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TotalAmount State Funds S Federal Funds S <br />Percentage County Funds Matching Funds S CFDA# <br />ln-Kind S <br />Explain <br />ls Equipment being purchased?Who owns equipment? <br />New Personnel being hired?Contact HR hiring - reporting requirements <br />Future impacts or liability to Kittitas County: <br />Financial lnformation <br />B lnformation <br />Pass Through lnformation <br />Agency to Pass Through <br />Amount to Pass Through Expense Code: <br />Sub-Contract Approved Date <br />Prosecutor Review <br />Budget Amendment Needed?*oF Why notYes ! attach budget form <br />New Division Created? <br />105 - 568.334.04.68 \ ,/'.'t )Revenue Code <br />los - s68.s4101 / s4t22 / <br />'LOOL <br />/ s2}0r / 54s9t V <br />Expense Code <br />Has the Prosecutor reviewed this agreement?Yes No <br />County De rtments I <br />BOCC I Needed? <br />ment of Tracki lnformation <br />Facilities MaintenanceAuditor <br />Human Resourcelnformation Services <br />TreasurerProsecutor <br />NonYes ! <br />Staff Member Presenting: <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