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DSHS CONTRACT NUMBER: <br />CONTRACT AMENDMENT 1563-44899 <br />INasl" gr' Srerc <br />L7C[� ERMU@�.}T OH <br />7 <br />5C7C SE VI[ESTH Amendment No. 01 <br />t— <br />This Contract Amendment is between the State of Washington Department of Program Contract Number <br />Social and Health Services (DSHS) and the Contractor identified below. Click here to enter text. <br />Contractor Contract Number <br />CONTRACTOR NAME <br />CONTRACTOR doing business as (DBA) <br />Kittitas County <br />Kittitas_County DDA County Services <br />WASHINGTON UNIFORM DSHS INDEX NUMBER <br />CONTRACTOR ADDRESS <br />BUSINESS IDENTIFIER (UBI) <br />507 North Nanum Street Suite 102 <br />Ellensburg, WA 98926- <br />192-002-673 1225 <br />CONTRACTOR CONTACT <br />CONTRACTOR TELEPHONE <br />CONTRACTOR FAX <br />CONTRACTOR E-MAIL ADDRESS <br />Robin Read <br />509-962-7515 <br />509-962-7581 <br />Robin.read@co.kittit <br />DSHS ADMINISTRATION <br />DSHS DIVISION <br />DSHS CONTRACT CODE <br />Developmental Disabilities Admin <br />Division of Developmental <br />1769CS-63 <br />Disabilities <br />DSHS CONTACT NAME AND TITLE <br />DSHS CONTACT ADDRESS <br />Roger Van Allen <br />1611 W Indiana Ave <br />Operations Manager <br />Spokane, WA 99205- <br />DSHS CONTACT TELEPHONE <br />DSHS CONTACT FAX <br />DSHS CONTACT E-MAIL ADDRESS <br />(509) 329-2952 <br />509) 568-3037 <br />vanalrl@dshs.wa.gov <br />1 IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? <br />CFDA NUMBERS <br />No <br />AMENDMENT START DATE <br />CONTRACT END DATE <br />04/18/2016 <br />06/30/2016 <br />PRIOR MAXIMUM CONTRACT AMOUNT <br />_ <br />AMOUNT OF INCREASE OR DECREASE <br />_ <br />TOTAL MAXIMUM CONTRACT AMOUNT <br />$689,190.00 <br />$49,751.00 <br />$738,941.00 <br />REASON FOR AMENDMENT; <br />CHANGE OR CORRECT MAXIMUM_ CONTRACT AMOUNT <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): Program Agreement Budget <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 />PRINTED NAME AND TITLE <br />DATE SIGNED <br />DSHS SIGNATURE <br />PRINTED NAME AND TITLE <br />DATE SIGNED <br />DSHS Central Contract Services Page 1 <br />6024PF Contract Amendment (3-31-06) <br />3s. �S�•��� <br />