HomeMy WebLinkAboutPSA Robin ReadThis Agreement is ma!9 by and between Kittitas county (hereinafter,,the County,,)and Robin Read (hereinafter "Coniractor"). The countv and Contractoiagree as follows:
GeneralConditions; ExhibitA (Scope of Work) and Exhibit B (Compensation).
copies of which are attached hereto and incorporated herein by this reference as fully as ifset forth herein.
The terrn of thisAgreement is forJ,uly 1 ,2o21through June 30,2022. Any party mayterminate this Agreement bv giving thirtr_(io) oays';;iil-ir-riiiiiiJ-"ither personaltydelivered or mailed postage-prepaid by certinio mail,'return receipt requested, to the partyblast known address for the purposes of giuing noti"e'r;;; th,;;il;;;fi.
contractor acknowledges and by signing this Agreement agrees that thelndemnification provisions set tortn in Paragradnr 7 gnoepeni"nt Cont12ctor), 9 (Taxes),15 (Defense and lndemnity Agreement),- 21 (Patenucopyrighi rnt ing"r"nt) and 24(Confidentiality), are totally
"nd-fully part of thls Agreement and have been mutuallynegotiated by the parties.
Professional Services Agreement
Page 1
of
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WHEREoF, the parties have executed this Agreemen ttnis flav
APPROVED:
BOARD OF COUNry COM
KITTITAS COUNry,
MISSIONERS
INGTON
Print N ame of Signatory
Gontractor Address:
1301 N Main Street
Ellensburg, WA 98926
Project Contact:
Robin Read
Brett , Chairman
ABSENT
Laura Osiadacz , Vice-Chairman
ht, Commissioner
sig of natory
b
(Date
D {*.
llll ll]r
C-,
pf
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Approved as to Form
{*)LEZ\-
Deputy Attorney
County's Address:
Kittitas County
205 West 5th Avenue, Suite 10g
Ellensburg, WA 9g926
Project Contact:
Kasey Knutson, KCPHD
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GENERAL CONDITIONS
1. Scope of Contractor's Services:
contractor agrees to provide to ftie county services and any materials set forth in the projectnarrative identified in Exhibit "A" durinq theAgreement period. No material, labor, orfacilitieswill be furnished by the County, unless othenrvise provided for in the Agreement.
2. Performance of Work:
c-ontrac@rkinaccordancewith,andshallcomplywith,alloftheprovisions
of this Agreement. Allwork shall comply with applicable codes jni oroinlnces.
3. Schedule of performance:
Unless directed othenrvise by the County, Contractor shall perform the work in accordancewith any schedules made a part of this Agreement.
4. Definitions:4'1 "Additional lnsured's" mean_s the County, its successors and assigns, andthe respective directors, officers, emptoyee., ;g;;t. "nl'r"pr"rini"tiu". otthe'County and its successors and assigns.4'2 "Support" means the following: Contra-ctor's directors, officers, employees,agents and representatives; and sub-Contractors of any tier; the respectivedirectors, officers, emptoyees, agents and representaiives of these sub-:Contractors of any tier; and any other person or entity acting under thedirection or control of,. or on behalf of, Contractor or any contrictor's sub-Contractors ojany tier in connection wiin or incident to the'performance of theWork or this Agreement.4'3 The "Work" means all of the duties listed in Exhibit A and the performance ofall other obligations, under this Agreement by Contractor or its Support.
I Accountinq and payment for Contractor Services:
Payment to the Contractor for services rendered under this Agreement shall be as set forthin Exhibit "B". Where Exhibit "B" requires payments Oy tne Co-unty, payrent shall be basedupon billings, supported unless othenrvise provided in txhibit;B;,'tjy #cu'mentation of unitsof work actually performed and amounts earned, including wnere appropriate, the actualnumber of days worked each month, total number of hours f6r the month,
"no
tn" total dollarpayment requested- Unless specifically stated in Exhibit "8" or approveo in writing inadvance by the Kittitas County Board of commissioners, the County witt not reimburse thecontractor for any costs or expenses incurred by G bontractor in f"rrorrance of thisAgreement. "'F-'
Where required, the County shall, upon receipt of appropriate documentation, compensatethe Contractor, no more often than monthly, lrrroufn the County voucher system, for thecontractor's service pursuant to the fee schedure set forth in Exhibit ,,8,,.
