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Conract between DOE and KCPHD Amend 1
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2026-05-05 10:00 AM - Commissioners' Agenda
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Conract between DOE and KCPHD Amend 1
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Last modified
4/30/2026 12:17:16 PM
Creation date
4/30/2026 12:15:26 PM
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Template:
Meeting
Date
5/5/2026
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Supporting documentation
Supplemental fields
Item
Request to Approve Amendment 1 to a Contract between Department of Ecology and the Kittitas County Public Health Department
Order
5
Placement
Consent Agenda
Row ID
144005
Type
Contract
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Docusign Envelope ID: A5542800-F07B-88E3-82CC-BiC8A3BDE84C <br />Face Sheet <br />CONTRACT INSTRUCTIONS <br />General: <br />Do not use this form for Grant or Loan Agreements. See the EAGL Face Sheet. <br />Project Officer, Program Budget Analyst, or Program Budget Manager familiar with the content of <br />the contract or amendment fills out the Face Sheet. <br />Program Budget Manager provides complete information in the Budget section. <br />Program sends final draft documents for review and approval by Contracts/Fiscal staff. <br />Contracts/Fiscal staff reviews and assigns a Contract number (if new), enters sub -object on Face <br />Sheet and signs their approval, then returns to the Program. <br />Obtain contractor signature and then appropriate Ecology signature. <br />When all parties have signed the contract -or amendment, Program sends the Face Sheet with the <br />signed contract or amendment to Fiscal for filing. <br />Line Specific: <br />Type: Contract - can be an IAA or contract. Master - generally has an RFQQ, Work Assignment - will <br />be related to a convience contract. <br />Total Eligible Cost: This line always shows the total eligible Ecology amount of the Contract. <br />Sales Tax: This line is IF the sales tax is not included in the contract cost but must be paid (usually <br />for public works contracts). <br />Program Budget Manager completes the Fund Information (Master Index Code (MIC), Fund, <br />Expenditure Authority Index (EAI), and Project & Sub -Project). <br />Encumbrance/Disbursement Section: See Examples tab for examples <br />In the fiscal year (FY) columns enter amounts, by MIC, fund/EAI, and project coding (if applicable): <br />Split codes must be split on separate lines on the face sheet <br />A. Original Contract -Enter the total amount for each fiscal year in the FY columns. <br />-OR- <br />B. Amendment - Leave original amounts OR sum pior bien amounts and on new rows enter <br />ONLY the increase decrease amounts for each fiscal year. <br />Sum prior bien amounts paid and enter in the "Prior Bien's" column. <br />Remarks: If descriptions for "other" fields above are too long, then enter here. Enter general <br />comments, note which MIC to pay from first, J code info, etc. <br />Federally Funded: Please select Yes or No and enter the federal dollars for the contract. <br />
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