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Docusign Envelope ID: A55428D0-F07B-88E3-82CC-B1 CBA3BDE84C <br />CONTRACT FACE SHEET <br />For Internal Routing Use <br />of ran 'm4f w (Instructions on Instructions Tab) <br />ECOLOGY <br />Type: Contract <br />CGP System #: 21938 <br />Contract #• C2500178 <br />Amendment #: 1 <br />Work Assignment #: <br />Contractor Statewide Vendor- SWV #: <br />'SWV 0010475-07 <br />EIN: <br />Contractor Name: <br />Kittitas County Public Health <br />Contract Title / Description / Bid #: <br />Pollution Prevention Assistance (PPA) - technical assistance and education outreach to small businesses. <br />Program: <br />MOO-HWTR <br />Project Officer: <br />Andrew Maher Phone: <br />509-329-3612 <br />Secondary Project Officer (i.e., Budget Analyst): <br />Ellen Hafer Phone: <br />564-233-8638 <br />Staff completed DES Contract Training <br />Yes <br />(check all that apply) <br />❑ Goods/Services RCW 39.26 <br />❑ Decision to Contract <br />El Interagency RCW 39.34 <br />❑ DES State Contract # <br />❑ IT RCW 39.26 <br />❑ Competitive Bid # <br />❑ Public Works RCW 39.04 <br />❑ Sole Source # <br />❑ Arch./Eng. RCW 39.80 <br />❑ Direct Buy <br />❑ Other: <br />OMWBE: (check all that apply) <br />LJ OMWBE 1 71 WA Small Bus. <br />Ll WA Veteran Bus. <br />Subcontractor: <br />❑ Uses Sub Contractor <br />AMENDMENT: (check all that apply) <br />❑ Time Extension Increase <br />❑ Decrease <br />Amount of Amendment: <br />$8,649.33 <br />LJ Other: Deliverable <br />Reduction <br />Total of Contract after <br />Amendments: <br />$116,959.51 <br />TERM: <br />Start Date: <br />7/1/2025 <br />End Date: <br />6/30/2027 <br />How To Encumber and Disburse: <br />Program Budget Manager Completes <br />Contract Cost: <br />$116,959.51 <br />Sales Tax (PW only): <br />$ - <br />Total Eligible Cost: <br />$ 116,959.51 <br />Required information: <br />MIC (8 char) Fund/EAI Project - Sub -Prof <br />M72311HO 23P/1-Ho <br />9M997D10 23N/D10 <br />(Required for Single -year Operating Appropriations & <br />contracts extending beyond current biennium) <br />Prior Bien's <br />Current BI <br />FY: 2026 <br />Current BI <br />FY: 2027 <br />Totals <br />38,921.94 <br />38,921.93 <br />77,843.87 <br />39,115.64 <br />19,557.82 <br />19,557.82 <br />(Fiscal Staff: <br />IGL: Subsidiary: Misc: <br />Budget Total $ 116,959.51 <br />Budget Total must equal Total Eligible Cost <br />Federolly Funded? No Federal Amount $ <br />(Remarks: Amending total and MICs. Spend operating (23P) before capital (23N), <br />Approved Contract Freeze form in Program's contract file. <br />Robyn Crawford - Signed Electronically 3/23/2025 <br />Fiscal / Contracts Approval Date Sub -Object <br />3/23/2026 <br />Program Budget Manager Approval Date <br />ECY 010-53 Rev 2/2024 <br />