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<br /> <br />DSHS Central Contract Services Page 1 <br />6024PF Contract Amendment (3-31-06) <br /> <br />CONTRACT AMENDMENT <br /> <br />DSHS CONTRACT NUMBER: <br />1563-43842 <br /> <br />Amendment No. 01 <br />This Contract Amendment is between the State of Washington Department of <br />Social and Health Services (DSHS) and the Contractor identified below. <br />Program Contract Number <br />Click here to enter text. <br />Contractor Contract Number <br /> <br />CONTRACTOR NAME <br /> <br />Kittitas County <br />CONTRACTOR doing business as (DBA) <br /> <br /> <br />CONTRACTOR ADDRESS <br /> <br />507 North Nanum Street Suite 102 <br />Ellensburg, WA 98926- <br />WASHINGTON UNIFORM BUSINESS <br />IDENTIFIER (UBI) <br /> <br />192-002-673 <br />DSHS INDEX NUMBER <br /> <br /> <br />1225 <br />CONTRACTOR CONTACT <br /> <br />Dave Wilson <br />CONTRACTOR TELEPHONE <br /> <br />(509) 925-9821 <br />CONTRACTOR FAX <br /> <br />(509) 837-7700 <br />CONTRACTOR E-MAIL ADDRESS <br /> <br />davew@meritresources.org <br />DSHS ADMINISTRATION <br />Behavioral Health and Service Integration <br />DSHS DIVISION <br />Division of Behavioral Health <br />and Recovery <br />DSHS CONTRACT CODE <br />1647CS-63 <br />DSHS CONTACT NAME AND TITLE <br /> <br />Melinda Trujillo <br />Program Manager <br />DSHS CONTACT ADDRESS <br /> <br />Sky Valley CSO <br />19705 SR 2 <br />Monroe, WA 98272 <br />DSHS CONTACT TELEPHONE <br />(360)805-8362 <br />DSHS CONTACT FAX <br />(360) 794-1334 <br />DSHS CONTACT E-MAIL ADDRESS <br />melinda.trujillo@dshs.wa.gov <br />IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? <br /> <br />No <br />CFDA NUMBERS <br /> <br /> <br />AMENDMENT START DATE <br /> <br />10/01/2015 <br />CONTRACT END DATE <br /> <br />03/31/2016 <br />PRIOR MAXIMUM CONTRACT AMOUNT <br />$219,646.00 <br /> <br />AMOUNT OF INCREASE OR DECREASE <br />$0.00 <br />TOTAL MAXIMUM CONTRACT AMOUNT <br />$219,646.00 <br />REASON FOR AMENDMENT; <br />CHANGE OR CORRECT CONTRACT TERMS OR SOW, SEE PAGE TWO <br />ATTACHMENTS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into <br />this Contract Amendment by reference: <br /> Additional Exhibits (specify): Exhibit B: Awards and Revenues <br />This Contract Amendment, including all Exhibits and other documents incorporated by reference, contains all of the terms <br />and conditions agreed upon by the parties as changes to the original Contract. No other understandings or <br />representations, oral or otherwise, regarding the subject matter of this Contract Amendment shall be deemed to exist or <br />bind the parties. All other terms and conditions of the original Contract remain in full force and effect. The parties signing <br />below warrant that they have read and understand this Contract Amendment, and have authority to enter into this Contract <br />Amendment. <br />CONTRACTOR SIGNATURE <br /> <br /> <br />PRINTED NAME AND TITLE <br /> <br />Obie O'Brien, Chairman Board Commissioners <br />DATE SIGNED <br /> <br /> <br />DSHS SIGNATURE <br /> <br />PRINTED NAME AND TITLE <br /> <br /> <br />DATE SIGNED <br /> <br /> <br />