension, continuation, renewal, amendment, or modification of this Federal contract, grant, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency of the United States Government, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, or cooperative agreement, the undersigned shall complete and submit Standard Form LLL, “Disclosure of Lobbying Activities'' in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontractors, subgrants, and contracts under grants and cooperative agreements) of $100,000 or more, and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S.C., any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. GHC Of Auburn, LLC Dba Siena Skilled Nursing & Rehabilitation Center Name of Contractor Printed Name of Person Signing for Contractor HHS000333 Contract/Grant Number Signature of Person Signing for Contractor Date Title Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 Approved by OMB 0348-0046 1. Type of Federal Action: [ ] a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. Status of Federal Action: [ ] a. bid/offer/application b. initial award c. post-award 3. Report Type: [ ] a. initial filing b. material change For Material Change Only: Year quarter date of last report 4. Name and Address of Reporting Entity: Prime Subawardee Tier _, if known: Congressional District, If known: 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: Congressional District, If known:

FEDERAL AWARD IDENTIFICATION. Subgrantee Name: GHC of Auburn, LLC dba Siena Skilled Nursing & Rehabilitation Center Xxxxxx Community Support Services Subgrantee DUNS Number: N/A Unique Entity Identifier (UEI): Federal Award Identification Number (XXXX): Federal Funds Obligated to the Subgrantee under this Agreement: $_ $ Federal Awarding Agency: Name of Agency Pass Through Entity: County of Placer, Health and Human Services Department Assistance Listing Name (formerly Catalog of Federal Domestic Assistance (CFDA) Name: Medi-Cal CFDA ): Assistance Listing Number: 93.778 Research and Development Grant: Yes (Project Grant) / No (Formula Grant) Indirect Cost Rate: 10% / Not Applicable Should the Subgrantee be determined to be a Subrecipient, pursuant to the criteria of 2 CFR Part 200 (the “Uniform Guidance”), the Subrecipient shall be subject to the Subrecipient Monitoring requirements outlined in the Uniform Guidance. Per 2 CFR Section 200.331, all pass-through entities must ensure that every sub-award is clearly identified to the subgrantee as a sub-award. As part of the Subrecipient Monitoring requirements, additional information will be provided to CONTRACTOR at the time of the of the subaward or when modified. Authorized Federal, State and County COUNTY representatives shall have the right to monitor and evaluate the Subrecipient’s administrative, fiscal and program performance pursuant to this Agreement. The Subrecipient agrees to cooperate with monitoring and evaluation processes and will make any administrative program and fiscal staff available during scheduled monitoring processes including but not limited to administrative processes, policies, procedures and procurement, audits, inspections of project premises, and interviews of project staff and participants. The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the making, awarding or entering into of this Federal contract, Federal grant, or cooperative agreement, and the extension, continuation, renewal, amendment, or modification of this Federal contract, grant, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency of the United States Government, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, or cooperative agreement, the undersigned shall complete and submit Standard Form LLL, “Disclosure of Lobbying Activities'' in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontractors, subgrants, and contracts under grants and cooperative agreements) of $100,000 or more, and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S.C., any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. GHC Of Auburn, LLC Dba Siena Skilled Nursing & Rehabilitation Center Name of Contractor Printed Name of Person Signing for Contractor HHS000333 Contract/Grant Number Signature of Person Signing for Contractor Date Title Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 Approved by OMB 0348-0046 1. Type of Federal Action: [ ] a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. Status of Federal Action: [ ] a. bid/offer/application b. initial award c. post-award 3. Report Type: [ ] a. initial filing b. material change For Material Change Only: Year quarter date of last report 4. Name and Address of Reporting Entity: Prime Subawardee Tier _, if known: Congressional District, If known: 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: Congressional District, If known:

FEDERAL AWARD IDENTIFICATION. Subgrantee Name: GHC of Auburn, LLC dba Siena Skilled Nursing First 5 Placer – Children & Rehabilitation Center Families Commission Subgrantee DUNS Number: N/A 004244926 Federal Award Identification Number (XXXX): 31-2021-TANF Federal Funds Obligated to the Subgrantee under this Agreement: $_ 125,000 Federal Awarding Agency: Department of Health and Human Services (HHS) Pass Through Entity: County of Placer, Health and Human Services Department Catalog of Federal Domestic Assistance (CFDA) Name: Medi-Cal Temporary Assistance for Needy Families CFDA Number: 93.778 93.558 Research and Development Grant: No (Formula Grant) Indirect Cost Rate: Not Applicable Should the Subgrantee be determined to be a Subrecipient, pursuant to the criteria of 2 CFR Part 200 (the “Uniform Guidance”), the Subrecipient shall be subject to the Subrecipient Monitoring requirements outlined in the Uniform Guidance. Per 2 CFR Section 200.331, all pass-through entities must ensure that every sub-award is clearly identified to the subgrantee as a sub-award. As part of the Subrecipient Monitoring requirements, additional information will be provided to CONTRACTOR at the time of the of the subaward or when modified. Authorized Federal, State and County representatives shall have the right to monitor and evaluate the Subrecipient’s administrative, fiscal and program performance pursuant to this Agreement. The Subrecipient agrees to cooperate with monitoring and evaluation processes and will make any administrative program and fiscal staff available during scheduled monitoring processes including but not limited to administrative processes, policies, procedures and procurement, audits, inspections of project premises, and interviews of project staff and participants. The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the making, awarding or entering into of this Federal contract, Federal grant, or cooperative agreement, and the extension, continuation, renewal, amendment, or modification of this Federal contract, grant, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency of the United States Government, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, or cooperative agreement, the undersigned shall complete and submit Standard Form LLL, “Disclosure of Lobbying Activities'' in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontractors, subgrants, and contracts under grants and cooperative agreements) of $100,000 or more, and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S.C., any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. GHC Of Auburn, LLC Dba Siena Skilled Nursing & Rehabilitation Center Name of Contractor Printed Name of Person Signing for Contractor HHS000333 Contract/Grant Number Signature of Person Signing for Contractor Date Title Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 Approved by OMB 0348-0046 1. Type of Federal Action: [ ] a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. Status of Federal Action: [ ] a. bid/offer/application b. initial award c. post-award 3. Report Type: [ ] a. initial filing b. material change For Material Change Only: Year quarter date of last report 4. Name and Address of Reporting Entity: Prime Subawardee Tier _, if known: Congressional District, If known: 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: Congressional District, If known: