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Today's Date <br />02/08/2017 <br />Fund/Department <br />116 -Public Health <br />Jr <br />�r\ <br />Kittitas County <br />Review Form <br />w r rrr.z5 s ��rr rr <br />Grants & Contract Agreement <br />Agenda Date <br />Contract/Grant Information <br />Contract /Grant Agency: Washington State DOH Amendment 1 <br />Period Begin Date: April 18, 2014 Period End Date: December 31, 2018 <br />Total Grant/Contract Amount: None <br />Grant/Contract Number: N19411 <br />Contract/Grant Summary: <br />Amendment 1 to the Contract N19411 changes the contact person information for DOH only to: <br />Dorothy Tibbetts <br />Office of Drinking Water <br />16201 E Indiana Suite 1600 <br />Spokane Valley, WA 99216 <br />509-329-2105 <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signature: Administrator Date: <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM: <br />Signature of Prosecutor's Office Date <br />Signature of Auditor's Office Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount $ State Funds $ Federal Funds $ <br />Grant/Contract Review Page 1 <br />