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mttt w.. ,,,, .. '"'' COUNTY DSHS Agreement Number 1 Department or Social PROGRAM AGREEMENT 1763-96341 Hea lth Scn;ces <br />TriJnsforming fives Consolidated Contract FY18-19 -- <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 County Agreement Number General Terms and Conditions, which is incorporated by reference . <br />DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER CCS CONTRACT CODE <br />Rehabilitation Administration Division of Community 1225 5024CS-63 <br />Programs <br />DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS <br />Barbara Kraemer OB2 <br />FA5 PO Box 45720 <br />Olympia , WA 98504 <br />DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL <br />(360)902-0765 (360)902-8108 kraembj @dshs.wa _gov <br />COUNTY NAME COUNTY DBA COUNTY ADDRESS <br />Kittitas County Rm 211 Kittitas Co Courthouse <br />205 W Fifth St <br />Ellensburg , WA 98926 <br />COUNTY UNIFORM BUSINESS IDENTIFIER (UBI) COUNTY CONTACT NAME <br />192-002-673 Michael Stafford <br />COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX COUNTY CONTACT E-MAIL <br />(509) 962-7516 ( ) -michael .stafford@co .kittitas .wa .us <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM CFDA NUMBERS <br />AGREEMENT? <br />No <br />PROGRAM AGREEMENT START DATE PROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT <br />07/01/2017 06/30/2019 See Exhibits <br />EXHIBITS. When the box below is marked with an X, the following Exhibits are attached and are incorporated <br />into this County Program Agreement: <br />~ Exhibits (specify): ~ Exhibit A : Consolidated Contract Term, Reimbursement Procedures, and Program <br />Responsibilities ; IZI Exhibit B : Juvenile Court Block Grant; IZI Exhibit C : Detention Services <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 />~~~dt12~raf~a v e th ~ho rity to e~u te this co n~ctA-h~ c ontr~(~ shall be 1 n di ~ on FJ H1 only <br />u m n..a~ ""' SH ~...A'A A-_ v l'll/1'n..--A If -t.~( {,(;"f /l. (Ja r. l -} <br />;W)~_ PRfNTEDtjE (S) AND T T LE (8) DATE (S) SIGNED <br />PaNl ewe / 8/' , 17 fOtJeu 0litY~ <br />DSI'!8 Sk:'l 'lR"T UKE -PRINTED NAME AND TITLE DATE SIGNED <br />i/u/ '7 --'-~ J.. .f Dell Hontano8as -Grants and Contracts Manager <br />'----- <br />DSHS Central Contract Services <br />5024CS County Consolidated Contract FY16-17 (6-22-2017)