HomeMy WebLinkAboutCon Con Amendment 2Kittitas County
Review Form
Grants & Contract Agreement
Today's Date
05/08/2018
Fund/Department
116 -Public Health
Contract/Grant Information
Agenda Date
Contract /Grant Agency: Consolidated Contract Amendment 2
Period Begin Date: January 1, 2018
Period End Date: 12/31/2020
Total Grant/Contract Amount: Increase of $12,483 for a revised maximum consideration of $93,521.00
Grant/Contract Number: CLH18249
Contract/Grant Summary:
The Consolidated Contract Amendment 2 amends Statements of Work for the following programs
Maternal and Child Health Block Grant, Office of Emergency Preparedness and Response, and
Supplemental Nutrition Assistance Program Education.
Recommendation for Board of Health and
Department Head Signature:
Board of Health Review on
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
Date
Signature of Board of Health member Date
Financial Information
Total Amount $ 12,483
State Funds $ 0 Federal Funds $ 12,483
Percentage County Funds
Matching Funds $ CFDA# 93.994 MCHGB;
In -Kind $ 93.069 PHER; 10.561 SNAP ED
Explain
Grant/Contract Review Page 1
Is Equipment being purchased? no Who owns equipment?
New Personnel being hired? no Contact HR hiring — reporting requirements
Future impacts or liability to Kittitas County:
Budget Information
Budget Amendment Needed? Yes ❑ attach budget form
New Division Created? no
Revenue Code 612.22.333.93.99 MCHBG
612.88.3.333.93.06 PHER
612.94.333.10.56 SNAP ED
Pass Through Information
Agency to Pass Through
Amount to Pass Through $
Sub -Contract Approved Date:
No D Why not amended funding
$ 893
$ 565
$ 11,025
Prosecutor Review
Has the Prosecutor reviewed this agreement? Yes❑ No
county uepartments impactea
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor I Treasurer
Submitted
Signature:
Department:
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Reviewer I Date
Grant/Contract Review Page 2
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2018 — 2020 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH18249 AMENDMENT NUMBER: 2
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:
Maternal & Child Health Block Grant - Effective January 1, 2018
Office of Emergency Preparedness & Response - Effective January 1, 2018
Supplemental Nutrition Assistance Program -Education - Effective January 1, 2018
❑ Deletes Statements of Work for the following programs:
2. Exhibit B-2 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-1 Allocations as
follows:
® Increase of $12,483 for a revised maximum consideration of9$ 3,521.
❑ Decrease of for a revised maximum consideration of
❑ No change in the maximum consideration of
Exhibit B Allocations are attached only for informational purposes.
Exhibit C-2 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces
Exhibit C-1.
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
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
APPROVED AS TO FORM ONLY
Assistant Attorney General
Page 1 of 18
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