HomeMy WebLinkAboutCon Con Amendment 6Today's Date
01/14/2018
Fund/Department
116 -Public Health
Kittitas County
Review Form
Grants & Contract Agreement
Agenda Date
Contract/Grant Information
Contract /Grant Agency: Consolidated Contract Amendment 6
Period Begin Date: 01/01/2018 1 1 Period End Date: 12/31/2020
Total Grant/Contract Amount: $269,544.00
Grant/Contract Number:
Contract/Grant Summary:
The Consolidated Contract amends Statements of Work for the following program:
• Maternal and Child Health Block Grant- Effective January 1, 2018
There is no change in the 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
Financial Information — NO CHANGE
tv 1-Y-1 tl�
Total Amount $ 269,554.00
State Funds $ 67,300.00
Federal Funds $ 202,254.00
Percentage County Funds
Matching Funds $
CFDA# No Changes
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 — NO CHANGE
Budget Amendment Needed?
Yes ❑ attach budget form
No ❑ why not
New Division Created?
Revenue Code - No Changes
Pass Through Information
Agency to Pass Through
Amount to Pass Through $
Sub -Contract Approved Date:
Prosecutor Review
Has the Prosecutor reviewed this agreement? Yes El No ❑
County Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Submitted
Signature: _
Department:
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Date:
Reviewer Date
Grant/Contract Review Page 2
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2018 — 2020 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH18249
AMENDMENT NUMBER: 6
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
❑ Deletes Statements of Work for the following programs:
2. Exhibit B-6 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-5 Allocations as
follows:
❑ Increase of for a revised maximum consideration of
❑ Decrease of for a revised maximum consideration of
® No change in the maximum consideration of $269.554.
Exhibit B Allocations are attached only for informational purposes.
3. Exhibit C-6 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces
Exhibit C-5.
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
Page 1 of 7
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
APPROVED AS TO FORM ONLY
Assistant Attorney General
Date
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