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# . /~--~ ~ --Kittitas County <br />Review Form {iL .--__ _~ .,...-=:;:-._---rc.:=....=.. <br />-!i!.l7J I '\ "t il , <br />Grants & Contract Agreement . . . -::ib (.Lj-\; <br />Teday's Date Ag enda Date ~ / Lj J /1-03/07/2017 <br />Fund/Department <br />116-Public Health <br />Contract/Grant Information <br />Contract /Grant Agency : PSA between KVH and Kittitas Cou nty Public Health (T B XRAYS ) <br />Period Begin Date: Upon execution I I Period End Date: 1 year from date of execution <br />Total Grant /Contract Amount: $59.86 for adults (si ng le view) and $71.14 for children (two view) <br />Grant/Contract Number: CH-001 <br />Contract/Grant Summary: <br />The Professional Services Agreement between Kittitas County (KCPHD) and Kittitas Valley Healthcare <br />(KVH) is an agreement entered into that allows the health department to send clients to KVH for <br />screening x-rays. The agreement includes a set fee for these services. <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signatu &Rt"1' ./::1.f-, Administrator Date :~ I 7 <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />AP PRO VED AS T O FOR M: <br />1"/ <br />Date <br />• /,1./ . -/1J -f> J -. 11;,' t ,L L(U )/ { <br />Sig n~tu~e ' ~f 'Prose c~t pl;ts Office <br />~'-t2b-; <br />Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount $58.96 or $71.14 per State Funds $ Federal Funds $ <br />xray <br />Percen tage County Funds 100% Matching Funds $ CFDA# <br />Grant/Contract Review Page 1