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Home My WebLink AboutKittitas County DDA County Services Amendment 3Kittitas County Review Form Grants & Contract Agreement Today's Date 06/19/2018 Fund/Department 116 -Public Health Contract/Grant Information Contract /Grant Agency: Kittitas Coun Period Begin Date: 07/01/2018 Total Grant/Contract Amount: $ 1,62E Grant/Contract Number: 1763-98187 Agenda Date DDA County Services Amendment 3 Period End Date: 06/30/2019 .424.00 Contract/Grant Summary: Change or correct period of performance and max contract amount. Contract amendment end date 06/30/2019; increased fund +$801.577. 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 Date Signature of Board of Health member Date Financial Information Total Amount $ 801,577 State Funds $ 801,577 Federal Funds $ Percentage County Funds Matching Funds $ CFDA# In -Kind $ Explain Is Equipment being purchased? Who owns equipment? New Personnel being hired? I Contact HR hiring — reporting requirements Grant/Contract Review Page 1 Future impacts or liability to Kittitas County: Budget Information Budget Amendment Needed? New Division Created? Revenue Code 105.568.334.04.68 Pass Through Information Yes ❑ attach budget form Amount Increase +$801,577 Agency to Pass Through .................... Amount to Pass Through $ Sub -Contract Approved Date: No ❑ Why not New Total $1,628,424 Prosecutor Review Has the Prosecutor reviewed this agreement? Yes El No ❑ County Departments Impacted Submitted Signature: Department: Assignment of Tracking Information Auditor's Office Human Resource Prosecutor's Office Who Signed the grant application Date: Reviewer Date Grant/Contract Review Page 2 Auditor Facilities Maintenance Information Services Human Resource Prosecutor Treasurer Submitted Signature: Department: Assignment of Tracking Information Auditor's Office Human Resource Prosecutor's Office Who Signed the grant application Date: Reviewer Date Grant/Contract Review Page 2 DSHS CONTRACT NUMBER: CONTRACT AMENDMENT 1763-98187 D Department of Social cial 7 & Health Services _ Amendment No. 03 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 CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS Joann Schaan 1 (509) 933-8233 I Click here to enter text. 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 (500)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 07/01/2018 06/30/2019 PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT $826,847.00 $801,577.00 $1,628,424.00 REASON FOR AMENDMENT: CHANGE OR CORRECT PERIOD OF PERFORMANCE AND MAX 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): 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 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 increased in the amount of $801,577 for a new Contract Amount of $1,628,424. 2. The Program Agreement end date is extended to June 30, 2019. 3. Special Terms and Conditions, Section 8, Billing and Payment is amended as follows: a. Program Agreement Budget: DSHS shall pay the County all allowable costs, which are defined by DDA as costs incurred by the program for: Program Administration : The County will provide program administration and may bill for administrative costs up to the identified amount in Exhibit B. Administrative costs reimbursement will not exceed 7% of the total combined allocation for Consumer Support and Other Consumer Support services unless millage has been declared or the Assistant Secretary of DDA approves a request for an exception under Chapter 388-850 WAC. Monthly claims for administrative costs will be for allowable expenditures incurred or 1/12 of the maximum Administration amount identified in Exhibit B, or the lessor of the two. 4. Exhibit B. Program Agreement Budget is hereby replaced with the following Budget Revision: 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 f Year Fund Source Original 1 St Revision 2"d Revision 2018 State Only 413,416 421,051 Waiver Local ............. _ Medicaid Match to Local Total Rev. $820,341 $835,289 $826,847 3rd Revision Fiscal Year Fund Source Original 1st Revision 2nd Revision 3rd Revision 2019 State Only 408,462 Waiver Local Medicaid Match to Local Total Rev. $801,577 DSHS Central Contract Services Page 2 6024PF Contract Amendment (1-26-2018) COUNTY FY 2019 SPENDING PLAN DSHS Central Contract Services Page 3 6024PF Contract Amendment (1-26-2018) Planned Expenditures Local PASRR Medicaid Funds Funds State Funds Funds TOTAL ADMINISTRATION (CMTS/AWA BARS 11) 76 28800 23564 52440 OTHER CONSUMER SUPPORTS (CMTS/AWA Code 31, 32, 41, 92, 93, 94) 26916 22022 48938 CONSUMER SUPPORT STATE -ONLY 6372 6372 _ Child Development MEDICAID CLIENTS 1079 346374 346374 693827 ROADS to COMMUNITY LIVING TOTAL 1155 L 408462 391960 801,577 DSHS Central Contract Services Page 3 6024PF Contract Amendment (1-26-2018)