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Kittitas CountY <br />Review Form <br />Grants & Contract Agreement <br />Contract/Grant lnformation <br />Recomme ndation for Board of Health Review on <br />Director Date 7 L> <br />Department Head Signature <br />Verification the contracting Agency is not suspended/Disbarred: <br />PA camas Request o' ry Llq E b <br />2 <br />Today's Date <br />Agenda Date:Fund/DePartment <br />1L6-Public Health <br />Contract /Grant AgencY: Elmview <br />Period End Date: 06/3012023 ./Period Beg in Date: OTIOL/2022 <br />Total Grant/Contract Amount: Compensat on actual services provided and is subject <br />roved services will be coveredDDA ato fundin On <br />ion shall be based <br />G rant/Contract N u mber: <br />Contract/Grant Su m marY: <br />The professional services agreement is to establish subcontracted employment and day services for <br />people with developmental disabilities in Kittitas County per the county's responsibilities as outlined in <br />attachments. <br />zr{iYk C-C*pqrr \{,.", <br />Date <br />Signatu re DAud <br />.=r (b l-t:' <br />II <br />d Board of Health Review and CommentKittitas CountY Prosecutor, A uditor, an <br />Signatur of Prosecutor's Office <br />\.t * <br />APPROVED AS TO FORM: <br />I Not Checked (reason)Agency is not suspended/disbarredE <br />Grant/Contract Review Page 1