HomeMy WebLinkAboutContract Amendment 1 Benton-Franklin Health DistrictCONTRACT FOR SERVICES
Between
Benton-Franklin Health District
And
Kittitas County Public Health
Amendment #1
This agreement is made and entered into between the Benton-Franklin Health District herein after
referred to as the "District" and the Kittitas County Public Health hereinafter referred to as
"Consultant".
Effective Dates: 3/1 /19 -6/30/19
Organizational Contact Information
.Benton-Franklin Health District
7102 W. Okanogan Place
.Kennewick, WA 99336
.Responsibility .Contact Name
Administrator/Signature .Jason
Authority Zaccaria
.Contracts/B illinQ/Payments .Bonnie Hall
.Proqram Supervisor .Carla Prock
Vanessa
.Proaram Support Contact Mccollum
.Invoice Submission .Jared Strait
Kittitas County Public Health
507 N. Nanum, Suite 102
. Ellensburg, WA 98926
Responsibility Contact Name
Atlwt1 V\'t_s-\-r~ \tJ;1'/Acting Tristen Lamb Signature Authority
Billing/Finance Tina Rowan
Program Contact Nea Alfaro
BFHD Kittitas Tobacco Preventio n Am end 1 2019
.Phone: (509) 460-4200
Fax: (509) 460-4590
.
.Phone .Fax .Email
.509-460-4567 .509-460-4590 .Jasonz®bfhd. wa. aov
.509-460-4553 .509-460-4590 .Bonnieh®bfhd.wa.aov
.509-460-4225 .509-460-4515 .Carlan®bfhd.wa.aov
.509-460-4258 .509-460-4590 Vanessam@bfhd. wa .aov
.509-460-4556 .509-460-4590 .Jareds@bfhd.wa .aov
Phone: 509-962-751'5
Fax: 509-962-7518
Phone Email
509-962-7003-T risten .Lamb@.co . kittitas . wa . us
509-962-7583 Tlna .rowangh(@.co .kiftitas.wa ,us
509-933-8399 Nea .alfaro(@co .kittltas . wa. us
Page 1
I
PURPOSE
The purpose of this amendment is to provide additional funding of $1500.00 to expand and enhance
the original scope of work by purchasing signage to support smoke-free and vape-free policies in
Kittitas County.
PERIOD OF PERFORMANCE
The period of performance of this amendment shall commence March 1, 2019 and be completed by
June 30, 2019 unless terminated or suspended sooner as provided for herein.
STATEMENT OF WORK
Contractor agrees to continue to perform the activities listed in the original agreement and to purchase
signage to support smoke-free and vape-free policies in Kittitas County.
REIMBURSEMENT
Additional funds of $1500.00 will be added to the contract for a total of $5,560.00. The District will
reimburse consultant for actual expenses after the services have been performed, based on the
submittal of monthly-itemized invoices for good and services provided during the period of
performance.
All other terms and conditions of the original agreement remain in full force and effect.
BENTON-FRANKLIN HEAL TH DISTRICT
7102 W. Okanogan Place
Kennewick, WA 99336
KITTITAS COUNTY PUBLIC HEAL TH
Tr.Sk.\l\ Lai«
507 N. Na n
Ellensburg,
Date:_(._..\......_) ~l ~-l-~----Date: _J..f..._--___..k::;..._--___._I_°}.____ ____ _
BFHD Kittitas Tobacco Prevention Amend 1 2019 Page 2
•'
Kittitas County
Review Form
Grants & Contract Agreement
Today's Date I Agenda Date
03/12/2019
Fund/Department
116-Public Health
Contract/Grant Information
Contract /Grant Agency: Benton Franklin and KCPHD
q/~ 1q
'
Period Begin Date: 03/01/2019 I I Period End Date: 06/30/2019
_,)
Total Grant/Contract Amount: Adds and additional $1500.00 for a new contract total of $5560.00
Grant/Contract Number:
Contract/Grant Summary:
(f
The purpose of the agreement is to provide additional funding in the amount of $1500.00 to expand and
enhance the original scope of work by purchasing signage to support smoke-free and vape-free policies
in Kittitas County.
Recommendation for Board of Health and Board of Health Review on
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APP O ED AS TO FORM:
Date
Date
Signature of Board of Health member Date
Financial Information
Total Amount$ 1,500 State Funds $ 1,500 Federal Funds$
Percentage County Funds Matching Funds $ CFDA#
In -Kind$
Explain
Grant/Contract Review Page 1
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 D Why not
New Division Created?
Revenue Code 116.612.44.334.04.93
Pass Through Information
Agency to Pass Through
Amount to Pass Through $
Sub-Contract Approved Date:
Prosecutor Review
[ Has the Prosecutor reviewed this agreement? j Yes D No D
County Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Submitted
I Signature:
Department :
I Date :
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
I Reviewer I Date
Grant/Contract Review Page 2