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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Today's Date Agenda Date 14 <br />01/07/2016 l r� <br />Fund/Department <br />116 -Public Health <br />Contract/Grant Information <br />Contract /Grant Agency: Kittitas County Community Network and Coalition and Kittitas Cou <br />Period Begin Date: October 1, 2015 Period End Date: June 30, 2016 <br />Total Grant/Contract Amount: $2,500.00 <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />The agreement is established between KCCNC and Kittitas County that defines the scope of work in <br />which the contractor shall perform for the Community Assessments of Neighborhood Stores <br />Deliverables (CANS) assessments of tobacco retailers in Kittitas County. <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Si natur L5 Administrator <br />p g -- <br />Date: Z;10 1(el <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM: <br />Signatu Prose or's ffice at <br />�okz__jl� 6, <br />Signatur o uitor's Office Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount $2,500 State Funds $ Federal Funds $2,500 <br />Percentage County Funds Matching Funds $ CFDA#93.305 <br />In -Kind $ <br />1 Explain <br />Grant/Contract Review Page 1 <br />