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6. Assiqnment and Subcontracting:
No portion of this.Agreement may be assigned or subcontracted to any other individual, firm
or entity without the express and prior written approval of the county.
7. lndependent Contractor:
The Contractor's services shall be furnished by the Contractor as an independent Contractorand nothing herein contained shall be construed to create a relationship of employer-employee or master-servant, but all payments made hereunder and all services periormedshall be made and performed pursuant to this Agreement by the Contractor as anindependent Contractor.
The Contractor acknowledges that the entire compensation for this Agreement is specifiedin Exhibit "B" and the Contractor is not entitled to any County beneits inctuding, but notlimited to: vacation pay, holiday pay, sick leave pay, medi."i, O"nt"l, or other insurance
benefits, or any other rights or privileges afforded to kittitas County employees.
Contractor will defend, indemnifiT and hold harmless the County, its Additional lnsured,s,officers, agents or employees from any loss or expense, iniluding but not limited tosettlements, judgments, setoffs, attorneys' fees or costs incurred by-reason of claims or'demands because of breach of the provisions of this paragraph
8. No Guarantee of Emplovment:
The performance of all or part of this Agreement by the Contractor shall not operate to vest
any employment rights whatsoever and shall not be deemed to guarantee any employment
of the Contractor or any employee of the Contractor or any sub-dontractor or any emfloyee
of any sub-contractor by the county at the present time or in the future.
9. Taxes:
The Contractor understands and acknowledges that the County will not withhold Federalor
State income taxes. Where required by State or Federal law, the Contractor authorizes theCounty to make withholding for any taxes other than income taxes (i.e. Medicare). Allcompensation received by the Contractor will be reported to the lnternal Revenue Service
at the end of the calendar yeat in accordance with ihe applicable IRS regulations. lt is theresponsibility of the Contractor to make the necessary esiimated tax payhents throughoutthe year, if any, and the Contractor is solely liable for any tax obligation arising troir tneContractor's performance. of this Agreement. The Contrattor hereSy agrees tJindemnifrTthe County against any demand to pay taxes arising from the Contracior's failure to pay
taxes on compensation earned pursuant to this Agreement.
The County will pay sales and use taxes imposed on goods or services acquired hereunderas required by law. The Contractor must pay all othler taxes including, but not limited to:Business and Occupation Tax, taxes based on the Contractor's gros! or net income, orpersonal property to which the County does not hold title. The bounty is exempt fromFederal Excise Tax.
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10. Requlations and Requirement:
This Agreement srratt-oel@o all laws, rules and regulations of the United states ofAmerica, and state of washington, and political suooivisi6ns of the siaie of washington,and to any other provisions set tortn herein or in the attached exhibits,
11. Riqht to Review:
This contract is subject to review by any Federal or state auditor. The county or its designeeshall have the right to review an-d monitor the financial and servic" .orponents of thisprogram by whatever means are deemed.expedient uy tne county. sr.n i"ui"w may occurwith or without notice, and may include, but is noiliniit"o to, .on-site inspection by countyagents or employees, inspection of all records o.otnei materials which ine county deemspertinent to the Asreement and its performr;;;: ;il;il;;J]li."rri'rjnications with orevaluation bv service r:ecipients und'er tnis Agree;;.-id ilH;t",.,i"', preserve andmaintain all financial records and records relatint io-in" performance of work under thisAgreement for 6 years after contract termination,"and-shall make them available for suchreview, within Kittitas county, state of w"shingl;;, ,p- request.
