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DSHS CONTRACT NUMBER <br />CONTRACT AMENDMENT 1563-44899 <br />❑ iVITII rwe 9!n!c <br />S IAE.irFFChT.'ri3 <br />c)='c`A�& if -A -H County Day Program Amendment No. 02 <br />S£iLVLCL•5 <br />r <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 />CONTRACTOR ADDRESS <br />WASHINGTON UNIFORM <br />DSHS INDEX NUMBER <br />BUSINESS IDENTIFIER (UBI) <br />507 North Nanum Street Suite 102 <br />Ellensburg, WA 98926- <br />192-002-673 <br />1225 <br />CONTRACTOR E-MAIL ADDRESS <br />CONTRACTOR CONTACT <br />CONTRACTOR TELEPHONE <br />CONTRACTOR FAX <br />DSHS ADMINISTRATION <br />DSHS DIVISION DSHS CONTRACT CODE <br />Developmental Disabilities Admin <br />Division of Developmental 1769CS-63 <br />Disabilities <br />DSHS CONTACT ADDRESS <br />DSHS CONTACT NAME AND T1TLE <br />Roger Van Allen <br />1611 W Indiana Ave <br />Operations Mana er <br />Spokane, WA 99205- <br />DSHS CONTACT TELEPHONE <br />D$H$ CONTACT FAX <br />DSHS CONTACT E-MAIL ADDRESS <br />(509)329-2 952 <br />(509).568-3037 <br />vanalrl@gshs.wa.gov <br />IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS <br />No <br />AMENDMENT START DA1'F CONTRACT END DATE <br />07/01/2016 06/30/2017 <br />PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT <br />$738,941.00 $762,332.00 $1,501,273.00 <br />REASON FOR AMENDMENT; <br />CHANGE OR CORRECT PERIOD OF PERFORMANCE AND MAX 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 />® Addltionel ExhIVb s eci :_Prograrn Agreement Budr�et tlrl�t Spendinc�Plan <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 />GON N WTOR SIGNATURE <br />PRINTED NAME AND TITLE <br />DATE 51GN A <br />-Pid K— <br />DSHS SIGNATURE <br />PRINTED NAME AND TITLE 6 <br />DATE <br />ASIGNED <br />j <br />Melissa Diebert, Contract Manageri`� <br />RECEIVED <br />DSHS Central Contract Services <br />6024PF Contract Amendment (3-31-06) n I G U l 6 AUG 10 2016 <br />DpA-.POKANE <br />RECEIVED <br />Page 1 AUC 2 6 2016 <br />DDA SPOKANE <br />