Laserfiche WebLink
Signature of Board of Health member Date <br />Financial Information <br />Total Amount $State Funds $Federal Funds $ <br />Percentage County Funds Matching Funds $CFDA# <br />In-Kind $ <br />Explain <br />Is Equipment being purchased?Who owns equipment? <br />New Personnel being hired?Contact HR hiring -reporting requirements <br />Future impacts or liability to Kittitas County: <br />Budget Information <br />Budget Amendment Needed?Yes O attach budget form No why not <br />New Division created? <br />Revenue Code <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through $ <br />Sub-Contract Approved Date: <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement?Yes No <br />County Departments Impacted <br />Auditor Facilities Maintenance <br />Information Services Human Resource <br />Prosecutor Treasurer <br />Submitted <br />Signature:Date: <br />Department: <br />Grant/Contract Review Page 2