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Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM: <br />Signature of Prosecutor's Office Date <br />Signature of Auditor's Office Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount $125,582 State Funds $ Federal Funds $125,582; $252,036 <br />Percentage County Funds Matching Funds $ CFDA# 93.070; 93.268; 21.019 <br />In -Kind $ <br />Explain <br />Is Equipment being purchased? I 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 />Revenue Code 116.615.08.04.333.93.07 - $111,000 116.39.21.333.21.01- $252,036 <br />FFY20 Envir Health Capacity -C (CDC); BITV-COVID Ed LHJ Allocation -CARES <br />116.612.39.24.333.93.26 - $14,582 (combines Amd 16 & 18 removing <br />FFY21 COVID-19 Vaccine Services -CARES; FEMA -75 COVID LHJ Allocation) <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through $ <br />Sub -Contract Approved Date: <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement? Yes El No ❑ <br />County Departments Impacted <br />Auditor Facilities Maintenance <br />Grant/Contract Review Page 2 <br />