HomeMy WebLinkAboutGrants and Contract AgreementKittitas County
Review Form
Grants & Contract Agreement
Contract/G ra nt I nformation
Recommendation for Board of Health Review on
Department Head Signature Director Date
Kittitas county Prosecutor, Auditor, and Board of Health Review and Comment:
APPR ED AS TO FORM
J a1 +?("t ,'( (r-
Signature of Prosec r's Office Date
Signature of Audi o r's Office Date
verification the contracting Agency is not suspended/Disbarred:
Today's Date
t0/1.0/2022 PA Camas Request #6qqhK
Fund/Department
11"6-Public Health Agenda Date
Contract lGrantAgency: lnterlocal Agreement between Kittitas County Public Health Department and
Kittitas Valle Hospital
Period Begin Date: Date of Execution Period End Date: 2 years from Date of
Execution
Total Grant/Contract Amount: None
G rant/Contract N umber:
The lnterlocal Agreement between KCPHD and KVH is established to promote efficiency in providing
health services to the citizens of Kittitas County, The agreement allows KCPHD emergency storage of
vaccine should the need arise at the health department because of power outage or storage failure.
Contract/G ra nt Summary:
I Agency is not suspended/disbarred I Not Checked (reason)
Grant/Contract Review Page L
Financial lnformation
Budget Information
Pass Thro h lnformation
Prosecutor Review
TotalAmount State Funds $Federal Funds S
Percentage County Funds Matching Funds S CFDA#
ln-Kind $
ln
ls Equipment being purchased?Who owns equipment?
New Personnel bein g hired?Contact HR hirin requirements-re rti
Future impacts or liability to Kittitas County
Bu et Amendment Needed?
New Division Created?
Yes ! attach budget form No fl why not
Revenue Code
Expense Code
Agency to Pass Through
Amount to Pass Through Expense Code:
Sub-Contract Approved Date:
e Prosecutor reviewed this agreement?Has th Yes No
County De rtments lm pacted
BOCC Approval Needed?
Assignment of Tracki lnformation
Auditor Facilities Maintenance
lnformation Services Human Resource
Prosecutor Treasurer
Yes fl Non
Staff Member Presenting:
Auditor's Office
Human Resource
Prosecutor's Office ,??L8 t+k LI*
Who Signed the grant application
Reviewer Date
Grant/Contract Review Page 2