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Kittitas County <br />Review Form <br />Grants & Contract Agreement 1+41t-aw <br />Today's Date Agenda Date <br />05/02/2019 <br />A <br />Fund/Department <br />116 -Public Health <br />Contract/Grant Information <br />Contract /Grant Agency: Amendment to PSA between Entrust and Kittitas Cou <br />Period Begin Date: June 1,2019 1 1 Period End Date: June 30, 2019 1 <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: <br />Administrator Date: <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM: <br />. I3 . <br />Signa?ure of�rosecutor'office Date Ao <br />Signatu e a ditor's Office Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount $ TBD <br />State Funds $ TBD <br />Federal Funds $ <br />Percentage County Funds <br />Matching Funds $ <br />CFDA# <br />In -Kind $ <br />Explain <br />Is Equipment being purchased? <br />Who owns equipment? <br />Grant/Contract Review Page 1 <br />