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Financial Information <br />Total Amount <br />State Funds $ <br />Fede-al Funds $ <br />Percentage County Funds <br />Matching Funds $ <br />CFDA# <br />In -Kind $ <br />Explain <br />Is Equipment being purchased? <br />Who owns equipment? <br />New Personnel being hired? <br />Contact HR hiring — reporting requirements <br />Future impacts or liability to Kittitas County: <br />Budget Intormation <br />Budget Amendment Needed? <br />New Division Created? <br />Yes ❑ attach budget form <br />No ® Why not <br />Revenue Code 116 — 612.39.23.333.93.324V-0 <br />116 — 615.02.02.334.4.9 <br />Expense Code <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through Expense Code: <br />Sub -Contract Approved Date: <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement? Yes ❑ No <br />county uepartments impactea <br />Auditor Facilities Maintenance <br />Information Services Human Resource <br />Prosecutor Treasurer <br />BOCC Approval Needed? <br />Yes ❑ <br />Lstaff Member Presenting: <br />Assignment of Tracking Information <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 <br />