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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Today's Date Agenda Date <br />04/23/2018 <br />Fund/Department <br />116-Public Health <br />Contract/Grant Information <br />Contract /Grant Agen cy : First Choice <br />·#' L/ ;;.1100 <br />~)l~IJ® <br />~ <br />Period Begin Date: Upon Signature Period End Date: Upon termination by either <br />p arty <br />Total Grant/Contract Amount : $ <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />The agreement between Kittitas County Public Health Department and First Choice is established so the <br />department can bill patients health insurance for services provided . <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signature:~, Administrator Date:~ (1'.'( <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 />Grant/Contract Review Page 1