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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Today's Date <br />05/09/2018 <br />Fund/Department <br />116-Public Health <br />Contract/Grant Information <br />Agenda Date m <br />Contract /Grant Agency: PSA between Youth Services of Kittitas County and Kittitas County <br />Period Begin Date: April 1, 2018 I I Period End Date: June 30, 2019 <br />Total Grant/Contract Amount: $28,151.88 <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />The PSA is established to allow Youth Services of Kittitas County to implement the Community <br />Prevention Wellness Initiative (CPWI) community based mentoring program in Kittitas County. <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signature : _________ __, Administrator Date: ___ _ <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM: <br />Date <br />Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount$ 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 />New Personnel being hired? Contact HR hiring -reporting requirements <br />Grant/Contract Review Page 1