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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 0 >t zz <br />Verification the contracting Agency is not suspended/Disbarred: <br />Today's Date <br />s/20/2022 PA Camas Request #: <br />Fund/Department <br />116-Public Health Asendaoate: [f llb tL0 <br />cy: DoH lnteragency Agreement contract Amendment 1 (GV126649- Health <br />E U <br />Contract /Grant Agen <br />Period Begin Date: March IS,2O2I Period End Date: December 31,2023 <br />Total Grant/Contract Amount: Not to Exceed SSOO,OOO.OOO <br />Grant/Contract Number <br />The purpose of the no-cost amendmenttothe DOH lnteragencyAgreement isto extend the period of <br />performance from May 3L, 2023, to December 31, 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/Gra nt Su m mary: <br />Kitti tas county Prosecutor, Auditor, and Board of Health Review and comment: <br />APP EDASTOF ORM: <br />2zW+)o il*r 7- <br />Signature of P utor's Office Date <br />o <br />Signature of Auditor's ce Date <br />I Agency is not suspended/disbarred I Not Checked (reason) <br />Grant/Contract Review Page L