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Total Amount $82,051.00 <br />State Funds $ <br />Federal Funds $82,051 <br />Percentage County Funds <br />Matching Funds $ <br />CFDA# various (see below) <br />In -Kind $ <br />Explain <br />Is Equipment being purchased? <br />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 />116-612.88.3.333.93.069 - $29,749 <br />116.612.32.9.336.04.25 - $42,000 <br />116.612.94.333.10.561- $10,302 <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through $ <br />Sub -Contract Agoroved Date: <br />No 0 Why not <br />Not an increase in bottom line <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement? Yes ❑ No ❑ <br />County Departments Impacted <br />Auditor Facilities Maintenance <br />Information Services Human Resource <br />Prosecutor Treasurer <br />Submitted <br />Signature: <br />Department: <br />Assignment of Tracking Information <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />Date: <br />Who Signed the grant application I I <br />Grant/Contract Review Page 2 <br />