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Today's Date <br />5/30/2019 <br />Fund/Department <br />116 -Public Health <br />Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Agenda Date <br />Contract/Grant Information <br />Contract /Grant Agency: PSA between Heather Carballo-DePuydt and KCPHD <br />Period Begin Date: June 1, 2019 <br />Total Grant/Contract Amount: $500.00 <br />Grant/Contract Number: <br />Period End Date: June 30,2019 <br />�� na z <br />1(j 'Tll:t7 C'UL'L ' <br />t-1Lj(PLev <br />Contract/Grant Summary: <br />Heather Carballo-DePuydt to provide contract deliverable for Community Prevention and Wellness <br />Initiative (DBHR grant), specifically Coalition Leadership Training. Training to occur June 2019. <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signature: Administrator Date: %47 <br />Kittitas County Prosecutor, Auditor, and Board o <br />APPRO\lLD AS TO FORM: <br />Sign�t-ure of Pro ecutor's O e Date <br />rt -y A�,� & / /, <br />Signa ur Auditor's Office Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount $ 500.00 <br />State Funds $ <br />Federal Funds $ <br />Percentage County Funds <br />Matching Funds $ <br />CFDA# <br />In -Kind $ <br />Explain <br />Is Equipment being purchased? no <br />Who owns equipment? no <br />Grant/Contract Review Page 1 <br />