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Kittitas County yA <br />Review Form <br />rrrrti� •tt r n• <br />Grants & Contract Agreement <br />Today's Date Agenda Date <br />July 7, 2018 _ l <br />Fund/Department <br />116 -Public Health <br />Contract/Grant Information <br />Contract /Grant Agency: PSA between Elmview and Kittitas County <br />Period Begin Date: July 1, 2018 <br />Total Grant/Contract Amount: Not to exceed $30,000.00 <br />Grant/Contract Number: <br />Period End Date: June 30, 2019 <br />I Contract/Grant Summary: <br />The Professional Services Agreement is established to provide a coordinated and comprehensive local <br />program of services for persons with developmental disabilities and to fulfill the county's responsibilities <br />as outlined in attachments. <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 Date <br />Financial Information <br />Total Amount $ TBD State Funds $ TBD Federal Funds $ <br />Percentage County Funds Matching Funds $ CFDA# <br />In -Kind $ <br />Explain <br />Grant/Contract Review Page 1 <br />