Laserfiche WebLink
DocuSign Envelope ID: 94D165AB-F367-4157-8526-77F15FF93CD8 <br />LICENSING <br />General Information <br />COUNTY LICENSING AGENT AGREEMENT <br />BETWEEN <br />DEPARTMENT OF LICENSING AND <br />KITTITAS COUNTY AUDITOR'S OFFICE <br />DOL Reference No. K6984 <br />Agent Reference No. <br />V01901 <br />- ........... ........ <br />Start date End date <br />January 1' 2020 !June 30 2025 <br />_...... <br />Amount <br />Non -Financial <br />Purpose (brief description) <br />This is a standardized Agreement for use by the Department <br />of Licensing when contracting for services with a County <br />Licensing Agent as set forth in RCW 46.01.140. <br />Agent <br />Agent Name <br />Email <br />Jerry Pettit <br />jerry.pettit@co.kittitas.wa.us <br />Agent Address <br />Agent Mailing Address (if different) <br />205 W 5th Ave #105 <br />Ellensburg, WA 98926-2891 <br />Agreement Manager <br />Agreement Manager Telephone <br />Agreement Manager Fax <br />Sue Higginbotham <br />509-962-7505 <br />Agreement Manager Mailing address (if different from Agent Address) <br />Agreement Manager Email <br />sue.higginbotham@co.kittitas.wa.us <br />Department of Licensing (DOL) <br />Department Administration <br />Vehicle and Vessel Operations <br />Agreement Manager <br />Jaime Grantham <br />... _...... <br />Telephone Fax <br />Division <br />Customer Relations <br />Address <br />PO Box 9020 Olvmvia. WA 98507-9020 <br />Email <br />(360) 902-3718 360-570-1248 jclranthamdoi.wa.gav <br />.... .... __ ...... <br />Attachments <br />The Agreement consists of the following attachments) and document(s) incorporated herein or by reference: <br />Attachment A — Statement of Work <br />Attachment B — Data Security Requirements <br />Attachments C — Title VI Compliance <br />Attachment D — Listing of Policy and Procedure <br />Subagent Contract Template — incorporated herein <br />ALL WRITINGS CONTAINED HEREIN: This Agreement, together with the attachments, exhibits, and all other documents <br />incorporated herein contains the entire agreement of the parties as now written and agreed upon. No other understanding, <br />oral or otherwise, regarding the subject matter of this Agreement has any effect. The parties executing this Agreement <br />affirm they have the authority to bind their respective entities herein. This Agreement is affective upon mutual execution of <br />the parties. <br />Agent Signature Date DOL Signature Date <br />rDoc LiSigned by: uocusJened by: <br />� Of 11/27/2019 ���t�z?bU. I,LAy� 11/27/2019 <br />Name / Titlts Name I Titles <br />Jerry Pettit Evelyne Lloyd <br />Kittitas County Agent Assistant Director, Administrative Services Division <br />OPTIONAL APPROVAL AS TO FORM: County Prosecuting Attorney Signature AAG Approval on File. <br />Print Name Date i <br />i <br />wA State Department of Licensing <br />Version: January 2020 <br />Page 1 of 26 <br />Agent Agreement <br />DOL Reference # K6984 <br />County Reference # VO 1901 <br />