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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Today's Date <br />01/24/2018 <br />Fund/Department <br />116-Public Hea lth <br />Contract/Grant Information <br />Agenda Date <br />Contract /Grant Agency: Northwest Vital Records and KCPHD <br />Period Begin Date: 02/01/2019 I j Period End Date : 02/28/2019 <br />Total Grant/Contract Amount: $68.00 <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />53/ <br />The Northwest Vital Records agreement will allow them to take old xrays from the department and <br />shred them and send us confirmation of shredding services provided : <br />Reco mmendation for Board of Health and Board of Health Review on <br />Department Head Signature: _________ _, Administrator Date: __ _ <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />AP DAS TO FORM: <br />e Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount$ 68 (expense) State Funds $ 0 Federal Funds$ 0 <br />Percentage County Funds Matching Funds$ CFDA# <br />In-Kind$ <br />Ex p lain <br />Is Equipment being purchased? Who owns equipment? <br />Grant/Contract Review Page 1