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Kittitas County �r <br />Review Form .......... �-� <br />Grants & Contract Agreement <br />Today's Date Agenda Date <br />03/07/2017 <br />Fund/Department 4 <br />116 -Public Health <br />Contract/Grant Information <br />Contract /Grant Agency: DSHS and County Agreement on General Terms and Conditions <br />Period Begin Date: July, 2011 H Period End Date: June 30, 2017 <br />Total Grant/Contract Amount: $0.00 <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />The DSHS and County Agreement outlines the general terms and conditions. These general terms and <br />conditions govern work to be performed under any program agreement between the parties. <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signature: , Administrator Dater <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 $ <br />State Funds $ 1Federal Funds $ <br />Percentage County Funds <br />Matching Funds $ CFDA# <br />In -Kind $ <br />Explain <br />Is Equipment being purchased? <br />Who owns equipment? <br />New Personnel being hired? <br />Contact HR hiring — reporting requirements <br />Grant/Contract Review Page 1 <br />