12 Modifications:
12'1 Either party may request changes in.the Agreement. Any and all agreedmodifications shail be in writing,ligned oy ea"cn of the parties.- '
12'2 The counV T"t, al any time, by written notice thereof to contractor (,,changeNotice") niares cnanies in rn" work within the general scope of thisAsreement, incruding, out not rimited. "; i"l ;fi;;';;, ievisions to,substitutions for, additions to or deletions or "ny work; (b) changes inschedule; and (c) acceleration, deceleration orsuspension of performance ofany Work.
12'3 lf any change in the work causes an increase or decrease on contractor,scost ol or the time required for, performance of the work, an equitabreadjustment in the compensation to contractoiand in the schedule for theperformance of the work shail be ;;;; refrect such an increase ordecrease.
12'4 Notwithstanding any dispute or delay in arriving at a mutually acceptableequitable adjustment, contractor shall pro.""o in accordance wiirr alt changeNotices. contractor must, within thirty'(3oj;ts after receipt of any changeNotice that does not set forth any acceptabie adjustment, submit to tne countya written statement setting forffrany ai;u"tment ttaimeo.
12'5 lf any change results in a decrease in the work performed, contractor shalbe entifled to compensation associated with changing the work, such as
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revising design already completed, revising calculations already performed,
and revising documents.
13. Termination for Default:
lf the Contractor defaults by failing to perform any of the obligations of the Agreement orbecomes insolvent or is declared bankiupt or commits any act of bankruptcy o-r insolvencyor makes an assignment for the benefit of creditors, the Cbunty r"y, by'd"positing writtennotice to the Contractor in the U.S. mail, postage prepaid, terminateih- ngr"rent, and atthe Countys option, obtain performance of [he work elsewhere. lf th; Agreement isterminated for default, the Contractor shall not be entitled to receive any furthlr paymentsunder the Agreement until all work called for has been fully performed. Any extra cost ordamage to the County_ resulting from such default(s) shall be deducted from any money dueor coming due to the Contractor. The Contractor shall bear any extra "rp"nr"l incurred bythe County in completing the work, and all damage sustainedl or *ni.n ray be sustainedby the County by reason of such default.
lf a notice of termination for default has been issued and it is later determined for any reasonthat the Contractor was not in default, the rights and obligations of tne p"rti", shall be thesame as if the notice of termination had been issued pursuant to the Teimination for public
Convenience paragraph hereof.
14. Term ation for P ic Co lence:
The County may term inate the Agreement in whole or in part whenever the Countydetermines, in its sole d iscretion that such termination is in the best interests of the CountyWhenever the Ag reement is terminated in accordance with th is paragraph, the Contractorshall be entitled to payment for actualwork performed at unit contract prices for completeditems of work. ln the event of such term ination, an eq uitable adjustment shall be made inthe compensation payable to Contractor
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An equitable adjustment in the contract price for partially completed items of work will bemade, but such adjustment shall not include provision for lbss of anticipated profit on deletedor uncompleted work. Termination of this Agreement by the County at any time during theterm, whether for default or convenience, shall not constitute a OreacfL oi'contract n| tneCounty.
15. Defense & lndemnitv Aqreement:
1h.9.-Contractor agrees to and shall defend, indemniff and hold harmless the County, itsAdditional lnsured's, appointed and elective officers, agents and employees, from andagainst all loss or expense,, including but not limited to judgments, setflements, attorney,sfees and costs by reason of any and itt claims and demands upon the county, its Additionallnsured's, its elected or appointed officials, agents, or employees for damages because ofpersonal or bodily injury, including death at any time resuiting therefrom, sJstained by anyperson or persons and on account of damage to property including loss of use thereoiwhether such injury to persons or damage io property ii oue to i'ne negligence of the
Contractor, its sub-contractors, its elected officers, employees or their agents, except onlysuch injury or damage as shall have been occasioned by the sole negligence of the County,its Additional lnsured's, appointed or elected officials, agents, or employees. lt is furtherprovided that no liability shall attach to the County by reason of entering into this contract,except as expressly provided herein.
