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Kittitas CountY <br />Review Form <br />Grants & Contract Agreement <br />Contract/Grant lnformation <br />Recommendation for Board of Health Review on <br />Department Head Signature Director Date t,t 2e <br />Verification the Contracting Agency is not Suspended/Disbarred: <br />Today's Date <br />7 <br />PBK#t\ c\v <br />Fund/Department <br />116-Public Health <br />Agenda Date: <br />Contract /Grant Agenda: PSA between HopeSource and Kittitas County <br />Period End Date: L2|3L/2O26Period Begin Date: JulY 15,202L <br />Total Grant/Contract Amount 750,000.00 <br />Grant/Contract N umber: <br />The pSA between HopeSource and Kittitas County is established for distribution of homelessness <br />surcharge funds awarded up to 5750,000.00 and will be used solely for the purposes described in the <br />original contract exhibit A (attached). <br />Co ntract/G ra nt Su m ma rY <br />Kittitas County Prosecutor, Auditor, and Board of Hea Ith Review and Comment: <br />D TO <br />-/5-' <br />Signature r's Office Date <br />lL -* L{"/o -/7, 2 <br />Signature of Auditor's Office Date <br />I Not Checked (reason)E Agency is not suspended/disbarred <br />c/a lrLr"olo,?z f,' /rt <br />Grant/Contract Review Page 1