HomeMy WebLinkAboutGrants and Contract 55234Kittitas County
Review Form
Grants & Contract Agreement
Contract/Grant I nformation
Recommendation for Board of Health Review on
Department Head Signature Director Date:,/t,l 1 r-:
Kittitas County P rosecutor, Auditor, and Board of Health Review and Comment:
APPROVED FORM
Signature o Prose r's Date
Signature of Auditor's Office Da
verification the contracting Agency is not suspended/Disbarred:
Today's Date
ot/04/2022 PA camas Request o, qW L 3
Fund/Department
116-Public Health Agenda Date
contract /Grant Agency: Amendment j. to psA between KC and Ellensbur g School District
Period Begin Date: 08/O!/2O22 Period End Date: 07/3U2023
Tota I G rant/Contract Amou nt lncrease of S3,915,00 for a new maximum award of SZS ,000.00
G ra nt/Contract N u mber:
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
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
enhance social connectivity lost during the Covid-l-9 pandemic as addressed on the Statement of Work.
Contract/G rant Sum mary:
I Agency is not suspended/disbarred I Not Checked (reason)
Grant/Contract Review Page 1"
Financial lnformation
Budget lnformation
Pass Through lnformation
Prosecutor Review
Total Amount S25,000 State Funds $Federal Funds S25,000
Percentage County Funds Matching Funds $CFDA#
ln-Kind S
tn
ls Equipment being purchased?Who owns equipment?
New Personnel bein g hired?Contact HR hiring - re requirementsrti
Future impacts or liability to Kittitas County
Budget Amendment Needed?
New Division Created?
Yes I attach budget form No E why not
Revenue Code L16,61.2.39. 26.333. 93.39 1
Expense Code 1,16. 672.39 .26.5 4 1,0L
Agency to Pass Through
Amount to Pass Through Expense Code
Sub-Contract Approved Date:
Has the Prosecutor reviewed this agreement?Yes No
Coun Departments lmpacted
BOCC Approval Needed?
Ass nment of Tracki ng lnformation
Auditor Facilities Maintenance
lnformation Services Human Resource
Prosecutor Treasu rer
Yes !NoE
Staff Mem ber Presenting:
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Reviewer Date
Grant/Contract Review Page 2