'16. lndustrial lnsurance Waiver:
with respect to the performance of this Agreement and as to claims against the county, itsAdditional lnsured's, 9ffic9rs, agents andemployees, the contractoilxpressly waives itsimmunity under Title 51 of the Revised Code'of 'Washington,
the lndustiial lnsurance Act,for injuries to its emplo.yees and agrees that the obrigatiins to inoemnitr, defend and holdharmless provided in this agreem6nt extend to anyt-laim oroughi ot'; on behalf of anyemployee of the contractor. This waiver is mutually negotiated by the parties to thisAgreement.
17. Venue and Choice of Law:
ln the event that any litigation should.arise concerning the construction or interpretation ofany of the terms of this Agreement, the venue ot su"cn ;.tiil;iliijrt." shal be in theSuperior Court of the State-of Washington in and for the County of Kittitas. This Agreementshall be governed by the raw of the stlte or wasningion
18. Wthholdinq payment:
ln the event the Contractor has failed.to perform any obligation to be performed by thecontractor under this Agreement within theiime set fortn in triis Agreemeni, th"n the countymay, upon written nottbe, withhold all monies or" ;.J;"yiil;;;.tractor, withoutpenalty, until such failure to perform is cured or othenrvise adjudicated.
1-9. F_uture Non-Allocation of Funds:
lf sufficient funds ar9 not appropriated or allocated for payment under this Agreement forany future fiscal p"tiod, the county will not be oblilated to mate p"vr"nt, for services oramounts incurred after the end of the current fiscit period. r.ro b"n"rtv'or expense shallaccrue to the County in the event this provision applies.
20
The Contractor represents and warrants to the County as follows20.1 The Contractor is duly inco rporated , validly existing and in good standingunder the laws of the State of Washington, and has all req uisite corporatepower and auth ority to enter i nto and to perform its oblig ations under thisAgreement
20.2 The contractor has.the authority to execute this Agreement, to make therepresentations and warranties set forth in it and t6 perlorm theobligations of the Contractor under this Agreement in accoroance with itsterms.
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20.3
20.4
20.5
20.6
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This Agreement has been validly executed by an authorized
representative of the Contractor and constitutes a valid and legally
binding and enforceable obligation of Contractor.
The contractor has or will obtain prior to the commencement date such
licenses, permits and other authorizations from federal, state and other
governmental authorities, as are necessary for the performance of its
obligations under this Agreement.
The contractor is not in violation of any applicable law, ordinance or
regulation the consequence of which will or may materially affect
contractor's ability to perform its obligations under this Agreement. The
contractor is not subject to any order or judgment of anyiourt, tribunal orgovernmental agency which materially and adversely affects its
operations or assets in the State of Washington, or its ability to perform
its obligations under this Agreement.
None of the representations or warranties in this Agreement, and none of
the documents, statements, certificates or schedules furnished or to be
furnished by contractor pursuant hereto or in connection with the
performance of the obligations contemplated under this Agreement,
contains or will contain any untrue statement of a materiaffact or omits or
will omit to state a material fact necessary to make the statements of fact
contained therein not misleading.
21. PatenUCopyriqht lnfrinqement:
Contractor will defend and indemnifiT the County from any claimed action, cause or demandbrought against the County; to the extent such action is based on the ctaim tnat intormaiion
supplied by the Contractor infringes any patent or copyright. The Contractor will pay thosecosts and damages attributable to any such claims inJt are finally awarded against theCounty in any action. Such defense and payments are conditioned Lpon the folldwing:21.1 Contractor shall be notified promptly in writing by County of any notice oisuch
claim.
21.2 Contractor shall have the right, hereunder, at its option and expense, to obtain
for the County the right to continue using the information, in the event such
claim of infringemenf is made, provided io reduction in performance or loss
results to the County.
