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Today's Date <br />01/24/2018 <br />Fund/Department <br />116 -Public Health <br />Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />[Agenda Date <br />pis n• is.. •e;,= <br />X45 1 <br />Contract/Grant Information <br />Contract /Grant Agency: Northwest Vital Records and KCPHD <br />Period Begin Date: 02/01/2019 Period End Date: 02/28/2019 <br />Total Grant/Contract Amount: $68.00 <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />The Northwest Vital Records agreement will allow them to take old xrays from the department and <br />shred them and send us confirmation of shredding services provided. <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signature: Administrator Date: <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />AEJLIQ ° D AS TO FORM. <br />i <br />Signatur f Pr secutor's Of ce Date <br />Signatiur of+' uditor's Office Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount $ 68 (expense) State Funds $ 0 Federal Funds $ 0 <br />Percentage County Funds Matching Funds $ CFDA# <br />In -Kind $ <br />Explain <br />Is Equipment being purchased? Who owns equipment? <br />Grant/Contract Review Page 1 <br />