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Financial Information <br />Total Amount NTE $35,000.00 State Funds Federal Funds $ <br />Percentage County Funds Matching Funds $ CFDA# <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 <br />I New Division Created? <br />Revenue Code: 105.568.334.04.68 <br />Expense Code: 105.568.54101 (Professional Services) <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through $ <br />Sub -Contract Approved Date: <br />NO ❑x Why not <br />Professional Services <br />Prosecutor Review <br />Has Prosecutor reviewed this agreement? Yes ❑ No <br />County Departments Impacted <br />Auditor <br />Information Services <br />Prosecutor <br />Submitted <br />Signature: <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 />Facilities Maintenance <br />Human Resource <br />Treasurer <br />Reviewer Date <br />Grant/Contract Review Page 2 <br />