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rrc AoIS...'4 :4 <br />t� L..- <br />Kittitas County �r <br />r <br />Review Form <br />Grants & Contract Agreement <br />Today's Date Agenda Date <br />05/09/2018 F1. <br />Fund/Department <br />116 -Public Health <br />Contract/Grant Information <br />Contract /Grant Agency: PSA between Youth Services of Kittitas County and Kittitas County <br />Period Begin Date: April 1, 2018 Period End Date: June 30, 2019 <br />Total Grant/Contract Amount: $28,151.88 <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />The PSA is established to allow Youth Services of Kittitas County to implement the Community <br />Prevention Wellness Initiative (CPWI) community based mentoring program in Kittitas County. <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signature: , Administrator Date: <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 Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount $ State Funds $ Federal Funds $ <br />Percentage County Funds Matching Funds $ CFDA# <br />In -Kind $ <br />Is Equipment being purchased? Who owns equipment? <br />New Personnel being hired? Contact HR hiring — reporting requirements <br />Grant/Contract Review Page 1 <br />