22. Disputes:
22.1 General
Differences between the Contractor and the County, arising under and by
virtue of the Agreement Documents shall be brought to the attention of the
County at the earliest possible time in order that such matters may be setfled
or other,appropriate action promptly taken. Except for such objections as are
made of record in the manner hereinafter specified and within the time limits
stated, the records, orders, instructions, and decisions of the Kittitas County
Commissioners shall be final and conclusive.
22.2 Notice of potential Claims
The Contractor shall not be entitled to additional compensation which
othenryise may be payable, or to extension of time for (1) any act or failure toact by the County, or (2) the happening of any event'or occurrence, unless
the Contractor has given the County a written Notice of potential Claim within
ten (10) days of the commencement of the act, failure, or event giving rise tothe claim, and before final payment by the County. The written Notice of
Potential Claim shall set forth the reasons for which the Contractor betieves
additional compensation or extension of time is due, the nature of the cost
involved, and insofaras possible, the amount of the potentialclaim. Contractor
shall keep full and complete daily records of the work performed, labor and
material used, and allcosts and additionaltime claimed to be additional.
22.3. Detaited Claim
The Contractor shall not be entitled to claim any such additional
compensation, or extension of time, unless within thirti (30) days of the
completion of the portion of the work from which the claim arose, and before
final payment by the County, the Contractor has given the Couniy a detailed
written statement of each element of cost or other compensation requested
and of all elements of additional time required, and copies of any supporting: documents evidencing the amount or extension of time claimed to be due.
23. Ownership of ltems produced:
All writings, programs, data, public records or other materials prepared by the Contractorand/or its consultants or sub-Contractors, in connection with pe*orm"nce oithis Agreementshall be the sole and absolute property of the County.
24. Confidentiality:
The Contractor, its employees, sub-Contractors, and their employees shall maintain theconfidentiality of all information provided by the County or acquiri,O Oy the Contractor inperformance of this Agreement, except upon the prior written consent of tne Kittitas CountyProsecuting Attorney or an order entered by a court after having
".qrir"O
jurisdiction overthe County' Contractor shall immediateiy give to the Couity notice of any judicial
proceedings seeking disclosure of such information. Contractor shall ind"rnify anO nolOharmless the County, its Additional lnsured's, officials, agents or employees from all loss orexpense, including, but not limited to settlements, judgments, setoifs,
-attorneys'
fees and
gosts resulting from contractor's breach of this provision.
To the extent that any information obtained Oy tne Contractor is required to be shared withor provided to others by the terms of the Statement of the Work, this provision is notbreached by such acts.
25. Notice:
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Except as set forth elsewhere in the Agreement, for all purposes under this Agreement,except service of process, notice shall be given by the Contiactor to the departrient headof the department for whom services are rendered, and to the (ittitas Countycommissioners, 205 W sth Ave, Suite 108, Ellensburg, wA 9g926. Notice to the contractorfor all purposes under this Agreement shall be glven to the address reflected on thesignature page. Notice may be given by delivery or by depositing in the U.S. Mail, first class,postage prepaid.
26. Severabilitv:
lf any term or condition of this Agreement or the application thereof to any person(s) orcircumstances is held invalid, such invalidity shall not affect other terms, conditions orapplications which can be given effect withoui the invalid term, condition or application. Tothis end, the terms and conditions of this Agreement are declared severable.
27. Miscellaneous:
27.1 The County's failure or delay to insist upon strict performance of any of the
,provisions of this Agreement or to exercise any:rights or remedies under thisAgreement shall not be construed as a waiver or relinquishment to any extent
of its right to assert or rely upon any such provisions, rights or remedies in thator any other instance; rather the same shall be and remain in full force and
effect.
