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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Contract/G ra nt I nformation <br />Recommendation for Board of Health Review on <br />Department Head Signature Director Date: lo/>t lzz <br />verification the contracting Agency is not suspended/Disbarred: <br />Today's Date <br />e/20/2022 PA camas Request r,T4+ll,ll <br />Fund/Department <br />116-Public Health Agenda Date t0 llbt?h <br />I <br />Grant Agency: DOH lnteragency Agreement Contract Amendment 1 (GV126649- Health <br />u <br />Contract / <br />Period Begin Date: March 15,2O2I Period End Date: December 3t,2OZ3 <br />Total Grant/Contract Amount: Not to Exceed $SOO,OOO.OOO <br />G rant/Contract N umber: <br />The purpose of the no-cost amendment to the DOH lnteragency Agreement is to extend the period of <br />performance from May 3L, 2023, to December 3L, 2023. The statement of work remains the same as in <br />the original contract and is attached and no increases or decreases in contractual consideration. <br />Contract/G rant Summary: <br />Kittitas county Prosecutor, Auditor, and Board of Health Review and comment: <br />APP ROVED AS TO RM: <br />.zQTl )o H*/""Signature of P utor's Office Date <br />o L <br />Signature of Auditor's ce Date <br />I Agency is not suspended/disbarred ! Not Checked (reason) <br />Grant/Contract Review Page L