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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 />Verification the Contracting Agency is not Suspended/Disbarred: <br />Agency is not suspended/disbarred ! Not Checked (reason) <br />Financial lnformation <br />Today's Date <br />oLl08/2024 PBK Request #: L0233 <br />Fund/Department <br />11-6-Public Health Agenda Date: z* LI ' z\ <br />Contract /Grant Agency: Community Builders /L/LOL^ of L% Tax award <br />Period Begin Date: OL/O7/2024 Period End Date: 72/3L/2025 <br />Total Grant/Contract Amount: $250,000 <br />Grant/Contract Number <br />Contract/G rant Su m ma ry: <br />Community Builders shall use the funds to operate the Upper County Teen Shop <br />3(bl>tDepartment Head Signature Director Date <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />D TO FORM <br />Signature of ecutor's Date <br />z <br />Signature of Auditor's Office Date <br />TotalAmount State Funds S Federal Funds S <br />Grant/Contract Review Page 1