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Financial Information <br />Total Amount $40,703 <br />State Funds $ <br />Federal Funds $40,703 <br />Percentage County Funds <br />Matching Funds $ <br />CFDA#93.757 <br />Human Resource <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 ❑ <br />New Division Created? <br />Revenue Code <br />116-612.49.03.333.93.757 - $15,500 <br />116-612.49.04.333.93.757 - $14,500 <br />_T— <br />d. <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through $ <br />Sub -Contract Approved Date: <br />attach budget form <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement? <br />Countv Departments Impacted <br />No ❑x Why not <br />Included in 2016 budget <br />Yes L1 No ❑ <br />Submitted <br />Signature: Date: <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 />Grant/Contract Review Page 2 <br />Auditor <br />Information Services <br />Prosecutor <br />Facilities Maintenance <br />Human Resource <br />Treasurer <br />Submitted <br />Signature: Date: <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 />Grant/Contract Review Page 2 <br />