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RECEIVED <br />OCT 11 2017 <br />■ %L—%-0S—S X71.—" <br />SEP 15't'017 <br />DSHS Central Contract Services Page 1 <br />1769CS County Agreement 6-15-2017 DDA SPOKANE- <br />U� <br />DDA SPOKANE <br />DSHS Agreement Number <br />rnglon <br />or social <br />V iie'a <br />t."�'i'"""'1763-98187 <br />'Illan ; ,�� ; ; �t:-, AUNTYeartment <br />7 lthservices <br />PROGRAM AGREEMENT <br />Transforming lives <br />DDA County Services <br />This Program Agreement is by and between the State of Washington Department of <br />Administration or Division <br />Social and Health Services (DSHS) and the County identified below, and is issued in <br />Agreement Number <br />conjunction with a County and DSHS Agreement On General Terms and Conditions, <br />which is incorporated by reference. <br />County Agreement Number <br />DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER DSHS CONTRACT CODE <br />Developmental Disabilities Division of Developmental 1225 1769CS-63 <br />Admin Disabilities <br />DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS <br />Seanna Woodard 1611 W Indiana Ave <br />Operations Manager <br />Spokane, WA 99205 <br />DSHS CONTACT TELEPHONE <br />DSHS CONTACT FAX <br />DSHS CONTACT E-MAIL <br />(509)329-2952 <br />509 568-3037 <br />woodas dshs.wa. ov <br />COUNTY NAME <br />COUNTY ADDRESS <br />Kittitas County <br />507 North Nanum Street Suite 102 <br />Kittitas County DDA County Services <br />Ellensburg, WA 98926 <br />COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME <br />NUMBER <br />Joann Schaan <br />COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX „COUNTY C NTACT EMAIL <br />0A <br />509 933-8233 �. tr:. G C <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM <br />CFDA NUMBERS <br />AGREEMENT? <br />No <br />PROGRAM AGREEMENT START DATE PROGRAM AGREEMENT END DATE <br />MAXIMUM PROGRAM AGREEMENT AMOUNT <br />07/01/2017 06/30/2018 <br />I <br />$820,341.00 <br />EXHIBITS. The following Exhibits are attached: Exhibit A — Data Security Requirements; Exhibit B — Budget and <br />Spending Plan; Exhibit C -Fund Match Certification <br />By their signatures below, the parties agree to the terms and conditions of this County Program Agreement and all <br />documents incorporated by reference. No other understandings or representations, oral or otherwise, regarding the <br />subject matter of this Program Agreement shall be deemed to exist or bind the parties. The parties signing below certify <br />that they are authorized to sign this Program Agree ent. <br />COUNTY SIGNATURE(S) <br />PRINTED NAME(S) AND TITLE(S) <br />DATE(S) SIGNED <br />DSHS SIGNATURE <br />PRIMED NAME AND TITLE <br />elissa Diebert <br />DATE SIGNED <br />Contract Manager <br />■ %L—%-0S—S X71.—" <br />SEP 15't'017 <br />DSHS Central Contract Services Page 1 <br />1769CS County Agreement 6-15-2017 DDA SPOKANE- <br />U� <br />