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DSHS Central Contract Services <br />8030CS County Long-Term Payable (3-28-2017) Page 1 <br />COUNTY <br />PROGRAM AGREEMENT <br />Working Advance Long-Term Payable <br />DSHS Agreement Number <br />2163-23580 <br />This Program Agreement is by and between the State of Washington Department of <br />Social and Health Services (DSHS) and the County identified below, and is issued in <br />conjunction with a County and DSHS Agreement On General Terms and Conditions, <br />which is incorporated by reference. <br />Administration or Division <br />Agreement Number <br />County Agreement Number <br />DSHS ADMINISTRATION <br />Facilities, Finance and <br />Analytics Administration <br />DSHS DIVISION <br />Financial Services <br />DSHS INDEX NUMBER <br />1225 <br />DSHS CONTRACT CODE <br />8030CS-63 <br />DSHS CONTACT NAME AND TITLE <br />Rebecca Doane <br />Office Chief <br />DSHS CONTACT ADDRESS <br />PO Box 45842 <br />Olympia WA 98504-5842 <br />DSHS CONTACT TELEPHONE <br />(360)763-2977 <br />DSHS CONTACT FAX <br />Click here to enter text. <br />DSHS CONTACT E-MAIL <br />rebecca.doane@dshs.wa.gov <br />COUNTY NAME <br />Kittitas County <br />Kittitas County <br />COUNTY ADDRESS <br />County Auditors Office <br />205 West 5th Ave County Courthouse Ste 105 <br />Ellensburg WA 98926 <br />COUNTY CONTACT NAME <br />Judy Pless <br />COUNTY CONTACT TELEPHONE <br />(509) 962-7502 <br />COUNTY CONTACT FAX <br />(509) 962-7687 <br />COUNTY CONTACT E-MAIL <br />judy.pless@co.kittitas.wa.us <br />IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM <br />AGREEMENT? <br />No <br />CFDA NUMBERS <br />PROGRAM AGREEMENT START DATE <br />07/01/2021 <br />PROGRAM AGREEMENT END DATE <br />06/30/2022 <br />MAXIMUM PROGRAM AGREEMENT AMOUNT <br />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 signature by DSHS. <br />COUNTY SIGNATURE(S) PRINTED NAME(S) AND TITLE(S) DATE(S) SIGNED <br />DSHS SIGNATURE PRINTED NAME AND TITLE <br />Kerra Lynch, Contract Manager <br />DSHS Central Contracts and Legal Services <br />DATE SIGNED <br />july 6, 2021Brett Wachsmith, Chairman <br />Board of County Commissioners <br />Current Working Advance $54,000