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In-Kind $ <br />EKplain <br />Is Equipment being purchased? No Who owns equipment? <br />New Personnel being hired? No Contact HR hiring -reporting requirements <br />Future impacts or liability to Kittitas County: We are estimating revenue of $20,000 per year in both <br />2009 and 2010. We are paid based on our activities related to working with Medicaid Eligible clients. <br />Budget Information <br />Budget Amendment Needed? Yes 0 attach budget form No []I Why not These funds are already <br />New Division Created? included in our budget <br />Revenue Code 116.6129533397781 <br />116.6129533397782 116.6129533397783 <br />116.6129533397784 <br />Pass Through Information <br />Agency to Pass Through n/a <br />Amount to Pass Through $ <br />Sub-Contract Approved Date: <br />Prosecutor Review <br />I Has the Prosecutor reviewed this agreement? I Yes 0 No D <br />County Departments Impacted <br />Auditor Facilities Maintenance <br />Information Services Human Resource <br />Prosecutor Treasurer <br />Submitted <br />I Signature: I Date: <br />Assignment of Tracking Information <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />I Reviewer I Date <br />Grant/Contract Review . Page 2