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ADMIN Version: 0 Supersedes: 0 Date Adopted: 12/01/2024 Modified By: Katie Odiaga Approval By: Chelsey Loeffers <br />Kittitas County Public Health <br />Contract/Agreement Review Form <br />Today’s Date: Legal Request #: <br />Fund/Department: Agenda Date: <br />Contract/Agreement Information <br />Contract/Agreement Agency: <br />Contract/Agreement Title: <br />Begin Date: End Date: <br />Total $ Amount: Contract/Agreement #: <br />Contract/Agreement Summary: <br />Kittitas County Prosecutor and Auditor Review and Comment: <br />APPROVED AS TO FORM: <br />Signature of Prosecutor’s Office Date <br />Signature of Auditor’s Office Date <br />Budget Information <br />Revenue Code(s): <br />Expense Code(s): <br /> Agency is not suspended/disbarred Not Checked (reason) <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through Expense Code: <br />Sub-Contract Approved Date: