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Total Amount $ 58,500 <br />State Funds $ (1,500) <br />Federal Funds $ 60,000 <br />Percentage County Funds <br />Matching Funds $ <br />CFDA# 93.439 <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 />Budget Information <br />Budget Amendment Needed? Yes ❑ attach budget form No ❑ why not <br />New Division Created? <br />Revenue Code LSPAN 612.31.333.93.43 $60,000 <br />Lead Environment 612.334.04.93 (-$1,500) <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through <br />$ <br />Sub -Contract Approved <br />Date: <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement? Yes ❑ No ❑ <br />county uepartments impactea <br />Auditor Facilities Maintenance <br />Information Services Human Resource <br />Prosecutor Treasurer <br />Submitted <br />Signature: Date: <br />Department: <br />Assignment of I raCKing Intormation <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />Reviewer Date <br />Grant/Contract Review Page 2 <br />