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--_. -- <br />COUNTY DSHS Agreement Number .mt1t .... ,M."," '"'' f)C pallmcnt of Social PROGRAM AGREEMENT <br />1563-44899 <br />&. I feallh Services -DDA County Services rransfO' ,-ming lives --This Progra r""T1 Agreement is by and between the State of Was hin gton Department of Administration or DivI sion <br />Socia l and Health Services (DSHS) and the County Identified below , and is issued in Agreement Number <br />conjunction with a County and DSHS Agreement On Genera l Terms and Conditions, <br />which is Incorporated by reference. County Agreement Number <br />CSt-IS ADMIN 1 STAATION DSHS DIVlSlON OSHS IN DEX NUMBER DSHS CONTRACT CODE <br />Developmental Disabilities Division of Developmental 1225 1769CS-63 <br />Admin Disabilities <br />OS HS CONTACT NAME ANo t'\"fLE DSHS COI'ITACT ADDRESS <br />Roger Van Allen 1611 W Indiana Ave <br />Operations (VI al~a oe r Spokan e. VVA 99205- <br />OSHS COf\\TAC"fIELEPHONE I DSHS CONTACT FAX I OSHS CO NTAC T E·MAIL <br />(509) 329-29 5 2 (509) 568-3037 van alrl@ds h s.wa .J:)Qv <br />COUNTY NAM F-COUNTY ADDRESS <br />Kittitas County 507 North Nanum Street Suite 102 <br />Kittitas County DDA County Services Ellensbtira. WA 98926- <br />COUNTY FEOE.F<J\L EM PLO YER IDENTIFICATION COUNTY CONTf'CT NAME <br />NUMBER C{ I-lp 00 ( 'jL{-q Sigrid Welker <br />COUNTY CONT'AOT TELEPHONE I COUNTY CONTACT FAX I COUNTY CON TACT SMAIL <br />(509) 962-7567 <br />IS THE. COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM CFOA NUMBERS <br />AGREEMENT? <br />No <br />PROGRAM AG R EEMEN T ST ART DAT E 1 PRO GRAM AGREeMEN T END DATE M AXIMUM PRO GRA M AGREEMENT AMOUNT <br />07/01/2015 06/30 /2016 $6a9 ,190 .00 <br />EXHI~IT S . The follow ing Exhi bits are attached : Exhibit A. -Data Security Requirements ; Exhi bit B -Program <br />Ag re ement Budget; Exhibit C -Local Match Certification <br />By th eir sig l1atures below , the parties agree to the terms ana conditions of th is County Program Agreement and all <br />documents incorporated by reference . No other understandings or representations , oral Of' otherwise, regarding the <br />subject matter of th is Program Agreement shail be deemed to exist or bind the parties. The parties signing below certify <br />t ha t they are j!,uthorized to s [~n th is Pro gra m Agreem e nt. reb NTY SIGNA TUREr:s) PRINTED NAME(S) AND TlTLE (S ) OATE(S) SIGNED <br />gt'YL-1 8 cvhd 1: ,~C;fifi-'L CH /'']//?) )"1 ~Jj-- <br />DSHS SICN f'TU t<.E PRJNT~O NAME AND TITI.E DATE SIGNED <br />,~:!;;.i.CJLv'7 )}7(~' [,.\.;:::-:t_. ~.-~ Melissa Diebert, Contract Manager ~l-.2J-/)- <br />,. "1:.\.,,1;;.1 ,,-l:-~ <br />OCT 05 Z015 <br />ODA SPOKANE <br />OSHS Centra l contract SerVices <br />1769CS County Agreement 7-14-2015 <br />Qece,Y~~ <br />S\F ~ ., ~e i St:P 257.015 <br />DDA SPOKA ~get Finiln ce & Gontracts <br />Page 1