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Kittitas Cou nty <br />Review Form <br />Grants & Contract Agreement <br />loday's Date Agenda Date lp/W 11-OS/25/2017 <br />Fund/Department I <br />116-Public Health <br />Contract/Grant Information <br />Contract /Grant Agency : Washington State Department of Health Immunization Program <br />Period Begin Date: May 1, 2017 I I Period End Date: A. tJ I' i J. 30, 2018 <br />Total Grant/Contract Amount: None <br />Grant/Contract Number: <br />Contract/Grant Summary: This agreement is between Washington State Department of Health <br />Immunization Program and Kittitas County Public Health Department. The agreement outlines the <br />guidelines providers must follow in order to participate in the Vaccine for Children Program (VFC). <br />Recommendation for Board of Health and Board of Health Review on <br />~" Department Head Signature: ~T\~ , Administrator oate:$(t7 <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM : <br />. -:;- <br />Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount $ State Funds $ Federal Funds $ <br />Percentage County Funds Matching Funds $ CFDA# <br />In-Kind $ <br />Explain <br />Is Equipment being purchased? Who owns equipment? <br />Grant/Contract Review Page 1