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a <br />Kittitas County Public Health <br />Contract/Agreement Review Form <br />Kitlitas Co(uty <br />Public Health <br />Departs€nt <br />Today's Date 12t04t2024 f Legat Request #\ l4-u r {,v <br />Fund/Department:1/1Oth of Mental Health fax I Agenda Date <br />Contract/Agreement I nformation <br />Bu lnformation <br />Pass Th lnformation <br />Contract/Agreement Agency: Damman School District <br />Contract/Agreement Title: Providing Mental Health Services to the Students at Damman School District <br />End Date: 1213112025Begin Date: O1lO1l2O25 <br />Contract/Agreement *: PH M H-005Total S Amount: $9,250.00 <br />Contract/Agreement Summa ry: <br />1/1Oth funding to Damman School district to contract with a licensed mental health care provider <br />to provide mental health services to the students in Damman School District. <br />Kittitas County Prosecutor and Auditor Review and Comment: <br />/- r7-J f <br />Signature Pros s Office <br />//1 , <br />Date <br />l'J t- <br />Signature of Auditor's Offic'e Date <br />Revenue Code(s):105 - 560.3134000 <br />105 - 560.54101Expense Code(s) <br />Not Checked (reason)Agency is not suspended/disbarred <br />Agency to Pass Through <br />Expense Code:Amount to Pass Through <br />Sub-Contract Approved Date <br />ADMIN Version:0 Supersedes: 0 Date Adopted : L2 / oL / 2O2a Modified By: Katie Odiaga Approval By: Chelsey Loeffers