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o <br />Kittitas County Public Health <br />Contract/Agreement Review Form <br />Kittitas Corrilty <br />Public Health <br />Department <br />Today's Date 12t04t2024 Legal Request #:\? tlt t <br />Fund/Department 1/1Oth of Mental Health Tax Agenda Date r),'1,1 x:) <br />Contract/ent lnformation <br />Budget lnformation <br />Pass Th lnformation <br />Contract/Agreement Agency: Ellensburg School District <br />Contract/AgreementTitle: Providing Mental Health Services to the Students at Ellensburg School District <br />End Date: 1213112026Begin Date: O11O112025 <br />Total $ Amount: $31 3,750.00 Contract/Agreement +: PHMH-0 1 0 <br />Contract/Agreement Summa ry: <br />1/1Oth funding to Ellensburg School districtto.contractwith a licensed mental health care <br />provider to provide mental health services to the students in Ellensburg School District. <br />Kittitas County Prosecutor and Auditor Review and Comment: <br />F RMD <br />l'sr'Js- <br />Dates OfficeSignaturePros <br />DateStr".trtt"f Auditor's Offic-J I <br />Revenue Code(s)105 - 560.3134000 <br />Expense Code(s)105 - 560.54'101 <br />Agency is not suspended/disbarred [ ruot Checked (reason) <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 : 12/ 01,/202a Modified By: Katie Odiaga Approval By: Chelsey Loeffers