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EXHIBIT "A" <br />Funding Information : <br />Chart of CFDA# BARS Funding Period Current Change Total <br />Accounts Revenue (LHJ Use Only) Consideration Increase Consideration <br />Program Name Code Start Date End Date (+) <br />or Title <br />Youth Tobacco N/A 334 .04 .93 01/01/15 06/30/15 5,750 (1 ,294) 4,456 <br />Prevention <br />FFY14 PHBG 93 .758 333.93 .75 01/01/15 09/30/15 11,750 (4,478) 7,272 <br />CBP Tobacco- <br />PPHF <br />FFY15 PHBG 93 .758 333.93 .75 10/01/15 12/30/15 0 1,000 1,000 <br />CBP Tobacco- <br />PPHF <br />FFY15 CDC 93 .305 333 .93 .30 03/29/15 03/28/16 0 2,000 2,000 <br />Tobacco <br />Prevention <br />Youth Tobacco N/A 334 .04 .93 07/01/15 06/30/16 0 4,000 4,000 <br />Prevention <br />TOTALS 17,500 1,228 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 Budget <br />DIRECT: <br />Salaries $2,522 <br />Benefits $963 <br />Goods & Services $2 ,500 <br />Total Direct Costs: $5,985 <br />INDIRECT: <br />Overhead $1,015 <br />Total Funding $7,000 <br />Youth Tobacco Interagency Agreement -Kittitas Amendment#l <br />11/6/15 Page 6