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DSHS Central Contracts and Legal Services Page 1 <br />6046 LF Long-Term Payable Amendment (5-5-20) <br />COUNTY PROGRAM or INTERLOCAL <br />LONG-TERM PAYABLE AGREEMENT <br />AMENDMENT <br /> <br />DSHS CONTRACT NUMBER: <br />1963-56865 <br />Amendment No. 01 <br />This Amendment is between the State of Washington Department of Social and <br />Health Services (DSHS) and the Contractor identified below. <br />Program Contract Number <br />Click here to enter text. <br />Contractor Contract Number <br />CONTRACTOR NAME <br />Kittitas County <br />CONTRACTOR doing business as (DBA) <br />CONTRACTOR ADDRESS <br />County Auditors Office <br />205 West 5th Ave County Courthouse Ste 105 <br />Ellensburg, WA 98926- <br />WASHINGTON UNIFORM BUSINESS <br />IDENTIFIER (UBI) <br />192-002-673 <br />DSHS INDEX NUMBER <br />1225 <br />CONTRACTOR CONTACT <br />Judy Pless <br />CONTRACTOR TELEPHONE <br />(509)962-7502 <br />CONTRACTOR FAX <br />(509)962-7687 <br />CONTRACTOR E-MAIL ADDRESS <br />judy.pless@co.kittitas.wa.us <br />DSHS ADMINISTRATION <br />Facilities, Finance and Analytics <br />Administration <br />DSHS DIVISION <br />Financial Services <br />DSHS CONTRACT CODE <br />8030CS-63 <br />DSHS CONTACT NAME AND TITLE <br />Mariann Schols <br />Manager, Finance <br />DSHS CONTACT ADDRESS <br />PO Box 45842 <br />Olympia, WA 98504-5842 <br />DSHS CONTACT TELEPHONE <br />(360)902-8170 <br />DSHS CONTACT FAX <br />(360)664-5775 <br />DSHS CONTACT E-MAIL ADDRESS <br />scholmj@dshs.wa.gov <br />IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? <br />No <br />CFDA NUMBERS <br />AMENDMENT START DATE <br />07/01/2020 <br />CONTRACT END DATE <br />06/30/2021 <br />PRIOR MAXIMUM CONTRACT AMOUNT <br />$0.00 <br />AMOUNT OF INCREASE OR DECREASE <br />N/A <br />TOTAL MAXIMUM CONTRACT AMOUNT Based on Annual Review <br />REASON FOR AMENDMENT; <br />CHANGE OR CORRECT PERIOD OF PERFORMANCE <br />ATTACHMENTS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into <br />this Amendment by reference: <br /> Additional Exhibits (specify): <br />This Amendment, including all Exhibits and other documents incorporated by reference, contains all of the terms and <br />conditions agreed upon by the parties as changes to the original County Program Agreement or Interlocal 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 Interlocal <br />Agreement remain in full force and effect. The parties signing below warrant that they have read and understand this <br />Amendment, and have authority to enter into this Amendment. <br />CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED <br />DSHS SIGNATURE PRINTED NAME AND TITLE <br />Clarissa Brechwald, Contracts Consultant <br />DSHS Central Contracts and Legal Services <br />DATE SIGNED <br />Brett Wachsmith, <br />Chairman Board Co Commissioners 06-16-2020 <br />$54,000 Advance