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Verification the Contracting Agency is not Suspended/Disbarred: <br />I] Agency is not suspended/disbarred ❑ Not Checked (reason) <br />I <br />Financial Information <br />Total Amount NTE $100,000 <br />Percentage County Funds <br />State Funds $ Federal Funds $ $100,000 <br />Matching Funds $ CFDA#93.268 <br />In -Kind $ <br />Explain <br />Is Equipment being purchased? Who owns equipment? <br />New Personnel being hired? I Contact HR hiring — reporting requirements <br />Future impacts or liability to Kittitas County: <br />Budget Information <br />Budget Amendment Needed? Yes ❑ attach budget form <br />New Division Created? <br />Revenue Code <br />Expense Code <br />116.61239243339332 <br />116.612392454101 <br />No D Why not <br />Funds already budgeted <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? YesEl No <br />County Departments Impacted <br />Auditor <br />Facilities Maintenance <br />Information Services <br />Human Resource <br />Prosecutor <br />Treasurer <br />BOCC Approval Needed? <br />Yes <br />Staff Member Presenting: <br />Assignment of Tracking Information <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />No ❑ <br />Grant/Contract Review Page 2 <br />