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 L>2-o ZL
Kitti tas county Prosecutor, Auditor, and Board of Health Review and comment:
A D TOF
Signature o Prose Date
//a 1 da
Signature of Auditor's Office Date
s Office
verification the contracting Agency is not suspended/Disbarred:
Today's Date
I1,I7.2022 PA camas Request +' f6D h
Fund/Depa rtment
1L6-Public Health Agenda Date lat
contract /Grant Agency: walla walla county Department of communi ty Health
Period Begin Date: July 1,,2022 Period End Date:June 30, 2023
Total Grant/contract Amount: lncrease of S14,000.00 for a revised maximum of s32,500.00
G rant/Contract N u mb er : 22-20
The amendment is entered into by and between Walla Walla County Department of Community
Health for services relative to Youth Cannabis and CommercialTobacco Prevention program and
amends the Statement of Work, Budget, and Reporting Requirements as attached in the
agreement.
Contract/G ra nt Summary:
f] Agency is not suspended/disbarred [] Not Checked (reason)
Grant/Contract Review Page 1
Financial lnformation
B lnformation
Pass Through lnformation
Prosecutor Review
Total Amount NTE 532,500.00 State Funds 532,SO0.OO Federal Funds $
Percentage County Funds Matching Funds $CFDA#
ln-Kind $
tn
ls Equipment being purchased?Who owns equipment?
New Personnel being hired?Contact HR hiring -uirementsortin
Future impacts or liability to Kittitas County
Bud Amendment Needed?
New Division Created?
Yes I attach budget form No K why not
Already Budgeted
Revenue Code 1.16.6L2.44.334. 04.93
Expense Code 116.612.44. 04. 53 1 15 / 1L6.6t2.44.0s.s 1001
Agency to Pass Through
Amount to Pass Through Expense Code:
Sub-Contract Approved Date:
Has the Prosecutor reviewed this agreement?Yes No
Cou D rtments lm ed
BOCCApproval Needed?
Assignment of Trackin lnformation
Auditor Facilities Maintenance
lnformation Services Human Resource
Prosecutor Treasurer
Yes I NoE
Staff Member Presenting: Kasey Knutson
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Reviewer Date
Grant/Contract Review Page 2