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DSHS SIGNATURE <br />*4 &a'rta-ert <br />COUNTY SIGNATURE(S) <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 they are authorized to siqn this Proqram Aqreement. <br />EXHIBITS. The following Exhibits are attached Exhibit A - Data Security Requirements; Exhibit B - Budget and <br />Spending Plan <br />PROGR,AM AGREEMENT START DATE <br />47rc1t2025 <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM <br />AGREEMENT? <br />No <br />COUNTY CONTACT TELEPHONE <br />(509) 962-7090 <br />COUNTY FEDERAL EMPLOYER IDENTIFICATION <br />NUMBER <br />COUNTY NAME <br />Kittitas County <br />Kittitas County DDA County Services <br />DSHS CONTACT TELEPHONE <br />t509)329-2952 <br />DSHS CONTACT NAME AND TITLE <br />Seanna Woodard <br />Operations Manager <br />DSHS ADMINISTRATION <br />Developmental Disabilities <br />Admin <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. <br />DSHS <br />W.ISHlNGL)N STATE <br />DeFartment ofSocial <br />and Health sedices <br />COUNTY <br />PROGRAM AGREEMENT <br />DDA County Services <br />DSHS DIVISION <br />Division of Developmental <br />Disabilities <br />PROGR,AM AGREEMENT END DATE <br />06130t2026 <br />COUNTY CONTACT FAX <br />(509) 962-5883 <br />DSHS CONTACT FAX <br />(509)568-3037 <br />COUNTY CONTACT NAME <br />Kasey Knutson <br />COUNTY ADDRESS <br />507 N NANUM STSTE 102 <br />Ellensburg WA 98926 <br />DSHS CONTACT ADDRESS <br />'1611 W lndiana Ave <br />Spokane WA 99205 <br />PRINTED NAME AND TITLE <br />Jennifer Albertson, Contracts Manag, <br />PRINTED NAME(S) AND T|TLE(S) <br />{ tt,i$e'1 L,*lf *.., <br />brrr&t' <br />1225 <br />DSHS INDEX NUMBER <br />MAXIMUM PROGMM AGREEMENT AMOUNT <br />$1,123,083.00 <br />ASSISTANCE LISTING NUMBERS <br />COUNTY CONTACT E-MAIL <br />kasev. kn utson@co. kittitas.wa. us <br />DSHS CONTACT E.MAIL <br />woodas@dshs.wa.qov <br />DSHS CONTRACT CODE <br />1769C5-63 <br />Administration or Division <br />Agreement Number <br />County Agreement Number <br />DSHS Agreement Number <br />2563-6431 0 <br />DATE SIGNED <br />)r 08t2012025 <br />DATE(S)SIGNED <br />,sl piro <br />DSHS Central Contract Services <br />1 769CS County Agreement (05-06-2025) <br />Page'1