HomeMy WebLinkAboutConsolidated Contract Amendment 6Today's Date
02/29/2016
Fund/Department
116 -Public Health
Kittitas County
Review Form
Grants & Contract Agreement
Agenda Date
f i/-.��._
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Contract/Grant Information
Contract /Grant Agency: Consolidated Contract Amendment 6
Period Begin Date: January 1, 2015 1 1 Period End Date: December 31, 2017
Total Grant/Contract Amount: Increase of $13,104 for a revised maximum consideration of $222,391
Grant/Contract Number: C17114
Contract/Grant Summary:
The Consolidated Contract amends the Statements of Work for the following programs:
• Emergency Preparedness and Response- Effective July 1, 2015
• Office of Drinking water Group A Program -Effective January 1, 2015
Exhibit B-6 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-5
Allocations as follows:
• Increase of $13,104 for a revised maximum consideration of $222,391
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 Comm
APPROVED AS TO FORM:
Signature of Prosecutor's Office Date
Signature of Auditor's Office Date
Signature of Board of Health member Date
Financial Information
Grant/Contract Review Page 1
Total Amount $13,104
State Funds $5,400
Federal Funds $7,704
Percentage County Funds
Matching Funds $
CFDA#93.069
In -Kind $
Explain
Is Equipment being purchased?
Who owns equipment?
New Personnel being hired?
Contact HR hiring — reporting requirements
Future impacts or liability to Kittitas County:
Budget Information
Budget Amendment Needed? Yes ❑ attach budget form
New Division Created?
Revenue Code
116-612.88.5.333.93.069 - $7,704
116-615.02.2.346.26.64 - $2,200
116-615.02.2.346.26.65 - $2,200
116-615.02.2.346.26.66 - $1,000
Pass Through Information
No ❑x Why not
Already in budget center or in 2016 budget
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:
NDDIr,IIFI1CIll UI 1 UdLKlflg If11UUMdUVf1
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Grant/Contract Review Page 2
Reviewer I Date
Grant/Contract Review Page 3
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2015 — 2017 CONSOLIDATED CONTRACT
CONTRACT NUMBER: C17114 AMENDMENT NUMBER: 6
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:
® Amends Statements of Work for the following programs:
Emergency Preparedness & Response - Effective July 1, 2015
Office of Drinking Water Group A Program - Effective January 1, 2015
❑ Deletes Statements of Work for the following programs:
2. Exhibit B-6 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-5 Allocations as
follows:
® Increase of $13,104 for a revised maximum consideration of $222,391.
❑ Decrease of for a revised maximum consideration of
❑ No change in the maximum consideration of
Exhibit B Allocations are attached only for informational purposes.
3. Exhibit C-6 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces
Exhibit C-5.
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
Date
Page 1 of 10
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
Date
APPROVED AS TO FORM ONLY
Assistant Attorney General
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