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LArA i. u; <br />Kittitas County ti <br />Review Form <br />Grants & Contract Agreement <br />Today's Date [Agenda Date <br />09/19/2017 <br />Fund/Department <br />116 -Public Health <br />Contract/Grant Information <br />Contract /Grant Agency: Kittitas County Health Network Letter of Agreement <br />Period Begin Date: July 1, 2017 Period End Date: May 31, 2018 <br />Total Grant/Contract Amount: $5000.00 <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />The letter summarizes the deliverable required and to be compensated for the in the HRSA Planning <br />Grant. <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signature: <br />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 <br />Signature of Board of Health member <br />Financial Information <br />Date <br />Date <br />Total Amount $5,000 <br />State Funds $ <br />Federal Funds $5,000 <br />Percentage County Funds <br />Matching Funds $ <br />CFDA# 93.912 <br />In -Kind $ <br />Explain <br />Is Equipment being purchased? <br />Who owns equipment? <br />Grant/Contract Review Page 1 <br />