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Jlo <br />frfir <br />Transformlng lives <br />Wr$,t1,?0tor Slrld <br />Deparlmcnt of Social <br />& llealth Services <br />GOUNTY PROGRAM AGREEMENT <br />AMENDMENT <br />DSHS Agreement Number <br />2363-49241 <br />Amendment No. <br />01 <br />This Program Agreement Amendment is by and between th <br />Department of Social and Health Services (DSHS) and the <br />e State of Washington <br />County identified below <br />Administration or Division <br />Agreement Number <br />Click here to enter text. <br />County Agreement Number <br />DSHS ADMINISTRATION <br />Developmental Disabilities <br />Admin <br />DSHS DIVISION <br />Division of Developmental <br />Disabilities <br />DSHS INDEX NUMBER <br />1225 <br />CCS CONTRACT CODE <br />1225 <br />DSHS CONTACT NAME AND TITLE <br />Seanna Woodard 16'11 W lndiana Ave <br />Spokane, WA 99205 <br />DSHS CONTACT ADDRESS <br />DSHS CONTACT TELEPHONE <br />(509)329-2952 <br />DSHS CONTACT FAX <br />(509)568-3037 <br />DSHS CONTACT E.MAIL <br />woodas@dshs.wa.qov <br />COUNW NAME <br />Kittitas County <br />Kittitas County DDA County Services <br />COUNTY ADDRESS <br />507 North Nanum Street Suite 102 <br />Ellensburg, WA 98926-2886 <br />COUNry FEDERAL EMPLOYER IDENTIFICATION <br />NUMBER <br />COUNTY CONTACT NAME <br />Kasey Knutson <br />COUNW CONTACT TELEPHONE <br />(509) 962-7090 <br />COUNryCONTACTFAX <br />(509) 962-5883 <br />COUNTY CONTACT E.MAIL <br />kasev. knutson@co. kittitas.wa. us <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM <br />AGREEMENT? <br />No <br />CFDA NUMAERS <br />AMENDMENT START DATE <br />1210112023 <br />PROGRAM AGREEMENT END DATE <br />06t30t2024 <br />PRIOR MAXIMUM PROGRAM AGREEMENT <br />AMOUNT <br />$854,839.00 <br />AMOUNT OF INCREASE OR DECREASE <br />$263,603.00 <br />TOTAL MAXIMUM PROGRAM AGREEMENT <br />AMOUNT <br />$1,118.442.00 <br />REASON FOR AMENDMENT; <br />CHANGE OR CORRECT MAXIMUM CONTRACTAMOUNT <br />EXHIBITS. When the box below is marked with a check (4) or an X, the following Exhibits are attached and are <br />incorporated into this Program Agreement Amendment by reference: <br />Xl exniOits (specitu): Exhibit 81 <br />This Program Agreement Amendment, including all Exhibits and other documents incorporated by reference, contains all <br />of the terms and conditions agreed upon by the parties as changes to the original Program Agreement. No other <br />understandings or representations, oral or othenruise, regarding the subject matter of this Program Agreement Amendment <br />shall be deemed to exist or bind the parties. All other terms and conditions of the original Program Agreement remain in <br />full force and effect. The parties signing below warrant that they have read and understand this Program Agreement <br />Amendment. and have authoritv to enter into this Proqram Aqreement Amendment. <br />DATE(S) SIGNED <br />1,\?-p{ <br />tw <br />&&e',npn <br />DSHS SIGNATURE <br />Jen nifer Albertson, Contract Managr <br />PRINTED NAME AND TITLE DATE SIGNED <br />)r 3127124 <br />DSHS Cenkal Contract Services <br />1769CP Contract Amendment (4-12-23) <br />Ft[1(';tht\/h,11] <br />[rL:B I ,i tt]?4 <br />Dt),A Flpr{:l }i fi.i'j : : <br />Page 1