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Jlrr <br />frfir <br />if r..;,!r r 0 i o il 5 r.t,, t <br />Deparlment ol Sociai <br />& Health Services <br />Irarrrforning /fves <br />COI,JNTY PROG RAM AG REEMENT <br />AMENDMENT <br />DDD County Services <br />DSHS Agreement Number <br />2163-24876 <br />Amendment No <br />02 <br />This Program Agreement Amendment is by and between the state of washington <br />Department of Social and Health Serv ces (DSHS) and the County identified below <br />Administration or Division <br />Agreemenl Number <br />CIicl< here to enter text. <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 />CCS CONTMCT CODE <br />1225 <br />DSHS CONTACT NAME AND TITLE <br />Seanna Woodard <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-MAII <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 />EI , wA 98926-2886 <br />COUNTY FEDERAL EMPLOYER IDENTIFICA-ION <br />NUMBER <br />COUNTY CONTACT NAME <br />Kasey Knutson <br />COUNTY CONTACT TELEPHONE <br />(509) 962-7090 <br />COUNTY CONTACT FAX <br />(50s) 962-5883 <br />COUNTY CONTACT E-I\4AIL <br />kasev. knutson @co kittitas.wa us <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM <br />AGREEMENT? <br />No <br />CFDA NUMBERS <br />AMENDMENT START DATE <br />01101t2023 <br />PROGRAM AGREEMENT END DATE <br />06t30t2023 <br />PRIOR MAXIMUM PROGMM AGREEMENT <br />AMOUNT <br />$1,261,284 00 <br />AMOUNT OF INCREASE OR DECREASE <br />$89,756 00 <br />TOTAL MAXIMUM PROGRAM AGREEMENT <br />AMOUNT <br />351 040.001 <br />REASON FOR AMFNDMENT; <br />CHANGE OR CORRECT OTHER: SEE PAGE TWO <br />theEXHBITSWhen box low IS mar ke d wit a ch ec 4 or X,th follow no Exh ibits a re attached d arehhk()n na <br />in co to this rogra m Ag ree me nt Amend me by referporated <br />Exhibits <br />n P tn n <br />Exhibit B-1 reement BudP <br />This Program Agreement Amendmenl including all Exhi bits and other documents incorporated by reference, coniains all <br />of the terms and conditions agreed up:n by the parties as changes to the orrginal Program Agreemeni. No other <br />understandings or representations, oral or otheruvise, re garding the subject matter of this Program Agreement Amendment <br />shall be deemed to exist or bind the parties. All other te rms and conditions of the original Program Agreement remain in <br />fullforce and effect. The parties signing belowwarrant that they have read and understand this Program Agreement <br />Amendment and ave into this ram reement Amendment. <br />COUNTY PRTNTED NAME(S) AND IrLE(S) <br />Cot,y lDt ig ht <br />be@ CLL-k/.LAl-n-- <br />DATE(S) SIGNED <br />o 5 l/uh3 <br />DSHS SIGNATURE <br />7-annX-lqfrE <br />PRINIED NAME AND TITLE <br />Tammy Layton, Contract Manager <br />DATE SIGNED <br />6t7t2023 <br />DSHS Central Contract Services <br />1769CP Contract Amendment (1 2-1 0-21 ) <br />f;{EilHlV$:[; <br />f,'l/XY t .t ?01:i <br />[]il].A $fr{-}Ki\t{t*Page 1