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Home My WebLink AboutAFS between KC and Robin Read Amend 2s Kittitas County Public Health Contract/Agreement Review Form Kittitas County Public Health partment Today's Date: 05/28/26 Legal Request #: 12517 Fund/Department: 116-Public Health Agenda Date: Contract/Agreement Information Contract/Agreement Agency: Robin Read Contract/Agreement Title: AFS Between Kittitas County and Robin Read Amendment Z Begin Date: 02.01.26 End Date: 03.01.27 Total $ Amount: $27,500.00 Contract/Agreement Summary: Contract/Agreement #: PHMH26-002 The Agreement is amended as follows: The Developmental Disabilities Biennial Plan 2026-2028 Creation, add hosting two listening sessions under data updates in the scope of work. Total contract amount increases by $3,500 to a new contract total of $27,500. Kittitas County Prosecutor and Auditor Review and Comment: APPROVED a$ TO FORM: Signature ofProsecutor's Office Signature of Auditor's Ottice Budget Information Revenue Code(s): Expense Code(s): HS2000101 /4101 - 0 Agency is not suspended/disbarred H H 1000101 /4101 - 001-1654101 Not Checked (reason) Pass Through Information Agency to Pass Through Amount to Pass Through Expense Code: Sub -Contract Approved Date: Date 6, • L(• Z, Date ADMIN I Version: 0 ` Supersedes: 0 1 Date Adopted: 12/01/2024 1 Modified By: Katie Odiaga Approval By: Chelsey Loeffers 6/2/26, 12:23 PM SAM.gov I Search t An official website of the United States government Here's how you know Contract Award Data Processing Delay Show Details x See All Alerts May 4, 2026 Subcontracting Plan Reporting Contract Retrieval Issue Show Details x Apr17, 2026 f! 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S� F" v'::'I; �t%IEe.C's �`rd�i�iI I�tt6�y�'F . .l� �t CSC .� G: �. `�. the 4alo � '..-��.. �� https://sam.gov/search/?page=1 &pageSize=25&sort=-relevance&index=ei&sfm%5BsimpleSearch%5D%5BkeywordRadio%5D=ALL&sfm%5BsimpleS... 2/2 KITTITAS COUNTY AMEND PH M H26-002 Amendment #2 MENT TO: This Amendment ("Amendment") is made as of June 2, 2026 by and between Kittitas County (hereinafter "County"), a political subdivision of the State of Washington, and Robin H Read Consulting (hereinafter "Contractor"). WHEREAS, the parties entered into an agreement February 1, 2026 (the "Agreement"); and WHEREAS, the grantee was requested to add additional data collection around developmental disabilities related information; WHEREAS, the parties desire to amend the Agreement; NOW, THEREFORE, the parties agree as follows: 1. Amendment The Agreement is amended as follows: in the Developmental Disabilities Biennial Plan 2026-2028 Creation, add hosting two listening sessions under data updates in the scope of work. Total contract amount increases by $3,500 to a new contract total of $27,500. 2. No Other Changes All other terms of the Agreement remain unchanged and in full force and effect. IN WITNESS WHEREOF, the parties have executed this Amendment as of the latest date written below. Kittitas County Amendment to: ILA, AGS, InterDept. MOU (8/28/25) Page 1 of 2 KITTITAS COUNTY BOARD OF COUNTY COMMI Cory Wright, Chair Brett Wachsmith, Vice -Chair Laura, Osiadacz, Commissic Date: Attest: Clerk of the Board ❑ Julie Kjorsvik ❑ Mandy Buchholz Kittitas County Amendment to: ILA, AGS, InterDept. MOU (8/28/25) Page 2 of 2 Kittitas County Public Health Public Health Contract/Agreement Review Form Today's Date: 103.17.26 Legal Request #: ! 12183 Fund/Department: 1116-Public Health I Agenda Date: Contract/Agreement Intormatlon Contract/Agreement Agency: Robin Read Contract/Agreement Title: AFS Between Kittitas County and Robin Read Amendment 1 Begin Date: 02.01.26 ^ 1 End Date: 03.01.27 Total $ Amount: $23,000.00 Contract/Agreement summary: Contract/Agreement#: PHMH26-002 The amendment is established to change the original begin date of the contract from: Upon Signature to 02.01.26 Kittitas County Prosecutor and Auditor Review and Comment: APPROVED AS TO FORM: Signature a Prosecut is Off ic Date 0 3.2-7. Z V Signatu of uditvr's bRice Date ..fir Revenue Code(s): Expense Code(s): d R.M01 I — I 5 D Agency is not suspended/disbarred Not Checked (reason) D�cc Thrm icrh Infnrmntinn Agency to Pass Through Amount to Pass Through Expense Code: Sub -Contract Approved Date: ADMIN Version: 0 Supersedes: 0 Date Adopted:12J01�'2024 Modified By: Katie Odiaga I Approval By: Chelsey Loeffers _ -- KITTITAS COUNTY AMENDMENT TO: Agreement for Services between Kittitas County and Robin H Read Consulting PHMH26-002 i This Amendment ("Amendment") is made as of April 7, 2026, by and between Kittitas County (hereinafter "County"), a political subdivision of the State of Washington, and Robin H Read Consulting (hereinafter "Contractor"). WHEREAS, the parties entered into an agreement dated March 3, 2026 (the "Agreement"); and WHEREAS, the parties desire to amend the Agreement; NOW, THEREFORE, the parties agree as follows: 1. Amendment The Agreement is amended as follows: Contract start date to change to February 1, 2026. 