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COUNTY DSHS Agreement Number mi1t .,,.,.,,,. '"" <br />Department of Social PROGRAM AGREEMENT 1863-28733 <br />& Health Services <br />Transforming lives Prevention Services <br />This Program Agreement is by and between the State of Washington Administration or Division <br />Department of Social and Health Services (DSHS) and the County identified Agreement Number <br />below, and is issued in conjunction with a County and DSHS Agreement On TM010056 / SP020155 <br />General Terms and Conditions, which is incorporated by reference. County Agreement Number <br />DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER DSHS CONTRACT CODE <br />Behavioral Health Division of Behavioral Health 1225 1644CS-63 <br />Administration and Recovery <br />DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS <br />Sarah Mariani 4500 Tenth Ave SE <br />Program Administrator PO Box45330 <br />Olympia. WA 98504-5330 <br />DSHS CONTACT TELEPHONE I DSHS CONTACT FAX I DSHS CONTACT E-MAIL <br />(360)725-377 4 (360)725-2253 mariaseCWdshs.wa.gov <br />COUNTY NAME COUNTY ADDRESS <br />Kittitas County 507 North Nanum Street Suite 102 <br />Kittitas County Health Department Ellensburq, WA 98926-2886 <br />COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME <br />NUMBER <br />Kasey Knutson <br />COUNTY CONTACT TELEPHONE I COUNTY CONTACT FAX I COUNTY CONTACT E-MAIL <br />(509) 962-7515 (509) 962-7581 kasey. knutson@co. kittitas. wa. us <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM CFDA NUMBERS <br />AGREEMENT? <br />93.959 <br />Yes <br />.PROGRAM AGREEMENTSTARTOAlc I PROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT <br />04/01/2018 06/30/2019 $158 ,037 .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 />!ZI Exhibits (specify): Exhibit A: Data Security; Exhibit B: Awards and Revenue; Exhibits C-K <br />0 No Exhibits. <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) PRINTED NAME(S) AND illLE (S) DATE(S) SIGNED <br /><fflVVVV-fzD~r~ l(ijaJ_,, 1/JVl 1'6 ·-~tlwu 11Jl ~1vfbtlv <br />DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED r Sv01 _,~(~ 014/&~~ 1]~,l11 BHA Contracts <br />J <br />DSHS Central Contract Services <br />1644CS Prevention Services -County (6-26-2015) Page 1