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DocuSign Envelope ID: 262ABA18-5354-4F41-9508-9B13C8ACBA6D <br />Signature of Contractor Authorized Representative Date <br />By signing this document, the Contractor Authorized Representative attests to the information. <br />HCA will not endorse the Contractor's sub -award until this form is completed and returned. <br />FOR HEALTH CARE AUTHORITY USE ONLY <br />HCA Contract Number: K <br />Sub -award Project Description (see instructions and examples below) <br />Instructions for Sub -award Project Description: <br />In the first line of the description provide a title for the sub -award that captures the main purpose of <br />the Subrecipients work. Then, indicate the name of the Subrecipient and provide a brief description <br />that captures the overall purpose of the sub -award, how the funds will be used, and what will be <br />accomplished. <br />Example of a Sub -award Project Description: <br />Increase Healthy Behaviors: Educational Services District XYZ will provide training and technical <br />assistance to chemical dependency centers to assist the centers to integrate tobacco use into their <br />existing addiction treatment programs. Funds will also be used to assist centers in creating tobacco <br />free treatment environments. <br />Washington State Page 34 of 53 HCA IAA K4649 <br />Health Care Authority Revised 10/2020 <br />