2. No Other Changes All other terms of the Agreement remain unchanged and in full force and effect. IN WITNESS WHEREOF, the parties have executed this Amendment as of the latest date written below. Kittitas County Amendment to: ILA, AGS, InterDept. MOU (8/28/25) Page 1 of 2 KITTITAS COUNTY BOARD OF COUNTY COMMISSIONERS Cory Wright, Chair L Brett achsmith, Vi ce -Chair -I La sia cz, Commissioner � ,l J Date_ � ► 1_J Attest: 1 erk of the Board _,fY— JuLie Kjorsvik ❑ Mandy Buchholz llti�� COJttJ77�,r� SEAT, �r t�~� CONTRACTOR 1� �- r signature .p �'b '- e- 6L4"( % H_ j Prin TitLE Kittitas County Amendment to: ILA, AGS, InterDept. MOU (8/28/25) Page 2 of 2 Kittitas County Public Health Public Health Contract/Agreement Review Form = Today's Date: 01/28/26 Legal Request M 12183 Fund/Department: 1116 Agenda Date: Contract/Agreement Information Contract/Agreement Agency: Robin Read Contract/Agreement Title: AFS between Kittitas County and Robin Read Begin Date: Upon Signature End Date: 03/31/� Total $ Amount: $23,000.00 Contract/Agreement #: PHMH26-002 Contract/Agreement Summary: The purpose of this Agreement is for the creation of plans for advisory committees including a 2 year strategic plan for mental health and substance use disorder prevention. an actions plan for homelessness an affordable housing, and an updated biennial plan for development disabilities advisory committee. Kittitas County Prosecutor and Auditor Review and Comment: APPROVED -!A T.O FORM: . I- 1.�[�1 Date Signature of'toj�uto's oI`Fice D Date is Office Budk t I tdrmatlan Revenue Code(s): Expense Code(s): HS2000101/4101 - HH1000101/4101 - 001-1654101 Agency is not suspended/disbarred Not Checked (reason) Pass Through Information Agency to Pass Through Amount to Pass Through Sub -Contract Approved Date: Expense Code: ADMIN ' Version: 0 Supersedes: 0 Date Adopted: 12101/2024 , Modified 13y: KatDe odiaga Approval BY: Chelsey Loeffers 1/28/26. 1:19 PM SAM.gov I Search n Status L✓ ; Active U Inactive Reset G =Domainsi Contracting Federal Assistance Entity Information , Federal Hierarchy 1 Wage De No matches found Yoursearch did not return any results foractive records. Would you like to include inactive records in your search results? Search Inactive Go Back Our Website Our Partners About This Site Acquisition.gov our Community USASpending.gov Release Notes Grants.gov System Alerts More Partners Customer Service Policies Terms of Use Help Privacy Policy Check Entity Status Federal Service Desk Restricted Data Use Freedom of Information Act External Resources Accessibility Contact https://SaM.gov/searcht?page=l &pageSize=25&sort=-modifedDate&sfm%5BsimpleSesrch%5D%5BkeywordRadio%5D=ALL&sfm°/a5BsimpleSearch. 2/3 KITTITAS COUNTY AGREEMENT FOR SERVICES PHMH26-002 This Agreement for Services (hereinafter "Agreement") is entered into by and between Kittitas County (hereinafter "County"), a political subdivision of the State of Washington, and Robin H Read Consulting (hereinafter "Contractor"). The purpose of this Agreement is as follows: creation of plans for advisory committees including a 2-year strategic plan for mental health and substance use disorder prevention, an action plan for homelessness and affordable housing, and an updated biennial plan for developmental disabilities advisory committee. The term of this Agreement shall be from the date of execution through March 31, 2027, unless the Agreement is terminated early or its term is extended as provided herein. The parties' addresses and points of contact for the administration of this Agreement are as follows: COUNTY 507 N Nanum Street Ste 102 Ellensburg, WA 98926 Kasey Knutson Human Services Manager Kittitas County Public Health Department Ka.sey,knutsc)n@co.kittitas.wa.us 509-962-7515 CONTRACTOR 1301 N Main Street Ellensburg, WA 98926 Robin Read Owner, Robin H Read Consulting robinhread@gmail.com 509-607-1375 This Agreement includes the following, which are attached hereto and hereby incorporated by this reference: Attachment "A": Scope of Work Attachment ,. B Compensation Attachment "C": General Terms and Conditions Attachment "D": W-9 (Contractor must complete and return to the County for payment) Attachment "E": Retirement Status Form (Contractor must complete and return to the County for payment if Contractor is an individual, as opposed to a corporate business entity) Kittitas County Agreement for Services (rev. 5/14/25) Page' 1 of 19 ATTACHMENT "A" SCOPE OF WORK 1/1e OF 1% MENTAL HEALTH