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® Agency is not suspended/disbarred ❑ Not Checked (reason) <br />Financial Information <br />Total Amount $20,940 <br />State Funds $ <br />Federal Funds $ <br />Percentage County Funds 100% <br />Matching Funds $ <br />CFDA# <br />In -Kind $ <br />Explain <br />Is Equipment being purchased? No <br />Who owns equipment? Cannon Solutions <br />New Personnel being hired? No <br />Contact HR hiring — reporting requirements <br />Future impacts or liability to Kittitas County: <br />Budget Intormation <br />Budget Amendment Needed? Yes ❑ attach budget form No ® why not <br />New Division Created? I Already Budgeted <br />Revenue Code 116.612.39.28.333.21.027 <br />Expense Code 612.39.28.51001 / 52001 / 50098 <br />Pass Through Information <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 El No ❑ <br />County Departments Impacted <br />Auditor Facilities Maintenance <br />Information Services Human Resource <br />Prosecutor Treasurer <br />BOCC Approval Needed? <br />Yes ❑ No FXI <br />Staff Member Presenting: <br />Assignment or i racKing inrormation <br />Auditor's Office <br />Human Resource <br />Grant/Contract Review Page 2 <br />