HomeMy WebLinkAboutPSA KCPH KC Community Network and CoalitionKittitas County
Review Form
Grants & Contract Agreement
Today's Date Agenda Date l£J1\\Lv-05/17/2016
Fund/Department
116-Public Health
Contract/Grant Information
Contract /Grant Agency: PSA between Kittitas County Public Health and Kittitas County Community
Network and Coalition (Youth For Truth) Amendment
Period Begin Date: January 1, 2016 I I Period End Date: June 30, 2016
Total Grant/Contract Amount: $2700.00
Grant/Contract Number:
Contract/Grant Summary :
The amendment to the PSA between Kittitas County and Kittitas County Community Network and
Coalition increases the original agreement amount of 1950.00 to $2700.00 for the "Youth for Truth"
program and extends contract period until June 30, 2016.
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:
APPROVEO AS TO FORM:
;';<d
/' " 1//./
Date
Signature of Board of Health member Date
Financial Information
Total Amount $2,700.00 State Funds $ Federal Funds $2,700.00
Percentage County Funds Matching Funds $ CFDA# 93.008
Grant/Contract Review Page 1
In-Kind $
Explain
Is Equipment being purchased? Who owns equipment?
New Personnel being hired? Contact HR hiring -reporting requirements
Future impacts or liability to Kittitas County:
Budget Information
Budget Amendment Needed? YesD attach budget form No []I Why not
New Division Created? Switching expenditure categories
Revenue Code
116-612.88.4.54122 -$2,700.00
Pass Through Information
Agency to Pass Through
Amount to Pass Through $
Sub-Contract Approved Date:
Prosecutor Review
I Has the Prosecutor reviewed this agreement? I Yes 0 No D
County Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Submitted
I Signature:
Department:
I Date:
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
I Reviewer I Date
Grant/Contract Review Page 2
PROFESSIONAL SERVICES AGREEMENT
BETWEEN KITTITAS COUNTY PUBLIC HEALTH AND KITTITAS COUNTY
COMMUNITY NETWORK COALITIONAMENDMENT
The Professional Services Agreement Amendment between KITTIT AS COUNTY
("County"), a subdivision of the State of Washington, and Kittitas County Community
Network & Coalition ("Contractor"), to provide Youth for Truth program services
attached hereto and incorporated by reference, is hereby amended to increase the total
contract amount by $750.00 making the new total contract amount $2700.00 . Printing
materials increased from $250.00 to $375.00, presentation materials increased from
$250.00 to $375.00, and space rental increased from $250.00 to $750.00. The contract
period has also been extended from June 1 to June 30,2016.
The amendment is mutually agreed to by the parties.
All other items in the original Agreement remain in effect.
Approved this f)tn day ofj lU ~ ,2016.
CONTRACTOR
Signa~
Address
Phone
Deputy Prosecutor