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Today's Date <br />10/30/2017 <br />Fund/Department <br />116-Public Health <br />Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Agenda Date <br />Contract/Grant Information <br />J:2 / L/ / /7- <br />Contract /Grant Agency: PSA between KCPHD and Community Health of Central Washington <br />Period Begin Date: 10/01/2017 1_ 1 Period End Date: 09/30/2018 <br />Total Grant/Contract Amount: maximum $13,258.00 <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />The agreement is in place between Community Health of Central Washington and the Kittitas County <br />Public Health Department. The contract provides a scope of work for Community Health of Central <br />Washington to be able to provide services for the Children with Special Health Care Needs program <br />which is a part of the Maternal Child Health Block Grant. <br />Recommendation for Board of Health and Board of Health Review on <br />--! I) ~t2l/~ I[;:t (') '1 J:J:.J" '7 Department Head Signatu r ~"",: "'-F'~--.:.t-------" Administrator Date:~ l <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />AP PROV ED S TO FORM : <br />Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount $13,258 State Funds $ Federal Funds $13,258 <br />Percentage County Funds Matching Funds $ CFDA#93.994 <br />Grant/Contract Review Page 1