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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Today's Date <br />Fund/Department <br />116-Public Health <br />Contract/Grant Information <br />I I Agenda Date <br />Contract /Grant Agency: DSHS DDA County Services Agreement <br />Period Begin Date: 07/01/2015 I I Period End Date: 06/30/2016 <br />Total Grant/Contract Amount: $689,190.00 <br />Grant/Contract Number: 1769CS-63 <br />Contract/Grant Summary: <br />The contract between the State of Washington Department of Social and Health Services and Kittitas <br />County is established to provide services and staff to administer DO services within the county as set in <br />the agreement. <br />Recommendation for Board of Health and Board of Health Review on <br />~==~--------~ <br />Department Head Signature : ____________ -', Administrator Date: ___ _ <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM : <br />Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount $689,190.00 State Funds $689,190.00 I Federal Funds $ <br />Percentage County Funds Matching Funds $ CFDA# <br />In-Kind $ <br />Explain <br />Grant/Contract Review Page 1