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t <br />Jlrt <br />fif,r <br />Washin0lon Slale <br />Department of Social <br />& Health Services <br />Transforming Iives <br />CONTRACT AMENDMENT <br />DSHS CONTRACT NUMBER <br />2463-57835 <br />Amendment No. 01 <br />This Contract Amendment is between the State of Washington Department of <br />Socialand Health Services (DSHS) and the Contractor identified below <br />Program Contract Number <br />Click here to enter text. <br />Contractor Contract Number <br />CONTRACTOR NAME <br />Kittitas County <br />CONTRACTOR doing business as (DBA) <br />CONTRACTOR ADDRESS <br />507 North Nanum Street Suite 102 <br />Ellensburq, WA 98926-2886 <br />WASHINGTON UNIFORM BUSINESS <br />IDENTIFIER (UBI) <br />192-002-673 <br />DSHS INDEX NUMBER <br />1225 <br />CONTRACTOR CONTACT <br />Chelsey Loeffers <br />CONTMCTOR TELEPHONE <br />(s09) 962-7s15 <br />CONTRACTOR FAX <br />(509) 962-7581 <br />CONTRACTOR E.MAIL ADDRESS <br />Chel sey. loeffers@co. kittitas.wa <br />us <br />DSHS ADMINISTRATION <br />Division of Vocational Rehabilitation <br />DSHS DIVISION <br />Division of Vocational <br />Rehabilitation <br />DSHS CONTRACT CODE <br />8500cc-63 <br />DSHS CONTACT NAME AND TITLE <br />Austin Diaz-Munoz <br />Contracts Specialist <br />DSHS CONTACT ADDRESS <br />4565 7th Ave SE <br />Lacev, WA 98503 <br />DSHS CONTACT TELEPHONE <br />(564\ 200-2812 <br />CONTACT FAX <br />Click here lo enter iext <br />DSHS CONTACT E-MAIL ADDRESS <br />Austi n. DiazMunoz@dshs.wa. gov <br />IS THE CONTRACTOR A sueRectplrNT FoR PURPoSES oF THls coNTRAcr? <br />No <br />CFDA NUMBERS <br />AMENDMENT START DATE <br />a3t31t2025 <br />CONTRACT END DATE <br />06t30t2025 <br />PRIOR MAXIMUM CONTRACT AMOUNT <br />$101,700.00 <br />AMOUNT OF INCREASE OR DECREASE <br />$-75,700.00 <br />TOTAL MAXIMUM CONTRACT AMOUNT <br />$26,000.00 <br />AMENDMENT; <br />CHANGE OR CORRECT CHOOSE ONE: <br />ATTACHMENTS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into <br />this Contract Amendment by reference. <br />Additional Exhibits Exhibit B - Estimated Bi-Annual <br />This Contract Amendment,ncluding all Exhibits and other documents incorPorated by reference, contains all of the terms <br />and conditions agreed upon by the parties as changes to the originalContract. No other understandings or <br />representations,oral or otherwise, regarding the subject matter of this Contract Amendment shall be deemed to exist or <br />bind the parties.Alt other terms and cond iti ons of the original Contract remaln tn full force nd effect.The pa rties sign tng <br />below warrant that they h ave read and un derstand this Contract Amendme nt,and have a uthority to enter into th IS c ontract <br />Amendment. <br />PRINTED NAME AND TITLE <br />\/^^^--vA, D s t A-oLr -e- z- <br />brve-t- Llt-aLrwl o4 <br />SIGNED <br />Irr /es <br />PRINTED NAME AND TITLE <br />/4.,n*f" n- J, floJ.. 6" L/ 14t,...''- <br />DATE SIGNED <br />05/n x /'2 <ztr- <br />DSHS Central Contract Services <br />6024PF Contract Amendment (1 -26-201 8) <br />Page 1