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Home My WebLink AboutDSHS Contract\ Washlnoton Slate Department of Social & Health Services Transforming lives COUNTY PROGRAM or INTERt,.OCAL LONG-TERM PAYABLE AGREEMENT AMENDMENT This Amendment is between the State of Washington Department of Social and Health Services (DSHS) and the Contractor identified below. DSHS CONTRACT NUMBER: 1763-88849 Amendment No. 01 Program Contract Number CIiek here to enter text. Contractor Contract Number CONTRACTOR NAME Kittitas Count CONTRACTOR doing busin_ess as (DBA) CONTRACTOR ADDRESS County Auditors Office WASAINGTON .UNIFORM BUSINESS DSHS INDEX NUMBER IDENTIFIER (UBI ? 205 West 5th Ave County Courthouse Ste 1 05 192-002-673 Ellensbur , WA 98926- CONTRACTOR CONTACT Jud Pless DSHS ADMINISTRATION Services and Enterprise Support Administration DSHS CONTACT NAME AND TITLE William Taplin Contracts Manager CONTRACTOR TELEPHONE 509 962-7502 CONTRACTOR FAX 509 962-7687 DSt-lS DIVISION Central Contracts & Legal Services · DSHS CONTACT ADDRESS 1111 Washington St South OI m ia, WA 98504-5811 DSHS CONTACT TELEPHONE DSHS CONTACT FAX 360 664-6046 Click here to enter text. - 15 THE CONTRACTOR A SUj3RECIP IENT FOR PURPOSES OF TtilS CONTRACT? No AMENDMENT START DATE 07/01/2018 PRIOR MAXIMUM CONTRACTAMOUNT $0.00 REASON FOR AMENDMENT; CONTRACT END DATE 06/30/2019 AMOUNT OF INCREASE OR DECREASE N/A CHANGE OR CORRECT PERIOD OF PERFORMANCE 1225 CONTRACTOR E-MAIL ADDRESS DSHS CONTRACT cobE 8030CS-63 ov TOTAL MAXIMUM CONTRACT AMOUNT Based on Annual Review ATTACHMENTS. When the box below is marked with an X, the-followi ng Exhibits are attached and are incorporated into this Amendment by reference: 0 Addltlonal Exhib(ts .s -~c;lf : This Amendment, including all Exhibits and other documents incorporated by reference, contains all of the terms arid - conditions agreed.upon by the parties as changes to the original County Program Agreement or lnterlocal Agreement. No other understandings or representations, oral or otherwise, regarding the subject matter of this Amendment shall be deemed to exist or bind the parties. All other terms and conditions of the original County Program Agreement or lnterlocal Agreement remain in full force and effect. The parties signing below warrant that they have read and understand this Amend ent. and have authorit to enter into this Amendment. DSHS Central Contracts and Legal Services • 6046 LF Long-Term Payable Amendment (5-2-18) Lsura Oaledacz , Ctialrml!n Board ol C::ounly'Com n,l strono,s May 15, 2018 PRINTED NAME AND TITLE DATE SIGNED Laura Wood, Contract Manager DSHS Central Contra cts and Le a l Service$ Page 1 ,\ud~!!I • Notj: 7ho amount KJll,l .. Cout11Y. has In advance i• $92, 144,00 r,lijv.1, 2D18 • Jtl<I Pto ll This Agreement between the State of Washington Department of Social and Health Services (DSHS) and the Contractor is hereby amended as follows: 1. DSHS extends the Agreement End Date twelve months from June 30, 2018, to June 30, 2019, as stated on Page One of this Amendment. All other terms and conditions of this Agreement remain in full force and effect. DSHS Central Contracts and Legal Services Page2 6046 LF Long-Term Payable Amendment (5-2-1B) in=""''"'""'"'' DSHS CONTRACT NUMBER: COUNTY PROGRAM or INTERLOCAL 1763-88849 7 Department o~ Social & Health Services LONG-TERM PAYABLE AGREEMENT Amendment No. 01 Transforming lives AMENDMENT This Amendment is between the State of Washington Department of Social and Program Contract Number Health Services (DSHS) and the Contractor identified below. Click here to enter tex t. Contractor Contract Number CONTRACTOR NAME CONTRACTOR doing business as (DBA) Kittitas County -CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS DSHS INDEX NUMBER IDENTIFIER (UBI) County Auditors Office 205 West 5th Ave County Courthouse Ste 105 192-002-673 1225 Ellensburo , WA 98926- CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS Judy Pless (509) 962-7502 (509) 962-7687 i udy. pless@co. kittitas. wa . us DSHS ADMINISTRATION DSHS DIVISION DSHS CONTRACT CODE Services and Enterprise Support Central Contracts & Legal 8030CS-63 Administration Services DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS William Taplin 1111 Washington St South Contracts Manager Olympia , WA 98504-5811 DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS (360)664-6046 Click here to enter text. tapliwh@dshs . wa . gov IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS No AMENDMENT START DATE CONTRACT END DATE 07/01/2018 06/30/2019 PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT $0 .00 N/A Based on Annual Review REASON FOR AMENDMENT; CHANGE OR CORRECT PERIOD OF PERFORMANCE ATTACHMENTS. When the box below is marked with an X , the following