AND CHEMICAL DEPENDENCY ADVISORY BOARD — CREATION OF A 2 YEAR STRATEGIC PLAN Pre -work o Review Kittitas County Behavioral Health assessment results o Research and review behavioral health plans from other counties o Attend committee meetings • Data Collection o Create interview questions and interview committee members and staff o Conduct Strengths, Weaknesses, Opportunities, Threats analysis with committee o Compile and present report of data collection results o Analyze services funded for duplication o Analyze performance data for people served and cost per person • In person strategic planning meetings o Create vision, mission, and value statements o Identify new name of committee o Identify and define strategic priorities o Create goal statements and desired outcomes o Identify strategies and objectives o Create implementation plan including activities, responsibility, and timeline Final Strategic Plan Documentation o Complete final strategic plan document o Create presentation slides for communication of plan Quarterly updates o Prepare quarterly updates on plan progress o Attend quarterly public health study sessions to present updates • 1-2-hour workshop on facilitation o Meetings with staff forfeedback on content o Development of content and activities o Provision of workshop HOMELESSNESS AND AFFORDABLE HOUSING ACTION PLAN CREATION • Pre -work o Review Kittitas County Homeless Housing Plan o Meet with HopeSource to identify strategies they will lead o Observe HAHC meeting • Prioritization o Plan and conduct prioritization exercise with HAHC to identify strategies they want to work on 9 2026Implementation Plan Kittitas County Agreement for Services (rev. 5/14/25) Page 3 of 19 ATTACHMENT "B" COMPENSATION THE COUNTY WILL NOT PROCESS PAYMENT FOR SERVICES RENDERED UNDER THIS AGREEMENT UNTIL CONTRACTOR SUBMITS A COMPLETED W-9 (SEE ATTACHMENT "E"). As full compensation for satisfactory performance of the work described in Attachment "A", and within thirty (30) days of receiving Contractor's itemized invoice, the County shall pay Contractor the following amount(s) plus any applicable taxes as detailed in Contractor's invoice: $24,000; Contractor will bill $150.00 per hour. Unless otherwise provided herein, Contractor shall be solely responsible for Contractor's travel and related expenses. Any uses of these funds outside of the listed allowable uses must be approved by Kittitas County in advance of the expenditure, in writing. All funding is based on local tax and fee revenue. If local economic conditions result in insufficient funds to compensate at the stated levels, the County reserves the right to renegotiate funding amounts to remain within available revenue balances. The County will notify the Contractor immediately if financial forecasting or actuals indicate such a circumstance. All funds must be spent by Mach 31, 2027. No extension of the funding period will be granted. Reimbursement Procedures A. The Contractor shall submit invoices for services due once a month, which shall be emailed to Katie Odiaga, Kittitas County Public Health Department, at katie.odia a co.kittitas.+a.us. B. ALI Invoices must be submitted bythe end of the month following the calendar month in which services were deLivered and will be reimbursement -based payment, only. C. The Contactor must provide adequate backup documentation to support costs in each invoice. This includes a general ledger from the financial accounting system detailsng Iltransactions and expenditure show employee dates for allowable activities within the period of performance. Payexpenses names, hourly rate, number of hours, total pay, and project code. Benefits can be one line item but should include project code. Non -payroll expenses must include a copy of the receipt or payment invoice. Payments to subcontractors must be listed as a specific line item per subcontractor. D. All invoices must include invoice date and an invoice number. E. Invoice must include hourly billing that clearly shows Funding heing invoiced an plan for homelessstrategic plan �for mental health and substance use disorder prevention (general fund), affordable housing (general fund), and the Kittitas County Developmental Disabilities plan 2026-2028 (millage). F. All invoices must also be accompanied by an updated Contractor Spending Form, as provided by Kittitas County, to ensure that billing record keeping matches County records. G. Kittitas County is not liable for services provided unless the invoice is received on time or prior arrangements are agreed to in writing signed by the County. In no event shall payments under this agreement total more than $24,000. Kittitas County Agreement for Services (rev. 5/14/25) Page 5 of 19 ndition of this