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I DSHS CONTRACT NUMBER: <br />CONTRACT AMENDMENT 1563-43842 ~~.,~."'." OEI'~R.T . £NT OF <br />Amendment No. soc l~Uv1~}TH 01 <br />I <br />This Contract Amendment is between the State of Washington Department of Program Contract Number <br />Social -and Health Services (DSHS) and the Contractor itleritifiedoelow. Click -here·to enter text . <br />Contractor Contract Number <br />CONTRACTOR NAME CONTRACTOR doing business as (DBA) <br />Kittitas County <br />CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS DSHS INDEX NUMBER <br />IDENTIFIER (UBI) <br />507 North Nanum Street Suite 102 <br />EliensburQ, WA 98926-192-002-673 1225 <br />CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS <br />Dave Wilson (509) 925-9821 (509) 837-7700 davew@meritresources .org <br />DSHS ADMINISTRATION DSHS DIVISION DSHS CONTRACT CODE <br />Behavioral Health and Service Integration Division of Behavioral Health 1647CS-63 <br />and Recovery <br />DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS <br />Melinda Trujillo Sky Valley CSO <br />Program Manager 19705 SR 2 <br />Monroe, WA 98272 <br />DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS <br />(360)805-8362 (360) 794-1334 melinda. trujillo_@dshs.wa.gov <br />IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS <br />No <br />AMENDMENT START DATE CONTRACT END DATE <br />10101/2015 03/31/2016 <br />PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT <br />$219,646.00 $0 .00 $219,646 .00 <br />REASON FOR AMENDMENT; <br />CHANGE OR CORRECT CONTRACT TERMS OR SOW, SEE PAGE TWO <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): Exhibit B: Awards and Revenues <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 />~NATUR E _/;) <br />-~O ..,. -7 \!: <br />DSHS SIGNATURE <br />~L <br />! <br />DSHS Central Contract Services <br />6024PF Contract Amendment (3-31-06) <br />PRINTED NAME AND TITLE DATE SIGNED <br />i.I <br />Obie O'Brien, Chairman Board Commissioners 21/~/Zo/f..., <br />~INTL NAME AND T ITLE ~~~~~~ D1J~~/1. <br />Page 1