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Amend 1
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12. December
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2017-12-05 10:00 AM - Commissioners' Agenda
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Amend 1
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Last modified
6/13/2018 12:32:37 PM
Creation date
6/13/2018 12:32:17 PM
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Meeting
Date
12/5/2017
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Fully Executed Version
Supplemental fields
Alpha Order
l
Item
Request to Approve Amendment No. 1 to the Department of Social & Health Services, Developmental Disabilities Administration
Order
12
Placement
Consent Agenda
Row ID
41021
Type
Agreement
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This Contract between the State of Washington Department of Social and Health Services (DSHS) and the <br />Contractor is hereby amended as follows: <br />1. The Total Maximum Contract Amount is hereby increased in the amount of $14,948 for a new Contract <br />Amount of $835,289. The additional amount is reflected in the attached amended Spend Plan. <br />All other terms and conditions of this Contract remain in full force and effect. <br />Fiscal <br />Year Fund Source <br />2018 State Only <br />Waiver <br />Local <br />Medicaid Match to <br />Local <br />Total Rev . <br />Fiscal <br />Year Fund Source <br />2019 State Only <br />Waiver <br />Local <br />Medicaid Match to <br />Local <br />Total Rev . <br />I <br />ADMINISTRATION <br />(CMIS/AWA BARS 11) <br />OTHER CONSUMER <br />SUPPORTS <br />(CMIS/AWA Code 31,32,41, <br />92,93,94) <br />CONSUMER SUPPORT <br />STATE-ONLY <br />DSHS Central Contract Services <br />6024PF Contract Amendment (3-31-06) <br />EXHIBIT B <br />Program Agreement Budget o Original Budget X Budget Revision <br />REVENUES <br />Original 1 sl Revision 2nd Revision 3m Revision <br />413,416 421,051 <br />$820 ,341 $835,289 <br />Original 1 sl Revision 2nd Revision 3rd Revision <br />COUNTY FY 2018 SPENDING PLAN <br />Planned Expenditures <br />Local PASRR Medicaid <br />Funds Funqs State Funds Funds TOTAL <br />651 29697 24298 54646 <br />27754 22708 50462 <br />I <br />464 6312 6776 <br />Page 2
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