HomeMy WebLinkAboutCon Con Amendment 7Kittitas County
Review Form
Grants & Contract Agreement
Today's Date
03/05/2019
Fund/Department
116 -Public Health
Contract/Grant Information
Agenda Date
Contract /Grant Agency: Consolidated Contract Amendment 7
Period Begin Date: 01/01/2018
Period End Date: 12/31/2020
Total Grant/Contract Amount: $277,154.00 (Increase of $7,600.00)
Grant/Contract Number:
Contract/Grant Summary:
The Consolidated Contract amends Statements of Work for the following program:
• Office of Drinking Water Group A Program- Effective January 1, 2018
Exhibit B-7 allocations amends and replaces Exhibit B-6 Allocations as follows:
• Increase of $7,600.00 for a revised maximum consideration of $277,154.00
Recommendation for Board of Health and Board of Health Review on
LDepartment Head Signature: , Administrator Date:
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APPROVED AS TO FORM:
Signature of Prosecutor's Office
Signature of Auditor's Office
Date
Date
Signature of Board of Health member Date
Financial Information
Total Amount $ $7,600
State Funds $2,800
Federal Funds $4,800
Percentage County Funds
Matching Funds $
CFDA#346.26.64, .65, .66
Grant/Contract Review Page 1
In -Kind $
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? Yes ❑ attach budget form No ❑ why not
New Division Created?
Revenue Code
116.615.2.2.346.26.64
116.615.2.2.346.26.65
116.615.2.2.346.26.66
$2,800
$2,800
$2,000
Pass Through Information
Agency to Pass Through
Amount to Pass Through $
Sub -Contract Approved Date:
EH Sanitary Survey — FS SS
EH Sanitary Survey — SS -State
EH Sanitary Survey — FS Tech Asst
Prosecutor Review
Has the Prosecutor reviewed this agreement? Yes ❑ No
rtments Impacted
Auditor
Information Services
Prosecutor
Submitted
Signature:
Department:
Assignment OT i racKing inrormation
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Facilities Maintenance
Human Resource
Treasurer
Reviewer Date
Grant/Contract Review Page 2
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2018 — 2020 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH18249 AMENDMENT NUMBER: 7
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 Drinking Water Group A Program - Effective January 1, 2018
❑ Deletes Statements of Work for the following programs:
2. Exhibit B-7 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-6 Allocations as
follows:
® Increase of $7,60U for a revised maximum consideration of $277,154.
❑ Decrease of for a revised maximum consideration of
❑ No change in the maximum consideration of
Exhibit B Allocations are attached only for informational purposes.
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
Pagel of 7
APPROVED AS TO FORM ONLY
Assistant Attorney General
Date
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