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l� <br />DSHS CONTRACT NUMBER: <br />slate tial CONTRACT AMENDMENT 1763-98187 <br />Department <br />Department of Social <br />& Health Services <br />L <br />_ Amendment No. 03 <br />Transforming lives <br />This Contract Amendment is between the State of Washington Department of Program Contract Number - <br />1 <br />Social and Health Services (DSHS) and the Contractor identified below. Click here to enter text <br />Contractor Contract Number <br />CONTRACTOR NAME CONTRACTOR doing business as (DBA) <br />Kittitas County Kittitas County DDA County Services <br />CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS DSHS INDEX NUMBER <br />507 North Nanum Street Suite 102 IDENTIFIER (UBI) 1225 <br />192-002-673 <br />Ellensbur , WA 98926-2886 <br />_ <br />CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS <br />Joann Schaan (509 933-8233 Click here to enter text. Click here to enter text. <br />DSHS ADMINISTRATION <br />DSHS DIVISION DSHS CONTRACT CODE <br />Developmental Disabilities Admin <br />Division of Developmental 1769CS-63 <br />Disabilities <br />DSHS CONTACT ADDRESS <br />DSHS CONTACT NAME AND TITLE <br />'Seanna Woodard <br />1611 W Indiana Ave <br />Operations Manager <br />S okane, WA 99205 <br />DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS <br />509 329-2952 (509)568-3037 1 woodaq@dshs.wa.gov <br />IS THE CONTRACTOR A SUSRECIPIENT 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 />$826,847.00 $801,577.00 $1,628,424.00 <br />REASON FOR AMENDMENT; <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 />❑ Additional Exhibits s ecif . <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 />PRINTFD ^0AIAC""'^""'rDATE SIGNED <br />A <br />*CONTRAAICT-06R—SIGNATUIRE <br />PRINTE@irt DATE SI NED <br />1AA 'Ai r <br />Contract Manager <br />Budget, Finance & <br />DSHS Central Contract Services Page 1 <br />6024PF Contract Amendment (1-26-2018) <br />