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DSHS Agreement Number <br />2463-57835COUNTY PROGRAM AGREEMENT <br />STW Program DeveloPment <br />-bfif,r <br />Washingtan Slate <br />Department of Social <br />& Health Services <br />Transforming lives <br />Administration or Division <br />Agreement Number <br />Cou nty Agreement Number <br />Washi nethofStateSIanbetweenngtodmrarsThbyProgAgreement <br />thed identifiedServicesanSociofaalHeandIthCounty(DSH s)Department <br />ntreeme OnDSHSandtnnunctioawithCouadnisedntyAgssuconjowbel, <br />referenceiswhichbyasConditionndsenGeraermT <br />NUMBERDtvtsloNTIONADDSHS I <br />1225Division of Vocational <br />Rehabilitation <br />Division of Vocational <br />Rehabilitation <br />-DSHS <br />CONTMCT CODE <br />8500cc-63 <br />OSHS COruTRCT ADDRESS <br />4565 7th Ave SE <br />Lacev, WA 98503 <br />DSHilONIACT NAME AND TITLE <br />Austin Diaz-Munoz <br />Contracts Specialist <br />DSHS CONTACT E-MAIL <br />Austin. DiazMunoz@dshs.wa. govDSHS CONTACT FAX <br />Click lrere to enter text. <br />-osnscoNtecrrELEPHoNE <br />(564\ 200-2812 <br />COUNWADDRESS <br />507 North Nanum Street Suite 102 <br />Ellensbu wA 98926-2886 <br />COUNW NAME <br />Kittitas CountY <br />COUttW FEDERAL EMPLOYER IDENTIFICATION <br />NUMBER <br />COUNTY CONTACT E.MAIL <br />Chelsey. loeffers@co. kitlllqq,lryq. u9-COUNTY CONTACT FAX <br />(509) 962-7581 <br />TELEPHONE <br />(509) 962-751 5 <br />COUNTY <br />LISTING NUMBASS <br />AGREEMENT? <br />No <br />OF THIS PROGRAMKPU:iE5IENT FOR PUIS THE COUNTY A SUBRECIP <br />MMIMUM PROG RAM AGREEMENTAMOUNT <br />$101 ,700.00 <br />PROGRAM AGREEMENT END DATE <br />03t31t2025 <br />PROGRAM AGREEMENT START DATE <br />08to112024 <br />County Program Agree <br />[l exnluits (specify): <br />l-l tto Exhibits. <br />ment by reference: <br />Exhibit A - Data Security Requirements Exhibit B - Estimated Bi-Annual Budget <br />attached and are incorporated into thisEXHIBITS. When the box below is marked with an X, the following Exhibits are <br />DATE(S)COUNTY <br />DATEPRINTED NAME Co'tt"qdr'./x\\ <br />TITLEDSHSTURE <br />A.rE\IDqtJf\0"AuxL,, <br />tt/,f=7 <br />andentire exclusivetheofndfinal,reareContractanconditionandofsthis presentationtermsntegrationThe oracommunicationsandwritientsallngs,andthebetween prevrous agreemnderstandumergingsupersedingngparties <br />readhave andrethatbelowtheyTheContract.presentsubthemofatterthissigpartiesnrngotherwise,or ing jectregard <br />I be ndibi on DSHSThiContractshal onlyContract.this ngtheexecutetothishaveandnderstaundauthorityContract, <br />RE(S)ANNAM <br />CK <br />T) <br />DSHS. <br />DSHS Centrat Contract Services <br />601 7CF County Program Agreement (1 0-31 -201 7)Page 1