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I <br />Kittitas CountY Public Health <br />Contract/Agreement Review Form <br />Kittitas CountY <br />Public Health <br />Department <br />Today's Date 01to812025 ll.iil L.e'r Request #I\2QV <br />Fu nd/Department:1/1Oth of 1% Mental Health Tax Agenda Date <br />Co <br />Bu lnformation <br />Pass Thro lnformation <br />nt lnformation <br />Agency: Cle Elum-Roslyn School DistrictContract/Agreement <br />ct/Agreemen Diool strictRomnSchCle-Eat luthtoStuadents slyHMentalServicesealthProvidTitlentraCong <br />End Date: 1213112025Begin Date: 0110112025 <br />Contract/Agreement *: PHMH-01 1Total $ Amount: $143,600 <br />Co ntract/Agreement Surnma rY: <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 />'2 s <br />Date <br />I '-t t-)s- <br />ofSign <br />DateSignature of Auditor's ce <br />Revenue Code{s)I 05 - 5L0.1t3Ltooo <br />Expense Code{s)/oi fVt ot <br />Agency is not suspended/disbarred Not Checked (reason) <br />Agency to Pass Through <br />Expense Code:Amount to Pass Through <br />Sub-Contract APProved Date: <br />ADMIN Version: 0 Supersedes: 0 Date Adopted: t2|OL/2O24 Modified By:Katie Odiaga Aoproval *Y: ChelseY Loeffers