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INTERAGENCY AGREEMENT <br />for <br />CPWI Prevention Services <br />HCA Contract Number: K3924 <br />ContractorNendor Contract Number: <br />THIS CONTRACT is made by and between Washington State Health Care Authority (HCA) and <br />Contractor. <br />CONTRACTOR NAME <br />Kittitas County <br />507 N Nan um St, Ste 102 <br />CONTRACTOR CONTACT <br />Chelsey Loeffers <br />Is Contractor a Subrecipient under this Contract1 <br />XYES ONO <br />Is Contractor a Subrecipient under this Contract? <br />HCA PROGRAM <br />DBHR <br />HCA CONTACT NAME AND TITLE <br />Fallon Baraga, Agreement Manager <br />HCA CONTACT TELEPHONE <br />360-725-2042 <br />CONTRACT START DATE <br />7/1/2019 <br />PURPOSE OF CONTRACT: <br />CONTRACTOR DOING BUSINESS AS (DBA) <br />City <br />Ellensburg <br />State <br />WA <br />Zip Code <br />98926 <br />CONTRACTOR TELEPHONE CONTRACTOR E-MAIL ADDRESS <br />509-962-7515 chelsey.loe'ffers@co.ki t titas .wa.us <br />CFDA NUMBER(S): FFATA Form Required <br />93 .959, 93.243, 93.788 !Z!YES O NO <br />CFDA NUMBER(S): FFATA Form Required <br />HCA DIVISION/SECTION <br />Prevention <br />HCA CONTACT ADDRESS <br />Health Care Authority <br />621 8th Avenue SE <br />Olympia, WA 98504 <br />HCA CONTACT E-MAIL ADDRESS <br />fallon.baraga@hca.wa.gov <br />CONTRACT END DATE TOTAL MAXIMUM CONTRACT AMOUNT <br />6/30/2021 $220,000 <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 and <br />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 />Washington State <br />Health Care Authority <br />PRINTE0 NAME AND TITLE <br />v 1 ~ i--l-ll1 L-a wJo . d <br />PRINT ED NAME AND TITLE <br />Rachelle Amerine, Contracts Administrator <br />Division of Legal Affairs <br />Page 1 of 90 HCA Contract No. K3924 <br />DATE SIGN ED