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Financial Information <br />Total Amount$ 117,548 State Funds $ 1,500 Federal Funds $ 116,048 <br />Percentage County Funds Matching Funds $ CFDA# 10.561 SnapEd; <br />In-Kind$ 93.069 EPR PHEP; 93.268 lmmz Rate <br />Explain 93.994 MCHGB <br />Is Equipment being purchased? Who owns equipment? <br />New Personnel being hired? Contact HR hiring -reporting requirements <br />Future impacts or liability to Kittitas County: <br />.1 <br />Budget Information <br />Budget Amendment Needed? Yes D attach budget form No[R] Why not -already in budget <br />New Division Created? <br />Revenue Code 612.94.333.10.56 SNAP ED $23,603 ($19, 745+$858+$3,000) <br />612.88.3.333.93.06 EPR PHEP $48,249 <br />612.22.333.93.99 MCHBG LHJ $44,196 <br />612.334.04.93 LEAD ENVIRONMT $ 1,500 <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? I Yes • No D <br />County Departments Impacted <br />Auditor Facilities Maintenance <br />Information Services Human Resource <br />Prosecutor Treasurer <br />Submitted I Signature: <br />Department: <br />I Date: <br />Assignment of Tracking Information <br />Auditor's Office <br />Human Resource <br />I <br />Prosecutor's Office <br />Who Signed the grant application <br />I Reviewer I Date <br />Grant/Contract Review Page 2