HomeMy WebLinkAboutSUPPLY PURCHASING AMENDMENT- Grant and Contract Review FormDES...TQ N
Kittitas County
Review Form
K17TI'1'AS CQl'�T'
Grants & Contract Agreement
Today's Date Agenda Date
August 8, 2023 August 15, 2023
Fund/Department
30 / Sheriff
Contract/Grant Information
Contract /Grant Agency: Ellensburg Family Medicine d/b/a CompassDirect Healthcare
Period Begin Date: upon signature
Period End Date: until funding is no longer
available, or until term'd by either party
Total Grant/Contract Amount: No greater than $310,000 annually.
Grant/Contract Number: #SH21-044 (3rd Modification)
Contract/Grant Summary: The purpose of this modification is to allow CompassDirect Healthcare to
purchase medical supplies, and equipment as needed. They will invoice The County to be reimbursed in
full.
Financial Information
Total Amount: Total compensation
to increase by up to $310,000
State Funds $0
Federal Funds $0
Percentage County Funds
Matching Funds $0
CFDA# na
In -Kind $
Explain
Is Equipment being purchased? No
I Who owns equipment? na
New Personnel being hired? No
I Contact HR hiring — na
Future impacts or liability to Kittitas County: Program is contingent upon the continuing availability of
grant funds.
Budget Information
Budget Amendment Needed? Yes❑ attach budget form No 0 Why not - Already budgeted
New Division Created? No
Revenue Code N/A
Expense Codes: 1001-3012365xxxx 1 001-3012355xxxx
Grant/Contract Review Page 1
Pass Through Information
Agency to Pass Through
NA
Amount to Pass Through
$0
Sub -Contract Approved
Date:
Prosecutor Review
Has the Prosecutor reviewed this agreement? YesEkNo❑ CAMAS# 10021
Countv Departments Impacted
Auditor
Facilities Maintenance
Information Services
Human Resource
Prosecutor
Treasurer
Submitted
Signature:
Date: 9 r & .
Department: Sheriff
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
/ 7 —
Who Signed the grant application
Reviewer I Date 71
Grant/Contract Review Page 2