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DSHS Agreem ent Number <br />2663-70974COUNTY PROGRAM AGREEMENT <br />School-to-Work Direct Service Pilot <br />Contract <br />V,/ it s h i,t../ I o I S l; { rl <br />Department of Social <br />& Health Services <br />Transforming lives <br />tn ntoteStaWashofthegbetweenisdanmreementbyThisPrograAg <br />uCo d tifiedenndethntyHndaIrhHeas)ServicesnteSocofal (DSrtmDepa o nndaDSHSAgreementainunwithctiontsnduedCountylssanJOWbelncerefereISratedwhchincorpoonsndaConditeneraGTmser <br />Administration or Division <br />Agreement Number <br />County Agreement Number <br />DSHS corutnnct <br />8500cc-631225 <br />IVISION <br />Division of Vocational <br />Rehabilitation <br />NISTRA <br />Division of Vocational <br />Rehabilitation RESS <br />4565 7th Ave SE <br />wA 98503 <br />Austin Diaz-Munoz <br />Contracts Specialist <br />NAMEc <br />DSHS <br />Austin.DiazMu dshs.wa. <br />I tetr,, Lit,r,'1;1 1,..,1'1. <br />FAXDSHS <br />( : lr:-.lr <br />ETELEPH <br />564 200-2812 <br />Kittitas CountY Court House <br />205 W Fifth St Room 211 <br />NTY ADDRESS <br />Ellens wA 98926 <br />Kittitas CountY <br />NAME <br />NAME <br />Kasey Knutson <br />COUNTY CPLOYER IDE TION <br />NUMBER <br />co <br />.kittitas.wa.usknutsonka962-5883 <br />NTYTELEP <br />509 962-7090 <br />COUNTY CO <br />ASSIST <br />AGREEMENT? <br />No <br />OSES OF PROGAIS <br />Fee For Service <br />RAM MENTMAXIMO DATE <br />a913012027 <br />PROGRAMSTART DATE <br />0510112026 <br />AGRE <br />County Program Agreement by reference: <br />X exnitits (specify): Exhibit A - Data Security Requirement.s Exhibit B ' Student Guide lnstructions' Exhibit C ' <br />Student Guide, Exhibit D - School-to-WorX Stu'dent bata, Exhibit E 'School-to-Work Billing Ghecklist <br />No Exhibits <br />and are incorPorated into thisExhibits are attachedWhen the box below is marked wilh an X, the followingEXHIBITS <br />DSHSonsnature <br />USIVCntireendtheoffinentational,ndarenration represthofSContractntegcoandonsndititermThes oralunicationscommndmentswritingreemdtnagersedanprevroustheergortiesbetweensupingderstandpaunngandreadhavethatnbeowheyTherepresentContract.sig ingofmatterpartiesthithorS€,otherwi ng subjeciregardi ndibi on DSHSbe onlyshallTlshngontractCCothisntract.executetotheauthorityhaveandContractthisunderstand <br />t <br />TE(S)P <br />*'ru- :r-,t.:414* <br />TUco <br />ff t"/?'b?{, <br />SIGNED <br />rf\ <br />{rr*'i:GtrK <br />{'l <br />HS <br />,1p*;, <br />E <br />DSHS Central Contract Services <br />6017CF County Program Agreemenl (10-31-2017) <br />Page 1