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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Today's Date <br />05/02/2019 <br />Fund/Department <br />116 -Public Health <br />Contract/Grant Information <br />Agenda Date <br />Contract /Grant Agency: Amendment to PSA between Elmview and Kittitas County <br />Period Begin Date: June 1,2019 Period End Date: June 30, 2019 <br />Total Grant/Contract Amount: To Be Determined (based on clients served) <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />The amendment is entered between the contractor and county to update the activity service rates for <br />employment and day activities for the Developmental Disabilities Program. <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 />APPROVED AS TO FORM: <br />z--)// h <br />Signature of Rrosecutor'slOffice <br />SignatuVebf guditor's Office <br />Date I <br />�r� k1 <br />Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount $ TBD State Funds $ TBD Federal Funds $ <br />Percentage County Funds Matching Funds $ CFDA# <br />In -Kind $ <br />Is Equipment being purchased? Who owns equipment? <br />Grant/Contract Review Page 1 <br />