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In -Kind $ <br />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 E]attach budget form <br />New Division Created? No <br />Revenue Code 612.32.333.93.26 $ 5,600 Immz Rate Increase <br />612.39.17.336.04.25 $42,000 FPHS CD <br />615.2.3.334.04.90 $10,000 Group B Water <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through $ <br />Sub -Contract Approved Date: <br />No FX Why not <br />Already in budget <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement? Yes ❑ No <br />County Departments Impacted <br />Auditor Facilities Maintenance <br />Information Services Human Resource <br />Prosecutor Treasurer <br />Submitted <br />Signature: Date: <br />Department: <br />Assignment of Tracking Information <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />Grant/Contract Review Page 2 <br />