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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Today's Date <br />12/19/2017 <br />Fund/Department <br />116 -Public Health <br />Contract/Grant Information <br />IAgenda Date <br />-„ <br />r' <br />1-1'1--11 i P"Y <br />Contract /Grant Agency: HCA and KCPHD Amendment 3 <br />Period Begin Date: 01/01/2018 Period End Date: 06/30/2018 <br />Total Grant/Contract Amount: $4750.00 <br />Grant/Contract Number: K763 <br />Contract/Grant Summary: <br />The HCA and KCPHD Amendment 3 to extend the term of the agreement from January 1, 2018- June 30, <br />2018 and add funding for that period. <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 <br />Signature of Board of Health member <br />Date <br />Date <br />Financial Information <br />Total Amount $4,750 State Funds $2,375 Federal Funds $2,375 <br />Percentage County Funds Matching Funds $ CFDA#93.778 <br />In -Kind $ <br />Explain <br />Is Equipment being purchased? Who owns equipment? <br />New Personnel being hired? Contact HR hiring — reporting requirements <br />Grant/Contract Review Page 1 <br />