HomeMy WebLinkAboutConsolidate Contract Amendment 1Today's Date
03/06/2018
Fund/Department
116 -Public Health
Kittitas County
Review Form
Grants & Contract Agreement
Agenda Date
1
Contract/Grant Information
Contract /Grant Agency: Consolidated Contract Amendment 1
Period Begin Date: January 1, 2018 1 1 Period End Date: 12/31/2020
Total Grant/Contract Amount: $81,038.00 (Increase of
Grant/Contract Number: CLH18249
Contract/Grant Summary:
The Consolidated Contract Amendment Adds a Statement of Work for childhood Lead Poisoning
Prevention Program, Effective January 1, 2018 through June 30, 2018.
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
Financial Information
Date
Date
Total Amount $81,038
State Funds $13,800
Federal Funds $67,238
Percentage County Funds
Matching Funds $
CFDA#
In -Kind $
Explain
Is Equipment being purchased?
Who owns equipment?
Grant/Contract Review Page 1
New Personnel being hired? I Contact HR hiring — reporting requirements
I Future impacts or liability to Kittitas County:
Budget Information
Budget Amendment Needed? Yes ❑ attach budget form
New Division Created?
Revenue Code 116.612.334.04.93.0
Pass Through Information
Agency to Pass Through
Amount to Pass Through $
Sub -Contract Approved Date:
No ❑x Why not
Unknown if funding to be used
Prosecutor Review
Has the Prosecutor reviewed this agreement? Yes ❑ No ❑
County Departments Impacted
Submitted
Signature:
Department:
Assignment of i racKi
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant ap
intormation
lication
Reviewer i Date
Grant/Contract Review Page 2
Auditor
Facilities Maintenance
Information Services
Human Resource
Prosecutor
Treasurer
Submitted
Signature:
Department:
Assignment of i racKi
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant ap
intormation
lication
Reviewer i Date
Grant/Contract Review Page 2
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2018 — 2020 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLU18249 AMENDMENT NUMBER: 1
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:
Childhood Lead Poisoning Prevention Program - Effective January 1, 2018
❑ Amends Statements of Work for the following programs:
❑ Deletes Statements of Work for the following programs:
2. Exhibit B-1 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B Allocations as
follows:
® Increase of $2,000 for a revised maximum consideration of $81=038.
❑ 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-1 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces Exhibit C.
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
Page 1 of 6
APPROVED AS TO FORM ONLY
Assistant Attorney General
Date
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