HomeMy WebLinkAboutGrants and Contract 55148Kittitas County
Review Form
Grants & Contract Agreement
Contract/G ra nt I nformation
Recommendation for Board of Health Review on
Department Head Signature:Director Date: t/tg tjl
Kittitas county Prosecutor, Auditor, and Board of Hearth Review and comment:
ROVED M
Signature secu ce Date
\
Signature of Auditor's ce Date
verification the contracting Agency is not suspended/Disbarred:
Today's Date
12/13/2022 PA camas Request -' h [( +h
Fund/Department
116-Public Health Agenda Date:
contract /Grant Agency: state of washington Department of Ecolo gy Amendment L
Period Begin Date: O7/OI/2OZI Period End Date: 06/30/2023
Total Grant/contract Amount: S79, j"60.00 (this is a decrease from St45 ,320.00)
G ra nt/Contract N u m ber: SWM LSWFA-2021- KiCpH D-00003
The agreement between the Department of Ecology State of Washington and KCpHD. The agreements
scope of work tasks the recipient with solid waste handling facility/site compliance, and solid waste
investigation, assistance, enforcement, as well as offering technical assistance.
Contract/G rant Su m ma ry
f, Agency is not suspended/disbarred ! Not Checked (reason)
Grant/Contract Review Page 1
Financial lnformation
Bu lnformation
Pass Throu lnformation
Prosecutor Review
TotalAmount State Funds $29,t60.00 Federal Funds 5
Percentage Cou nty Funds Matching Funds S CFDA#
ln-Kind S
ls Equipment being purchased?Who owns equipment?
New Personnel bei ng hired?Contact HR hirin uirementsrtin-re
Future impacts or liability to Kittitas County:
et Amendment Needed?Bu
New Division Created?
Yes I attach budget form No tr why not
Revenue Code 1 16. 6 15.03.8. 334.03. 1"00
Expense Code 116.615.03.8
Agency to Pass Through
Amount to Pass Through Expense Code:
Sub-Contract Approved Date:
Has the Prosecutor reviewed this agreement?Yes No
Cou De artments lm cted
BOCC A I Needed?
Assi ment of Trackin lnformation
Auditor Facilities Maintenance
lnformation Services Human Resource
Prosecutor Treasurer
Yes I NoI
Staff Member Presenting:
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Reviewer Date
Grant/Contract Review Page 2