agreement. The Contractor shall appropriately monitor the comply with any applicable term or coevent hal activities of the Subcontractor to assure fiscal theconclitliabilitynof the ios of 1Contractorntoln no the Cs ountyforl any breach c n he subcontract operate to release o performance of the Subcontractor's duties. ty is not liable for claims or damages arising from a Every subcontract shall include a term that Coun Subcontractor's performance of the subcontract. Federal or State 6. Right to Review: Maintenance of Records: This Agreement is subjectto review by any auditor. The County or its designee shall have the right to review and monitor the financial and service components of the work performed under this Agreement by whatever means are deemed expedient by the County. Such review may occur with or without notice, and may include, without limitation, on -site inspection, inspection of all records or other materials which the County deems pertinent, and any and maintain all records nd all communications with or evaluation by service recipients under this Agreement. Contractor shall preserverequest relating to this Agreement for six (6) years after termination or expiration of the Agreement, andupauthor led Shall make them available for review by any Federal or State auditor, the County, and/or any per -sons by the County. 7. modification 7.1. This Agreement may be amended by mutual agreement of the parties. Any such amendment shall be in writing and signed by both parties. 7.2 The County may unilaterally amend this Agreement at any time by written once ("Change of Notice") to Contractor, to modify the work to be performed under this Agreement, within the general to be the Agreement. Such changes may include, buare substttutiont addition, tllmited to, chans in the exact scope of or deletion of requiied asks) and changes the performed (including modification, schedule of performance. If any such Change Notice causes an increase or decrease to Contractors cost of, or the ensation or time required for, performance of the work, work san hall bedjustment in the made by the Coontypto reflecttouchnan increasetractor /or in the schedule for the performance o decrease. Notwithstanding any dispute or delay in arriving at a mutually acceptable equitable adjustment, Contractor shall proceed in accordance with all Change Notices. Within thirty (30) days after receipt of any Change Notice which, in Contractor's ❑pinion, lacks an adequate adjustment, Contractor must submit to the County a ill forfeit its right to any such written statement requesting a modified adjustment; otherwise, Contractor w modified adjustment. The County retains the final right to determine adjustments hereunder. 8. Termination 8.1 This Agreement may be terminated at any time by mutual written agreement of the parties. 8.2 The County, by giving written notice, inay terminate this Agreement at any time without cause and without further obligation to Contractor except for payment due for deliverables provided and/or services performed prior to the effective date of termination. An equitable adjustment in the contracted price for partially completed tasks will be made by the County, but such adjustment shall not include compensation for loss of anticipated profit on uncompleted work. 8.3 If Contractor defaul':s by failing to perform any of its obligations under this Agreement, or becomes insolvent, is declared bankrupt or commits any act of bankruptcy or insolvency, or makes n assigand nt for the benefit of creditors, the County may, by written notice to Contractor, terminate the Ag the County's option, obtain performance of the work elsewhere. If the Agreement is terminated under this paragraph, Contractor shall not be entitled to receive any further payments under this Agreement until all of its obligations hereunder have been fully performed, and any extra cost or damage to the County shall be deducted Kittitas county Agreement for Services (rev. 5/14/25) Page 7 of 19 12.1 Contractor is duly incorporated, validly existing and in good standing under the laws of the State of Washington, and has all requisite corporate power and authority to enter into and to perform its obligations under this Agreement. 12.2 Contractor has the authority to execute this Agreement, to make the representations and warranties set forth herein, and to perform its obligations hereunder. 12.3 This Agreement has been validly executed by an authorized representative of Contractor and constitutes a valid and legally binding and enforceable obligation of Contractor. 