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333 <br />WHh,n~ton Stitt <br />Department of Social <br />& Health Services <br />COUNTY <br />PROGRAM AGREEMENT <br />DDA County Services <br />DSHS Agreement Number <br />, .196'3-58859 <br />Transforming lives <br />Administration or Division <br />Agreement Number <br />This Program Agreement is by and between the State of Washington Department of <br />Social and Health Services (DSHS) and the County identified below, and is issued in <br />conjunction with a County and DSHS Agreement On General Terms and Conditions , <br />which is incorporated by reference . County Agreement Number <br />DSHS ADMINISTRATION <br />Developmental Disabilities <br />Admin <br />DSHS DIVISION DSHS INDEX NUMBER <br />1225 Division of Developmental <br />Disabilities <br />DSHS CONTACT NAME AND TITLE <br />Seanna Woodard <br />Operations Manager <br />DSHS CONTACT TELEPHONE <br />509 329-2952 <br />COUNTY NAME <br />Kittitas County <br />Kittitas County ODA County Services <br />COUNTY FEDERAL EMPLOYER IDENTIFICATION <br />NUMBER <br />DSHS CONTACT ADDRESS <br />1611 W Indiana Ave <br />S okane ,WA 99205 <br />DSHS CONTACT FAX <br />509 568-3037 <br />COUNTY ADDRESS <br />507 North Nan um Street Suite 102 <br />Ellensbur , WA 98926-2886 <br />COUNTY CONTACT NAME <br />Kasey K1nutson <br />DSHS CONTRACT CODE <br />1769CS-63 <br />COUNTY CONTACT TELEPHONE <br />509 6 2-7090 <br />COUNTY CONTACT FAX COUNTY CONTACT E-MAIL <br />Click here to enter te xt <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM <br />AGREEMENT? <br />No <br />CFDA NUMBERS <br />PROGRAM AGREEMENT START DATE PROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT <br />07/01/2019 06/30/2020 $728,032 .00 <br />EXHIBITS. The following Exhibits are attached: Exhibit A -Data Security Requirements; Exhibit B -Budget and <br />S endin Plan <br />By their signatures below, the parties agree to the terms and conditions of this County Program Agreement and all <br />documents incorporated by reference . No other understandings or representations , oral or otherwise, regarding the <br />subject matter of this Program Agreement shall be deemed to exist or bind the parties . The parties signing below certify <br />that the are authorized to si n this Pro ram A reement. <br />DSHS Central Contract Services <br />1769CS County Agreement 5-1-2019 <br />PRINTED NAME AND TITLE <br />Melissa Diebert , Contracts Manager <br />S[P 2 7 2019 <br />DOA SPOKANE <br />RECEIVED <br />AUG 2 8 2019 <br />DATE(S) SIGNED <br />DATE SIGNED <br />Page 1