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333 <br />Jlrt <br />fiRr <br />Wathto0too Str,t <br />Department of Social <br />& Health Senices <br />Translorming lives <br />COUNTY <br />PROGRAM AGREEMENT <br />DDA Gounty Services <br />DSHS Agreement Number <br />2163-24876 <br />This Program Agreement is <br />Social and Health Services <br />by and between the State of Washington Department of <br />(DSHS) and the Coung identified below, and is issued in <br />conjunction with a County and DSHS Agreement On General Terms and Conditions, <br />which is incorporated by reference. <br />Adminislration or Division <br />Agreemenl Number <br />County Agreemenl Number <br />DSHS ADMINISTRATION <br />Developmental Disabilities <br />Admin <br />DSHS DIVISION <br />Division of Developmental <br />Disabilities <br />DSHS INDEX NUMBER <br />1225 <br />DSHS CONTRACT CODE <br />1769CS-63 <br />DSHS CONTACT NAME AND TITLE <br />Seanna Woodard <br />Operations Manager <br />DSHS CONTACTADDRESS <br />1611 W lndiana Ave <br />Spokane, WA 99205 <br />DSHS CONTACT TELEPHONE <br />(509)329-2952 <br />DSHS CONTACT FAx <br />(509)568-3037 <br />DSHS CONTACT E-MAIL <br />woodas@dshs.wa.oov <br />COUNTY NAME <br />Kittitas County <br />Kittitas County DDA County Services <br />COUNTYADDRESS <br />507 North Nanum Street Suite 102 <br />, wA 98926-2886 <br />COUNTY FEDERAL EMPLOYER IDENTIFICATION <br />NUMBER <br />91-6001 349 <br />COUNTY CONTACT NAME <br />Kasey Knutson <br />FAX <br />962-7090 962-s883 wa. <br />IS THE COUNryA <br />AGREEMENT? <br />PURPOSES OF THIS CFDA <br />No <br />PROGRAM AGREEMENT START DATE <br />07101t2021 <br />PROGRAM AGREEMENT END DATE <br />06t30t2022 <br />MAXIMUM PROGRAM AGREEMENT AMOUNT <br />$630,642.00 <br />following Exhibits are attached: Exhibit A - Data Security ExhlbltB-Budgetand <br />Plan <br />By their sig natu res below the pa rties agree to the term s and conditions of th is Cou nty Program reement and all <br />documents incorporated by reference.No other understand ings or representation s,oral or oth erwtse,regarding the <br />subject matte I of th ls Program Ag reement shall be deemed to exist or bind the parties.Th parties sl gn ing below certify <br />that are au n th ls ram <br />couNw STGNATURE(S)PRTNTED NAME(S) AND TTTLE(S) <br />Trrshv l-oWb <br />DrREcroR # <br />DATE(S) STGNED <br />0l lur <br />D1 <br />DSHS srcNArr*r (/ <br />VZoZ;ua Daloct <br />PRINTED NAME AND TITLE <br />Melissa Diebert, Management Analvst <br />DATE SIGNED <br />09t24t21 <br />DSHS Central Contract Seruices <br />1 769CS County Agreement 06-08-2021 <br />Page 1