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Financial Information <br />Total Amount <br />Percentage County Funds <br />State Funds $ <br />Matching Funds $ <br />In -Kind $ <br />Federal F <br />CFDA# <br />Is Equipment being purchased? Who owns equipment? <br />New Personnel being hired? Contact HR hiring — reporting requirement_., <br />Future impacts or liability to Kittitas County: <br />Budget Information <br />Budget Amendment <br />Needed? <br />New Division Created? <br />Expense Code: <br />Revenue Code: <br />Yes ❑ attach budget form I No ® Why not <br />116.612.39.23.54101 <br />116.612.39.23.333.93.324 <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 <br />Information Services <br />Prosecutor <br />BOCC Approval Needed? <br />Yes <br />Staff Member Presenting: Chelsey Loeffers <br />Assignment of Tracking Information <br />Auditor's Office <br />' Hi uman Resource <br />Prosecutor's Office <br />Who Signed the grant <br />application <br />Facilities Maintenance <br />Human Resource <br />Treasurer <br />No ❑ <br />FReviewer Date <br />Grant/Contract Review Page 2 <br />