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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Today's Date <br />09/13/2017 <br />Fund/Department <br />116 -Public Health <br />Contract/Grant Information <br />1 Agenda Date <br />Contract /Grant Agency: Accountable Communities of Health (ACH) <br />Period Begin Date: July 1, 2017 <br />Total Grant/Contract Amount: Not to exceed $1,374.00 <br />Grant/Contract Number: <br />K11 I -11-1S4 rll • 17' <br />Period End Date: December 31, 2017 <br />Contract/Grant Summary: <br />The Agreement is entered into by and between Walla Walla County Department of Community Health, <br />hereinafter "County," and Kittitas County Public Health Department, hereinafter "Contractor," for <br />engagement and participate with Greater Columbia Accountable Community of Health, as outlined in <br />the attached Statement of Work. The rights and obligations of both parties are governed by the General <br />Terms and Conditions, and the following Exhibits attached. <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 <br />Signature of Board of Health member <br />Financial Information <br />Date <br />Date <br />Total Amount $ <br />State Funds $ <br />I <br />Federal Funds $ <br />Percentage County Funds <br />Matching Funds $ <br />CFDA# <br />Grant/Contract Review Page 1 <br />