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~ t """'"''" '"" DSHS CONTRACT NUMBER: <br />COUNTY PROGRAM or INTERLOCAL 1763-88849 <br />Department of 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 (OBA) <br />Kittitas County <br />CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS DSHS INDEX NUMBER <br />IDENTIFIER (UBI) <br />County Auditors Office <br />192-002-673 1225 205 West 5th Ave County Courthouse Ste 105 <br />Ellensburg, WA 98926- <br />CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS <br />Judy Pless (509) 962-7502 (509) 962-7687 iudy.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 (specify): <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 />Amendment, and have authority to enter into this Amendment. <br />"e7.,7 ~ ,~~ <br />DSHS~I0NATUR <br />DSHS Central Contracts and Legal Services <br />6046 LF Long-Term 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 />Audilor's Note: The amount Kittitas <br />County has in advance is $92.144 00 <br />Ma y 1, 2018 -Judy Pless