HomeMy WebLinkAboutSH Grants and Contract Review Form Compass DirectKittitas County
Review Form
Grants & Contract Agreement
Today's Date
January 30,2023
Agenda Date
February 7,2023
Fund/Department
30 / Sheriff
Contract I Grant Information
Contract /Grant Agency: Ellensburg Family Medicine DBA C Healthcare
Period Begin Date: 01/0112022 Period End Date: until term
Total Grant/Contract Amount:
Grant/Contract Number: SH2 I -049
ContracVGrant Summary: Kittitas County Sheriff s Office is in an agreement Ellensburg Family Medicine
DBA Compass Direct Healthcare for the purpose to conduct pre-employment medical screening for employment.
Sheriff s Office has received on 01130123 a updated price list for the pre-employment physical screening. (Note-
original Agreement was approved by the BOCC on 12l2ll2l).
Financial Information
Bu Information
Pass Throu Information
Total Amount State Funds $0 Federal Funds $0
Percentage County Funds Matching Funds $0 CFDA# na
In-Kind $
Explain
Is Equipment being purchased? NO Who owns uipment? na
New Personnel being hired? NO Contact HR - reporting requirements - na
Future impacts or liability to Kittitas County:
Budget Amendment Needed?
New Division Created? NO
Yes! attach budget form No f[ Why not - Already budgeted
Revenue Code NA
Expense Code 00l30xxx4l13
Agency to Pass Throueh NA
Amount to Pass Throueh $o
Sub-Contract Approved Date:
Grant/Contract Review Page L
Prosecutor Review
Has the Prosecutor reviewed this agreement?YesDk No CAMAS# S:;" 3 tte
Coun D rtments Im
Submitted
S Date: 2 l'ltrZ
Department: Sheriff tr I
Ass ent of Trackin Information
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Auditor's Office
Human Resource
Prosecutor's Office -I 74-
Who Signed the grant application {
Reviewer Date
Grant/Contract Review Page 2