HomeMy WebLinkAboutAmendment 1 to PSA between Elmview and Kittitas CountyKittitas County
Review Form
Grants & Contract Agreement
Today's Date
05/02/2019
Fund/Department
116 -Public Health
Contract/Grant Information
Agenda Date
Contract /Grant Agency: Amendment to PSA between Elmview and Kittitas County
Period Begin Date: June 1,2019 Period End Date: June 30, 2019
Total Grant/Contract Amount: To Be Determined (based on clients served)
Grant/Contract Number:
Contract/Grant Summary:
The amendment is entered between the contractor and county to update the activity service rates for
employment and day activities for the Developmental Disabilities Program.
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:
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Signature of Rrosecutor'slOffice
SignatuVebf guditor's Office
Date I
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Date
Signature of Board of Health member Date
Financial Information
Total Amount $ TBD State Funds $ TBD Federal Funds $
Percentage County Funds Matching Funds $ CFDA#
In -Kind $
Is Equipment being purchased? Who owns equipment?
Grant/Contract Review Page 1
New Personnel being hired? I Contact HR hiring—reporting requirements
Future impacts or liability to Kittitas County:
Budget Information
Budget Amendment Needed? Yes ❑ attach budget form No ❑ why not
New Division Created?
Revenue Code 105.568.334.04.68
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 Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Submitted
Signature: Date:
Department:
of Tracking Information
Reviewer I Date
Grant/Contract Review Page 2
Amendment No.1 to the Professional Service Agreement
between Elmview and Kittitas County
June 1, 2019- June 30, 2019
The Professional Services Agreement between Elmview and Kittitas County, is hearby
amended to amend the activity service rate for employment day activities for the
Developmental Disabilities Program as follows (Attachement "A"):
• Individual Employment (IE) $75.00 per service hour
• Group Supported Employment (GSE) $53.00 per service hour
• Community Inclusion (CA) $35.00 per service hour
All other terms and conditions of the agreement remain in full force and effect.
IN WITNESS WHEREOF, the parties have executed this Agreement this
2019.
ELMVIEW
Signature of Signatory
(Date
Print Name of Signatory
APPROVED-
BOARD OF COUNTY COMMISSIONERS
KITTITAS COUNTY, WASHINGTON
Corey Wright, Chairman
Brett Wachsmith, Vice -Chairman
Laura Osiadacz, Commissioner
Professional Services Agreement Amendment No.1
Page 1
day of
Contractor Address:
Elmview
204 East 6th Avenue
Ellensburg, WA 98926
Project Contact:
Bruce Tabb
Executive Director
Attest
❑ Julie Kjorsvik
❑ Mandy Buchholz
Clerk of the Board
County's Address:
Kittitas County
205 West 5th Avenue, Suite 108
Ellensburg, WA 98926
Project Contact:
Kasey Knutson
County Coordinator
Professional Services Agreement Amendment No.1
Page 2
ATTACHMENT "A"
Program Activity Level and Payment Rate Schedule
Kittitas County -Department of Developmental Disabilities
2018-2019 Contract Rate Schedule
Individual Employment (IE) $75.00 per service hour
Group Supported Employment (GSE) $53.00 per service hour
Community Inclusion (CA) $35.00 per service hour
Professional Services Agreement Amendment No.1
Page 3