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JIn <br />frRr <br />ll/,r J i, fl (, I I r .l t,t, p <br />DcparlnlBnl oI Social <br />& llealih Services <br />Translorming lives <br />COUNTY <br />PROGRAM AGREEMENT <br />DDA County Services <br />DSHS Agreement Number <br />2363-49241 <br />This Program Agreement is by and between the State of Washi ngton Department ofSocial and Health Se rvices (DSHS) and the County identified below, and is issued in <br />conju nction with a County and DSHS Agreement On General Terms and Conditions, <br />which is incorporated by reference. <br />Administration or Division <br />Agreement Number <br />County Agreement 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 TIiLE---_-- <br />Seanna Woodard <br />Operations Manager <br />DSHS CONTACT ADDRESS <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.qov <br />COUNTY NAME <br />Kittitas County <br />Kittitas County DDA County Services <br />COUNTY ADDRESS <br />507 North Nanum Street Suite 102 <br />Ellensburo. WA 98926-2886 <br />couNTy FEDERAL EMpLoyER rorruirrtcATtotr- <br />NUMBER <br />COUNTY CONTACT NAME <br />Kasey Knutson <br />ACT CONTACT <br />962-7090 962-5883 kn kittitas.wa.us <br />IS THE A SUBRECIPIENT PURPOSES OF PROGRAM ASSISTANCE LISTI NUMBERSAGREEMENT? <br />No <br />PROGRAM AGREEMENT START DATE <br />07101t2023 <br />PROGRAM AGREEM ENT END DATE <br />06t30t2024 <br />MAXIMUM PRoGRAM ncneeIIIIENT nMotIHIr- <br />$854839.00 <br />EXHIBITS The following Exhibits are attached Exhibit A <br />Spendinq <br />- Data Security Requirements; <br />Plan <br />ExhibitB-Budgetand <br />By their srgn atu res below the parties agree to the terms nd conditions of this County P rogram Agreement and alldocumentsncorporatedbyreferenceNootherunderstandingsorrepresentationsoralorothenviseregardingthsubjectmatterofthisPrograAgreementhallbe <br />e <br />m dee med to exist or bi n d the parties.The pa rties si gni ng below certifythatareauthorizedtohISent. <br />TURE(S)PRINTED AND TITLE(S)ED <br />htncy Lullr,re <br />t0,Ptyb \wrAr #)r)ut <br />DSHS <br />K&a',.fop* <br />PRINTED NAME AND TITLE <br />Jennifer Albertson, Contract Managel <br />DATE SIGNED <br />11t14t23 <br />DSHS Cenlral Conlract Services <br />1769CS County Agreement 0S-16-2023 <br />Page 1