12.4 Contractor holds, or will obtain prior to commencing work under this Agreement, such licenses, permits and other authorizations from federal, state and local governmental authorities, or from any applicable industrial or professional certification or licensing bodies, as are necessary for the lawful performance of its obligations under this Agreement, and will maintain such throughout the term of this Agreement. 12.5 Contractor is not in violation of any applicable law, ordinance or regulation the consequence of which will or may materially affect Contractor's ability to perform its obligations under this Agreement. Contractor is not subject to any order or judgment of any court, tribunal or governmental agency which materially and adversely affects its operations or assets in the State of Washington, or its ability to perform its obligations under this Agreement. Contractor is not presently debarred, suspended, proposed for debarment, declared ineligible or 12.6 voluntarily excluded from covered transactions by any Federal or State department or agency. 12.7 None of the representations or warranties in this Agreement, and none of the documents, statements, certificates or schedules furnished by Contractor in connection with the performance of the obligations contemplated under this Agreement, contains or will contain any untrue statement of a material fact or omits or will omit a material fact necessary to make the statements of fact contained therein not misleading. 13. Qwnersh':p or' hems Produced: All writings, programs, data, reports, films, recordings, or other materials prepared by Contractor anti/or its consultants or subcontractors, in connection with the performance of this Agreement, shall be the sole and absolute property of the County. The County will have atl rights of ownership therein, including but not limited to the right to use, copyright, trademark, and/or patent, and the ability to transfer any or all ownership rights. 14. In#ellectual Prn a Infrin ement: Contractor will defend and indemnify the County from any claimed action, cause or demand brought against the County, to the extent such action is basd onthe clay third aim that information and/or materials supplied by Contractor infringe any intellectual propertyrights party(ies). Contractor will pay all costs and damages attributable to any such claims finally a awarded to shallthe County in any action. Such defense and payments are conditioned upon the following: ( ) notified promptly in writing by the County of any notice of such claim; and (2) Contractor shall have the right hereunder, at its option and expense,, to obtain for the county the right to continue using the information and/or materials that are the subject of such claim, provided no reduction in performance or loss results to the County. 15. Use of Count Name and Lo ❑: Contractor may not use the County's name, logo(s), trademark(s), or other identifying information, or identify the County as a current or former client, on its website or in any marketing or promotional materials without the prior written consent of the County. 16. Disputes: Any dispute between the parties arising under or relating to this Agreement shall be resolved informally if possible. However, in the event such a dispute cannot be so resolved, it shall be adjudicated Kittitas County Agreement for Services (rev. 5/14/25) Page 9 of 19 21.1 In the performance of this Agreement, Contractor will not discriminate against any employee or applicant for employment on the grounds of age, race, creed, color, national origin, citizenship or immigration status, sex, sexual orientation, marital status, honorably discharged veteran or military status, or the presence of any sensory, mental or physical disability or the use of a trained dog guide or service animal by a person with a disability; provided that the prohibition against discrimination because of such disability shall not apply if the particular disability prevents the proper performance of the particular worker involved. Contractor shall ensure that applicants are employed, and that employees are treated during employment, without discrimination because of their age, race, creed, color, national origin, citizenship or immigration status, sex, sexual orientation, marital status, honorabiydischarged veteran or military status, or the presence of any sensory, mental or physical disability or the use of a trained dog guide or service animal by a person with a disability. Such requirements apply, without limitation, to the following: employment, promotion, demotion, transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms of compensation, and programs for training, including apprenticeships. Contractor shall take such action with respect to this Agreement as may be required to ensure full compliance with local, state and federal laws prohibiting discrimination in employment. 