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- <br />DSHS Agreement Number <br />COUNTY 1963-56865 $---w··'·" EPART ENTOF <br />CJ.A l-6'H~.l11-t PROGRAM AGREEMENT SEiR.Vl <br />I <br />Working Advance Long-Term Payable <br />This Program Agreement is by and between the State of Washington Department of Administration or Division <br />Social and Health Services (DSHS) and the County identified below, and is issued in Agreement Number <br />conjunction with a County and DSHS Agreement On General Terms and Conditions, <br />County Agreement Number which is incorporated by reference. <br />DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER DSHS CONTRACT CODE <br />Facilities, Finance and Financial Services 1225 8030CS-63 <br />Analvtics Administration <br />DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS <br />Mariann Schols PO Box45842 <br />Manager, Finance <br />Olvmoia WA 98504-5842 <br />DSHS CONTACT TELEPHONE I DSHS CONTACT FAX I DSHS CONTACT E-MAIL <br />(360)902-8170 (360)664-5775 scholmi@dshs. wa. qov <br />COUNTY NAME COUNTY ADDRESS <br />Kittitas County County Auditors Office <br />205 West 5th Ave County Courthouse Ste 105 <br />Ellensburg WA 98926 <br />COUNTY CONTACT NAME <br />Judv Pless <br />COUNTY CONT ACT TELEPHONE I COUNTY CONTACT FAX I COUNTY CONTACT E-MAIL <br />(509) 962-7502 (509) 962-7687 judy.pless@co.kittitas.wa.us <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM CFDA NUMBERS <br />AGREEMENT? <br />No <br />PROGRAM AGREEMENT START DATE I PROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT <br />07/01/2019 06/30/2020 Based on Annual Review <br />The terms and conditions of this Contract are an integration and representation of the final, entire and exclusive <br />understanding between the parties superseding and merging all previous agreements, writings, and communications , oral <br />or otherwise , regarding the subject matter of this Contract. The parties signing below represent that they have read and <br />understand this Contract, and have the authority to execute this Contract. This Contract shall be binding on DSHS only <br />upon siqnature by DSHS. <br />COUNTY SIGNATURE(S) PRINTED NAME(S) AND TITLE(S) DATE(S) SIGNED <br />~t'v Cory Wright -Chairman, Board of County Commissioners 06-18-19 <br />osHr;•y;~\~~ PRINTED NAME AND TITLE DATE SIGNED <br />William Taplin, Contracts Manager 6/-z1/t1 <br />HJ <br />DSHS Central Contract Services <br />8030CS County Long-Term Payable (3-28-2017) Page 1