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In -Kind $ <br />Is Equipment being purchased? Who owns equipment? <br />New Personnel being hired? _ _ Contact HR hiring — reporting requirements <br />Future impacts or liability to Kittitas County: <br />Budget Information <br />Budget Amendment Needed? Yes ❑ attach budget form <br />New Division Created? <br />Revenue Code <br />116-615.06.346.22 - $4000.00 max <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through $ <br />Sub -Contract Approved Date: <br />NO ❑x Why not <br />Included in 2016 budget <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement? Yes❑ No ❑ <br />county uepartments impactea <br />Auditor Facilities Maintenance <br />Information Services Human Resource <br />Prosecutor Treasurer <br />Submitted <br />Signature: Date: <br />Department: <br />Assignment of Tracking Intormation <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />Reviewer Date <br />Grant/Contract Review Page 2 <br />