Laserfiche WebLink
\ <br />Washlnoton Slate <br />Department of Social <br />& Health Services <br />Transforming lives <br />COUNTY PROGRAM or INTERt,.OCAL <br />LONG-TERM PAYABLE AGREEMENT <br />AMENDMENT <br />This Amendment is between the State of Washington Department of Social and <br />Health Services (DSHS) and the Contractor identified below. <br />DSHS CONTRACT NUMBER: <br />1763-88849 <br />Amendment No. 01 <br />Program Contract Number <br />CIiek here to enter text. <br />Contractor Contract Number <br />CONTRACTOR NAME <br />Kittitas Count <br />CONTRACTOR doing busin_ess as (DBA) <br />CONTRACTOR ADDRESS <br />County Auditors Office <br />WASAINGTON .UNIFORM BUSINESS DSHS INDEX NUMBER <br />IDENTIFIER (UBI ? <br />205 West 5th Ave County Courthouse Ste 1 05 192-002-673 <br />Ellensbur , WA 98926- <br />CONTRACTOR CONTACT <br />Jud Pless <br />DSHS ADMINISTRATION <br />Services and Enterprise Support <br />Administration <br />DSHS CONTACT NAME AND TITLE <br />William Taplin <br />Contracts Manager <br />CONTRACTOR TELEPHONE <br />509 962-7502 <br />CONTRACTOR FAX <br />509 962-7687 <br />DSt-lS DIVISION <br />Central Contracts & Legal <br />Services · <br />DSHS CONTACT ADDRESS <br />1111 Washington St South <br />OI m ia, WA 98504-5811 <br />DSHS CONTACT TELEPHONE DSHS CONTACT FAX <br />360 664-6046 Click here to enter text. - <br />15 THE CONTRACTOR A SUj3RECIP IENT FOR PURPOSES OF TtilS CONTRACT? <br />No <br />AMENDMENT START DATE <br />07/01/2018 <br />PRIOR MAXIMUM CONTRACTAMOUNT <br />$0.00 <br />REASON FOR AMENDMENT; <br />CONTRACT END DATE <br />06/30/2019 <br />AMOUNT OF INCREASE OR DECREASE <br />N/A <br />CHANGE OR CORRECT PERIOD OF PERFORMANCE <br />1225 <br />CONTRACTOR E-MAIL ADDRESS <br />DSHS CONTRACT cobE <br />8030CS-63 <br />ov <br />TOTAL MAXIMUM CONTRACT AMOUNT <br />Based on Annual Review <br />ATTACHMENTS. When the box below is marked with an X, the-followi ng Exhibits are attached and are incorporated into <br />this Amendment by reference: <br />0 Addltlonal Exhib(ts .s -~c;lf : <br />This Amendment, including all Exhibits and other documents incorporated by reference, contains all of the terms arid - <br />conditions agreed.upon by the parties as changes to the original County Program Agreement or lnterlocal Agreement. No <br />other understandings or representations, oral or otherwise, regarding the subject matter of this Amendment shall be <br />deemed to exist or bind the parties. All other terms and conditions of the original County Program Agreement or lnterlocal <br />Agreement remain in full force and effect. The parties signing below warrant that they have read and understand this <br />Amend ent. and have authorit to enter into this Amendment. <br />DSHS Central Contracts and Legal Services <br />• 6046 LF Long-Term Payable Amendment (5-2-18) <br />Lsura Oaledacz , Ctialrml!n Board ol C::ounly'Com n,l strono,s May 15, 2018 <br />PRINTED NAME AND TITLE DATE SIGNED <br />Laura Wood, Contract Manager <br />DSHS Central Contra cts and Le a l Service$ <br />Page 1 <br />,\ud~!!I • Notj: 7ho amount KJll,l .. <br />Cout11Y. has In advance i• $92, 144,00 <br />r,lijv.1, 2D18 • Jtl<I Pto ll