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Today's Date <br />12/27/2018 <br />Fund/Department <br />116 -Public Health <br />Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Agenda Date <br />Ch�n•5�5 .• Te �, <br />Y <br />Nil K311m ["m'�l'1" <br />Contract/Grant Information <br />Contract /Grant Agency: PSA between Community Health of Central Washington and Kittitas County <br />Public Health Department <br />Period Begin Date: 10/01/2018 <br />Total Grant/Contract Amount: $13,258.00 <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />Period End Date: 09/30/2019 <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 Signature: <br />Administrator Date: <br />f 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 $ 13,258 State Funds $ 0 Federal Funds $ 13,258 <br />Percentage County Funds Matching Funds $ CFDA# 93.994 <br />Grant/Contract Review Page 1 <br />