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Jlo <br />flfrr <br />Washington State <br />Department of Social <br />& Health Services <br />Transforming lives <br />COUNTY PROGRAM or INTERLOCAL <br />LONG.TERM PAYABLE AGREEMENT <br />AMENDMENT <br />DSHS CONTRACT NUMBER: <br />'1963-56865 <br />Amendment No. 01 <br />the State of Washington Department of Social and <br />Health Seruices (DSHS) and the Contractor identified below <br />This Amendment is between Program Contract Number <br />Click here to enter text. <br />Contractor Contract N umber <br />CONTRACTOR NAME <br />Kittitas County <br />CONTRACTOR doing business as (DBA) <br />County Auditors Office <br />205 West Sth Ave County Courthouse Ste 105 <br />98926-Ellensburq, <br />CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSIN ESS <br />IDENTIFIER (UBI) <br />192-002-673 <br />DSHS INDEX NUMBER <br />1225 <br />CONTRACTOR CONTACT <br />Judy Pless <br />CONTRACTOR TELEPHONE <br />(509) 962-7502 <br />CONTRACTOR FAX <br />(509) 962-7687 <br />CONTRACTOR E.MAIL ADDRESS <br />iudv. pless@co. kittitas.wa. us <br />DSHS ADMINISTRATION <br />Facilities, Finance and Analytics <br />Administration <br />DSHS DIVISION <br />Financial Services <br />DSHS CONTRACT CODE <br />8030cs-63 <br />DSHS CONTACT NAME AND TITLE <br />Mariann Schols <br />Manager, Finance <br />DSHS CONTACT ADDRESS <br />PO Box 45842 <br />Olympia, WA 98504-5842 <br />DSHS CONTACT TELEPHONE <br />(360)902-8170 <br />DSHS CONTACT FAX <br />(360)664-5775 <br />DSHS CONTACT E-MAIL ADDRESS <br />scholmj@dshs.wa.gov <br />rs rHE coNTRAcroR A suBRECtptENT FoR puRposES oF THts coNTRAa- <br />No <br />CFDA NUMBERS <br />AMENDMENT START DATE <br />07t01t2020 <br />CONTRACT END DATE <br />06130t2021 <br />PRIOR MAXIMUM CONTRACT AMOUNT <br />$0.00 <br />AMOUNT OF INCREASE OR DECREASE <br />N/A <br />TOTAL MAXIMUM CONTRACT AMOUNT <br />Based on Annual Review <br />REASON FOR AMENDMENT; <br />CHANGE OR CORRECT PERIOD OF PERFORMANCE <br />ATT thWhen eENTS.HM box OWbel markedIS anwith the followi areExhibits andattached areX,ntongincorporated <br />is Amendment rerefe nce:th by <br />Additional Exhibits <br />Agreement remain in full force and etfect. The parties signing <br />Amendment, and havfAuthoritv tq,qter into this Amendment. <br />documents incorporated by reference, contains all of the terms and <br />nges to the original County Program Agreement or lnterlocalAgreement. No <br />or otherwise, regarding the subject matter of this Amendment shall be <br />co <br />This Amendment, including all Exhibits and other <br />conditions agreed upon by the parties as cha <br />other understandings or representations, oral <br />deemed to exist or bind the parties. All other terms and nditions of the original County Program Agreement or lnterlocal <br />below warrant that they have read and understand this <br />CONT PRINTED NAME AND TITLE <br />Brett Wachsmith, <br />Chairman Board Co Commissioners <br />DATE SIGNED <br />06-16-2020 <br />DSHS SIGNATURT PRINTED NAME AND TITLE <br />Clarissa Brechwald, Contracts Consultant <br />DSHS Central Contracts and Leqal Services <br />DATE SIGNED <br />+l(l LazD <br />DSHS Central Contracts and Legal Services <br />6046 LF Long-Term Payable Amendment (5-5-20) <br />lotDn <br />{or C\crvr <br />$54,000 Advance <br />gcrFoh <br />W\L ch WilCL Page 1