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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Today's Date PBK# <br />10/03/2024 � {� <br />_ r <br />Fund/Department Agenda Date: <br />116-Public Health <br />Contract/Grant Information <br />Contract /Grant Agenda: PSA between HopeSource and Kittitas County <br />Period Begin Date: July 15, 2021 Period End Date: 12/31/2026 <br />Total Grant/Contract Amount: $750,000.00 <br />Grant/Contract Number: 0A V JYU�� <br />Contract/Grant Summary: <br />The PSA between HopeSource and Kittitas County is established for distribution of homelessness <br />surcharge funds awarded up to $750,000.00 and will be used solely for the purposes described in the <br />original contract exhibit A (attached). <br />Recommendation for Board of Health Review on <br />Department Head Signature: {' Director Date: <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM: <br />Signature of ;Prosec is Office Date <br />I <br />Signature of Auditor's Office Date <br />Verification the Contracting Agency is not Suspended/Disbarred: <br />❑x Agency is not suspended/disbarred ❑ Not Checked (reason) <br />f�7D� SAGS �- �sGGIL! fi or1, `�d n� �• Zo 4 t _ <br />Grant/Contract Review Page 1 <br />