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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Contract/G ra nt I nformation <br />Recommendation for Board of Health Review on <br />Department Head Signature Director Date tltslzz <br />Verification the Contracting Agency is not Suspended/Disbarred: <br />Agency is not suspended/disbarred ! Not Checked (reason) <br />Today's Date <br />6/30/2022 PA Camas Request #{7?r'- <br />Fund/Department <br />116-Public Health Agenda Date: <br />Contract /Grant Agency: Consolidated Contract Amendment 5 <br />Period Begin Date: January 1,,2022 /Period End Date: L2/31"/2024 <br />Total Grant/Contract Amount: lncrease of 52L7,313.00 for a revised maximum consideration of / <br />53,ogs,724.oo <br />Grant/Contract Number: CLH310L5 <br />Contract/Grant Su mmary: <br />The Consolidated Contract Amendment #5 amends the following statement of work: <br />COVID Mass Vaccination-FEMA- Effective January 1,,2022 <br />DCHS-ELC COVID-19 Response- Effective January 1.,2022 <br />Exhibit B-5 Allocations, attached and incorporated bythis reference, amends and replaces Exhibit B-4 <br />Allocations as follows: <br />lncrease of 5217,313.00 for a revised maximum consideration of 53,095,724.00 <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM: <br />Signature of Au ce <br />(" <br />7 <br />r'Da <br />vk ft^I 1-L- <br />utor's OfficePsroceSignatu Date <br />z$+'| <br />Grant/Contract Review Page 1