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a <br />Kittitas County Public Health <br />Contract/Agreement Review Form <br />Kittitas County <br />Public Health <br />Department <br />Today's Date 2t2712025 I Legat Request#:11 362 <br />Fund/Department:1/1Oth of 1% MentalHealth fax! Agenda Date <br />Contract/ <br />lnformation <br />nt lnformation <br />Contract/Agreement Agency: Cle Elum-Roslyn School District (CERSD) <br />Contract/AgreementTitle: Amendment 1 to PSA between CERSD and Kittitas Gounty <br />End Date: 1213112025Begin Date: 0110112025 <br />Total S Amount: $143,600 Contract/Agreement *: PHMH-01 1 <br />Contract/Agreement Summary: <br />1/1Oth funding to Cle Elum -Roslyn School District to provide mental health services to the <br />students in Cle Elum-Roslyn School District. <br />Kittitas County Prosecutor and Auditor Review and Comment: <br />APP <br />.1- r -2s <br />Signature bf y'rosecutort ofti[e / <br />Xl not/oru Epr,z <br />Date <br />3 .to.zr <br />Signatu re of Auditor's'Office Date <br />Revenue Code(s)105 - 560.3134000 <br />Expense Code(s)105 - 560.54101 <br />Agency is not suspended/disbarred Not Checked (reason)n <br />Agencyto PassThrough <br />Amount to Pass Through Expense Code <br />Sub-Contract Approved Date <br />Pass lnformation <br />ADMIN Version:0 es: 0 Date Ado t210L12024 Modified Katie Od Loeffers