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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Contract/G ra nt I nformation <br />Recommendation for Board of Health Review on <br />ification the contracting Agency is not suspended/Disbarred: <br />Today's Date <br />02t PA Camas Request #: |aq;l|Fund/Department <br />116-Public Health Agenda Date: V ts a} <br />Contract /Grant Agency: Entrust <br />Period Begin Date: Februa ry L,2022 Period End Date: June3}th,2022 <br />Total G rant/Contract Amount: <br />G rant/Contract N umber: <br />Contract/Grant Su mmary: <br />tEn rust emesprovid aent dnp servt uces nloym d vtaer suaday Wbcontract hit ittK itas Cou fo fnty <br />eveloD n Dtal isab it Adres mpme ronnistrat es.activiti stEntru swa usl cedaprevio n a tonsplv aprovintrcostatusactfornno-com ncea hwitp rovt tn fo rm oati whpding thich en,sWA otin fi ed tn uJofagency lyof202InDeceermbraftedditalonaEWrevtEntrustlnremaIednsrovitonacontractpastatusdngiven <br />corrective acti no ts o com lete Ja un a 3pby 2.202 EntrurYI,st mco d corthose replete ctive cta aions wtnd lthavethetonalstatusprovisremovedfromtherncoratmctovinfoforwardthrobreeamnerdtofeh <br />nfu d n ra <br />Department Head Signatu "7 n-'tlrLDirector Date <br />Signature Prosecutor's <br />ature of Auditor's Office <br />'r- <br />Date <br />k,"_ <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM: <br />Agency is not suspended/disbarred fl Not Checked (reason) <br />Grant/Contract Review Page 1