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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Today's Date <br />03/07/2017 <br />Fund/Department <br />116 -Public Health <br />Contract/Grant Information <br />Agenda Date <br />Contract /Grant Agency: PSA between KVH and Kittitas County Public Health (TB XRAYS) <br />Period Begin Date: Upon execution Period End Date: 1 year from date of execution <br />Total Grant/Contract Amount: $62.12 single view or double view image <br />Grant/Contract Number: CH -001 <br />Contract/Grant Summary: <br />The Professional Services Agreement between Kittitas County (KCPHD) and Kittitas Valley Healthcare <br />(KVH) is an agreement entered into that allows the health department to send clients to KVH for <br />screening x-rays. The agreement includes a set fee for these services. <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signature: <br />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 />Total Amount $62.12 <br />Percentage County Funds 100% <br />Date <br />Date <br />State Funds $ <br />Matching Funds $ <br />In -Kind $ <br />Federal Funds $ <br />CFDA# <br />Grant/Contract Review Page 1 <br />