21.2 Contractor will not discriminate against any recipient of any services or benefits provided for under this Agreement on the grounds of age, race, creed, color, national origin, citizenship or immigration status, sex, sexual orientation, marital status, honorably discharged veteran or military status, or the presence of any sensory, mental or physical disability or the use of a trained dog guide or service animal by a person with a disability. 21.3 If any assignment and/or subcontracting has been authorized by the County, said assignment or subcontract shall include appropriate safeguards against discrimination. 22. Waiver: The waiver of any default or breach of this Agreement, or the failure of a party to enforce any provision hereof or to exercise any right or privilege hereunder, shall not be deemed to waive any prior or subsequent default or breach, the enforcement of any provision hereof, or the exercise of any right or privilege hereunder, unless otherwise stated in a writing, signed by the parties hereto. 23. Headin s: The headings of sections and paragraphs of this Agreement are for convenience of reference only and are not intended to restrict, affect, or be of any weight in the interpretation or construction of the provisions of such sections or paragraphs. 24. 5urvival: The provisions of paragraphs 2, 3, 4, 6, S, 9, 10, 13, 14, 15, 16, 17, 19, 20, 22, 24, and 28 of these General Terms and Conditions shall survive the completion, expiration, termination or cancellation of this Agreement for any reason. 25. Com fete A regiment: This Agreement constitutes the entire agreement between the parties and supersedes any and all other agreements, understandings, negotiations and discussions, oral or written, express or implied, regarding the work to be performed hereunder. The parties agree that no other representations, inducements, promises, agreements, orwarranties relating to this Agreement, oral or otherwise, have been made between the parties. Except as provided elsewhere in this Agreement, no modification or waiver of this Agreement shall be valid or binding unless in writing and signed by the parties. 26. 5everabili : If any term or condition of this Agreement or the application thereof to any person(s) or circumstances is held invalid, such invalidity shall not affect other terms, conditions or applications which can be given effect without the invalid term, condition or application. To this end, the terms and conditions of this Agreement are declared to be severable. Kittitas County Agreement for Services (rev. 5/14/25) page 11 of 19 ATTACHMENT "'W" Folin Y1f M7 Request for Taxpayer Give form to the (Rev March 2024) Identification Number and Certification requester. Do not Crpanmenl at the Trnasury send to the IRS. InluraW Aovenvn 30NICo Go to wwwJmgov/FormM for instructions and the latest information. Before you thrgin- For g:.r:t:tiro c related to the f:r,1l:iit of Form N-G. sae 'c:rocso or Form, below. ,flame of entity/ndrvldual An entry is required. (For a sole proprietor or disregarded enlay. cntar Iho owners r.r+mp en lino I and enter ;he businasm-OWagardea entt 3 name on'ine 2.) h 0 In husmass namerduregorded entity name, if d:fferunt from abovo. -10 C11?ak the :tppro priate aer 'a ferterat taz cL,ssi'iaa l,on at Ihn ertrry/,nd, rrdual :vho>.: n3rne i3 ?nl.?red cn 4ne '. 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The TIN ptovidnd must nratci, ;ha: air:e given on Tine t to avoid S"iat--xcuttraynurnher r"esiduo Sane t)Ialts For proprietor. u2tis, ogo cl geeol4fy7 your sodal4rsI salcuL.,crj ihy for Parr (Sate For rarer fora +ssiderll afle+a, Selg proprietor- nf hi4ldgptq'!ed eM1liry sett Ih7 it slrl�Crrc:is for Part ;, a!er For other I�j I IMF _JL- •' entities, :! is your ?mployer identification numoer IEIN). If you do not nave a numoer, see Now to get a or T?N, later rHnpfYya+ •danti:ic./:inn nu mnrr ;tote: If the account is in more r.+an one name. sae ire insrn,chons icr line I See also 'YJhat Name and r I t Numoer To Glva the .Requasler!ar guideimds -n v nose number to enter. I i Certtfilcatt ri Under penalties of perjury, 1 cenIN that: I The number snown on this form is my ccrrecr :axpayer denification numoer for I am waiting for :t number to be issued to me): and 2 1 am not subject to backup ,61nholdln-y because !a) I am exempt from oackup withholding, or (b) ; nave not been notified oy :he !ntemol Revenue Sarnce (IRS) !hat I am subject to -ackup v,ithhofdi;,g as 3 re_suit of a faaure to report all Interest or nividends, or !c) the IRS nas nolVied m_ Ina! I am no longer subject to backup withholding; and 3 1 am a U S. citizen or other U.S person 'derined below): and 4. The FaTCA codes) entered cn :his form (if any) indicating that I am exempt from FATCA reportino s correct Cartilleatico instructions. You must cross out item 2 Wove it you nave b?5]n notified by the IRS !rlat you are currentty subject (a backuo v ith'-oldii beiau5Dyou have faj(&d to report sll interest and cliv,dends on ytwr lax return For real -,stave transactions, item 2 does not apply. For mortgage nterart paid. acquisili or abandonment of secured prop-m/, cancellation of debt, con0butions to an individua ra -el' 2i-anger• r; IFM;•, ard, ;er•,r.:,ly pay!