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Signature of Board of Health member Date <br />Financial Information <br />Total Amount $ 665,415 State Funds $ 223,200 Federal Funds $ 442,215 <br />Percentage County Funds Matching Funds $ CFDA# see below <br />In -Kind $ <br />Explain <br />Is Equipment being purchased? Who owns equipment? <br />New Personnel being hired? 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 />Amount to Pass Through <br />Consolidated Contract Amendment #10 <br />Revenue Code see below <br />Date: { <br />116.612.94.333.10.561 <br />$ <br />20,603 <br />FFY20 SNAP ED PROGRAM <br />116.612.88.3.333.93.069 <br />$ <br />49,133 <br />FFY19 PHEPR LHJ FUNDING <br />116.612.31.333.93.439 <br />$ <br />60,000 <br />FFY19 LSPAN PROGRAM <br />116.615.02.333.40.490 <br />$ <br />20,000 <br />GFS GROUP B (FO -E) (7/20-12/20) <br />116.612.39.17.336.04.25 <br />$ <br />42,000 <br />FPHS FUNDING LHJ's (7/20-12/20) <br />116.612.39.17.336.04.25 <br />$ <br />42,000 <br />FPHS FUNDING LHJ's (7/19-6/20) <br />116.615.02.2.346.26.64 <br />($-3,200) <br />YR21 SRF (FS) SS (END 06/30/19) <br />116.615.02.2.346.26.64 <br />$ <br />3,200 <br />YR22 SRF (FO -E) SS (1/19-12/19) <br />116.615.02.2.346.26.66 <br />($-4,000) <br />YR21 SRF (FS) TA (END 06/30/19) <br />116.615.02.2.346.26.66 <br />$ <br />2,000 <br />YR22 SRF (FO -E) TA (01/19-12/19) <br />Pass Throueh 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❑ NoEj <br />county uepartments Impacted <br />Auditor Facilities Maintenance <br />Information Services Human Resource <br />Prosecutor Treasurer <br />Grant/Contract Review Page 2 <br />