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Attachment "F" <br />JIrL <br />rHilt <br />Transforming lives <br />Washington S!ate <br />Department of Social <br />& Health Services <br />COUNTY PROGRAM AGREEMENT <br />School-to-Work Direct Service Pilot <br />Gontract <br />DSHS Agreement Number <br />2663-70974 <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 />Administration or Division <br />Agreement Number <br />County Agreement Number <br />DSHS ADMINISTRATION <br />Division of Vocational <br />Rehabilitation <br />DSHS DIVISION <br />Division of Vocational <br />Rehabilitation <br />DSHS INDEX NUMBER <br />1225 <br />DSHS CONTRACT CODE <br />8500cc-63 <br />DSHS CONTACT NAME AND TITLE <br />Austin Diaz-Munoz <br />Contracts Specialist <br />DSHS CONTACT ADDRESS <br />4565 7th Ave SE <br />Lacev. WA 98503 <br />DSHS CONTACT TELEPHONE <br />(564\ 200-2812 <br />DSHS CONTACT FAX <br />Click here to enter text. <br />DSHS CONTACT E.MAIL <br />Austin. DiazMunoz@dshs.wa. gov <br />COUNW NAME <br />Kittitas County <br />COUNTY ADDRESS <br />Kittitas County Court House <br />205 W Fifth St Room 211 <br />Ellensburq, WA 98926 <br />COUNry FEDERAL EMPLOYER IDENTIFICATION <br />NUMBER <br />COUNTY CONTACT NAME <br />Kasey Knutson <br />COUNry CONTACT TELEPHONE <br />(509) 962-7090 <br />COUNTY CONTACT FAX <br />(509) 962-5883 <br />COUNTY CONTACT E-MAIL <br />kasev. knutson@co. kittitas.wa. us <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM <br />AGREEMENT? <br />No <br />ASSISTANCE LISTING NUMBERS <br />PROGRAM AGREEMENT START DATE <br />o't01t2026 <br />PROGRAM AGREEMENT END DATE <br />09t30t2027 <br />MAXIMUM PROGRAM AGREEMENT AMOUNT <br />Fee For Service <br />EXHIBITS. \A/tren the box below is marked with an X, the following Exhibits are attached and are incorporated into this <br />County Program Agreement by reference: <br />I exniUits (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 />No Exhibits. <br />The terms and conditions Contract are an integration and representation of the final, entire and exclusive <br />understanding between the parties superseding and merging all previous agreements, writings, and communications, oral <br />or otherwise, iegarding the subject matter of this Contract. The parties signing below represent that they have read and <br />understand this bontract, and have the authority to execute this Contract. This Contract shall be binding on DSHS only <br />DSHS. <br />couNrY srGNAruRE(S)PRINTED NAME(S) AND TITLE(S)DATE(S) SIGNED <br />DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED <br />DSHS Central Contract Services <br />6017CF County Program Agreement (10-31-2017)Page 1