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COUNTY <br />DSHS Agreement Number <br />lVrShlNQIdR S7Jft <br />Department of Social <br />� <br />2363-49241 <br />719 & Ilealth Services PROGRAM AGREEMENT <br />Transforming lives DDA County Services <br />This Program Agreement is by and between the State of Washington Department of <br />Administration or Division <br />Social and Health Services (DSHS) and the County identified below, and is issued in <br />Agreement Number <br />conjunction with a County and CSHS Agreement On General Terms and Conditions, <br />which is incorporated by reference. <br />County Agreement Number <br />DSHS ADMINISTRATION DSHS DI\ASION 1J51-iS INDEX NUMBER <br />DSHS CONTRACT CODE <br />Developmental Disabilities Division of Developmental 1225 <br />1769CS-63 <br />Admin Disabilities <br />DSHS CONTACT NAME AND TITLE <br />DSHS CONTACT ADDRESS <br />Seanna Woodard <br />1611 W Indiana Ave <br />Operations Manager <br />S okane, WA 99205 <br />DSHS CONTACT TELEPHONE <br />DSHS CONTACT FAX DSHS CONTACT E-MAIL <br />(509)329-2952 <br />1509)568-3037 woodas dshs.wa.aov <br />COUNTY NAME <br />`'CUNTY 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 />BOUNTY CONTACT NAME <br />NUMBER <br /><asey Knutson <br />COUNTY CONTACT TELEPHONE <br />COUNTY CONTACT FAX COUNTY CONTACT E-MAIL <br />509 962-7090 <br />1509 962-5883 l kase .knutson -co.kittitas.wa.us <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOS=S OF THIS PROGRAM <br />ASSISTANCE LISTING NUMBERS <br />AGREEMENT? <br />No <br />PROGRAM AGREEMENT START DATE <br />PROGRAM AGREEMENT END DATE <br />MAXIMUM PROGRAM AGREEMENT AMOUNT <br />07/01 /2023 <br />1 06PSO/20 24 <br />$854,839.00 <br />EXHIBITS. The Following Exhibits are attEched: Exhibit A — Data Security Requirements; Exhibit B — Budget and <br />Spending Plan <br />By their signatures below, the parties agree to the terms and conditions of this County Program Agreement and all <br />documents Incorporated by reference. No other understandings or representations, oral or otherwise, regarding the <br />subject matter of this Program Agreement shall be deemed to exist or bind the parties. The parties signing below certify <br />that they are authorized to sign this Program Agreement. <br />COUNTY SIGNATURE(S) <br />PRINTED NAME(S) AND TITLE(S) <br />DATE(S) SIGNED <br />C heIvi L4VIIZ7 <br />�) I W <br />IV" �1►qaw <br />DSHS SIGNATURE <br />PRINTED NAME AND TITLE <br />DATE SIGNED <br />Jennifer Albertson, Contract Manage <br />11/14/23 <br />Page 1 <br />DSHS Central Contract Services <br />1769CS County Agreement 05-16-2023 <br />