-;ns utter than interest and a.•t±itr_:: are net rnc,,:r..y -o �It;is Ina ter firalrtn, but rcu m1s{;;•d..r:n ;ci T)N S,yi the •elrr+rofi —n tar ?art !I. :,Gr. Sign J Signahire of Here_ U.S. parson pate General Instru-ticins Section -eferences are to the Internal Revenue Cede unless ochermse noted. Future devoopmenG. For the Wes', nigrnng¢.ar about develcorlenls retafee to Form 'N-9 and Its Instruvibl`•.'L !"h 23 legislation enacted arter lney were published, go to ,vtvy rr-gov1F-3rm N/9. Ili/fiat's New I141a 3a nos beer rnoditieb to Danny now s 15regarded ?niiDy "mpletes 1- s 11ne. Art i !ha- •s a o,sregamed orwy •theurd .heck the appropnale rox rcr ro tax cinssiflcalion'I •ts owner OthoraiSE% it should creck the 'LAC" box and _nler its approora:e !a classification. New Ine 3b has oean added to Inns norm. A 4ow•Inraugh antily is urK1 to _ t. r%! [n.: ill •a to irc,:;Cif tl'n! t `•.! :_t or cir:bt ,i a-: ±r•, . •:r cr „ereVcinr:e- .a+•m :!ros:de5 T- Fcrrrt N/•3 to tl!n1,•.:r also. '•ilbl.gl,•)rtttpy n ."Ion I nits 11' r:a'•_`r5hip 111.)"''1, This cnonge is Intended ,o orovide a Ildw•through entity •eilfh nWrinalion ••t.; the status of its.rc-irect 'oruign o.wr.:n:. o•:.rr,r.- or cos• zl c .1-3s, so !hat it _a!, -a:afy ary a.)pn. 2t; er_i rry:r•r. sii For .>>In�is, a nnnn• ship'Ii ^ . it r • .u;i !ore:gn. cril -rq may oe •cruiroc to ccrr{aau, Sc^cc:rl• : �t-:ru•if !C-3. see !ho Partnership Irs11',c::ons for Schedules %42 and r:•3 (Form ;Gi Purpose- or Form An indlvidual or enh'.v (Form'P/-9 r=.questet; •Hno is ,-quirad :o lile in nformation rebum •arilh the IRS is giving you :his ierm xcause -hay el r. r•n'etf -'?rev 3R02.1', Kittitas County Agreement for Services (rev. 5/14/25) Page 13 of 19 Form W-e (pev 3-2024) Page 3 ,:;,rfaln payees and payments are ?xempt Trot.: backup withholding, See Exempt payee code. later, and thasaparale Instruclions for the Requester of Form W 9 for more information. See also Esfatrlishrng U.S. status for purposes of chapter 3 and chapter J ivifhficfding, earner. What Is FATCA Reporting? The Foreign Account Tax Compliance Act fFAFCAI requiresa parlicipating foreign finandaf ,lsstitution :o span all U.S account h*Idets lhal are specified U.S. persons. 0-eeain payees are axempI from CATCA reporting. See 15,tenViOn froor FATCA repoiing coin. later, and the Instituctions for the Requaafer of Fors W-9 for more information. Updating Your Information You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and ansietpala r,, crving reportable payments in the future from this person. For e?tarnple, you may ilesd 10 provide updated inforrltation if You are a C rorparati*n That alaCls to be an S -:4rporalion. or if you are no longer tax ex.mpl. In add;lion, you IIIusl Furnish a new Form W-9 4 :he name or TIN char.9ss for thz account, far exampfv. it the granter •.71 a grantor trust dies. Penalties Failure to kumisIt TIN. if you fail to furnish your corm. TIN to a fdquuslar, you are subpcl to a penalty of S50 for each such failure unless your failure is due Io reasonable causy and gotta s.rllful neglect. Civil penalty for ftllsr III forinalion with respect to withholding. If you mak:- a false statement with no r}asi�,nabt? basis that resulls in no backup withholding, you are subject to a 5500 penalty. CAminal penalty for falsifying information. Willfully falsifying certification. or affirmations may subject you to criminal penaRies including fines andfarimprisonment. Misuse of TINS. If the requester discloses or uses TINS in violation of federal law, the requester may be subject to civil and criminal penalties. Specific Instructions Line 1 You must enter one of the following on this line; do not leave this line blank. The name should match the name on your tax return. It Otis Form W-9 is far a joint account {other than an account n:ainraincd by a foreign rinancral rnslnuliort OFF})i- fist firf• Arid :hen 1:trcf3. she name at the personn *r in .thane -comber y am anitr xl lit tsar ! ai l=umt'!'J-9. If you era pr.�vrd�n;i Form'<I.9 1d an FF: !a dccvment a joint arcounl ?ach ru.4der of ihe? aGCanIII It:a1 is d'3.$. rr Is must provide a Form W-% • fndividual. Generally. Mtar the name shown on your tax r-imm.