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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Contract/G ra nt I nformation <br />Recommendation for Board of Health Review on <br />Department Head Signature Director Date n l>3 <br />verification the contracting Agency is not suspended/Disbarred: <br />Today's Date <br />12/13/2022 PA Camas Request #:fr ] <br />Fund/Department <br />116-Public Health Agenda Date: /- f -l-*.->.,, <br />nCo rat ct ar tn e n bPSA/c eetw Kitten tasAgcy uCo n na Thod Sc oh o istD ctfl Aty m ne md nte 1.rp <br />Period Begin Date: 8/I/Z0ZT Period End Date: 07/3L/2O23 <br />otT a raG Contr Aact mount/n t 2 5 00000 crn asee romf flo n a moa ntu fo t 00500.gr s 2, <br />Grant/Contract Number <br />The amendment to the PSA between Kittitas County and Thorp School District increases the total award <br />amount from $12,500,00 to 525,000,00. <br />Contract/G rant Su m mary: <br />Kittitas County Prosecutor, Aud itor, and Board of Health Review and Comment: <br />PR FORM <br />Signature f Prose s Date <br />Signature of Auditor's Office D ate <br />I Agency is not suspended/disbarred fl Not Checked (reason) <br />Grant/Contract Review Page L