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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Today's Date Agenda Date 'J 5\ \lJJ <br />Fund/Department <br />116-Public Health <br />Contract/Grant Information <br />Contract /Grant Agency: Interagency Agreement Amendment 1 between Grant County and KCPHD <br />Period Begin Date: January 1, 2015 I I Period End Date: September 30,2017 <br />Total Grant/Contract Amount : 18,728.00 <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />The Interagency agreement between Grant County Health District and Kittitas County Public Health <br />Department to provide a mechanism for the collaborative work, completion of deliverables, and transfer <br />of funds necessary to carry out the priority health improvement initiatives associated with tobacco <br />prevention and control in Central Washington. <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signature: -,-________ -', Administrator Date: \ flu 1 / V) <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM: <br />ice <br />Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount $7000.00 State Funds $4000.00 Federal Funds $3000.00 <br />Percentage County Funds Matching Funds $ CFDA# 93.758 <br />93.305 <br />Grant/Contract Review Page 1