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Financial Information <br />Total Amount $ <br />State Funds $ <br />Federal Funds $ <br />Percentage County Funds <br />Matching Funds $ <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 />Pass Through Information <br />to Pass Through <br />Amount to Pass Through $ <br />Sub -Contract Approved Date: <br />No ❑ Why not <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement? YesEl 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 —I <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />Date: <br />Grant/Contract Review Page 2 <br />