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Is Equipment being purchased? yesWho owns equipment? KCPHD <br />New Personnel being hired? yes Contact HR hiring — reporting requirements <br />Future impacts or liability to Kittitas County: <br />Budget Information <br />Budget Amendment Needed? Yes D attach budget form No ❑ why not <br />New Division Created? yes <br />Revenue Code 116.612.47 Behavioral Health & Recovery <br />L. <br />GL REVENUE <br />I <br />DESCRIPTION <br />612.47.1.333.93.959 <br />SABG SUBSTANCE ABUSE BLOCK GRANT <br />612.47.2.333.93.243 <br />PFS PARTNERSHIP FOR SUCCESS <br />612.47.3.334.04.6X <br />GFS GENERAL FUND STATE ADMIN <br />612.47.4.334.04.6X <br />DMA DEDICATED MARIJUANA ACCOUNT <br />TOTAL <br />Treasurer <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through $ <br />Sub -Contract Approved Date: <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement? <br />County Departments Impacted <br />SFY-18 SFY-19 <br />17,548 71,553 <br />21,614 12,318 <br />1,261 3,009 <br />7,614 23,120 <br />48,037 110,000 <br />Yes ❑ No ❑ <br />TOTAL <br />89,101 (FED) <br />33,932 (FED) <br />4,270 (STATE) <br />30,734 (STATE) <br />158,037 (TOTAL) <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 />Reviewer Date <br />Grant/Contract Review Page 2 <br />Auditor <br />Facilities Maintenance <br />Information Services <br />Human Resource <br />Prosecutor <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 />Reviewer Date <br />Grant/Contract Review Page 2 <br />