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Washingtorr State <br />Department of Social <br />& Health Services <br />Transforming lives <br />CONTRACT AMENDMENT <br />DSHS CONTRACT NUMBER: <br />1763-98187 <br />Amendment No. 03 <br />This Contract Amendment is between the State of Washington Department of <br />Social and Health Services (DSHS) and the Contractor identified below. <br />Program Contract Number <br />Click here to enter tex t. <br />Contractor Contract Number <br />CONTRACTOR NAME <br />Kittitas County <br />CONTRACTOR ADDRESS <br />507 North Nanum Street Suite 102 <br />Elle nsbur , WA 98926-2886 <br />CONTRACTOR CONTACT <br />Joann Schaan · <br />' DSHS A DMINISTRATION <br />Developmental Disabilities Admin <br />DSHS GONTACT NAME AND TiTLE <br />Seanna Woodard <br />Operations Manager <br />DSHS CONTACT TELEPHONE <br />509 329-2952 <br />CONTRACTOR doing business as (DBA) <br />Kittitas County DDA County Services <br />WASHINGTON UNIFORM BUSINESS DSHS INDEX NUMBER <br />IDENTIFIER (UBI) 1225 <br />192-002-673 <br />CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS <br />509 933-8233 Click here to enter tex t. Click here to enter text. <br />DSHS DIVISION DSHS CONTRACT CODE <br />Division of Developmental 1769CS-63 <br />Disabilities <br />DSHS CONTACT ADDRESS <br />1611 W Indiana Ave <br />S okane, WA 99205 <br />DSHS CONTACT FAX <br />509 568-3037 <br />IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? <br />No <br />AMENDMENT START DATE <br />07/01/2018 <br />PRIOR MAXIMUM CONTRACT AMOUNT <br />$826,847.00 <br />REASON FOR AMENDMENT; <br />CONTRACT END DATE <br />06/30/2019 <br />AMOUNT OF INCREASE OR DECREASE <br />$801,577.00 <br />TOTAL MAXIMUM CONTRACT AMOUNT <br />$1,628,424.00 <br />CHANGE OR CORRECT PERIOD OF PERFORMANCE AND MAX CONTRACT AMOUNT <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 />D Additional Exhibits speci ): <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 />CONTRACTOR SIGNATURE <br />DSHS Central Contract Services <br />6024PF Contract Amendment (1-26-2018) <br />PRINTFn "1" ••c: A ....... ~·~· ~ <br />/I -VIS <br />B d t F. e & r •ro•~··· .... -.. t.,., U ge , inane . vUn L (,JAt, <br />DAT E S IGNED <br />Page 1