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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Contract/G rant I nformation <br />Recommendation for Board of Health and Board of Health Review on <br />Financial lnformation <br />e4Õu7s <br />Today's Date <br />02/27/2OL9 <br />Agenda Date 3l tqltq <br />Fund/Department <br />L16-Public Health <br />Contract /Grant Agency: Adult Vaccine Program (AVP) <br />Period Begin Date: 0L/0L/z}tg Period End Date: 1213t/2O2O <br />Total G rant/Contract Amou nt: <br />Grant/Contract Number <br />Contract/G ra nt Summary: <br />The Adult Vaccine Program is established for participating providers in the AVP to provide free vaccine <br />to those adults 19 and over that do not have insurance. The agreement outlines eligibility and scope of <br />work for the health department. <br />Department Head Sign Administrator o^r", Z/Zg// j <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />o <br />Signatu s Date <br />Sign itor's Office Date <br />Signature of Board of Health member Date <br />TotalAmount S State Funds 5 Federal Funds S <br />Percentage County Funds Matching Funds S CFDA# <br />ln-Kind S <br />Expla¡n <br />Grant/Contract Review Page 1-