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KittitasCountyReviewForm/KlTTIT45flWTT1Grants&ContractAgreementToday'sDatePACamasRequest#:06/15/2022Fund/DepartmentAgendaDate:116-PublicHealthContract/GrantInformationContract/GrantAgency:HCAAmendmentforABCDKittitasCountyPeriodBeginDate:July1,2022PeriodEndDate:June30,2024TotalGrant/ContractAmount:$25,386.00Grant/ContractNumber:K2747Amendment4Contract/GrantSummary:•TheMaximumCompensationpayabletotheContractorfortheperformanceofallthingsnecessaryfororincidenttotheperformanceoftheworkassetforthinScheduleA-3:StatementofWorkhasincreasedby$25,376.00,foranewContractMaximumCompensationof$68,638.00,andincludesanyallowableexpenses.•ScheduleA-2:StatementofWorkisreplacedinitsentiretywithScheduleA-3:StatementofWork,attachedheretoandincorporatedherein.•ExhibitA-2:ABCDQuarterlyCommunityandProviderOutreachandCaseManagementReportisreplacedinitsentiretywithExhibitA-3:ABCDQuarterlyCommunityandProviderOutreachandcaseManagementReport,attachedheretoandincorporatedherein.•ExhibitB-2:ABCDQuarterlyOutreachandCoordinationofCareReportisreplacedinitsentiretywithExhibitB-3:ABCDQuarterlyOutreachandCoordinationofCareReport,attachedheretoandincorporatedherein.•ExhibitC-1:ABCDYearlyBudgetToolisreplacedinitsentiretywithExhibitC-2:ABCDYearlyBudgetTool,attachedheretoandincorporatedherein.RecommendationforBoardofHealthReviewonDepartmentHeadSignature:,DirectorDate:KittitasCountyProsecutor,Auditor,andBoardofHealthReviewandComment:APPROVEDASTOFORM:SignatureofProsecutor'sOfficeDateSignatureofAuditor'sOfficeDateVerificationtheContractingAgencyisnotSuspended/Disbarred:Agencyisnotsuspended/disbarredONotChecked(reason)Grant/ContractReviewPage1