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Washington State INTERAGENCY AGREEMENT HCA Contract Number: K3924 <br />for Contractor/Vendor Contract Number: <br />Health Care uthority CPWI Prevention Services <br />THIS CONTRACT is made by and between Washington State Health Care Authority (HCA) and <br />Contractor. <br />CONTRACTOR NAME <br />CONTRACTOR DOING BUSINESS AS (DBA) <br />Kittitas County <br />HCA CONTACT ADDRESS <br />CONTRACTOR ADDRE9S I Street City <br />State <br />Zip Code <br />PO Box 881 Ellensburg <br />WA <br />98926 <br />Ellensburg, WA 98926 <br />HCA CONTACT E-MAIL ADDRESS <br />360-725-2042 <br />CONTRACTOR CONTACT <br />CONTRACTOR TELEPHONE <br />CONTRACTOR E-MAIL ADDRESS <br />Kasey Knutson <br />509-962-9775 <br />ann.riley@kccn.org <br />Is Contracto© Subrecipient under this Contract? <br />CFDA NUMBER(S): <br />FFATA Form REgired <br />®YES NO <br />1 93.959, 93.243, 93.788 <br />® YES NO <br />HCA PROGRAM <br />DBHR <br />HCA DIVISION/SECTION <br />Prevention <br />HCA CONTACT NAME AND TITLE <br />HCA CONTACT ADDRESS <br />Fallon Baraga, Agreement Manager <br />Health Care Authority <br />621 8"'Avenue SE <br />Olympia, WA 98504 <br />HCA CONTACT TELEPHONE <br />HCA CONTACT E-MAIL ADDRESS <br />360-725-2042 <br />fallon.baraga@hca.wa.gov <br />CONTRACT START DATE I CONTRACT END DATE I TOTAL MAXIMUM CONTRACT AMOUNT <br />7/1/2019 1 6/30/2021 1 $220,000 <br />PURPOSE OF CONTRACT: <br />Obtaining CPWI Prevention Services in order to increase capacity to implement direct and environmental substance use <br />prevention services in high need communities qualified to immediately implement identified evidence -based practices <br />and programs to prevent and reduce the misuse and abuse of alcohol, tobacco, marijuana, opioids, and other drugs. <br />The parties signing below warrant that they have read and understand this Contract, and have authority to <br />execute this Contract. This Contract will be binding on HCA only upon signature by HCA. <br />CONTRACTOR SIGNATURE <br />PRINTED NAME AND TITLE <br />DATE SIGNED <br />HCA SIGNATURE <br />PRINTED NAME AND TITLE <br />DATE SIGNED <br />Kerry J Breen, Acting Contracts Administrator <br />Division of Legal Affairs <br />Washington State Page 1 HCA Contract No. K3924 <br />Health Care Authority <br />