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Docusign Envelope ID: A5542800-1`0713-88E3-82CC-131 C8A3BDE84C <br />Contracts Unit Freeze Exemption Tracking Form for <br />r� <br />qvvp� Contract/IAA/Amendments <br />DEPARTMENT OF Instructions: This form must be submitted with all Contract/IAA/Amendment packets <br />ECOLOGY <br />State of`Nashington to the Fiscal Contracts Unit. If the Program is seeking an exemption/exception that <br />requires Deputy Direct approval (see section 2 and guidance page), the Freeze Exemption/Exception <br />Request Form for Service Contracts must also be filled out, approved, and included in the packet <br />submitted to the Fiscal Contracts Unit. <br />Request Information <br />Date: 1 /30/26 <br />To Program Budget Manager: Ellen Hafer <br />From Approving Manager: Elaine Snouwaert <br />Program/Office/Division: HWTR / ERO / PPA <br />Contract/IAA/Amendment Information <br />New Service Contract: Yes 7 No <br />New IAA: Yes No <br />New Work Assignment: Yes F✓ No <br />New DES Work Order: Yes W No <br />Amendment No. (if applicable): 01 <br />Contract No. (if applicable): C2500178 <br />Contractor/IAA Agency: Kittitas County Public Health District <br />Exemption Information <br />This form affirms that the attached contract/amendment meets a freeze exemption or has been <br />approved by the Deputy Director as outlined in Ecology's Directive 24-19 Freeze Guidance and <br />Forms page. <br />Section 1 — Contracts and Amendments that DO NOT required Deputy Director approval and <br />exempt from the OFM Freeze: <br />❑ Service Contract or Amendment costing less than $10.000. <br />Note: This also includes Interagency and Intergovernmental Agreements (IAAs), Tier 2 Work <br />Orders under DES Master Contracts, and Work Assignments under Ecology's Convenience <br />Contracts (Prime). <br />ECY Internal Form — Contracts Unit Freeze Exemption Tracking Form Rev. 1/14/25 <br />