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DSHS Central Contract Services <br />5048CF County Program Agreement (11-22-2011) Page 1 <br />COUNTY <br />DSHS Agreement Number <br />washiWgonstare <br />PROGRAM AGREEMENT <br />1863-31751 <br />PARTMENT HIAL frHEALTH <br />7FFsoD( <br />7� SERVICES <br />Jail Services 18 years and older <br />This Program Agreement is by and between the State of Washington <br />Administration or Division <br />Department of Social and Health Services (DSHS) and the County identified <br />Agreement Number <br />below, and is issued in conjunction with a County and DSHS Agreement On <br />County Agreement Number <br />General Terms and Conditions, which is incorporated by reference. <br />DSHS ADMINISTRATION <br />DSHS DIVISION <br />DSHS INDEX NUMBER <br />DSHS CONTRACT CODE <br />Rehabilitation Administration <br />Division of Community <br />1225 <br />5000CC-63 <br />Programs <br />DSHS CONTACT NAME AND TITLE <br />DSHS CONTACT ADDRESS <br />Barbara Kraemer <br />OB 2 <br />FA5 <br />PO Box 45720 <br />Olympia, WA 98504 <br />DSHS CONTACT TELEPHONE <br />DSHS CONTACT FAX <br />DSHS CONTACT E-MAIL <br />(360)902-0765 <br />(360)902-8108 <br />kraembj@dshs.wa.gov <br />COUNTY NAME <br />COUNTY ADDRESS <br />Kittitas County <br />205 W 5th Ave Ste1Jail <br />Kittitas Co. Sheriffs Office <br />Ellensburg,WA 98926 <br />COUNTY FEDERAL EMPLOYER IDENTIFICATION <br />COUNTY CONTACT NAME <br />NUMBER <br />Paula Hoctor <br />COUNTY CONTACT TELEPHONE <br />COUNTY CONTACT FAX <br />COUNTY CONTACT E-MAIL <br />(509) 962-7617 <br />(509) 962-7037 <br />paula.hoctor@co.kittitas.wa.us <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM <br />CFDA NUMBERS <br />AGREEMENT? <br />No <br />PROGRAM AGREEMENT START DATE <br />PROGRAM AGREEMENT END DATE <br />MAXIMUM PROGRAM AGREEMENT AMOUNT <br />07/01/2018 <br />1 06/30/2019 <br />L$20,000.00 <br />EXHIBITS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into this <br />County Program Agreement by reference: <br />® Exhibits (specify): Exhibit A - Data Security Requirements and Exhibit B Statement of Work <br />The terms and conditions of this Contract are an integration and representation of the final, entire and exclusive <br />understanding between the parties superseding 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 the authority to execute this Contract. This Contract shall be binding on DSHS only <br />upon signature by DSHS. <br />COUNTY SIGNATURE(S) <br />PRINTED NAME(S) AND TITLE(S) <br />DATE(S) SIGNED <br />(SeOC _'b A 0A ov�t ,;-r <br />6/ 2, o/zo /dr <br />DSHS SIGNATURE <br />PRINTED NAME AND TITLE <br />DATE SIGNED <br />Del R. Hontanosas <br />Grants and Contract Manager <br />DSHS Central Contract Services <br />5048CF County Program Agreement (11-22-2011) Page 1 <br />