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Jlrl <br />frRr <br />ly!Jrrntl0t st,tt? <br />Dcpailmcnt of Social <br />& llealth Services <br />Transforming lives <br />COUNTY PROGRAM AGREEMENT <br />AMENDMENT <br />DSHS Agreement Number <br />2363-49241 <br />Amendment No. <br />a2 <br />This Program Agreement Amendment is by and between the State of Washington <br />Department of Social and Health Services (DSHS) and the County identified below <br />Administration or Division <br />Agreement Number <br />Click lrere to enter text. <br />Counly 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 CONTRACT 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-MAIL <br />woodas@dshs.wa.qov <br />COUNry NAME <br />Kittitas County <br />Kittitas County DDA County Services <br />Ellensburq, WA 98926-2886 <br />COUNTY ADDRESS <br />507 North Nanum Street Suite 102 <br />COUNTY FEDERAL EMPLOYER IDENTIFICATION <br />NUMBER <br />COUNTY CONTACT NAME <br />Kasev Knutson <br />COUNTY CONTACT TELEPHONE <br />(s09) 962-7090 <br />COUNTY CONTACT FAX <br />(509) 962-5883 <br />COUNry CONTACT E-MAIL <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 />07t01t2024 <br />PROGRAM AGREEMENT END DATE <br />06t30t2025 <br />PRIOR MAXIMUM PROGRAM AGREEMENT <br />AMOUNT <br />$1,118,442.00 <br />AMOUNT OF INCREASE OR DECREASE <br />$883,352.00 <br />IOTAL MAXIMUM PROGRAM AGREEMENT <br />AMOUNT <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:X Exhibits (specifv): Exhibit 81 Proqram Aqreement Budqet <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 othenrvise, regarding the subject matter of this Program Agreement Amendment <br />shall be deemed to exist or bind the parties. All other ierms 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 Proqram Aqreement Amendment. <br />COUNry SIGNATURE(S)PRINTED NAME(S) ANQ TITLEIS) <br />ckrlx".l Lr*111u> <br />?, tl^if*t{"Uv.'eb. <br />DATE(S) SIGNED <br />*l tzfz,1 <br />DSHS <br />4/6arAen, <br />PRINTED NAME AND TITLE <br />Jennifer Albertson, Contract Speciali <br />DATE SIGNED <br />;t 1013124 <br />DSHS Central Conlracl Services <br />1 769CP Contract Amendmenl (6-1 0-24) <br />RECEIVED <br />AUG 16 202tr <br />DDASPOKANE <br />Page 1