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TotalAmount $State Funds $Federal Funds S <br />Percentage Cou nty Funds Matching Funds S CFDA# <br />ln-Kind S <br />Explain <br />ls Equipment being purchased?Who owns equipment? <br />New Personnel bei ng hired?Contact HR hiring - reporting requirements <br />Future impacts or liability to Kittitas County <br />Financial lnformation <br />Budget lnformation <br />Pass Through lnformation <br />Agency to Pass Through <br />Amount to Pass Through Expense Code <br />Sub-Contract Approved Date <br />Prosecutor Review <br />Budget Amendment <br />Needed? <br />Yes ! attach budget form No E why not <br />New Division Created? <br />Revenue Code 1,1,6.612.90.369.40 ornea t^.,o6enent / serrLan,en f tva'-toy]'4-l <br />rlor,nn Se-lhenen'l' <br />Expense Code 1t6.6L2.90.541.Ot <br />Has the Prosecutor reviewed this agreement?Yes No <br />County Departments lmpacted <br />Auditor Facilities Maintenance <br />lnformation Services Human Resource <br />Prosecutor Treasurer <br />BOCC Approval Needed? <br />Assignment of Trackin lnformation <br />Yes I Non <br />Staff Member Presenting: Chelsey Loeffers <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office tz.-$* *Ho,l. <br />Who Signed the grant <br />application <br />(Jrr <br />Reviewer Date <br />Grant/Contract Review Page 2