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Home My WebLink AboutKittitas County DDA County Services Amendment 2Kittitas County Review Form Ii11 I t'.l4 VII Today's Date 06/19/2018 Fund/Department 116 -Public Health Grants & Contract Agreement Agenda Date Contract/Grant Information Contract /Grant Agency: Kittitas County DDA County Services Amendment 2 Period Begin Date: May 1, 2018 Period End Date: June 30, 2018 Total Grant/Contract Amount: -$8,442.00 Grant/Contract Number: 1763-98187 Contract/Grant Summary: The contract agreement revises the program agreement budget by decreasing the budget by $8,442.00. Recommendation for Board of Health and Board of Health Review on Department Head Signature: , Administrator Date: Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: APPROVED AS TO FORM: Signature of Prosecutor's Office Date Signature of Auditor's Office Signature of Board of Health member Financial Information Date Date Total Amount $-8,422 State Funds $-8,422 Federal Funds $ Percentage County Funds Matching Funds $ CFDA# In -Kind $ Explain Is Equipment being purchased? Who owns equipment? New Personnel being hired? Contact HR hiring — reporting requirements Grant/Contract Review Page 1 Future impacts or liability to Kittitas County: Budget Information Budget Amendment Needed? Yes ❑ attach budget form ................... No ❑ Why not New Division Created? Will only need if actual amount billed exceeds Contract amount — will do at year end Revenue Code Amount Decrease New Total 105.568.334.04.68 $-8,442 $826,847 Pass Through Information Agency to Pass Through Amount to Pass Through $ Sub -Contract Approved Date: Prosecutor Review Has the Prosecutor reviewed this agreement? Yes ❑ No ❑ county uepartments impactea Auditor Facilities Maintenance Information Services Human Resource Prosecutor Treasurer Submitted Signature: Date: Department: MbbigFUTIMrll OF 1 rdGKlnj' Iriyurmailon Auditor's Office Human Resource Prosecutor's Office Who Signed the grant application Reviewer I Date Grant/Contract Review Page 2 —911111 DSHS CONTRACT NUMBER: Washington State CONTRACT AMENDMENT 1763-98187 Department o ento f Social 7 1 1 & Health Services Amendment No. 02 Transforming lives This Contract Amendment is between the State of Washington Department of Program Contract Number Social and Health Services (DSHS) and the Contractor identified below. Click here to enter text Contractor Contract Number CONTRACTOR NAME CONTRACTOR doing business as (DBA) Kittitas County Kittitas County DDA County Services CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS DSHS INDEX NUMBER 507 North Nanum Street Suite 102 IDENTIFIER (UBI) 1225 192-002-673 Ellensburg, WA 98926-2886 CONTRACTOR CONTACT CONTRACTOR TELEPHONE I CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS Joann Schaan 1 (509) 933-8233 1 Click here to enter text I Click here to enter text. DSHS ADMINISTRATION DSHS DIVISION DSHS CONTRACT CODE Developmental Disabilities Admin Division of Developmental 1769CS-63 Disabilities DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS Seanna Woodard 1611 W Indiana Ave Operations Manager Spokane, WA 99205 DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS (509)329-2952 (509)568-3037 woodas@dshs.wa.gov IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS No AMENDMENT START DATE CONTRACT END DATE 05/01/2018 06/30/2018 PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT $835,289.00 $-8,442.00 $826,847.00 REASON FOR AMENDMENT; CHANGE OR CORRECT MAXIMUM CONTRACT AMOUNT ATTACHMENTS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into this Contract Amendment by reference: ® Additional Exhibits (specify): Exhibit B This Contract 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 Contract. No other understandings or representations, oral or otherwise, regarding the subject matter of this Contract Amendment shall be deemed to exist or bind the parties. All other terms and conditions of the original Contract remain in full force and effect. The parties signing below warrant that they have read and understand this Contract Amendment, and have authority to enter into this Contract Amendment. CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED Melissa Diebert, Contract Specialist DSHS Central Contract Services Page 1 6024PF Contract Amendment (1-26-2018) This Contract between the State of Washington Department of Social and Health Services (DSHS) and the Contractor is hereby amended as follows: 1. The Total Maximum Contract Amount is hereby decreased in the amount of ($8,442) for a new Contract Amount of $826,847. The decreased amount is reflected in the attached amended Spend Plan. All other terms and conditions of this Contract remain in full force and effect. EXHIBIT B Program Agreement Budget ❑ Original Budget X Budget Revision REVENUES Fiscal Year Fund Source Original 1St Revision 2nd Revision 3`d Revision 2018 State Only 413,416 421,051 TOTAL ADMINISTRATION Waiver Waiver Local Medicaid Match to Local Total Rev. Local Medicaid Match to Local 29697 1 24298 54093 Total Rev. OTHER CONSUMER $820,341 $835,289 $826,847 Fiscal Year Fund Source Original 1" Revision 2nd Revision 3d Revision 2019 State Only State Funds Funds TOTAL ADMINISTRATION Waiver (CMTS/AWA BARS 11) Local Medicaid Match to Local 29697 1 24298 54093 Total Rev. OTHER CONSUMER COUNTY FY 2018 SPENDING PLAN Planned Expenditures Child Development DSHS Central Contract Services 6024PF Contract Amendment (1-26-2018) I Page 2 Local PASRR I Medicaid Funds Funds State Funds Funds TOTAL ADMINISTRATION 98 (CMTS/AWA BARS 11) 29697 1 24298 54093 OTHER CONSUMER SUPPORTS (CMIS/AWA Code 31, 32, 41, 92, 93, 94) 27754 22708 50462 CONSUMER SUPPORT STATE -ONLY 6312 464 6776 Child Development DSHS Central Contract Services 6024PF Contract Amendment (1-26-2018) I Page 2 DSHS Central Contract Services Page 3 6024PF Contract Amendment (1-26-2018) MEDICAID CLIENTS 940 357288 357288 715516 ROADS to COMMUNITY LIVING TOTAL 1502 421051 404294 826,847 DSHS Central Contract Services Page 3 6024PF Contract Amendment (1-26-2018)