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Kittitas CountY <br />Review Form <br />Grants & Contract Agreement <br />Contract/Grant lnformation <br />Recommendation for Board of Health Review on <br />Depa rtment Head Signature Director Date:l,t 2e <br />Verification the Contracting Agency is not Suspended/Disbarred: <br />Agency is not suspended/disbarred I Not Checked (reason) <br />"/a-ru- g.zo <br />\O\VPBK# <br />L <br />Today's Date <br />Agenda DateFund/Department <br />116-Public Health <br />Contract /Grant Agenda: PSA between HopeSource and Kittitas County <br />Period End Date: L2l3Ll2O26Period Begin Date: luly 15,2O2t <br />Total Grant/Contract Amount:50,000.00 <br />Grant/Contract N umber: <br />The PSA between HopeSource and Kittitas County is established for distribution of homelessness <br />surcharge funds awarded up to S750,OOO.OO and will be used solely for the purposes described in the <br />original contract exhibit A (attached). <br />Co ntract/G rant Su mmarY: <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />/5t <br />Signature Prosec s Office Date <br />/o-/7-z <br />Signature of Auditor's Office Date <br />Grant/Contract Review Page 1