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Kittitas County Review Form Grants & Contract Agreement Contract/G ra nt I nformation Recommendation for Board of Health Review on verification the contracting Agency is not suspended/Disbarred: Today's Date 06/Ls/2022 PA camas Request r, Wtrhh Fund/Department 116-Public Health Agenda Date: Contract /Grant Agency: HCA Amendment for ABCD Kittitas County Period Begin Date: July I,2022 Period End Date: June3O,2024 Total G rant/Contract Amount: $ZS,g8O.OO Grant/Contract Numb er: K2747 Amendment 4 Contract/G rant Sum mary o The Maximum Compensation payable to the Contractor for the performance of all things necessary for or incident to the performance of the work as set forth in Schedule A-3: Statement of Work has increased by $25,376.00, for a new Contract Maximum Compensation of 568,638.00, and includes any allowable expenseso Schedule A-2: Statement of Work is replaced in its entirety with Schedule A-3: Statement of Work, attached hereto and incorporated herein. o Exhibit A-2: ABCD Quarterly Community and Provider outreach and Case Management Report is replaced in its entirety with Exhibit A-3: ABCD Quarterly Community and Provider Outreach and Case Management Report, attached hereto and incorporated herein. r Exhibit B-2:ABCD QuarterlyOutreach and Coordination of Care Report is replaced in itsentiretywith Exhibit B-3: ABCD Quarterly Outreach and Coordination of Care Report, attached hereto and incorporated herein.o Exhibit C-1: ABCD Yearly Budget Tool is replaced in its entirety with Exhibit C-2: ABCD yearly Budget Tool, attached hereto and inco orated herein. Department Head Signature LLDirector Date: t I ul Kittitas county Prosecutor, Auditor, and Board of Health Review and comment: Signature of P s Office Date Signature of ditor's Office Dat # i-uti +-4 d:-,''tl zL APP TO FORM ! Agency is not suspended/disbarred ! Not Checked (reason) Grant/Contract Review Page L