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COUNTY <br />PROGRAM AGREEMENT <br />Working Advance Long-Term Payable <br />This Program Agreement ',s 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 Ag reement Number <br />1763-88849 <br />Administration or Division <br />Agreement Number <br />County Agreement Number <br />DSHS ADMINISTRATION <br />Executive Administration <br />DSHS 'DIVISIQN DSHS INDEX NUMBER DSHS CONTRACT CODE <br />Operation Support and 1225 8030CS-63 <br />DSHS CONTACT NAME AND TITLE <br />Angela Williams <br />Contracts Supervisor <br />Services Division <br />. DSHS CONTACT ADDRESS -- <br />1115 S Washjngton St <br />Olympia WA 98504-5811 <br />OSHS COtiiTACTTELEPHQNE <br />(360) 664~6046 I DSHS CONTACT FAX <br />(360) 664-6184 <br />I DSHS CONTACTE.·MAiL <br />J williah@~shs.wa.gov <br />COlJ~NAME <br />Kittitas County <br />JUdy Pless - <br />'COUNTY AODRESS <br />County Auditors Office <br />205 West 5th Ave County Courthouse Ste 105 <br />Eilensburg WA 98926 <br />· COUNTY OElNT/(CTTElEP.HONE I C9~TY C,€!NTACT FAX <br />· (509) 962-7502 (SP9 962-7687 I COUliIlY,CONTACiE-MAIL <br />·iiJ~y.pJE$S@co.k.jttitas .wa.lJs <br />· IS THECOUNTY A SUBRECIPIENT F·OR PURP0$ESOF THIS PROGRAM <br />AGREEMENT? <br />No _ <br />. CFDA NUMBERS <br />PROGRAM AGREEMENT START DATE I PROGRAM AGREEMENT ENcrOATE Mf\XlMUM PROGRAM AGREEMENT AMOUNT <br />07/01 /2017 _ 06/3U/,2018 Bas~d on Annual Review <br />The terms ariC! conaitions jjf this C.ontract are an integration and representation of the final, entire and exclusive <br />understanding between the parties supersed ing and merging all previous agreements , writings, and communications, oral <br />or otherwise, regarding the subject matter of this Contract. The parties signing below represent that they have read and <br />understand this Contract, and have th e authority to execute this Contract. This Contract shall be binding on DSHS only <br />upon signature bY ,DSHS. <br />PRINTED NAME({),AND TlTLE($) DATE(S) SIGNED <br />J../ /1£//7 <br />PRINTED NAME AND TITLE DAlE SIGNED <br />4-/ "Z4} )1- <br />DS~G!lATURE -__ <br />(~ Angie Williams, Contract Manager <br />DSHS C.entral Contracts and LeQa l Services <br />DSHS Central Contract Services <br />8030CS county Long-Term Payable (3·28-2017) Page 1