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Washington State Department of <br />Hea I th <br />CONTRACT AMENDMENT <br />1. NAME OF CONTRACTOR <br />2. CONTRACT NUMBER <br />Vittitas County Public Health De artment <br />N19411 <br />Ia. ADDRESS OF CONTRACTOR (STREET) <br />2a. AMENDMENT NUMBER <br />507 N Nanum Street, Suite 102 <br />1 <br />lb. CITY, STATE, ZIP CODE <br />Ellensburg, WA 98926 <br />3. ® THIS ITEM APPLIES ONLY TO BILATERAL AMENDMENTS. <br />The Contract identified herein, including any previous amendments thereto, is hereby amended as set forth in Item 5 below by <br />mutual consent of all parties hereto. <br />4. ❑ THIS ITEM APPLIES ONLY TO UNILATERAL AMENDMENTS. <br />The Contract identified herein, including any previous amendments thereto, is hereby unilaterally amended as set forth in Item 5 <br />below pursuant to that changes and modifications clause as contained therein. <br />5. DESCRIPTION OF AMENDMENT: The purpose of this amendment is to update the Contact Person <br />information for DOH. The rest of the agreement remains unchanged. <br />5a. AGREEMENT MANAGEMENT: <br />The Contact Person for DOH is: <br />Dorothy Tibbetts <br />Office of Drinking Water <br />16201 E Indiana Suite 1600 <br />Spokane Valley, WA 99216 <br />(509) 329-2105 <br />6. All other terms and conditions of the original contract and any subsequent amendments thereto remain in full force and <br />effect. <br />7. ❑This is a unilateral amendment. Signature of contractor is not required below. <br />® Contractor hereby acknowledges and accepts the terms and conditions of this amendment. Signature is required below. <br />8. CONTRACTOR SIGNATURE (also, please print/type your name) <br />DATE <br />9. DOH CONTRACTING OFFICER SIGNATURE <br />DATE <br />I his document has been approved as to form only by the Assistant Attorney General. <br />DOH Amendment N19411-1 Page 1 of 1 <br />