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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Contract/G rant I nformation <br />Recommendation for Board of Health Review on <br />Verification the Contracting Agency is not Suspended/Disbarred: <br />ffi Agency is not suspended/disbarred ! Not Checked (reason) <br />CVLaM- 4rr l>1 <br />Today's Date <br />01.30.24 PBK Request #\lrllpo <br />Fund/Department <br />116-Public Health Agenda Date: <br />Contract /Grant Agency: At Work! <br />Period Begin Date: 03.01.24 Period End Date: 06.30.24 <br />Total Grant/Contract Amount: Compensation shall be based on actual services provided and is subject <br />to funding. Only DDA approved services will be covered. <br />Grant/Contract Number: DD N. D DD I <br />The professional services agreement isto establish a subcontracted employment and dayservices <br />provider for people with developmental disabilities in Kittitas County perthe county's responsibilities <br />outlined in attachments, <br />Department Head Signature nLlDirector Date <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM: <br />- M ol[,Vlr[),,^,",a1 o:zlzzluzt <br />Signature of Prosecutor;r bfi."hrrbA +s-r-]qo Date <br />Signature of Auditor's Office Date <br />Grant/Contract Review Page 1