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I Today's Date l 09/02/2015 <br />I Fund/Department <br />Ll1~~Public Health <br />Kittitas Cou nty <br />Review Form <br />Grants & Contract Agreement <br />-----. ~--. --[[Agenda Date C1 ) 14 ) ) h <br />Contra ct/Grant Information <br />I <br />J <br />rc o~tract /Grant Agency: Profession ;iServic ~s Ag~'eement between Elmviewand ~Kitti t asCounty Heal ilil <br />I ~:~:;:;~ Date ~~~~1 /2 015 _ _. ~.-JJie~iod E~d ~~~t;:~~016> -".. -=J <br />Total Graf}!lfontract Amou ~t: Not to exc~ed$?51,32Q..OO _ ~ <br />. GE~ntl92!:!.!ract Number: i <br />I Contract/G~ant sum~a rV: ... ... .. . 1 I The Professional Services Agreement IS established to provide a coordinated and comprehensive local I i progra~ of .services for persons with developmental disabilities and to fulfill the county's responsibilities I <br />Las, outlined 1M atta_chments. _ J <br />Recommendation for Boa r d of Health and Board of Health Review on -_.... ._,-._._. --. --:.:.;::".,,=== <br />Department Head Signature: ~.~._ .~. ' __ '===~~ ___ ' Administrator Date: ___ _ <br />rKitt-it~~~county prosec'utor, Au dltor,~n d Board of HealthRevi e~ and Comment: <br />APPROVED AS TO FORM: <br />I <br />i <br />I <br />Date <br />I ~~-~.-.----.-'~--.-~~.-~~--~~~=. ~---~-~~~~=j <br />I Signature of BoardofHealth m_ember ~~D~ate <br />Financial Information <br />~~=:-----.. ----~~-.-'~~~-=~=~""I 1 _T.Qt~al~A_m_.ou_n_t~ $55 t .... ( =-3=2-",,-0 _____ 1 StateF u nd s $55 1 1 32 0 ~_federalf!:'~,~.?} ... 1 <br />~ Percentage County Funds _' .~~M~a~~C_h i ng Fund s $ _ CFDA# . -~ .. ~ ... --~~-~.-""-,~~J <br />Ii ! In -Kind $ I <br />. !~~ ~ <br />Grant/Contract Review Page 1