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DSHS Central Contract Services <br />1644CS Prevention Services - County (6-26-2015) Page 1 <br />COUNTY <br />DSHS Agreement Number <br />7 r lui 11 sI "- :o <br />j ` ifC�3lt1 SCiti]CC'S <br />PROGRAM AGREEMENT <br />1863-28733 <br />Transforming lives <br />Prevention Services <br />This Program Agreement is by and between the State of Washington <br />Administration or Division <br />Department of Social and Health Services (DSHS) and the County identified <br />Agreement Number <br />below, and is issued in conjunction with a County and DSHS Agreement On <br />TMO10056 / SP020155 <br />General Terms and Conditions, which is incorporated by reference. <br />County Agreement Number <br />DSHS ADMINISTRATION <br />DSHS DIVISION <br />DSHS INDEX NUMBER <br />DSHS CONTRACT CODE <br />Behavioral Health <br />Division of Behavioral Health <br />1225 <br />1644CS-63 <br />Administration <br />and Recover <br />DSHS CONTACT NAME AND TITLE <br />DSHS CONTACT ADDRESS <br />Sarah Mariani <br />4500 Tenth Ave SE <br />Program Administrator <br />PO Box 45330 <br />Olympia, WA 98504-5330 <br />DSHS CONTACT TELEPHONE DSHS CONTACT FAX <br />DSHS CONTACT E-MAIL <br />(360)725-3774 (360)725-2253 <br />mariase@dshs.wa.gov <br />COUNTY NAME <br />COUNTY ADDRESS <br />Kittitas County <br />507 North Nanum Street Suite 102 <br />Kittitas County Health Department <br />Ellensburg, WA 98926-2886 <br />COUNTY FEDERAL EMPLOYER IDENTIFICATION <br />COUNTY CONTACT NAME <br />NUMBER <br />Kasey Knutson <br />COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX <br />COUNTY CONTACT E-MAIL <br />(509) 962-7515 (509) 962-7581 <br />kasey.knutson@co.kittitas.wa.us <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM <br />CFDA NUMBERS <br />AGREEMENT? <br />93.959 <br />Yes <br />PROGRAM AGREEMENT START DATE <br />PROGRAM AGREEMENT END DATE <br />MAXIMUM PROGRAM AGREEMENT AMOUNT <br />04/01/2018 <br />06/30/2019 <br />$158,037.00 <br />EXHIBITS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into this <br />County Program Agreement by reference: <br />® Exhibits (specify): Exhibit A: Data Security; Exhibit B: Awards and Revenue; Exhibits C -K <br />❑ No Exhibits. <br />The terms and conditions of this Contract are an integration and representation of the final, entire and exclusive <br />understanding between the parties superseding and merging all previous agreements, writings, and communications, oral <br />or otherwise, regarding the subject matter of this Contract. The parties signing below represent that they have read and <br />understand this Contract, and have the authority to execute this Contract. This Contract shall be binding on DSHS only <br />upon signature by DSHS. <br />COUNTY SIGNATURE(S) <br />PRINTED NAME(S) AND TITLE(S) <br />DATE(S) SIGNED <br />DSHS SIGNATURE <br />PRINTED NAME AND TITLE <br />DATE SIGNED <br />BHA Contracts <br />DSHS Central Contract Services <br />1644CS Prevention Services - County (6-26-2015) Page 1 <br />