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M1g[ M1�7�'•_ [�y� <br />Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Today's Date <br />07/28/2017 <br />Fund/Department <br />116 -Public Health <br />Contract/Grant Information <br />Agenda Date <br />Contract /Grant Agency: Health Care Authority Amendment 2(K763) <br />Period Begin Date: 07/01/2017 1 1Period End Date: 12/31/17 <br />Total Grant/Contract Amount: $4750.00 <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />The purpose of the Health Care Authority (HCA) contract outlines the Statement of Work for the Kittitas <br />County Public Health Department to assist the HCA to reduce dental decay and improve oral health in <br />those Medicaid -eligible children birth to six years by increasing the utilization of dental services among <br />the population in Washington. <br />The Health Care Authority Amendment 2 extends the period of performance, replaces the Statement of <br />Work, and increases the total maximum consideration by $4750.00. <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signature: _ , 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 Date <br />Signature of Board of Health member <br />Date <br />Financial Information <br />Total Amount $4750.00 State Funds $2375.00 Federal Funds $2375.00 <br />Percentage County Funds Matching Funds $ CFDA#93.778 f <br />Grant/Contract Review Page 1 <br />