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OCT 112017 <br />-J .. 1 u ~ '/ DS H d :1. >lIiK .lLIlU;; ,'~I <>"'-'''''II ._~_ .... ! 1iiiit ." . ",." '" COUN~get) FlmHlce ,'!;. GUll r<:l ,. • L: -- <br />1763-98187 7 Oeparlmenl of Sod al <br />& HC<llltl SCI 5U d, t, I~\nan c e ROORAM AGREEMENT =,~ <br />" Transforming lives <br />DDA County Services <br />This Program Agreement is by and between the State of Washington Department of Administration or Division <br />Social and Health Services (DSHS) and the County identified below, and is issued in Agreement Number <br />conjunction with a County and DSHS Agreement On General Terms and Conditions, <br />County Agreement Number which is incorporated by reference. <br />DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER DSHS CONTRACT CODE <br />Developmental Disabilities Division of Developmental 1225 1769CS-63 <br />Admin Disabilities <br />DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS <br />Seanna Woodard 1611 W Indiana Ave <br />Operations Manager <br />Spokane,WA 99205 <br />DSHS CONTACT TELEPHONE I DSHS CONTACT FAX I DSHS CONTACT E-MAIL <br />(509)329-2952 (509)568-3037 woodas@dshs,wa,gov <br />COUNTY NAME COUNTY ADDRESS <br />Kittitas County 507 North Nanum Street Suite 102 <br />Kittitas County DDA County Services Ellensburg, WA 98926 <br />COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME <br />NUMBER <br />qIJ~oo/3'17 Joann Schaan <br />COUNTY CONTACT TELEPHONE I COUNTY CONTACT FAX u~ad~lIM ~'h. YlllHftr. b _l509) 933-8233 <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM CFDA NUMBERS <br />AGREEMENT? <br />No <br />PROGRAM AGREEMENT START DATE I PROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT <br />07/01/2017 06/30/2018 $820,341.00 <br />EXHIBITS. The following Exhibits are attached: Exhibit A -Data Security Requirements; Exhibit B -Budget and <br />Spending Plan; Exhibit C-Fund Match Certification <br />By thei r 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 , regard ing the <br />subject matter of this Program Agreement shall be deemed to exist or bind the parties . The parties signing below certify <br />that th ey are authorized to si g n this P rogram A greement. <br />COUNTY SIGNATU RE(S) P RI~TE D NAME(S) AND TITLE(S) DATE(S ) SIGNED <br />~~~ QhbJVl ~1 ~JmJVl()trtdvr q(I?-(i( <br />DSHS SIGNATURE <br />rrw.tLA4 ,t-" j)Jebe/lf <br />DSHS Central Contract Services <br />1769CS County Agreement 6-15-2017 <br />PRINTED NAME AND TITLE <br />Melissa Diebert <br />Contract Manager ! <br />DAT ~GNED ~!~ .;;/1 7 .-.,. ................ ~ <br />·'~"'~llfL.U <br />SEP 1 52017 <br />DDASPOKANE <br />Page 1