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Kittitas County <br />Review Form <br />Grants & Contract Agreement it L(cJ-1-b { <br />Today's Date <br />03/23/2018 <br />Fund/Department <br />116-Public Health <br />Contract/Grant Information <br />Agenda Date LJ 17 <br />Contract /Grant Agency: Health Care Authority Amendment #2 (Admatch) <br />Period Begin Date: 01/01/2017 I I Period End Date: 12/31/2018 <br />Total Grant/Contract Amount: Fee for Service <br />Grant/Contract Number: K1407 <br />Contract/Grant Summary: <br />The Healthcare Authority Amendment 2 amends the contract manager information and replaces the <br />Statement of Work section in original contract. <br />Recommendation for Board of Health and Board of Health Review on <br />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$ NO MAX State Funds $ Federal Funds$ NO MAX <br />Percentage County Funds Matching Funds $ CFDA# 93. 778 <br />In-Kind$ <br />Explain <br />Is Equipment being purchased? Who owns equipment? <br />Grant/Contract Review Page 1