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Financial lnformation <br />B lnformation <br />Pass Throu Information <br />Prosecutor Review <br />Total Amou nt 5L,L34,44L.00 State Funds S 0 Federal Funds 5I,t34,44loo <br />Percentage County Funds Matching Funds $CFDA# <br />ln-Kind S <br />Explain <br />ls Equipment being purchased?Who owns equipment? <br />New Personnel being hired?Contact HR hiring - re porting requirements <br />Future impacts or liability to Kittitas County: <br />Budget Amendment Needed? <br />New Division Created? <br />Yes f attach budget form No D Why not <br />Revenue Codes: 1,16.6L2.32.8.333.93.26 S354,803.00 <br />(com bi n ed ) 116.6 1 2.39.23.333.93.3Z 57 67,238.00 <br />116.615.02.2.346.26.64 S 10,400.00 <br />rL6.6L5.02.2.346.26.66 5 2,000.00 <br />Vaccine Services CARES <br />ELC #4 EDE/COVID LHJ Allocation <br />Sanitary Survey Local Asst (FO-E) Fed <br />Tech Assist LocalAsst (FO-E) <br />Agency to Pass Through <br />Amount to Pass Through s <br />Sub-Contract Approved Date: <br />Has the Prosecutor reviewed this agreement?Yes No <br />County Departments I <br />Submitted <br />Signature Date: <br />De rtment <br />Assignment of Tracki lnformation <br />Auditor Facilities Maintenance <br />lnformation Services Human Resource <br />Prosecutor Treasurer <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />Reviewer Date <br />Grant/Contract Review Page 2