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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />To ad y's Date <br />07/11/2017 <br />Fund/Department <br />116 -Public Health <br />Contract/Grant Information <br />Agenda Date <br />i <br />Contract /Grant Agency: Consolidated Contract Amendment 12 <br />}.. „41 <br />Imo k <br />T Il'L %N ['Its. 7jy <br />Period Begin Date: lI lPeriodEndDate: o_ tUMW_4 s3t <br />Total Grant/Contract Amoun . $jj;��} . <br />Grant/Contract Number: C17114 <br />Contract/Grant Summary: The Consolidated Contract Amendment 12 is amending the Statements of <br />Work for the Office of Immunization & Child Profile. It also amends and replaces Exhibit C-9 with Exhibit <br />C-10 Schedule of Federal Awards. <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signature: Administrator Date: <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM: <br />Signat a of Prosecutors ffice Date <br />Signa ur of editor's Office Date <br />Signature of Board of Health member Date <br />Financial Information_ <br />Total Amount $ <br />Percentage County Funds <br />State Funds $ <br />Matching Funds $ <br />In -Kind $ <br />Explain <br />Federal Funds $ <br />CFDA# <br />Is Equipment being purchased? Who owns equipment? <br />Grant/Contract Review Page 1 <br />