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Attachment "F" <br />DSHS Agreement Number <br />2663-70974COUNTY PROGRAM AGREEMENT <br />School-to-Work Direct Service Pilot <br />Contract <br />Jlrt <br />frf,r <br />Transforming lives <br />Washinglon State <br />Department of Social <br />& Health Services <br />Administration or Division <br />Agreement Number <br />County Agreement Number <br />This Program Agreement is by and between the State of Washington <br />Department of Social and Health Services (DSHS) and the County identified <br />below, and is issued in conjunction with a County and DSHS Agreement On <br />GeneralTerms and Conditions, which is incorporated by reference <br />DSHS INDEX NUMBER <br />1225 <br />IJSHS riUN tRAU I COlJt <br />8500cc-63 <br />DSI{S DIVISION <br />Division of Vocational <br />Rehabilitation <br />D3H3 ADMINISTRATION <br />Division of Vocational <br />Rehabilitation <br />DSHS CONTACTADDRESS <br />4565 7th Ave SE <br />Lacev, WA 98503 <br />DSHS CONTACT NAME AND TITLE <br />Austin Diaz-Munoz <br />Contracts Specialist <br />DSHS CONTACT E-MAIL <br />Austin. DiazMunoz@dshs.wa.qov <br />DSHS CONTACT FAX <br />elick here to enter text. <br />DSHS CONTACT TELEPHONE <br />$64\ 200-2812 <br />COUNry ADDRESS <br />Kittitas County Court House <br />205 W Fifth St Room 211 <br />Ellensburo. WA 98926 <br />COUNTY NAME <br />Kiftitas County <br />COUNTY CONTACT NAME <br />Kasey Knutson <br />COUNTY FEDEML EMPLOYER IDENTIFICATION <br />NUMBER <br />COUNTY CONTACT E-MAIL <br />kasev. knutson@co. kittitas.wa. us <br />COUNW CONTACT FAX <br />(509) 962-5883 <br />COUNTY CONTACT TELEPHONE <br />(509) 962-7090 <br />ASSISTANCE LISTING NUMBERSIS THE COUNry A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM <br />AGREEMENT? <br />No <br />MAXIMUM PROGMM AGREEMENT AMOUNT <br />Fee For Service <br />PROGRAM AGREEMENT END DATE <br />09t30t2027 <br />PROGRAM AGREEMENT START DATE <br />05t01t2026 <br />EXHIBITS. When the box below is marked with an X, the following Exhibits are attached and are in <br />County Program Agreement by reference: <br />I exniOits (specify): Exhibit A - Data Security Requirements Exhibit B - Student Guide Instructions, Exhibit C - <br />Student Guide, Exhibit D - School-to-Work Student Data, Exhibit E - School-to-Work Billing Checklist <br />corporated into this <br />n No Exhibits. <br />aentire exclusivendandtheofandtermsofconditionststhareContractanTherepresentationntegration <br />an d oralandallcommunications,thebetween writings,superseding mergrng previous agreementspartiesunderstanding <br />that readhave andTheContract.belowotherwiseorsuthematterthis represent theyofslgnpartiesngregardingbject <br />HContractThisbeshallbiDS S ononhandtheavetothisexecuteContract.lythisunderstandndingContract,authority <br />DSHS. <br />DATE(S) SIGNEDPRINTED NAME(S) AND TITLE(S)COUNTY SIGNATURE(S) <br />DATE SIGNEDPRINTED NAME AND TITLEDSHS SIGNATURE <br />DSHS Central Contract Services <br />6017CF County Program Agreement (10-31-2017)Page 1