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ATTACHMENT "E'' <br />DSHS Agreement Number <br />2563-6431 0 <br />COUNTY <br />PROGRAM AGREEMENT <br />DDA County Services <br />DSHS <br />WASHINGTON STATE <br />Department ofSoclal <br />and Health Seruices <br />Administration or Division <br />Agreement Number <br />County Agreement Number <br />This Program Agreement is by and between the State of Washington Department of <br />Socialand Health Services (DSHS) and the County identified below, and is issued in <br />conjunction with a County and DSHS Agreement On GeneralTerms and Conditions, <br />which is incorporated by reference. <br />DSHS INDEX NUMBER <br />1225 <br />DSHS CONTRACT CODE <br />1769CS-63 <br />DSHS ADMINISTRATION <br />Developmental Disabil ities <br />Admin <br />Division of Developmental <br />Disabilities <br />DSHS DIVISION <br />DSHS CONTACTADDRESS <br />1611 W lndiana Ave <br />Sookane. WA 99205 <br />DSHS CONTACT NAME AND TITLE <br />Seanna Woodard <br />Operations Manager <br />DSHS CONTACT E-MAIL <br />woodas@dshs.wa.qov <br />DSHS CONTACT TELEPHONE <br />(509)329-2952 <br />DSHS CONTACT FAX <br />(509)568-3037 <br />507 N NANUM ST STE 102 <br />Ellensburq, WA 98926 <br />COUNTY ADDRESS <br />Kittitas County <br />Kittitas County DDA County Services <br />COUNTY NAME <br />COUNTY FEDERAL EMPLOYER IDENTIFICATION <br />NUMBER <br />COUNTY CONTACT NAME <br />Kasey Knutson <br />COUNTY CONTACT E-MAIL <br />kasev. knutson@co. kittitas.wa. us <br />COUNTY CONTACT TELEPHONE <br />(509) 962-7090 <br />COUNTY CONTACT FAX <br />(509) 962-5883 <br />ASSISTANCE LISTING NUMBERSIS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM <br />AGREEMENT? <br />No <br />PROGRAM AGREEMENT END DATE <br />06t30t2026 <br />MAXIMUM PROGRAM AGREEMENT AMOUNT <br />$1,123,083.00 <br />PROGRAM AGREEMENT START DATE <br />07t01t2025 <br />EXHIBITS. The following Exhibits are attached: Exhibit A - Data Security Requirements; Exhibit B - Budget and <br />Spendinq 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, oralor 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 thev are authorized to siqn this Proqram Aqreement. <br />DATE(S) STGNEDPRINTED NAME(S) AND TITLE(S)COUNTY SIGNATURE(S) <br />DATE SIGNEDPRINTED NAME AND TITLEDSHS SIGNATURE <br />DSHS Central Contract Services <br />1 769CS County Agreement (05-06-2025) <br />Page 1