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Total Amount $88,882.67 <br />State Funds $66,662.00 <br />Federal Funds $ <br />Percentage County Funds 25% <br />Matching Funds $22,220.67 <br />CFDA# <br />In -Kind $ <br />Explain <br />Is Equipment being purchased? <br />Who owns equipment? <br />New Personnel being hired? <br />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 />116-615.03.334.03.10 - $49,693.97 <br />116-615.03.4.334.03.10 - $0.00 <br />116-615.03.6.334.03.10 - 539.188.70 <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through $ <br />Sub -Contract Approved Date: <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement? <br />County Departments Impacted <br />Nox❑ Why not <br />Total grant included in annual budget <br />Yes ❑ No ❑ <br />Submitted <br />Signature: <br />Department: <br />Assignment of Tracking Information <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />Date: <br />Grant/Contract Review Page 2 <br />Auditor <br />Facilities Maintenance <br />Information Services <br />Human Resource <br />_ <br />Prosecutor <br />Treasurer <br />Submitted <br />Signature: <br />Department: <br />Assignment of Tracking Information <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />Date: <br />Grant/Contract Review Page 2 <br />