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Financial Information <br />Total Amount <br />Percentage County Funds <br />State Funds NTE $35,000 <br />Matching Funds $ <br />Federal Funds $ <br />CFDA# <br />In -Kind $ <br />Explain <br />Is Equipment being purchased? <br />Who owns equipment? <br />New Personnel being hired? <br />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 _� 105.568.334.04.68 <br />Expense Code 105.568.5410 <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through <br />Sub -Contract Approved Date: <br />No ® Why not <br />Expense Code: <br />_Prosecutor Review <br />Has the Prosecutor reviewed this agreement? Yes F_� No <br />County Departments Impacted <br />BOCC Approval Needed? <br />Yes ❑ No <br />Staff Member Presenting: <br />Assignment of Tracking Information <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />Reviewer I Date I <br />Grant/Contract Review Page 2 <br />