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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Contract/Grant I nformation <br />Recommendation for Board of Health Review on <br />Department Head Signature Director Date:,/t,l 1 r-: <br />Kittitas County P rosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED FORM <br />Signature o Prose r's Date <br />Signature of Auditor's Office Da <br />verification the contracting Agency is not suspended/Disbarred: <br />Today's Date <br />ot/04/2022 PA camas Request o, qW L 3 <br />Fund/Department <br />116-Public Health Agenda Date <br />contract /Grant Agency: Amendment j. to psA between KC and Ellensbur g School District <br />Period Begin Date: 08/O!/2O22 Period End Date: 07/3U2023 <br />Tota I G rant/Contract Amou nt lncrease of S3,915,00 for a new maximum award of SZS ,000.00 <br />G ra nt/Contract N u mber: <br />The Amendment to the PSA is established to increase the initialcontract award from $21,0g5.00 to $25,000.00.The original PSA is established to support covlD-19 recovery and advance health equity for high-risk or <br />underserved populations' Utilize non-clinicalinterventions to address behavioralhealth concerns related tocovlD-19. Activities may include, but are not limited to, healthy activity, coping mechanisms , andf or resiliency to <br />enhance social connectivity lost during the Covid-l-9 pandemic as addressed on the Statement of Work. <br />Contract/G rant Sum mary: <br />I Agency is not suspended/disbarred I Not Checked (reason) <br />Grant/Contract Review Page 1"