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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Today's Date Agenda Date t\tlg\ (CO 01/07/2016 <br />Fund/Department <br />, <br />116-Public Health <br />Contract/Grant Information <br />Contract /Grant Agency: Kittitas County Community Network and Coalition and Kittitas County <br />Period Begin Date: October 1, 2015 I I Period End Date: June 30, 2016 <br />Total Grant/Contract Amount : $2,500.00 <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />The agreement is established between KCCNC and Kittitas County that defines the scope of work in <br />which the contractor shall perform for the Community Assessments of Neighborhood Stores <br />Deliverables (CANS) assessments of tobacco retailers in Kittitas County. <br />Recommendation for Board of Health and Board of Health Review on <br />dilJJL~ 1 •. v .. ~ <br />Department Head Signatur . ~~ ·0 , Administrator Date: I po! Vp <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM: <br />Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount $2,500 State Funds $ Federal Funds $2,500 <br />Percentage County Funds Matching Funds $ CFDA#93.305 <br />In-Kind $ <br />Explain <br />Grant/Contract Review Page 1