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Total Amount 5 State Funds $Federal Funds $ <br />Percentage County Funds Matching Funds S CFDA# <br />ln-Kind S <br />Explain <br />ls 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 lnformation <br />Budget Amendment Needed?Yes I attach budget form No I why not <br />New Division Created? <br />Revenue Code tt6.672392354LOL - 6*histrru1 code / <br />Pass Through lnformat:on <br />Agency to Pass Through <br />Amount to Pass Through Expense Code <br />Sub-Contract Approved Date: <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement?Yes No <br />County Departments lmpacted <br />Auditor Facilities Maintenance <br />lnformation Services Human Resource <br />Prosecutor Treasurer <br />BOCC A roval Needed? <br />Assi nment of Tracki lnformation <br />Yes I Non <br />Staff Member Presenting <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office I t\ {+z'tfer fr"-\)(k l("r4-1 ?/t(/z- <br />Who Signed the grant application I vlr <br />Reviewer Date <br />Grant/Contract Review Page 2