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COUNTY <br />PROGRAM AGREEMENT <br />Working Advance Long-Term Payable <br />DSHS Agreement Number <br />2163-23580 <br />This Progra m Ag reeme nt ts by and between the State of Was hington Department of <br />Social and Health S ervices (DSHS)and the Co unty ide ntified below and issued tn <br />conjunction with a County and DSHS Agreement On Genera Terms and Conditions, <br />wh ic h IS I ncorporated by reference. <br />Administration or Division <br />Agreement Number <br />County Agreement Number <br />DSHS ADMINISTRATION <br />Facilities, Finance and <br />Analytics Adm inistration <br />DSHS DIVISION <br />Financial Services <br />DSHS INDEX NUMEER <br />1225 <br />DSHS CONTMCT CODE <br />8030cs-63 <br />DSHS CONTACT NAME AND TITLE <br />Rebecca Doane <br />Office Chief <br />DSHS CONTACT ADDRESS <br />PO Box 45842 <br />-lQlympia WA 98504-5842 <br />DSHS FAX DSHS CONTACT E-MAIL <br />763-2977 Click to enter text <br />NAME COUNTY <br />Kittitas County <br />Kittitas County County Auditors Office <br />205 West 5th Ave County Courthouse Ste 105 <br />EI wA 98926 <br />co <br />J Pless <br />CONTACT COUNTY ACT E-MAIL <br />962-7502 kittitas.wa.us <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM <br />AGREEMENT? <br />No <br />CFOA NUMBERS <br />PROGRAM AGREEMENT START DATE <br />07t01t2021 <br />PROGRAM AGREEMENT END DATE <br />06BAl2A22 <br />MAXIMUM PROGRAM AGREEMENT AMOUNT <br />Based on Annual Review <br />The terms and con ditions of this Contract are an integration and re presentation of the final,enti re nd exclusive <br />understand tng between the parties superseding and merg tng all prevrous agreements,writings and comm unications,oralorothenruise,regarding the subject matter of th is Contract.The parties sig ning below represent that they have read and <br />understand this Contract,nd have the uthority to execute this Co ntract.This Contract shall be bi nding o n DSH S only <br />nature <br />AND TITLE(S)SIGNED <br />Brett Wachsmith, Chairman <br />Board of County Commissioners iuly 6,2021 <br />DSHS SIGNATURE PRINTED NAME AND TITLE <br />Kerra Lynch, Contract Manager <br />DSHS Central Contracts and Leoal Services <br />DATE SIGNED <br />7t19t2021 <br />DSHS Central Contract Services <br />8030CS County Long-Term Payable (3-28-2017) <br />Current Working Advance $54,000 <br />Page !