HomeMy WebLinkAboutConsolidated Contract Amendment 11Today's Date
May 9, 2017
Fund/Department
116 -Public Health
Kittitas County .
Review Form ---�
Grants & Contract Agreement
Agenda Date
Contract/Grant Information
Contract /Grant Agency: Consolidated Contract Amendment 11
Period Begin Date: j I Period End Date:
Total Grant/Contract Amount: Decrease of $300.00 for a revised maximum consideration of $358,397.00
Grant/Contract Number: C17114 _
Contract/Grant Summary:
The Consolidated Contract Amendment 11 is Amended to add a statement of work for the Office of
Immunization and Child Profile Diamond Project. It also amends statements of work for the Office of
Drinking Water Group A Program and Office of Immunization Child Profile. The Amendment Exhibit B-11
Allocations is decreased by $300.00 for a new maximum consideration of $358,397.00.
Recommendation for Board of Health and Board of Health Review on
Department Head Signature: , Administrator Date:
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APPROVED AS TO FORM:
Signature of Prosecutor's Office Date
Signature of Auditor's Office
Signature of Board of Health member
Date
Date
Financial Information
Total Amount $2100.00 (inc) State Funds $ Federal Funds $2100.00 (inc)
Percentage County Funds Matching Funds $ CFDA#93.733, 93.268
Grant/Contract Review Page 1
Budget Information
Budget Amendment Needed? Yes ❑ attach budget form
New Division Created?
Revenue Code
116-612.32.15.333.93.733 - $1000
116-612.32.11.333.93.268 - $1100
Pass Through Information
No FRI Why not
No increase in expenditures, offset
Agency to Pass Through
Amount to Pass Through
$
Sub -Contract Approved
Date:
Prosecutor Review
Has the Prosecutor reviewed this agreement? Yes ❑ No []
County Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Submitted
Signature: Date:
Department:
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Reviewer Date
Grant/Contract Review Page 2
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2015 — 2017 CONSOLIDATED CONTRACT
CONTRACT NUMBER: C17114 AMENDMENT NUMBER: 11
PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as
"DOH", and KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT hereinafter referred to as "LHJ", pursuant to the
Modifications/Waivers clause, and to make necessary changes within the scope of this contract and any subsequent
amendments thereto.
IT IS MUTUALLY AGREED: That the contract is hereby amended as follows:
1. Exhibit A Statements of Work, attached and incorporated by this reference, are amended as follows:
® Adds Statements of Work for the following programs:
Office of Immunization & Child Profile -Diamond Project - Effective January 1, 2017
® Amends Statements of Work for the following programs:
Office of Drinking Water Group A Program - Effective January 1, 2015
+ Office of Immunization & Child Profile - Effective January 1, 2017
❑ Deletes Statements of Work for the following programs:
2. Exhibit B-11 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-10 Allocations
as follows:
❑ Increase of for a revised maximum consideration of
® Decrease of $300 for a revised maximum consideration of $358,397.
❑ No change in the maximum consideration of
Exhibit B Allocations are attached only for informational purposes.
3. Exhibit C-9 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces
Exhibit C-8.
Unless designated otherwise herein, the effective date of this amendment is the date of execution.
ALL OTHER TERMS AND CONDITIONS of the original contract and any subsequent amendments remain in full force
and effect.
IN WITNESS WHEREOF, the undersigned has affixed his/her signature in execution thereof.
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT STATE OF WASHINGTON
DEPARTMENT OF HEALTH
Date Date
APPROVED AS TO FORM ONLY
Assistant Attorney General
Page 1 of 17
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