HomeMy WebLinkAboutReview FormKittitas 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
Kittitas county Prosecutor, Auditor, and Board of Health Review and comment
APPROVED AS TO FORM:
S tgn atu ofP uto r's Date
d1 0s-
Signatu re d ito r's
verification the contracting Agency is not suspended/Disbarred:
I Agency is not suspended/disbarred ! Not Checked (reason)
Today's Date
PA camas Request #' ffW lJ[b
Fund/Department
116-Public Health Agenda Date / lzlt'i
contract /Grant Agency: PSA between KCPHD and comprehensive Healthcare
Period Begin Date: December L,2022 Period End Date: October 31,2023
Total Grant/Contract Amount: S25,000
G ra nt/Contract N u mber:
Contract/G rant Su m mary
The PSA between KCPHD and Comprehensive Healthcare is established to aid in the support of Covid-19
recovery and advance health equity for high-risk or underserved populations. Utilize non-clinical
interventions to address behavioral health concerns related to Covid-19. Activities may include, but are
not limited to, healthy activity, coping mechanisms, and/or resiliency to enhance social connectivity lost
during the Covid-19 pandemic.
Page LGrant/Contract Review
l ll AY".d^
Financial lnformation
Bu lnformation
Pass Thro h lnformation
Prosecutor Review
Total Amount NTE 525,000 State Funds $Federal Funds SZS,OOO
Percentage County Funds Matching Funds S CFDA#
ln-Kind S
ls Equipment being purchased?Who owns equipment?
New Personnel bei hired?Contact HR hiring-tn requirements
Future impacts or liability to Kittitas County:
Budget Amendment Needed?
New Division Created?
Yes ! attach budget form No E why not
Revenue Code 6L2.39.26.333.93.391
Expense Code 6L2.39.26.54L0t
Agency to Pass Through
Amount to Pass Through Expense Code
Sub-Contract Approved Date
Has the Prosecutor reviewed this agreement?Yes No
Cou Departments lm acted
BOCC A roval Needed?
Assignment of Tracki ng lnformation
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Auditor Facilities Maintenance
lnformation Services Human Resource
Prosecutor Treasurer
Yes I NoX
Staff Member Presenting: Kasey Knutson
Reviewer Date
Grant/Contract Review Page 2