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EXHIBIT "A" <br />Funding Information: <br />Chart of <br />CFDA # <br />BARS <br />Funding Period <br />Current <br />•Change <br />'Total <br />Accounts <br />$963 <br />Revenue <br />(LHJ Use Only) <br />Consideration <br />Increase <br />Consideration <br />(Program Name <br />INDIRECT: <br />Code <br />Start Date End Date <br />$1,015 <br />N <br />$7,000 <br />or Title <br />Youth Tobacco <br />N/A <br />334.04.93 <br />01/01/15 <br />06/30/15 <br />5,750 <br />(1,294) <br />4,456 <br />Prevention <br />FFY14 PHBG <br />93.758 <br />333.93.75 <br />01/01/15 <br />09/30/15 <br />11,750 <br />(4,478) <br />7,272 <br />CBP Tobacco— <br />PPHF <br />FFY15 PHBG <br />93.758 <br />333.93.75 <br />10/01/15 <br />12/30/15 <br />0 <br />1,000 <br />1,000 <br />CBP Tobacco— <br />PPHF <br />FFY15 CDC <br />93.305 <br />333.93.30 <br />03/29/15 <br />03/28/16 <br />0 <br />2,000 <br />2,000 <br />Tobacco <br />Prevention <br />Youth Tobacco <br />N/A <br />334.04.93 <br />07/01/15 <br />06/30/16 <br />0 <br />4,000 <br />4,000 <br />Prevention <br />TOTALS <br />17,500 <br />1,228 <br />18,728 <br />Billing Information: <br />All A-19 Invoice billings with original signatures and detailed documentation attached are to be sent to <br />Grant County Health District 1038 W Ivy Ave Suite 1, Moses Lake WA 98837 attn: Ryan Brimacombe. <br />Please indicate the costs for each separate component on your A-19. <br />Billings should be submitted monthly within 30 days after the close of a month. Exception: For the <br />month after a funding source's expiration date please have the billing submitted within 25 days after the <br />close of the month. <br />Line Item Budget: <br />Kittitas Budget (Oct 1, 2015 —Jun 30, 2016) <br />Description <br />Budget <br />DIRECT: <br />Salaries <br />$2,522 <br />Benefits <br />$963 <br />Goods & Services <br />$2,500 <br />Total Direct Costs: <br />$5,985 <br />INDIRECT: <br />Overhead <br />$1,015 <br />Total Funding <br />$7,000 <br />Youth Tobacco Interagency Agreement — Kittitas Amendment#1 <br />11/6/15 Page 6 <br />