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DSHS Agreement Number <br />wasmoton s ste COUNTY PROGRAM AGREEMENT 2163-24876 <br />Department of Social <br />I &Health services AMENDMENT Amendment No. <br />Transforming lives DDD County Services 02 <br />This Program Agreement Amendment is by and between the State of Washington Administration or Division <br />Department of Social and Health Services (DSHS)and the County identified below.Agreement Number <br />Click here to enter text. <br />County Agreement Number <br />DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER CCS CONTRACT CODEDevelopmentalDisabilitiesDivisionofDevelopmental12251225 <br />Admin Disabilities <br />DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS <br />Seanna Woodard 1611 W Indiana Ave <br />Spokane,WA 99205 <br />DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL(509)329-2952 (509)568-3037 woodas@dshs.wa.gov <br />COUNTY NAME COUNTY ADDRESS <br />Kittitas County 507 North Nanum Street Suite 102 <br />Kittitas County DDA County Services <br />Ellensburg,WA 98926-2886 <br />COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME <br />NUMBER <br />Kasey Knutson <br />COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX COUNTY CONTACT E-MAIL(509)962-7090 (509)962-5883 kasey.knutson@co.kittitas.wa.us <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM CFDA NUMBERSAGREEMENT? <br />No <br />AMENDMENT START DATE PROGRAM AGREEMENT END DATE <br />01/01/2023 06/30/2023 <br />PRIOR MAXIMUM PROGRAM AGREEMENT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM PROGRAM AGREEMENTAMOUNTAMOUNT <br />$1,261,284.00 $89,756.00 <br />$1,351,040.00 <br />REASON FOR AMENDMENT; <br />CHANGE OR CORRECT OTHER:SEE PAGE TWO <br />EXHIBITS.When the box below is marked with a check (4)or an X,the following Exhibits are attached and areincorporatedintothisProgramAgreementAmendmentbyreference: <br />Exhibits (specify):Exhibit B-1,Program Agreement Budget. <br />This Program Agreement Amendment,including all Exhibits and other documents incorporated by reference,contains allofthetermsandconditionsagreeduponbythepartiesaschangestotheoriginalProgramAgreement.No other <br />understandings or representations,oral or otherwise,regarding the subject matter of this Program Agreement Amendment <br />shall be deemed to exist or bind the parties.All other terms and conditions of the original Program Agreement remain in <br />full force and effect.The parties signing below warrant that they have read and understand this Program Agreement <br />Amendment,and have authority to enter into this Program Agreement Amendment. <br />COUNTY SIGNATURE(S)PRINTED NAME(S)AND TITLE(S)DATE(S)SIGNED <br />DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED <br />DSHS Central Contract Services <br />1769CP Contract Amendment (12-10-21)Page 1