27.2 This Agreement embodies the entire Agreement between the County andContractor, and supersedes any and all prior agreements, regarding the.Work. No change, amendment or modification of any provisions of thisAgreement shall-be valid unless set forth in a written instiumeii.'gr"o;yih"
party to be bound thereby.
27.3 The rights and remedies of the County set forth in any provision of thisAgreement are in addition to and do not in any way limit any other rights ofremedies afforded to the County by any other provisions of inis Agre6ment,
by any of Contractor's Support or by law,
27 '4 The headings of sections and paragraphs of this Agreement are for
convenience of reference only and are not intended to restrict, affect or beof any weight in the interpretation or construction oi tn" piouirionr ;i;r;;
sections or parag raphs.
28. Waiver:
Waiver of any breach or condition of this Agreement shall not be deemed a waiver of anyprior or subsequent breach. No terms or conditions of this Agreement shall be held to bewaived, modified or deleted except by an instrument, in writing,-signed by the parties hereto.29. Survival:
The provisions of paragraphs 7, 9, 11, 13, 14, 1s, 16, 1T , 1g, 19, 20,21,22,2g,24,2g, go,
and 31, 32 shall survive, notwithstanding the termination or invalidity of this Agreement foiany reason.
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30. Nondiscrimination:
30.1 The County is an equal opportunity employer
30.2 N lscnmtn ation in Em tln the performance of this Agreement, the Contractor will notdiscriminate against any employee or applicant for employment on thegrounds of race, creed,color,national origin, sex, sexual oiientation,marital status, age or the presence of any sensory, mental orphysical handicap; prov ided that the prohi bition against discriminationin employment becau se of handicap shall not apply if the particulardisability prevents the proper performance of the particular workerinvolved. The C ontractor shall ensure that applicants are employedand that employees are treated duri ng employment withoutdiscrimination because of their race creed, color, national origin, sex,sexual orientation, marital status,age or the presence of any senso a,me ntal or physical handicap. Su ch action shall include, but not beited to: employment, u pgrading, demotion or transfers , recruitment orrecruitment advertising, I ayoff or termination, rates of pay or otherforms of compensation,and programs for training includi ngapprenticeships. The Co ntractor shall take such action w ith respect tothis Agreement as may be required to ensure full com pliance withlocal, state and federal laws prohibiting discrimination in employment
30.3 Nondiscrimination inServices
The Contractor will not discriminate against any recipient of any servicesor benefits provided for in this Agreement on the grounds of race,creed, color, national origin, sex, sexual orientation, marital status, age orthe presence of any sensory, mentar or physicar handicap.
30'4 [ "ny assignment and/or subcontracting has been authorized by theco-unty, said assignment or subcontract shall include appropriatesafeguards against discrimination. The Contractor shall tat<e sucnaction as may be required to ensure full compliance with theprovisions in the immediately preceding paragraphs herein.
31. Prevailinq Waqe:
Contractor shall pay-the prevailing rate of wages to all workers, laborers, or mechanicsemployed in the performance of any part of the Work in accordance with RCW 39.12and the rules and regulations of the Department of Labor and lndustries. The scheduleof prevailing wages rates for the locality or localities of the Work is determined by the
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lndustrial Statistician of the Department of Labor and lndustries. lt is the Contractor,sresponsibility to verifi7 the applicable prevailing wage rate. lt is understood that thecontractor is responsible for obtaining and coirpteiing all required government formsand submitting same to the proper authorities. - -'--'. --
Disputes regarding prevailing wage rates shall be referred for arbitration to the Directorof the Department of Labor and lndustries. The arbitration decision shall be final andconclusive and binding on all parties involved in the dispute as provided for by RCW39.12.060.
