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DSHS CONTRACT NUMBER: <br />CONTRACT AMENDMENT 1563-44899 ."~"II.."'." County Day Program OEf'or ENT OF Amendment No . 02 soc I\' &~W'rH 5 RV . <br />I <br />This Contract Amendment is between the State of Washington Department of Program Contract Number <br />Social and Health Services (DSHS) and the Contractor identified below. Click here to enter text . <br />Contractor Contract Number <br />CONTRACTOR NAME CONTRACTOR doing business as (DBA) <br />Kittitas County Kittitas County DDA County Services <br />CONTRACTOR ADDRESS WASHINGTON UNIFORM DSHS INDEX NUMBER <br />BUSINESS IDENTIFIER (UBI) <br />507 North Nanum Street Suite 102 <br />Ellensburg , WA 98926-192-002-673 1225 <br />CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS <br />DSHS ADMINISTRATION DSHS DIVISION DSHS CONTRACT CODE <br />Developmental Disabilities Admin Division of Developmental 1769CS-63 <br />Disabilities <br />DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS <br />Roger Van Allen 1611 W Indiana Ave <br />Operations ManaQer Spokane, WA 99205- <br />DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS <br />(509) 329-2952 (509) 568-3037 vanalrl@dshs .wa.gov <br />IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS <br />No <br />AMENDMENT START DATE CONTRACT END DATE <br />07/01/2016 06/30/2017 <br />PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT <br />$738,941 .00 $762,332.00 $1,501,273.00 <br />REASON FOR AMENDMENT; <br />CHANGE OR CORRECT PERIOD OF PERFORMANCE AND MAX CONTRACT AMOUNT <br />ATTACHMENTS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into <br />this Contract Amendment by reference : <br />[g] Additional Exhibits (specify): Program AQreement Budget and Spending Plan <br />This Contract Amendment, including all Exhibits and other documents incorporated by reference, contains all of the terms <br />and conditions agreed upon by the parties as changes to the original Contract. No other understandings or <br />representations , oral or otherwise, regarding the subject matter of this Contract Amendment shall be deemed to exist or <br />bind the parties. All other terms and conditions of the original Contract remain in full force and effect. The parties signing <br />below warrant that they have read and understand this Contract Amendment, and have authority to enter into this Contract <br />Amendment. <br />C~7 ~ <br />"\1 '-. W v v . ./ ~ <br />DS Hm~ /;);~~-. <br />DSHS Central Contract Services <br />6024PF Contract Amendment (3-31-06) <br />PRINTED NAME AND TITLE <br />~o b,·~H ,~{tC~l AvtWU~i~ :5!8"f~ (Q <br />PRINTED NAME AND TITLE DATE SIGNED <br />Melissa Diebert, Contract Manager J''-/:5i-/b <br />RECEIVED RECEIVED <br />AUG 1 02016 AUtb 2 A 2016 <br />DDA SPOKIffffA SPOKANE