HomeMy WebLinkAboutCon Con Amendment 5Today's Date
11/06/2018
Fund/Department
116 -Public Health
Kittitas County
Review Form
Grants & Contract Agreement
Agenda Date
Contract/Grant Information
Contract /Grant Agency: Consolidated Contract Amendment 5
Period Begin Date: 01/01/2018 Period End Date: 12/31/2020
.f�
71 -
I Total Grant/Contract Amount: $269,544.00 (Increase of 885.00) 1
Grant/Contract Number: CLH18249
Contract/Grant Summary:
The Consolidated Contract amends Statements of Work for the following program:
! Office of Emergency Preparedness and Response- Effective July 1, 2018
Exhibit B-5 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-4
Allocations as follows:
• Increase of $885.00 for a revised maximum consideration of $269,554.00
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:
APPROVED AS TO FORM:
Signature of Prosecutor's Office Date
Signature of Auditor's Office
Date
Signature of Board of Health member Date
l
Financial Information
Total Amount $ 885.00 State Funds $ 0 Federal Funds $ 885.00
Grant/Contract Review Page 1
Percentage County Funds
Matching Funds $
CFDA# 93.069 EPR PHEP
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?
New Division Created? 1
Revenue Code 612.88.3.333
Pass Throueh Information
Agency to Pass Through
Amount to Pass Through 1 $
Yes ❑ attach budget form
93.06 EPR PHEP
Sub -Contract Approved I Date:
NO ® Why not — already in budget
$885.00
Prosecutor Review
Has the Prosecutor reviewed this agreement? YesEl No ❑
County Departments Impacted
'� Auditor
Information
Prosecutor
Submitted
Signature:
Department:
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Reviewer Date
Grant/Contract Review Page 2
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2018 — 2020 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH18249
AMENDMENT NUMBER: 5
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:
• Office of Emergency Preparedness & Response - Effective July 1, 2018
❑ Deletes Statements of Work for the following programs:
2. Exhibit B-5 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-4 Allocations as
follows:
® Increase of $885 for a revised maximum consideration of2b$ 9.554.
❑ Decrease of for a revised maximum consideration of
❑ No change in the maximum consideration of
Exhibit B Allocations are attached only for informational purposes.
3. Exhibit C-5 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces
Exhibit C-4.
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 STATE OF WASHINGTON
DEPARTMENT OF HEALTH
Date
Page 1 of 6
APPROVED AS TO FORM ONLY
Assistant Attorney General
Date
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