The URL can be used to link to this page

Home My WebLink AboutState of Wa DSHS-DDA Amendment 1• Kittitas County Public Health APublic Health Contract/Agreement Review Form Today's Date: 05/28/2026 I Legal Request #: 12449 Fund/Department: 116-Public Health I Agenda Date: Contract/Agreement Information Contract/Agreement Agency: State of WA. DSHS- Developmental Disabilities Contract/Agreement Title Begin Date: 03/01/2026 DSHS-Developmental Disabilities Amendment 1 End Date: 06/30/2026 Total $ Amount: $1,139,083.00 Contract/Agreement #: 2563-64310 Amend 1 Contract/Agreement Summary: The program agreement amends the total maximum contract amount. T by $16,000.00 for a new contract amount of $1,139,083.00. Kittitas County Prosecutor and Auditor Review and Comment: APPROVED AS TQFORM: Signature Signature of Auditor's Office—/ Budget Information Revenue Code(s): 105 - 568.334.04.68 Expense Code(s): HS1000-101 / 1001/1002/4122 ✓❑ Agency is not suspended/disbarred Not Checked (reason) Pass Through Information Agency to Pass Through Amount to Pass Through _ �xpense Code: Sub -Contract Approved Date: _1 Date Date ADMIN I Version: 0 1 Supersedes: 0 Date Adopted: 12/01/2024 1 Modified By: Katie Odiaga Approval By: Chelsey Loeffers 6/2/26, 12:22 PM SAM.gov 1E An official website of the United States government Here's how you know Contract Award Data Processing Delay Show Details X May 4, 2026 Subcontracting Plan Reporting Contract Retrieval Issue Show Details Apr 17, 2026 �!� SAM*oov@ Home Search Data Bank Data Services Help Entity FM See All Alerts 00 00 l�J LE I!I Washington State Department of Social and Health ID Services Assigned The entity record has been validated as unique and existing, but is not registered in T SAM.gov. Unique Entity ID Physical Address Version J75BJHP3G7H9 8805 Steilacoom Blvd Current Record SW null Lakewood, WA 98498-4770, USA hftps://sam.gov/entities/view/J75BJHP3G7H9?versionld=O 113 6/2/26, 12:22 PM SAM.gov Our Website Our Partners About This Site Acquisition.gov Our Community USASpending.gov Release Notes Grants.gov System Alerts More Partners Policies Customer Service Terms of Use Help Privacy Policy Check Entity Status Restricted Data Use Federal Service Desk Freedom of Information Act External Resources Accessibility Contact 0 WARNING This is a U.S. General Services Administration Federal Government computer system that is "FOR OFFICIAL USE ONLY." This system is subject to monitoring. Individuals found performing unauthorized activities are subject to disciplinary action including criminal prosecution. https://sam.gov/entities/view/J75BJHP3G7H9?versionld=0 2/3 6/2/26, 12:22 PM SAM.gov This system contains Controlled Unclassified Information (CUI). All individuals viewing, reproducing or disposing of this information are required to protect it in accordance with 32 CFR Part 2002 and GSA Order CIO 2103.2 CUI Policy. SAM.gov An official website of the U.S. General Services Administration https://sam.gov/entities/view/J75BJHP3G7H9?versionld=0 3/3 COUNTY PROGRAM AGREEMENT r & Healm nt of Services AMENDMENT 7 i &Health Services Transforming lives This Program Agreement Amendment is by and between the State of Washington Department of Social and Health Services (DSHS) and the County identified below. DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER Developmental Disabilities Division of Developmental 1225 Admin Disabilities DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS Seanna Woodard 1611 W Indiana Ave Spokane, WA 99205 DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS 509 329-2952 509 568-3037 wood COUNTY NAME COUNTY ADDRESS Kittitas County 507 N NANUM ST STE 102 Kittitas County DDA County Services Ellensburg, WA 98926 COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME NUMBER Kasey Knutson COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX 509 962-7090 509 962-5883 IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM AGREEMENT? No AMENDIIRENT START DATE PROGRAM AGREEMENT END DATE 03/01 /2026 06/30/2026 PRIOR MAXIMUM PROGRAM AGREEMENT I AMOUNT OF INCREASE OR DECREE' AMOUNT $1,123,083.00 $16,000.00 DSHS Agreement Number 2563-64310 Amendment No. 01 Administration or Division Agreement Number Click here to enter text. County Agreement Number 1225 E-MAIL COUNTY CONTA( kase .knutson CFDA NUMBERS TOTAL MAXIMUM AMOUNT $1.139.083.00 E-MAIL ;o. kittitas.wa.us REASON FOR AMENDMENT; CHANGE OR CORRECT MAXIMUM CONTRACT AMOUNT EXHIBITS. When the box below is marked with a check (4) or an X, the following Exhibits are attached and are incorporated into this Program Agreement Amendment by reference: ® Exhibits (specify)., Exhibit B-1 This Program Agreement Amendment, including all Exhibits and other documents incorporated by reference, contains all of the terms and conditions agreed upon by the parties as changes to the original Program Agreement. No other understandings or representations, oral or otherwise, regarding the subject matter of this Program Agreement Amendment shall be deemed to exist or bind the parties. All other terms and conditions of the original Program Agreement remain in full force and effect. The parties signing below warrant that they have read and understand this Program Agreement Amendment, and have authority to enter into this Pro ram A reement Amendment. COUNTY SIGNATURE(S) I PRINTED NAMES) AND TITLE(S) DATES) SIGNED DSHS SIGNA PRINTED NAME AND TITLE DATE DSHS Central Contract Services 1769CP Contract Amendment (6-10-24) Page 1 This Program Agreement between the County and the State of Washington Department of Social and Health Services (DSHS) is hereby amended as follows: 1. The Total Maximum Contract Amount is hereby increased in the amount of $16,000 for anew Contract Amount of $1,139,083. 2. Exhibit B. Program Agreement Budget is hereby replaced with the following Exhibit B-1, Program Agreement Budget. All other terms and conditions of this Contract remain in full force and effect. DSHS Central Contract Services Page 2 1769CP Contract Amendment (6-10-24) Exhibit B-1 Program Agreement Budget Original Budget X Budget Revision REVENUES Fiscal Year Fund Source Original 1st Revision 2026 State only 567,912 576,712 Medicaid 555,171 562,371 Total Rev. $1,123,083 $1,139,083 Fiscal Year Fund Source 2027 State only Medicaid Total Rev. 2"d Revision I 3rd Revision ininni 1st Revision 2"d Revision I 3rd Revision $ 1 $ Job Foundation Funds PASRR Funds State Funds Medicaid Funds TOTAL ADMINISTRATION (11, 12, 13, 14)56153 45944 102,097 OTHER CONSUMER SUPPORTS (31, 32, 41, 92, 93, 94, 97) 45536 37257 82,793 CONSUMER SUPPORT STATE -ONLY 62, 64, 65, 67, 69) _ - — Child Develo ment 61 MEDICAID CLIENTS 62(16416T69,95, 96 18.000 462149 462149 942.298 ROADS to COMMUNITY LIVING (62, 64, 65, 67, 69 2974 8921 11, 895 TOTAL 18,000 566,812 554,271 1,139,083 DSHS Central Contract Services Page 3 1769CP Contract Amendment (6-10-24)