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Is Equipment being purchased? NO Who owns equipment? <br />New Personnel being hired? NO Contact HR hiring-reporting requirements <br />Future impacts or liability to Kittitas County: <br />Budget Information <br />Budget Amendment Needed? Yes D attach budget form No D Why not <br />New Division Created? <br />Revenue Code 116.612.47 Behavorial Health <br />Expense Code 116.612.47.54101 Professional Services <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through $ <br />Sub-Contract Approved Date: <br />Prosecutor Review <br />I Has the Prosecutor reviewed this agreement? ! Yes D No D <br />County Departments Impacted ~ <br />Auditor Facilities Maintenance rr <br />Information Services Human Resource ~ <br />Prosecutor Treasurer I,;-.:. <br />Submitted I Signature: <br />Department: <br />I Date : <br />Assignment of Tracking Information <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />/ Reviewer I Date <br />Grant/Contract Review Page 2