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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Today's Date <br />04/04/2016 <br />Fund/Department <br />116 -Public Health <br />Contract/Grant Information <br />Contract/Grant Agency: Washington <br />Period Begin Date: May 1, 2016 <br />Total Grant/Contract Amount: None <br />Grant/Contract Number: <br />Agenda Date <br />(-L.01_._ , <br />State Department of Health Immunization Program <br />Period End Date: May 1, 2017 <br />Contract/Grant Summary: This agreement is between Washington State Department of Health <br />Immunization Program and Kittitas County Public Health Department. The agreement outlines the <br />guidelines providers must follow in order to participate in the Vaccine for Children Program (VFC). <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 />Federal Funds $ <br />Percentage County Funds <br />Matching Funds $ <br />CFDA# <br />In -Kind $ <br />Explain <br />Is Equipment being purchased? <br />Who owns equipment? <br />Grant/Contract Review Page 1 <br />