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In-Kind$ <br />fl:lph1ln <br />Is Eq ui p ment being purchased? No Who owns eq ui p ment? <br />New Personnel being hired? No Contact HR hi r i ng -reportin g requirements <br />Future impacts or liability to Kittitas County: <br />Budget Information <br />Budget Amendment Needed? Yes • attach budget form No []I Why not <br />New Division Created? No Already in budget <br />Revenue Code 612.32.333.93.26 $ 5,600 lmmz 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 />Prosecutor Review I Has the Prosecutor reviewed this agree ment? I Yes D No D <br />County Departments Impacted <br />Auditor Facilities Maintenance <br />Information Services Human Resource <br />Prosecutor Treasurer <br />Submitted I Signature : <br />Dep artment : <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 />Grant/Contract Review Page 2