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i <br />Kittitas County Public Health Kittitas County <br />APublic Health <br />Contract/Agreement Review Form Department <br />Today's Date: 2/27/2025 1 1 Legal Request #: 11362 <br />Fund/Department: 1 1/10th of 1% Mental Health Tax Agenda Date- <br />Contract/Agreement Information <br />Contract/Agreement Agency: Cie Elum-Roslyn School District (CERSD) <br />Contract/Agreement Title: Amendment 1 to PSA between CERSD and Kittitas County <br />Begin Date: 01 /01 /2025 <br />Total $ Amount: $143,600 <br />Contract/Agreement Summary: <br />End Date: 12/31/2025 <br />Contract/Agreement#: PHMH-011 <br />1/10th funding to Cie Elum -Roslyn School District to provide mental health services to the <br />students in Cie Elum-Roslyn School District. <br />Kittit is County Prosecutor and Auditor Review and Comment: <br />APPROVED AS TO FORM: <br />-�7 <br />Signature of 6osecutoA of ice Date <br />,% 5 5.10'Z� <br />Signature of Auditor's Office Date <br />Budget Information <br />Revenue Code(s): 105 - 560.3134000 <br />Expense Code(s): ' 105 - 560.54101 <br />❑l Agency is not suspended/disbarred Not Checked (reason) <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through Expense Code: <br />Sub -Contract Approved Date: <br />ADMIN I Version: 0 1 Supersedes: 0 1 Date Adopted: 12/01/2024 1 Modified By: Katie Odiaga Approval By: Chelsey Loeffers <br />