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3 <br />Kittitas County Public Health <br />Contract/Agreement Review Form <br />Kittita5 County <br />Public Health <br />Department <br />Today's Date:06109t25 Legal Request #11 655 <br />Fund/Depa rtment:Agenda Date <br />Contract/Agreement Agency: Washington State DSHS <br />Contract/Agreement Title: DSHS/DVR School to Work Direct Service Pilot <br />Begin Date: 0510112025 End Date: 0913012026 <br />TotalS Amount: Fee for Service Contract/Agreement #: <br />Contract/Agreement Summa ry: <br />The contract is an agreement that outlines the School to Work Direct Service Pilot Program <br />fnecEMffim <br />Auc - 5 ?0?5 <br />i; xrrrff*9.[ll,'*i,t],,,, <br />BOARD OF S0#6't'ii <br />Contract/Agreement Information <br />lnformation <br />Pass Through lnformation <br />Agency to Pass Through <br />Amount to Pass Through Expense Code <br />Sub-Contract Approved Date <br />Kittitas County Prosecutor and Auditor Review and Comment: <br />fu gts -a5 <br />Signature of Frosdcutor's dffice <br />/ <br />A *^,[r,t <br />C*o > <br />Date <br />b'>r. > rr- <br />Signature of Au{o/s office ' s Date <br />Revenue Code(s)105 - 568.334.04.68 <br />Expense Code(s)105 - 568.54101 <br />Not Checked (reason)7l ngency is not suspended/disbarred <br />ADMIN Version: 0 Supersedes: o Date Adopted : t2/ 0t/2024 Modified By: Katie Odiaga Approval By: Chelsey Loeffers