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Kittitas County Public Health A <br />Kit`'"5 `Ou"•y <br />Public Health <br />Contract/Agreement Review Form Depdirtmaiit <br />Today's Date: 12/04/2024 Legal Request #: <br />Fund/Department: 1/10th of Mental Health Tax Agenda Date: <br />Contract/Agreement Information <br />Contract/Agreement Agency: Kittitas School District <br />Contract/Agreement Title: Providing Mental Health Services to the Students in Kittitas School District <br />Begin Date: 01/01/2025 End Date: 12/31/2025 <br />Total $ Amount: $83,734.00 / Contract/Agreement #: PHMH-007 <br />Contract/Agreement summary: <br />1 /10th funding to Kittitas School district to contract with a licensed mental health care provider to <br />provide mental health services to the students in Kittitas School District. <br />Kittitas County Prosecutor and Auditor Review and Comment: <br />APPROVED AS TO FORM: <br />of <br />of Auditor's <br />Budget Information <br />Revenue Code(s): 105 - 560.3134000 <br />Expense Code(s): 105 - 560.54101 <br />7 Agency is not suspended/disbarred <br />Not Checked (reason) <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through Expense Code: <br />Sub -Contract Approved Date: <br />o�S <br />Date <br />—I <br />Date <br />ADMIN I Version: 0 1 Supersedes: 0 Date Adopted: 12/01/2024 1 Modified By: Katie Odiaga I Approval By: Cheisey Loeffers <br />