Exhibits are attached and are incorporated into this Amendment by reference: D Additional Exhibits (s pec ifv): This Amendment, including all Exhibits and other documents incorporated by reference, contains all of the terms and conditions agreed upon by the parties as changes to the original County Program Agreement or lnterlocal Agreement. No other understandings or representations, oral or otherwise, regarding the subject matter of this Amendment shall be deemed to exist or bind the parties. All other terms and conditions of the original County Program Agreement or lnterlocal Agreement remain in full force and effect. The parties signing below warrant that they have read and understand this A mendment, and have authority to enter into this Amendment. ~~t;J DSHS SIGNATURE DSHS Central Contracts and Legal Services 6046 LF Long-Tenn Payable Amendment (5-2-18) PRINTED NAME AND TITLE DATE SIGNED Laura Osiadacz , Chairman Board of County Commissioners May 15, 2018 PRINTED NAME AND TITLE DATE SIGNED Laura Wood, Contract Manager DSHS Central Contracts and Legal Services Page 1 Auditor's Nole : The amount Killitas Co unty has in ad va nce is $92,14 4.00 May 1, 2018 -Ju d Pless II This Agreement between the State of Washington Department of Social and Health Services (DSHS) and the Contractor is hereby amended as follows: 1. DSHS extends the Agreement End Date twelve months from June 30, 2018, to June 30, 2019, as stated on Page One of this Amendment. All other terms and conditions of this Agreement remain in full force and effect. DSHS Central Contracts and Legal Services Page 2 6046 LF Long-Term Payable Amendment (5-2-18) ~ t """'"''" '"" DSHS CONTRACT NUMBER: COUNTY PROGRAM or INTERLOCAL 1763-88849 Department of Social & Health Services LONG-TERM PAYABLE AGREEMENT Amendment No. 01 Transforming lives AMENDMENT This Amendment is between the State of Washington Department of Social and Program Contract Number Health Services (DSHS) and the Contractor identified below. Click here to enter tex t. Contractor Contract Number CONTRACTOR NAME CONTRACTOR doing business as (OBA) Kittitas County CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS DSHS INDEX NUMBER IDENTIFIER (UBI) County Auditors Office 192-002-673 1225 205 West 5th Ave County Courthouse Ste 105 Ellensburg, WA 98926- CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS Judy Pless (509) 962-7502 (509) 962-7687 iudy.pless®co.kittitas.wa .us DSHS ADMINISTRATION DSHS DIVISION DSHS CONTRACT CODE Services and Enterprise Support Central Contracts & Legal 8030CS-63 Administration Services DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS William Taplin 1111 Washington St South Contracts Manager Olympia, WA 98504-5811 DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS (360)664-6046 Click here to enter text. tapliwh@dshs.wa.gov IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS No AMENDMENT START DATE CONTRACT END DATE - 07/01/2018 06/30/2019 PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT $0 .00 N/A Based on Annual Review REASON FOR AMENDMENT; CHANGE OR CORRECT PERIOD OF PERFORMANCE ATTACHMENTS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into this Amendment by reference : D Additional Exhibits (specify): This Amendment, including all Exhibits and other documents incorporated by reference , contains all of the terms and conditions agreed upon by the parties as changes to the original County Program Agreement or lnterlocal Agreement. No other understandings or representations, oral or otherwise, regarding the subject matter of this Amendment shall be deemed to exist or bind the parties. All other terms and conditions of the original County Program Agreement or lnterlocal Agreement remain in full force and effect. The parties signing below warrant that they have read and understand this Amendment, and have authority to enter into this Amendment. "e7.,7 ~ ,~~ DSHS~I0NATUR DSHS Central Contracts and Legal Services 6046 LF Long-Term Payable Amendment (5-2-18) PRINTED NAME AND TITLE DATE SIGNED Laura Osiadacz, Chairman Board of County Commissioners May 15, 2018 PRINTED NAME AND TITLE DATE SIGNED Laura Wood , Contract Manager DSHS Central Contracts and Legal Services Page 1 Audilor's Note: The amount Kittitas County has in advance is $92.144 00 Ma y 1, 2018 -Judy Pless This Agreement between the State of Washington Department of Social and Health Services (DSHS) and the Contractor is hereby amended as follows: 1. DSHS extends the Agreement End Date twelve months from June 30, 2018, to June 30, 2019, as stated on Page One of this Amendment. All other terms and conditions of this Agreement remain in full force and effect. DSHS Central Contracts and Legal Services Page 2 6046 LF Long-Term Payable Amendment (5-2-18)