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Service Agreement #17-76 <br />between <br />WALLA WALLA COUNTY DEPARTMENT OF COMMUNITY HEALTH <br />and <br />KITTITAS COUNTY PUBLIC HEALTH <br />The Agreement is entered into by and between Walla Walla County Department of Community <br />Health, hereinafter "County," and Kittitas County Public Health Department, hereinafter <br />"Contractor," for engagement and participate with Greater Columbia Accountable Community of <br />Health, as outlined in the attached Statement of Work. The rights and obligations of both parties <br />are governed by the General Terms and Conditions, and the following Exhibits, copies of which <br />are attached hereto and incorporated herein by this reference as fully as if set forth herein: <br />Exhibit A -Statement of Work <br />Exhibit B -Budget <br />Exhibit C -Expenditure Report Form <br />Exhibit D -Participation Report Form <br />Performance Period: The terms ofthis Agreement shall commence on July 1st, 2017 and shall, <br />unless terminated or renewed as provided elsewhere in the Agreement, <br />terminate on December 3 1, 2017. <br />Compensation: Payment to Contractor for services rendered under this Agreement shall be <br />as set forth in Exhibit B -Budget. The allocation of funding is currently <br />awarded for Calendar Year 2017. The amount of payment for the <br />performance period of this Agreement shall not exceed $1,374. <br />By their signatures below, the parties agree to the terms and conditions of this Agreement and all <br />documents incorporated by reference. The parties signing below certify that they are authorized <br />to sign this Agreement. <br />IN WITNESS WHEREOF, the parties hereto have signed this Agreement. <br />COUNTY: CONTRACTOR: <br />Ji b ~/O -j Io-;]CJ17 <br />Chair, Board of County Commissioners <br />W alla Walla County <br />314 W. Main <br />Authorized By Date <br />~~~~~\~~OOm203 e D~h 0{(A BAmlfIJ lSiYNtD v <br />Walla Walla, W A 99362 Ptint HIm: & Title or PCI'SOD Sigtling , _ <br />Phone: (509) 524-2505 Fax: (509) 524-2512 f(l> hln ,tECld (t 00 . ILl fhfAr · lPt:f . () j <br />Telephone Number / Email Address: S~ .q (Q l ·75 15 <br />----~--------------------------- <br />Mailing Address (Street address required in addition to PO Box.): 5Dl N NbtVlUrYlt±.-{ 02 <br />@ 11,h S' bu V?( V\M g~1 C( <br />Social Security or Business Tax ID#: 01· Lt 0 0 \.3 CJ"l <br />CFDA# (if applicable): -UBI#: ------------------------ <br />State Industrial Account ID # (if applicable): -------------------- <br />#17-76 ACH Engagement Columbia Co-General Terms and Conditions Page 1 of 10