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Washington State COUNTY PROGRAM AGREEMENT <br />Department of Social <br />& Health Services STW Program Development <br />Transforming fives <br />This Program Agreement is by and between the State of Washington <br />Department of Social and Health Services (DSHS) and the County identified <br />below, and is issued in conjunction with a County and DSHS Agreement On <br />General Terms and Conditions, which is incorporated by reference. <br />Division of Vocational <br />Rehabilitation <br />DSHS CONTACT NAME AND TITLE <br />Austin Diaz -Munoz <br />Contracts Specialist <br />DSHS CONTACT TELEPHONE <br />(564) 200-2812 <br />DSHS DIVISION DSHS !NDEX NUMBER <br />Division of Vocational 1225 <br />Rehabilitation <br />DSHS CONTACT AC <br />4565 7th Ave SE <br />DSHS Agreement Number <br />2463-57835 <br />Administration or Division <br />Agreement Number <br />County Agreement Number <br />DSHS CONTRACT CODE <br />850OCC-63 <br />Lacey, WA 98503 <br />DSHS CONTACT FAX DSHS CONTACT E-MAIL <br />Click here to enter text Austin. DiazMunoz c <br />COUNTY NAME COUNTY ADDRESS <br />Kittitas County 507 North Nanum Street Suite 102 <br />Ellensburg, WA 98926-2886 <br />COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME <br />NUMBER Chelsey Loeffers <br />COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX COUNTY CONTACT E-MAIL <br />509 962-7515 509) 962-7581 Chelsey.loeffers@co.kittitas.wa.us <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM ASSISTANCE LISTING NUMBERS <br />AGREEMENT? <br />No <br />PROGRAM AGREEMENT START DATE PROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT <br />08/01 /2024 03/31 /2025 $101,700.00 <br />EXHIBITS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into this <br />County Program Agreement by reference <br />® Exhibits (specify): Exhibit A - Data Security Requirements Exhibit B - Estimated Bi-Annual Budget <br />❑ No Exhibits. <br />The terms and conditions of this Contract are an integration and representation of the final, entire and exclusive <br />understanding between the parties superseding and merging all previous agreements, writings, and communications, oral <br />or otherwise, regarding the subject matter of this Contract. The parties signing below represent that they have read and <br />understand this Contract, and have the authority to execute this Contract. This Contract shall be binding on DSHS only <br />upon signature by DSHS. <br />ED <br />COUNTY SIGNATURE(S) PRINTED NAMIE(5) AND TITLES) DATE{S) SIGN <br />DSHS SIGNATURE <br />PRINTED NAME AND TITLE <br />DATE SIGNED <br />DSHS Central Contract Services <br />6017CF County Program Agreement (10-31-2017) Page 1 <br />