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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Today's Date <br />June 21,2021 <br />Agenda Date <br />2021 <br />Fund/Department <br />30 / Sheriff <br />Contract I Grant Informatio n <br />Financial Information <br />Bud Information <br />Pass Throu Information <br />Contract /Grant Agency: SH21-014 Amendment to test/examination prices to the cunent Occupational <br />Medicine Services Agreement between KVH workplace Health Medicine and Kittitas County Sheriff s <br />Office. <br />Period Begin Date: June 1,202I Period End Date: one vear from start date <br />Total Grant/Contract Amount: n/a <br />Grant/Contract Number: SH2 I -014 <br />ContracVGrant Summary: This is amending some test/examination prices to the current Agreement <br />between Kittitas County Sheriff s Office and KVH Workplace Health Medicine to conduct appropriate <br />pre-employment and other examinations. <br />Total Amount State Funds $0 Federal Funds $0 <br />Percentage County Funds Matching Funds $0 CFDA# n/a <br />In-Kind $ <br />Explain <br />Is Equipment being purchased? NO Who owns equipment? rVa <br />New Personnel being hired? NO Contact HR hiring - reporting requirements - rVa <br />Future impacts or liability to Kittitas County <br />Budget Amendment Needed? <br />New Division Created? <br />Yes! attach budget form No $ Why not - In Budget. <br />Revenue Code <br />Expense Code 00130xxx41 l3 <br />Agency to Pass Through NA <br />Amount to Pass Through $o <br />Sub-Contract Approved Date: <br />Grant/Contract Review Page 1