32. Debarment Certification :
The Contractor certifies that it:32'1 ls not presently debarred, suspended, proposed for debarment, declaredineligible or voluntarily excluded from covered transactionr ov lnv F"o"Lrdepartment or agency.32'2 Has not within a three-year period preceding the execution of this contractwith Kittitas County, been convicted of or ha--d a:civilirOgr"nt i"nO"-r"J"'against them for commission of fraud or a criminat oifenle in connectionwith obtaining, attempting to obtain, or performing a pubiic or privateagreement or transaction, violation of Federat or-Staie antitrust statutes orcommission of embezzlement, theft, forgery, bribery, falsification ordestruction of records, making farse stailmeni;:t",i ;;;;;, receivingstolen property, making farse claims, or obstruction of justice.32'3 ls not presently indicted for or othenrvise criminally or diuirry .harged by a ,governmental entity (Federal, State, or local) wittr commisiion oi"ny otthe offenses enumerated in paragra ph 32.2 of this section.32'4 Has not within a three-year periol pieceding tn" pre.loing tn" executionof this contract with Kittitas County had one or more publiJtransactions
(Federal, state, or local) terminated for cause of defaurt.
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EXHI !rArr
SCOPE OF WORK
The Contractor shall perform the following:
' Facilitation of Developmental Disability Advisory Committee (DDAC) meetings tocreate partnership projects to provide employment support and services foryoung adults with developmental disabilities.o Facilitate development of comprehensive plan for DD services as required bywAc 388-850-0202.. Facilitation of up to 5 meetings or events.
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l
q
EXHI lT "E}"
COMPENSATION
As full compensation for satisfactory performance of the work, the County shall payContractor the following compensation :
$75'00 pe.r hour, which inctudes preparation and on-site facilitation.
prease.,o##,f,"
^ErfuGnd
{ t-rn *}ru^ Ul'ti",/
Kasey Knutson
flttitas County Public Health Department
507 N. Nanum St, Suite 102
Ellensburg, WA 98926
Kasey.knutson@co.kittitas.wa.us :
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Professional Services Agreement
Page 14
*,n
Kittitas County
Review Form
Grants & Contract Agreement
Today's Date
7/1./2O2L Agenda Date 3 ZI
Fund/Department
116-Public Health
Contract/Grant lnform ation
Recommendati on for Board of Health and Board of Health Review on
Robin Didricksen-ReadContract/Grant
Begin Date: July t,2O2LPeriod Period End Date: June 30,2022
00
Total rG raant/Cont ct Amo nu t ntCo ract Not oT Exceed
Grant/Contract Nu mber:
Facilitation of Developmental Disability Advisory committee (DDAc) meetings to create partnershipprojects to provide employment support and services fo, yorng adults with ievelopmental disabilities.
Contract/G rant Su m ma ry:
Department Head Sign Administrator Date:
Signa ditor's Officeof Date
DateSignature of Board of Health member
Kittitas County prosecutor,
APPROVED AS TO FORM:
Auditor, and Board of Health Review and Comment:
ItzQ& S*-?*P"-
si of Prosecutor's Office Date
Grant/Contract Review
Page 1
Financial lnformation
B lnformation
Pass Thro h lnformation
Prosecutor Review
TotalAmount s State Funds s Federal Funds SPercenCouFundsMatchiFunds S CFDA#
ln-Kind 5
ls urchased?nt beingLIIme Who owns ui ent?New Personnel bei ng hired?Contact HR hi irementsreFuture impacts or t iability to Kittitas County:
Bu Amendm ent Needed?
New Division Created?
Yes f] attach budget form No E why not
Professional Services
(Professional Services105.568.54101
Revenue Code:
nse Code
10s.568.33 4.04.68
to Pass Throu
Amount to Pass Th
Sub-Contract roved
reement?aH ths e roP es cu to revr e dWC t h s Yes No
Cou Departments lm cted
Submitted
Assignment of Track ing lnformation
Auditor Facilities Mainten ancelnformation Se rvlces Human ResourceProsecutorTreasurer
re Date
rtment
Auditor's Office
Human Resource
Prosecutor's Office
Who S ed the plicationnt
Reviewer Date
Grant/Contract Review
Page 2