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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Today's Date I Agenda Date <br />August 22, 2019 September 3, 2019 <br />Fund/Department <br />30 / Sheriff <br />Contract/Grant Information <br />Contract /Grant Agency: Community Health of Central Washington (CHCW) -SUD Services <br />Period Begin Date: August 19, 2019 Period End Date: until terminated by either <br />party <br />Total Grant/Contract Amount: <br />Grant/Contract Number: SH19-016 <br />Contract/Grant Summary: This Agreement is between Kittitas County Sheriffs Office and Community Health of <br />Central Washington (CHCW) to provide Substance Use Disorder (SUD) treatment for person(s) incarcerated at <br />Kittitas County Corrections Center. CHCW will make attempts to bill patient's insurance, and then bill the <br />patient's responsible share of the bill to KCCC. KCCC will bear the up-front cost of services, but will bill each <br />patient's inmate trust account to recover as much of the cost as possible . <br />Financial Information <br />Total Amount$ Variable State Funds $0 Federal Funds $0 <br />Percentage County Funds 100% Matching Funds $0 CFDA# NA <br />In-Kind $0 <br />Explain <br />Is Equipment being purchased? NO Who owns equipment? NA <br />New Personnel being hired? NO Contact HR hiring -reporting requirements -N/ A <br />Future impacts or liability to Kittitas County: Contractor will maintain professional liability insurance as <br />required by contract. <br />Budget Information <br />Budget Amendment Needed? Yes D attach budget form No[J Why not -Already budgeted <br />New Division Created? NO <br />Revenue Code NA <br />Expense Code 001-300954113 <br />Pass Through Information <br />Agency to Pass Through NA <br />Amount to Pass Through $0 <br />Sub-Contract Approved Date: <br />Grant/Contract Review Page 1