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COUNTY DSHS Agreement Number ~lrr,81"''''~S<"' PROGRAM AGREEMENT 1663-65231 <br />D£PART NT OF S()(:JA~ft~TH 5 VI Jail Services for 18 year & older <br />This Program Agreement is by and between the State of Washington Administration or Division <br />Department of Social and Health Services (DSHS) and the County identified Agreement Number <br />below, and is issued in conjunction with a County and DSHS Agreement On County Agreement Number General Terms and Conditions, which is incorporated by reference. <br />DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER DSHS CONTRACT CODE <br />Rehabilitation Administration Division of Community 1225 5000CC-63 <br />Programs <br />DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS <br />Barbara Kraemer OB 2 <br />FA5 PO Box 45720 <br />Olympia, VVA 98504 <br />DSHS CONTACT TELEPHONE I DSHS CONTACT FAX I DSHS CONTACT E-MAIL <br />(360)902-0765 (360)902-8108 kraembj@dshs.wa.gov <br />COUNTY NAME COUNTY ADDRESS <br />Kittitas County 205 VV 5th Ave Ste1 Jail <br />Kittitas Co. Sheriffs Office Ellensburg, VVA 98926 <br />COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME <br />NUMBER <br />Paula Hoctor <br />COUNTY CONTACT TELEPHONE I COUNTY CONTACT FAX I COUNTY CONTACT E-MAIL <br />(509) 962-7617 (509) 962-7037 paula.hoctor@co.kittitas.wa.us <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM CFDA NUMBERS <br />AGREEMENT? <br />No <br />PROGRAM AGREEMENT START DATE I PROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT <br />07101/2016 06/30/2018 $40,000.00 <br />EXHIBITS. VVhen 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 />[gI Exhibits (specify): No Data Security Exhibit; Exhibit A: Statement of Work -Jail Services for Youth 18 years and Older <br />Committed to the RA. <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 commun ications, 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) PRINTED NAME(S) AND TITLE(S) DATE(S) SIGNED <br />G~~~ l.G..IT \~~ {I::J . <br />Ge~,--e.. ~tl"'\.t\. Gt~LiP':; a & Ii), I 'J1-~ I j" <br />DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED <br />~.J 12 Del R. Hontanosas (,/~/" Grants and Contract Manager .--..... <br />"--- <br />DSHS Central Contract Services <br />5048CF County Program Agreement (11-22-2011) Page 1