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WSDOH Contract Amendment
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2023-06-20 10:00 AM - Commissioners' Agenda
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WSDOH Contract Amendment
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Entry Properties
Last modified
6/28/2023 10:33:57 AM
Creation date
6/28/2023 10:33:52 AM
Metadata
Fields
Template:
Meeting
Date
6/20/2023
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Fully Executed Version
Supplemental fields
Item
Request to Approve Amendment No. 2 to the Rural Health Equity Grant
Order
11
Placement
Consent Agenda
Row ID
104780
Type
Agreement
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r3f Washlngton Stare Department ot <br />HEALTH CONTRACT AMENDMENT <br />This document has been <br />DOI-I Anrerrdrn ent GY L26649 -2 <br />Revisron 04/2020 <br />I. NAMEOFCONTRACTOR <br />Kittitas County Public Health Department <br />2. CONTRACTNUMBER <br />GVL26649 <br />1a. ADDRESS OF CONTRACTOR (STREET) <br />507 N Nanum St Ste 102 <br />2a. AMENDMENT NUMBER <br />1 <br />Ib. CITY, STATE, ZIP CODE <br />Ellensbu rg, wA 98926 <br />Unique Entity Identifi er: <br />WQ23XPBSAU44 <br />3. I rurs rTEM APPLIES ONLY TO BILATERAL AMENDMENTS. <br />The Contract identified herein, including any previons arnendments thereto, is hereby amended as <br />set forth in Itern 5 below by mutual consent of all parties hereto. <br />4. L_l THIS ITEM APPLIES ONLY TO UNILATERAL AMENDMENTS. <br />The Contract identified herein, including any previous arnendrnents thereto, is hereby unilaterally <br />amended as set forlh in ltern 5 below pursuant to tliat changes and modifications clause as <br />contained therein. <br />D M The purpose of this non-cost amendment is to revise the <br />ent of Work and to extend the Period of Performance. <br />5a. Statement of Work: Exhibit A-1 is revised in accordance with Exhibit A-2, attached hereto <br />and incorporated herein. <br />5b. Consideration: This amendtnent neither increases nor decreases the Contract Consideration; <br />therefore, the maximum consideration of this contract and all amendrnents shall not exceed <br />$300,000.00. <br />Contractor agrees to comply with applicable rules and regulations associated with these funds. <br />5d. Period of Performance: is extended through May 31,2024. <br />5e. The Effective Date of this A mendment: is the Date of Execution. <br />6. All other terms and conditions of the original contract and any subsequent amendments thereto <br />remain in full force and effect. <br />7. nfnls is a unilateral amendment. Signature of contractor is not required below. <br />I Contractor hereby acknowledges and accepts the terms and conditions of this amendment <br />Signature is required below <br />8. CONTRACTOR SIGNATURE (also, please print/type your name) <br />Cheke,q l-oeffe,rr <br />Cheley r oplFs ( run )6: /o/3 t3 qr pot I <br />DATE <br />Jun26,2023 <br />9. DOH CONTRACTING OFFICER SIGNATURE <br />-4--/ -LLJ,t-&r--(r-* U <br />DATE <br />Jun26,2023 <br />approved as to form only by the Assistant Attorney General. <br />Page l of4
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