Laserfiche WebLink
DSHS Agreement Number <br />2463-57835COUNTY PROGRAM AGREETI'ENT <br />STW Program DeveloPment <br />Jlrt <br />fifrr <br />Vlashing!on Slzle <br />Department of Social <br />& Health Seruices <br />Transforming lives <br />Agreement Number <br />County Agreement Nurnber <br />Admi n or Division <br />below, and is issued in conjunction with <br />GeneralTerms and Conditions, which is <br />ndanthbetweenStateeofWashiThmisngtotsbyPrograAgreement <br />edidentifiServicesHealthandtheSociofaandCounty(DSHS)Department <br />S mentree OnaCouDSHandAgnty <br />rated reference. <br />SSHS CONTRACT CODE <br />8500cc-63 <br />DSHS INDEX NUMSER <br />1225 <br />DSHS DIVISION <br />Division of Vocational <br />Rehabilitation <br />Division of Vocational <br />Rehabilitation <br />4565 7th Ave SE <br />wA 98503 <br />DSHs coNTAcr NAME AND TIrLE <br />Austin Diaz-Munoz <br />Contracts SPecialist <br />TEFSTdtwncr E+rntl <br />Austi n. Di azMunoz@dshs.wa. gov <br />DSHS CONTACT FAX <br />Cilck Irere to enter tex!. <br />oSnS eoltrncr TELEPHoNE <br />(564\ 200-2812 <br />coururv nooRuSs <br />507 North Nanum Street Suite '102 <br />Ellensburq, WA 98926-2886 <br />COUNTY NAME <br />Kittitas CountY <br />COU|tTY CONTACT NAME <br />Chelsey Loeffers <br />COUru.fY TTNERAL EMPLOYER I DtrN]-IFICATION <br />NUMBER <br />kittitas.wa.us <br />COUNTYTouruTY coNTAcr rAX <br />(509) 962-7581 <br />COUNw coN].ACT TELEPHONE <br />(509) 962-7515 <br />NGNIS THE COUNTY A SUBRECIPIENT FOR <br />AGREEMENT? <br />No <br />PURPOSES OF THIS PROGRAM <br />-MAXt tvtUMFRoc RAtvl- A€n€E r',1 erur auclurur <br />s101 .700.00 <br />PROGRAM AGREEMENT END DATE <br />03131t2025 <br />pn6cnnu AGREEMENT srART DATE <br />ogto1t2g24 <br />County Program Agreement by reference <br />X ex-triOitJ lspecityl: Exhibit A - Data Security Requirements Exhibit B - Estimated Bi-Annual Budget <br />No Exhibits. <br />ed and are incorporated into thisits are attachEXlBITS. \Men the box below is marked with an X, the following <br />DSHS <br />theof nalfi entireonononsnrecondititermsandrepresentatiintegrati <br />oraicommunandwritiications,entsmandall gs,thebetween rti ES rsed agreemngergrngpreviousunderstandingpasupe <br />readhave andthattheybelowofmatterthCSontract.The representotherwitheSUsigpartiesnrngorse,bjectregarding <br />DSHon onSbeshall lyContractbindingThisontract-nda thehave execute thistothisunderstandcontract,uthority <br />DATE(S) SIGNED <br />uft1rt <br />PFiNffi-NAME(s) AND rrle(s) ^ndA*{1,,(x4krs <br />|idc{zt' <br />COUNry SIGNA ruRE(s) <br />DATE SiGNEDPruUTEO ruNUE AND TITLEDSHS SIGNATURE <br />DSHS Central Contract Services <br />6017CF County Program Agreement (10-31 2017)Page 1