Laserfiche WebLink
Docusign Envelope lD: A5542800-F078-88E3-82CC-B1C8A3BDE84C <br />.*ffiffiGontractsUnitFreezeExemptionTrackingFormfor <br />= <br />contracUlAA/Amendments <br />fi*;V tnstructions: This form must be submitted with all contraculAA/Amendment packets <br />s.iro'wa,ing,c, to the Fiscal contracts Unit. lf 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 lnformation <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 />ContracUlAA/Amendment I nformation <br />Yes Z *o <br />Yes Z *o <br />Yes E *o <br />Yes Z *o <br />Amendment No. (if aPPlicable): 01 <br />Contract No. (if applicable): C2500178 <br />contractor/lAAAgency: Kittitas county Public Health District <br />Exemption lnformation <br />This form affirms that the attached contracuamendment meets afreeze 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 orAmendment costing less than $10,000. <br />Note: This also includes lnteragency and lntergovernmentalAgreements (lAAs), rier 2 Work <br />orders under DES Master cOntracts, and work Assignments under Ecorogy's convenience <br />Contracts (Prime). <br />ECYlnternalForm_ContractsUnitFreezeExemptionTrackingForm <br />New Service Contract: <br />New IAA: <br />New WorkAssignment: <br />New DES Work Order: <br />Rev.1l14l25