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COUNTY DSHS Agreement Number --~" PROGRAM AGREEMENT 1863-31751 EP'AR: OF <br />01\L&.HMLTH <br />SER.VICES Jail Services 18 years and older <br />This Program Agreement is by and between the State of Washington Administration or Division <br />Department of Social and Health Services (DSHS) and the County identified Agreement Number <br />below, and is issued in conjunction with a County and DSHS Agreement On County Agreement Number General Terms and Conditions, which is incorporated by reference. <br />DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER DSHS CONTRACT CODE <br />Rehabilitation Administration Division of Community 1225 S000CC-63 <br />ProQrams <br />DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS <br />Barbara Kraemer 082 <br />FAS PO Box45720 <br />Olympia, WA 98504 <br />DSHS CONTACT TELEPHONE I DSHS CONTACT FAX I DSHS CONTACT E-MAIL <br />(360)902-0765 {360)902-8108 kraembj@dshs.wa.gov <br />COUNTY NAME COUNTY ADDRESS <br />Kittitas County 205 W 5th Ave Ste1 Jail <br />Kittitas Co. Sheriffs Office Ellensbura. WA 98926 <br />COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME <br />NUMBER <br />Paula Hoctor <br />COUNTY CONTACT TELEPHONE I COUNTY CONTACT FAX I COUNTY CONTACT E-MAIL <br />{509) 962-7617 {509) 962-7037 paula.hoctor@co.kittitas.wa.us <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM CFDA NUMBERS <br />AGREEMENT? <br />No <br />PROGRAM AGREEMENT START DATE I PROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT <br />07/01/2018 06/30/2019 $20,000.00 <br />EXHIBITS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into this <br />County Program Agreement by reference: <br />~ Exhibits (specify): Exhibit A-Data Security Requirements and Exhibit B Statement of Work <br />The terms and conditions of this Contract are an integration and representation of the final, entire a:nd exclusive <br />understanding between the parties superseding and merging all previous agreements, writings, and communications , oral <br />or otherwise, regarding the subject matter of this Contract. The parties signing below represent that they have read and <br />understand this Contract, and have the authority to execute this Contract. This Contract shall be binding on DSHS only <br />upon signature bv DSHS . <br />COUNTY SIGNATURE(S) <br />~})~ <br />DSHS SIGNATURE <br />~J D~ -'-- <br />DSHS Central Contract Services <br />5048CF County Program Agreement (11-22-2011) <br />PRINTED NAME(S) AND 11TLE(S) DATE(S) SIGNED <br />Gev, c:...-01\-{'I A-, Stte-,..,i-,c~ h/ 2.,~/21J/f' <br />PRINTED NAME AND TITLE DATE SIGNED <br />Del R. Hontanosas '?(r/tq; Grants and Contract Manager <br />RECEIVED <br />KITTITAS COUNTY SHERIFF <br />ACCOUNTING <br />Page 1