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I <br />Kittitas County <br />Review Form <br />Grants & Contract Agreement olPlt <br />Today's Date <br />05/01/2018 <br />Fund/Department <br />116-Public Health <br />Contract/Grant Information <br />Agenda Date , <br />Contract /Grant Agency: Washington State Department of Health Immunization Program <br />Period Begin Date: May 1, 2018 I I Period End Date: May 1, 2019 <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 />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