HomeMy WebLinkAboutGrants and ContractKittitas County
Review Form
Grants & Contract Agreement
Contract/G rant lnformation
Recommendation for Board of Health Revi ew on
Department Head Signature:Director Date 7p
verification the contracting Agency is not suspended/Disbarred:
Today's Date
June L, 2023 PA Camas Request #:h\L n
Fund/Department
116-Public Health Agenda Date:
contract /Grant Agency: psA Amendment- comprehensive Healthcare
Period Begin Date: December t,2O2Z Period End Date: October 3j.,2023
Total Grant/Contract Amount: S25,000.00
Gra nt/Contract Nu mber:
The purpose of the no-cost amendment to the Professional Services Agreement between
Comprehensive Healthcare and KCPHD is to remove the budget categories and update compensation
language. The updated Exhibit B reflects the removal of budget categories and updated compensation
language,
Contract/G rant Sum mary
Kittitas County Prosecuto r, Auditor, and Board of Health Review and Comment
APPROVED AS TO F ORM:
t 4-RECElVED
Jl,t _S fti;ij
""^'f HH,f,3,!!['n,*,
Signature of P ecutor's Office e
Signature of Auditor's Office Dat
Agency is not suspended/disbarred I Not Checked (reason)
Savn.3ov c'l,vau,A- t" I a-l>AaJ
ProfessionaI Service Agreement Amendment No. j.Page L
Financial lnformation
Budget lnformation
Pass Th lnformation
Prosecutor Review
TotalAmount State Funds $Federal Funds S
Percentage County Funds Matching Funds S CFDA#
ln-Kind S
la in
ls Equipment being purchased?Who owns equipment?
New Personnel bein hired?Contact HR hirin orting re-re uirements
Future impacts or liability to Kittitas County
Budget Amendment Needed?
New Division Created?
Yes f, attach budget form No E why not
No $ changes
Revenue Code 1.1.6.6L2.39. 26. 333.93.39 1 [4t
Expense Code 1"L6. 6L2.39 .26.5 41.0 1
Agency to Pass Through
Amount to Pass Through Expense Code:
Sub-Contract Approved Date
e Prosecutor reviewed this agreement?Has th Yes No
County De a rtments lmpacted
BOCC A roval Needed?
Assi nment of Tracki lnformation
Auditor Facilities Maintenance
lnformation Services Human Resource
Prosecutor Treasu rer
Yes I NoI
Staff Mem ber Presenting
Auditor's Office
Human Resource
Prosecutor's Office t>tg+t (b
Who Signed the grant application
Reviewer Date
Professionai Service Agreement Amendment No. j.
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