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in=""''"'""'"'' <br />DSHS CONTRACT NUMBER: <br />COUNTY PROGRAM or INTERLOCAL 1763-88849 <br />7 Department o~ Social <br />& Health Services <br />LONG-TERM PAYABLE AGREEMENT Amendment No. 01 <br />Transforming lives <br />AMENDMENT <br />This Amendment is between the State of Washington Department of Social and Program Contract Number <br />Health Services (DSHS) and the Contractor identified below. Click here to enter tex t. <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 />County Auditors Office <br />205 West 5th Ave County Courthouse Ste 105 192-002-673 1225 <br />Ellensburo , WA 98926- <br />CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS <br />Judy Pless (509) 962-7502 (509) 962-7687 i udy. pless@co. kittitas. wa . us <br />DSHS ADMINISTRATION DSHS DIVISION DSHS CONTRACT CODE <br />Services and Enterprise Support Central Contracts & Legal 8030CS-63 <br />Administration Services <br />DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS <br />William Taplin 1111 Washington St South <br />Contracts Manager <br />Olympia , WA 98504-5811 <br />DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS <br />(360)664-6046 Click here to enter text. tapliwh@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 />07/01/2018 06/30/2019 <br />PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT <br />$0 .00 N/A Based on Annual Review <br />REASON FOR AMENDMENT; <br />CHANGE OR CORRECT PERIOD OF PERFORMANCE <br />ATTACHMENTS. When the box below is marked with an X , the following Exhibits are attached and are incorporated into <br />this Amendment by reference: <br />D Additional Exhibits (s pec ifv): <br />This Amendment, including all Exhibits and other documents incorporated by reference, contains all of the terms and <br />conditions agreed upon by the parties as changes to the original County Program Agreement or lnterlocal Agreement. No <br />other understandings or representations, oral or otherwise, regarding the subject matter of this Amendment shall be <br />deemed to exist or bind the parties. All other terms and conditions of the original County Program Agreement or lnterlocal <br />Agreement remain in full force and effect. The parties signing below warrant that they have read and understand this <br />A mendment, and have authority to enter into this Amendment. <br />~~t;J <br />DSHS SIGNATURE <br />DSHS Central Contracts and Legal Services <br />6046 LF Long-Tenn Payable Amendment (5-2-18) <br />PRINTED NAME AND TITLE DATE SIGNED <br />Laura Osiadacz , Chairman Board of County Commissioners May 15, 2018 <br />PRINTED NAME AND TITLE DATE SIGNED <br />Laura Wood, Contract Manager <br />DSHS Central Contracts and Legal Services <br />Page 1 <br />Auditor's Nole : The amount Killitas <br />Co unty has in ad va nce is $92,14 4.00 <br />May 1, 2018 -Ju d Pless <br />II