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DocuSign Envelope ID: 4166FC64-6496-4305-B555-38A174BDAA73 <br />By signing this document, the Contractor Authorized Representative attests to the information. <br />HCA will not endorse the Contractor's subaward until this form Is completed and returned. <br />FOR HEAL TH CARE AUTHORITY USE ONL Vi <br />HCA Contract Number: <br />Sub-award Project Description (see instructions and examples below) <br />Instructions for Sub-award Project Description: <br />In the first line of the description provide a title for the sub-award that captures the main purpose of the <br />subrecipients work. Then, indicate the name of the subrecipient and provide a brief description that captures <br />the overall purpose of the sub-award, how the funds will be used, and what will be accomplished. <br />Example of a Sub-award Project Description: <br />Increase Healthy Behaviors: Educational Services District XYZ will provide training and technical assistance to <br />chemical dependency centers to assist the centers to integrate tobacco use into their existing addiction <br />treatment programs. Funds will also be used to assist centers in creating tobacco free treatment environments. <br />Local Health Jurisdiction <br />Washington State Health Care Authority <br />Page 43 of 59 Medicaid Administrative Claiming <br />Contract # K3069