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DSHS Agreement Number <br />2663-71228 <br />COUNTY <br />PROGRAM AGREEMENT <br />DDCS Gounty Services <br />sHs <br />vJA!rltt{GToN srATr <br />Dep6rtfrent of Soclal <br />and ffcdlth Sedkes <br />Administration or Division <br />Agreement Number <br />County Agreement Number <br />This Program Agreement is 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 CONTRACT CODE <br />1769CS-63 <br />DSHS ADMINISTRATION <br />Developmental Disabilities <br />Admin <br />Division of Developmental <br />Disabilities <br />DSHS DIVISION DSHS INDEX NUMBER <br />1225 <br />DSHS CONTACT ADDRESS <br />1611 W lndiana Ave <br />Sookane. WA 93205 <br />DSHS CONTACT NAME AND TITLE <br />Seanna Woodard <br />Operations Manager <br />DSHS CONTACT E-MAIL <br />woodas@dshs.wa.oov <br />DSHS CONTACT TELEPHONE <br />(509\329-2952 <br />DSHS CONTACT FAX <br />(509)568-3037 <br />507 North Nanum Street Suite 102 <br />Ellensburq. WA 98926-2886 <br />COUNTY ADDRESS <br />Kittitas County <br />Kittitas County DDA County Services <br />COUNTY NAME <br />COUNW CONTACT NAME <br />Kasey Knutson <br />COUNTY FEDERAL EMPLOYER IDENTIFICATION <br />NUMBER <br />COUNry CONTACT E-MAIL <br />kasev. knutson(Oco. kittitas.wa. us <br />COUNW CONTACT FAX <br />(509) 962-5883 <br />COUNry CONTACT TELEPHONE <br />(509) 962-7090 <br />ASSISTANCE LISTING NUMBERSIS THE COUNry A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM <br />AGREEMENT? <br />No <br />PROGMM AGREEMENT END DATE <br />06t30t2027 <br />MAXIMUM PROGRAM AGREEMENT AMOUNT <br />$1.021,440.00 <br />PROGRAM AGREEMENT START DATE <br />0710112026 <br />Exhibits are aftached: Exhibit A - Data Security Requirements; Exhibit B - Budget and <br />and ofconditions this ndatermAgreementtheirbelowresthereetoCountyProgramagBysignatuparties <br />lhenderstandiUororotherwisentationsoraldocumentsreference.otherNo regardingngsrepreseincorporatedby <br />belowaThbeshalltodeemedorexistthebindsrgnrng certifysuattermthisofmentparliesAgreepartiesbjectProgram <br />that are <br />EXHIBITS. The <br />Plan <br />ent. <br />DATE(S) SIGNED <br />b)Llz1 <br />PRINTED NAME(S) AND TITLE(S) <br />(r*rg \,^'Yr-tc'r q <br />()u,*rrt, bo<L <br />COUNry SIG <br />PRINTED NAME AND TITLE <br />Jessica Barbour, Contract Specialist <br />DATE SIGNED <br />08t05t2026Bazlou' <br />@6fIS SIGNATURE <br />DSHS Central Contract Services <br />1 769CS County Agreem enl (1 2-26-2025) <br />REC[:{V[:D <br />JUl. 2 $ t026 <br />tru),E $pCIl{'Allffi' <br />Page 1