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Docusign Envelope lD: CEBC6B3C-DFA1-4B6C-AFE8-6A4A63440086 <br />ExgrHTA <br />Facrr,rrv LocATIoNs Anp PnovmER RosrERs <br />1. Please complete the following Location Roster for all locations to be coveredunder this Agreement: <br />Contract #5908-662684 <br />Group fiN(nIN) <br />Group DBAName <br />Group LegalName <br />GROI'P CONTRACT INFORMATION <br />9r-6001349 <br />Kittitas County Shedffs Office <br />Kittitas County Sheriffs Office <br />Group NPI t063226272 <br />o <br />6l <br />CJ <br />j <br />LOCATION to be LINKED to CONTRACT <br />l[PI: Sarne as above? <br />TIN: Same as above? <br />Office Phone <br />City <br />Street Address 2 <br />Street Address 1 <br />Location Name <br />Yes X <br />Yes I <br />509-962-7s27 <br />Ellensburg <br />205 W $h Ave, Sie 1 <br />Kittitas County Jail <br />NoO <br />NoO <br />Office X'ax <br />State WA zip 98926 <br />$ <br />c <br />cdgl <br />Fl <br />LOCATION to be LINtr(EI) to CONTRACT <br />llPI: Same as above? <br />TIN: Same as above? <br />Office Phone <br />City <br />Street Address 2 <br />Street Address 1 <br />Location Name <br />Yes E <br />Yes E <br />s09-962-7s2s <br />Ellensbwg <br />30? 'W Umptanum Road <br />Kiuita"s County SherifPs Offrce <br />NoO <br />NoO <br />Officelax <br />State WA zip 98926 <br />Q <br />o <br />GI <br />C)o <br />Fl <br />LOCATION to beLINKED to CONTRACT <br />NPI: Same as above? <br />TIN: Sarne as above? <br />Office Phone <br />City <br />Street Addrcss 2 <br />Street Address 1 <br />Location Name <br />Yes O <br />Yes O <br />NoO <br />NoO <br />Office Fnx <br />State Z;tp <br />2020 Facility Agmt - Template Page 25 of51