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Is Equipment being purchased? NO Who owns equipment? <br />New Personnel being hired? NO Contact HR hiring — reporti <br />Future impacts or liability to Kittitas County: <br />uirements <br />Budget Information <br />Budget Amendment Needed? Yes ❑ attach budget form No ❑ why not <br />New Division Created? <br />Revenue Code 116.612.47 Behavorial Health <br />Expense Code 116.612.47.54101 <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through $ <br />Sub -Contract Approved Date: <br />Professional Services <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement? YesL1 No ❑ <br />county uepariments impactea <br />Auditor Facilities Maintenance <br />Information Services Human Resource <br />Prosecutor Treasurer <br />Submitted <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 />Reviewer <br />Date <br />Grant/Contract Review - Page 2 <br />