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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Today's Date <br />02/27/2019 <br />Fund/Department <br />116 -Public Health <br />Contract/Grant Information <br />Contract /Grant Agency: Adult Vaccine Program (AVP <br />Period Begin Date: 01/01/2019 <br />Total Grant/Contract Amount: <br />Agenda Date <br />ASC A� 1, 4 <br />r <br />Period End Date: 12/31/2020 <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />The Adult Vaccine Program is established for participating providers in the AVP to provide free vaccine <br />to those adults 19 and over that do not have insurance. The agreement outlines eligibility and scope of <br />work for the health department. <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 />Financial Information <br />Date <br />Date <br />Total Amount $ <br />State Funds $ <br />Federal Funds $ <br />Percentage County Funds <br />Matching Funds $ <br />CFDA# <br />In -Kind $ <br />Explain <br />Grant/Contract Review Page 1 <br />