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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Today's Date <br />03/12/2019 <br />Fund/Department <br />L116 -Public Health <br />Contract/Grant Information <br />Contract /Grant Agency: Professional Services <br />Period Begin Date: 04/01/2019 <br />Agenda Date <br />�nsc -kris. •v n <br />hr7-r� ras r�u++7 �• <br />-kk 453 3 <br />ment between KVH and KCPHD (TB xr <br />Period End Date: 04/01/2020 <br />Total Grant/Contract Amount: $70.00 for each single -view or double view Tuberculosis image performed <br />contractor <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />The Professional Services Agreement between Kittitas County (KCPHD) and Kittitas Valley Healthcare <br />(KVH) is an agreement entered into that allows the health department to send clients to KVH for <br />screening x-rays. The agreement includes a set fee for these services. <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signature: <br />Administrator Date: <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM: <br />I <br />Signature of secutor' ffice Date <br />Signature f A4litor's Office Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount $70.00 <br />State Funds $ <br />Federal Funds $ <br />Percentage County Funds 100% <br />Matching Funds $ <br />CFDA# <br />Grant/Contract Review Page 1 <br />