HomeMy WebLinkAboutDSHS Agreement Amend 1Jlo
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Washington State
Department of Social
& Health Services
Transforming lives
COUNTY PROGRAM or INTERLOCAL
LONG.TERM PAYABLE AGREEMENT
AMENDMENT
DSHS CONTRACT NUMBER:
'1963-56865
Amendment No. 01
the State of Washington Department of Social and
Health Seruices (DSHS) and the Contractor identified below
This Amendment is between Program Contract Number
Click here to enter text.
Contractor Contract N umber
CONTRACTOR NAME
Kittitas County
CONTRACTOR doing business as (DBA)
County Auditors Office
205 West Sth Ave County Courthouse Ste 105
98926-Ellensburq,
CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSIN ESS
IDENTIFIER (UBI)
192-002-673
DSHS INDEX NUMBER
1225
CONTRACTOR CONTACT
Judy Pless
CONTRACTOR TELEPHONE
(509) 962-7502
CONTRACTOR FAX
(509) 962-7687
CONTRACTOR E.MAIL ADDRESS
iudv. pless@co. kittitas.wa. us
DSHS ADMINISTRATION
Facilities, Finance and Analytics
Administration
DSHS DIVISION
Financial Services
DSHS CONTRACT CODE
8030cs-63
DSHS CONTACT NAME AND TITLE
Mariann Schols
Manager, Finance
DSHS CONTACT ADDRESS
PO Box 45842
Olympia, WA 98504-5842
DSHS CONTACT TELEPHONE
(360)902-8170
DSHS CONTACT FAX
(360)664-5775
DSHS CONTACT E-MAIL ADDRESS
scholmj@dshs.wa.gov
rs rHE coNTRAcroR A suBRECtptENT FoR puRposES oF THts coNTRAa-
No
CFDA NUMBERS
AMENDMENT START DATE
07t01t2020
CONTRACT END DATE
06130t2021
PRIOR MAXIMUM CONTRACT AMOUNT
$0.00
AMOUNT OF INCREASE OR DECREASE
N/A
TOTAL MAXIMUM CONTRACT AMOUNT
Based on Annual Review
REASON FOR AMENDMENT;
CHANGE OR CORRECT PERIOD OF PERFORMANCE
ATT thWhen eENTS.HM box OWbel markedIS anwith the followi areExhibits andattached areX,ntongincorporated
is Amendment rerefe nce:th by
Additional Exhibits
Agreement remain in full force and etfect. The parties signing
Amendment, and havfAuthoritv tq,qter into this Amendment.
documents incorporated by reference, contains all of the terms and
nges to the original County Program Agreement or lnterlocalAgreement. No
or otherwise, regarding the subject matter of this Amendment shall be
co
This Amendment, including all Exhibits and other
conditions agreed upon by the parties as cha
other understandings or representations, oral
deemed to exist or bind the parties. All other terms and nditions of the original County Program Agreement or lnterlocal
below warrant that they have read and understand this
CONT PRINTED NAME AND TITLE
Brett Wachsmith,
Chairman Board Co Commissioners
DATE SIGNED
06-16-2020
DSHS SIGNATURT PRINTED NAME AND TITLE
Clarissa Brechwald, Contracts Consultant
DSHS Central Contracts and Leqal Services
DATE SIGNED
+l(l LazD
DSHS Central Contracts and Legal Services
6046 LF Long-Term Payable Amendment (5-5-20)
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This Agreement between the State of Washington Department of Social and Health Services (DSHS) and the
Contractor is hereby amended as follows:
1 DSHS extends the Agreement End Date twelve months from June 30,2020, to June 30,2021, as
stated on Page One of this Amendment.
All other terms and conditions of this Agreement remain in full force and effect.
DSHS Central Contracts and Legal Services
6046 LF Long-Term Payable Amendment (5-5-20)
Page 2