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<br /> <br />DSHS Central Contract Services <br />5024CS County Consolidated Contract FY16-17 (6-22-2017) 1 <br /> <br />COUNTY <br />PROGRAM AGREEMENT <br />Consolidated Contract FY18-19 <br /> <br />DSHS Agreement Number <br /> <br /> 1763-96341 <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 />General Terms and Conditions, which is incorporated by reference. <br />Administration or Division <br />Agreement Number <br /> <br />County Agreement Number <br /> <br />DSHS ADMINISTRATION <br /> <br />Rehabilitation Administration <br />DSHS DIVISION <br /> <br />Division of Community <br />Programs <br />DSHS INDEX NUMBER <br /> <br />1225 <br />CCS CONTRACT CODE <br /> <br />5024CS-63 <br />DSHS CONTACT NAME AND TITLE <br /> <br />Barbara Kraemer <br />FA5 <br />DSHS CONTACT ADDRESS <br /> <br />OB 2 <br />PO Box 45720 <br />Olympia, WA 98504 <br />DSHS CONTACT TELEPHONE <br /> <br />(360)902-0765 <br />DSHS CONTACT FAX <br /> <br />(360)902-8108 <br />DSHS CONTACT E-MAIL <br /> <br />kraembj@dshs.wa.gov <br />COUNTY NAME <br /> <br />Kittitas County <br />COUNTY DBA <br /> <br /> <br />COUNTY ADDRESS <br /> <br />Rm 211 Kittitas Co Courthouse <br />205 W Fifth St <br />Ellensburg, WA 98926 <br />COUNTY UNIFORM BUSINESS IDENTIFIER (UBI) <br /> <br />192-002-673 <br />COUNTY CONTACT NAME <br /> <br />Michael Stafford <br />COUNTY CONTACT TELEPHONE <br /> <br />(509) 962-7516 <br />COUNTY CONTACT FAX <br /> <br />( ) - <br />COUNTY CONTACT E-MAIL <br /> <br />michael.stafford@co.kittitas.wa.us <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM <br />AGREEMENT? <br /> <br />No <br />CFDA NUMBERS <br /> <br /> <br />PROGRAM AGREEMENT START DATE <br /> <br />07/01/2017 <br />PROGRAM AGREEMENT END DATE <br /> <br />06/30/2019 <br />MAXIMUM PROGRAM AGREEMENT AMOUNT <br /> <br />See Exhibits <br />EXHIBITS. When the box below is marked with an X, the following Exhibits are attached and are incorporated <br />into this County Program Agreement: <br /> Exhibits (specify): Exhibit A: Consolidated Contract Term, Reimbursement Procedures, and Program <br />Responsibilities; Exhibit B: Juvenile Court Block Grant; Exhibit C: Detention Services <br />The terms and conditions of this 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, regarding the subject matter of this Contract. The parties signing below represent that they have read and <br />understand this Contract, and have the authority to execute this Contract. This Contract shall be binding on DSHS only <br />upon signature by DSHS. <br />COUNTY SIGNATURE (S) <br /> <br /> <br /> <br />PRINTED NAME (S) AND TITLE (S) <br /> <br /> <br /> <br />DATE (S) SIGNED <br />DSHS SIGNATURE <br /> <br /> <br />PRINTED NAME AND TITLE <br /> <br />Del/ Hontanosas <br />Grants and Contracts Manager <br />DATE SIGNED <br />