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Kittitas County Public Health <br />Contract/Agreement Review Form <br />Kittitas County <br />Public Health <br />Today's Date: <br />01/08/2025 <br />Legal Request #: <br />Fund/Department: <br />1/10th of 1% Mental Health Tax <br />. <br />Agenda Date: <br />Contract/Agreement Information <br />Contract/Agreement Agency: Cie Elum-Roslyn School District <br />Contract/Agreement Title: Providing Mental Health Services to the Students at cle-Elum Roslyn School District <br />Begin Date: 01/01/2025 <br />End Date: 12/31/2025 <br />Total $ Amount: $143,600 14 Contract/Agreement #: PHMH-011 <br />Contract/Agreement Summary: <br />1/10th funding to Cie Elum -Roslyn School District to provide mental health services to the <br />students in Cie Elum-Roslyn School District. <br />Kittitas County Prosecutor and Auditor Review and Comment: <br />APPROVED AS TO FORM: <br />Signature of Prosecutor's Office <br />Date <br />Signature of Auditor's Office <br />Date <br />Bud,qet Information <br />Revenue Code(s): <br />105 - 560.3134000 <br />Expense Code(s): <br />105 - 560.54101 <br />❑� <br />Agency is not suspended/disbarred <br />❑ <br />Not Checked (reason) <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through Expense Code: <br />Sub -Contract Approved Date: <br />ADMIN I Version: 0 1 Supersedes: 0 1 Date Adopted: 12/01/2024 1 Modified By: Katie Odiaga I Approval By: Chelsey Loeffers <br />