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DSHS Agreement Number <br />COUNTY PROGRAM AGREEMENT <br />2363-49241 <br />Department of Social <br />V <br />7 &HealthserVices <br />AMENDMENT <br />Amendment No. <br />02 <br />Transforming lives <br />This Program Agreement Amendment is by and between the State of Washington <br />Administration or Division <br />Department of Social and Health Services (DSHS) and the County identified below. <br />Agreement Number <br />Click here to enter text. <br />County Agreement Number <br />DSHS ADMINISTRATION <br />DSHS DIVISION <br />DSHS INDEX NUMBER <br />CCS CONTRACT CODE <br />Developmental Disabilities <br />Division of Developmental <br />1225 <br />1225 <br />Admin <br />Disabilities <br />DSHS CONTACT NAME AND TITLE <br />DSHS CONTACT ADDRESS <br />Seanna Woodard <br />1611 W Indiana Ave <br />Spokane, WA 99205 <br />DSHS CONTACT TELEPHONE <br />DSHS CONTACT FAX DSHS CONTACT E-MAIL <br />509 329-2952 <br />509)568-3037 woodas@dshs.wa.gov <br />COUNTY NAME <br />COUNTY ADDRESS <br />Kittitas County <br />507 North Nanum Street Suite 102 <br />Kittitas County DDA County Services <br />Ellensburg. WA 98926-2886 <br />COUNTY FEDERAL EMPLOYER IDENTIFICATION <br />COUNTY CONTACT NAME <br />NUMBER <br />Kasey Knutson <br />COUNTY CONTACT TELEPHONE <br />COUNTY CONTACT FAX <br />COUNTY CONTACT E-MAIL <br />509 962-7090 <br />509 962-5883 <br />kase .knutson co.kittitas.wa.us <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM <br />CFDA NUMBERS <br />AGREEMENT? <br />No <br />AMENDMENT START DATE <br />PROGRAM AGREEMENT END DATE <br />07/01 /2024 <br />06/30/2025 <br />PRIOR MAXIMUM PROGRAM AGREEMENT <br />AMOUNT OF INCREASE OR DECREASE <br />TOTAL MAXIMUM PROGRAM AGREEMENT <br />AMOUNT <br />AMOUNT <br />$1,118,442.00 <br />$883,352.00 <br />$2,001,794.00 <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 are <br />incorporated into this Program Agreement Amendment by reference: <br />® Exhibits (specify): Exhibit 61 Program Agreement Budget <br />This Program Agreement Amendment, including all Exhibits and other documents incorporated by reference, contains all <br />of the terms and conditions agreed upon by the parties as changes to the original Program Agreement. 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) <br />PRINTED NAME(S) AND TITLE(S) <br />DATE(S) SIGNED <br />DSHS SIGNATURE <br />PRINTED NAME AND TITLE <br />DATE SIGNED <br />DSHS Central Contract Services <br />1769CP Contract Amendment (6-10-24) Page 1 <br />