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Today's Date <br />12/17/201~ <br />Fund/Department <br />116-Public Health <br />Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Agenda Date <br />Contract/Grant Information <br />\j I C) J I Lp . <br />Contract /Grant Agency: Community Health of Central Washington: Children with Special Health Care <br />Needs Program <br />Period Begin Date: January 1, 2016 I I Period End Date: September 30, 2016 <br />Total Grant/Contract Amount: Maximum of $10,600.00 <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />The agreement is in place between Community Health of Central Washington and the Kittitas County <br />Public Health Department. The contract provides a scope of work for Community Health of Central <br />Washington to be able to provide services for the Children with Special Health Care Needs program <br />which is a part of the Maternal Child Health Block Grant. <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signatu ~v~ Z"\:J ,Administrator DateJjdllz <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM: <br />Date <br />FEB -2 20 16 <br />Signature of Board of Health member Date <br />... ~ ,.. .... • .:. ..... '.""~ \,.., ~,-I ll. <br />Financial Information <br />Total Amount $10,660 State Funds $ Federal Funds $10,660 <br />Percentage County Funds Matching Funds $ CFDA#93.994 <br />Grant/Contract Review Page 1