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C h psis. � <br />Kittitas County !'r <br />Review Form <br />� rrras t ui•rry <br />Grants & Contract Agreement <br />Today's Date Agenda Date <br />01/09/2017 <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: January 1, 2017 Period End Date: December 31, 2017 <br />Total Grant/Contract Amount: Not to exceed $12,500.00 <br />Grant/Contract Number: DD PH -001 <br />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 <br />Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount $12,500.00 <br />Percentage County Funds <br />State Funds $12,500.00 <br />Matching Funds $ <br />In -Kind $ <br />Federal Funds $ <br />CFDA# <br />Explain <br />Grant/Contract Review Page 1 <br />