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Attachment "F" <br />DSHS Agreement Number <br />2663-70974COUNTY PROGRAM AGREEMENT <br />School-to-Work Direct Service Pilot <br />Gontract <br />Washlngton State <br />Department of Social <br />& Health Services <br />Transforming lives <br />Administration or Division <br />Agreement Number <br />Cou nty Agreement Number <br />WashStatetheofndabetween ingtonramrsPThisbyAgreementrog <br />identifiedCoutheDSandandealthHntyServicesofrtment(HS)SocialDepa <br />OnDSHSandwithnctionAgreementarsstsinueduandCountylowbeconJ <br />rence.referatedbyichwhonsConditiermsTandeneralG <br />IN DEX NUMBER <br />1225Division of Vocational <br />Rehabilitation <br />Division of Vocational <br />Rehabilitation <br />oSHs corurRncr coDE <br />8500cc-63 <br />AND TITLE <br />here to enter text564200-2812 <br />CONTACT <br />Austin <br />4565 7th Ave SE <br />ACT AD <br />wA 98503 <br />FAXCONTACT <br />Austin Diaz-Munoz <br />Contracts Specialist <br />DSHS <br />Ciick <br />COUNTY ADDRESS <br />Kittitas CountY Court House <br />205 W Fifth St Room 211 <br />wA 98926 <br />COUNTY NAME <br />Kittitas CountY <br />RAL EMPLOYER IDENTIFICATIONCOUNW FEDE <br />NUMBER <br />kasev.knutson@co.kittitas.wa.us <br />Tour.n'Y coNTAcr E-MAILCOU]tW CONTACT FAX <br />(509) 962-5883 <br />COLJI.ITY CONTACT TELEPHONE <br />(509) 962-7090 <br />NUASSISTtvt <br />AGREEMENT? <br />No <br />MAXIMUM PROGRAM AGREEMENT AMOUNT <br />Fee For Service <br />PREiGRAM AGREEMENT END DATE <br />09t30t2027 <br />PROGRAM AGREEMENT START DATE <br />05t0112026 <br />County Program Agreement by reference: <br />XiiiioiJ (speci-ity): Exhibit A - Data Security Requirements Exhibit B - student Guide lnstructions, Exhibit c ' <br />student Guide, Exhibit D - schoot-to-work student bata, Exhibit E - school-to'work Billing checklist <br />No Exhibits. <br />the following Exhibits areEXHIBITS. \Nhen the box below is marked with an X,and are incorPorated into this <br />DSHS <br />ustveexclandentirethefinal,ndanarethisofContract representationtermsTheconditionsintegrationand oralunications,and commentsallagreemwritingsandprevlousthebetweenmergrngsupersedingpartiesunderstanding andreadhavethattheybelowTherepresentpartiessigningofmatterContract.thisrditheorotherwise,rega ng subject DSHSonbindibeContractThis onlyshalContract.this ngexecutetohtheaveandthisauthoritynderstandContract,u <br />DATE(S)SIGNED?RTNTED NAME(s) AND TIrLE(s)NTY SIGNA <br />DATE SIGNEDD TITLENAMDSHS SIGNATURE <br />DSHS Central Contract Services <br />6017CF County Program Agreement (10-31-2017)Page 1