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Is Equipment being purchased? Who owns equiptni <br />New Personnel being hired? Contact HR hiring — <br />Future impacts or liability to Kittitas County: <br />Budget Information _ <br />Budget Amendment Needed? Yes ❑ attach budget form <br />New Division Created? _ <br />Revenue Code 116.615.03.8.334.03.10 $64,691.33 <br />116.615.03.6.334.03.10 $12,200.00 <br />Pass Through Information <br />nt? <br />ine reauirements <br />No Qx Why not, already budgeted <br />LSWFA General Task 1 <br />LSWFA Syringe Exchange Task 2 <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement? <br />County Departments Impacted <br />Auditor <br />Information Services <br />Prosecutor <br />Submitted <br />Facilities Maintenance <br />Human Resource <br />Treasurer <br />Signature: Date: <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 />E <br />Reviewer Date <br />Grant/Contract Review Page 2 <br />