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Percentage County Funds <br />Matching Funds $ CFDA# 93.778 <br />Human Resource <br />In -Kind $ <br />Explain <br />Is Equipment being purchased? <br />Who owns equipment? <br />New Personnel being hired? <br />Contact HR hiring — reporting requirements <br />Future impacts or liability to Kittitas County: <br />Bui <br />Bud <br />Information <br />,et Amendment Needed? I Yes ❑ attach budget form <br />New Division Created? <br />Revenue Code 116.612.95.333.93.778 --- no max <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through $ <br />Sub -Contract Approved Date: <br />No ❑x Why not <br />Included in budget process <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement? Yes ❑ No ❑ <br />County Departments Impacted <br />Submitted <br />Signature:Date: <br />._........ <br />Department: <br />Assignment of Tracking Information <br />Auditor's Office <br />Auditor <br />Human Resource <br />Facilities Maintenance <br />17 <br />Information Services <br />Who Signed the grant application <br />Human Resource <br />Prosecutor <br />Treasurer <br />Submitted <br />Signature:Date: <br />._........ <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 />_ <br />Reviewer Date <br />Grant/Contract Review Page 2 <br />