• if you have changed your, last name wtltout informing the Social Security Admntslradon iS$Af of the narne tratuse. emir your tir5i namr. the last :Wow as shown on your social securd,,,rrard. and yotrrrt-tv Ise naa,ta Nate for ITIN applicant Enter your individual name as it was entered on yxrr Form W-r appllcation, ling ta, rhis shat;ld also b-� the rams zs tIN name you entered on III- ibmt 111.0 yLu Tiled urth •four apphafi*n. • Sale prof) ri-etot. Egl+ryour individual narnt: as aitcsvn.y,r your Form t aG ->n ene 1 Enter your business, trace. Or - Wa,rly bu5rn0s as 01;A; name an firm 2. • Aartn.rship. C eorfsor-WAr- 5 corporation, or LLC, other Ih an a ahetgarded entity. Enter the=nuty's na,n-e as st,s=n on the anlity's ia, return on line 1 and any bustneas, trade, or DBA name on line 2. • rather entities. Enter your name as shown on required U.S. f _derat tax documents on line 1. This name should match the name shown on the CharWe Or other legal document creating the enrir,. Enter any business, trade, or DSA name on line 2. • Visregarded entity. In general, a IOUs Mess entity that has a single owner, including an LLC, and is not a corporation, is disregarded as an entity separate front its ovig.tr ,a diyr: )ard_ d entit•(l. See R..yu1 :runs section 301 T7p 1.2{cjf21. A disregarded?MAy srlould ch-ck the ]opropriate box for th? tax :lassriicatran *1 ,is G.rn_r 9nl?r th. X•mer'i erarne *n tine i dart narn? of th. *'.vn=r-;r1t=ref qn fine t should rlov:r be a +fro-ga►ded snn4% 'The name an hne t smuid u+r tram•. 3ha:m *n Ili; rncnma tax rstvm •rn ulech the! qcorn-e Shouldba'.;per, _4 Far Kittitas County Agreement for Services (rev. 5/14/25) Page 1S of 19 example• it a i*reign LLC that is Ire WWI as a disf-gor&d emery for U.S. f6der3J ttL% putp*ses has a single *wrier that is a U.S. person. the U.S. owner's flan* is required 10 be provided on liar 1. it :he direct onvner on the eraity is also a disregarded entity. enter dhe first *+•mar thal Is not disregarded for federal LU purposes Enter the disregarded entity's name an kn: 2. If the oernar of the disregarded early is a joleignpierson. the arr:nes must compute an apyrcpnat. Form Vi-a a*"d of a t:orm W-9, iths is Ih? case Oven if 1ha ioresn P!lmor. has a U.S, TIN, Line 2 If you have a business name, trade name, DBA name, or disregarded entity name, enter it on line 2. Line 3a Check the appropriate box on fine 3a for the L4S. federal tat classification of the person whose name is entered on tin-- 1_ Check only one box on line 3a. IF the entityrindividual on tine 1 THEN check the box for... is a(n) ... • Corporation Corporation. • Individual or f Individual/sole proprietor • Sole proprietorship • LLC classified as a partnership Limited Lability company and for U.S. federal tax purposes or enter the appropriate tax • LLC that has filed Form 8W2 or classification: 2553 electing to be' ax--d as a P = Partnership, corporation C = C corporation, or S = S corporation. • Partnership Partnership. • TrusVestate TrusVstate- Line 3b Chc-rk lh,s box 1 yeti act a rutnnMNo irncludinC an i.1.0 Amk ied as a AaManlitp for u S. federal fax Wirpesesi. -ru 5z. or ±slat. the has any foreign parurses. )r•ners. nr beneicwm-s, and yrou are. pro'ndinQ ihls fomt to a partnership, rru:r, or esMt-. r, tiler, you ha:. ar. 7vm±e;hip rntcf:st You must Check the box an line at -if you rge=rtA a ear n VJ-6 for 11,cunleMar,'?vsdsn:e) Iron„ any pannsr..ivrr.w. v b -.keficrar f "tablishmu t*reign SMILr5 *r if you receive a Form 'N-9 norn anv Gann=r, ownef. ar Lam'Hieticiaiy'ha, has checked the sax on ling 3b Note: A partnership lhat pro'od=s a F.ann b:'-a are ch_cks t4s'0 Ira:, b•a re•.)urrad to Comotele Schedules K-^ and ti-3 I.Form 10e51, Far note infoanation. sae the Partnership Instruction; for :„-h.dut=s K and K�3 (Form 1065). 11 y*u try (-quif*d :o >Wnp1310ine 3b -tit f'd•3 X- dv, so. •tau may nor eeChive the mformalton Al- a Currsct ,nfarrtlandn 9'4t1it7i l7rh the iRS or furnish a correct payee statement to your partners or beneficiaries. See, far Example, sections 6699, 6722, and 672d for penalties that may apply. Line 4 Exemptions ii you are -exempt Iran: bcshun :,lllthofv nc ar.dior cA i CA rar+aning, enter in 1h? app;opnair spat_ oir One: any _oil sj than ma, apply to you. Exempt payee code- ' Generally, Individuals finduding sole rropnetorsj are nct exempt from backup :vithnoldinq. • 'eecept as provided belrv.-..:orporations are-ntempt from backup 1.v,lbWk1knc rot certain payments. including irrt.rxt and drvidt-ids. • CorpOralions are not =.menlpl iron: backup erthholding for papiler,ts made in s?ttlemen: of payment card �jr lhiM-party nenrork tran;.aclions Corporahons are not exempt item ba•_kup :rTthpidwlg :nth orb. z to attom,ys' fiaa,s or groFS pros ed`- Aa:c! to att j.,n�y5. and :t17p6ratiRnS That provide medreat or h+•Wth car.'sar:xax are not ?if?mpr vnlh rest E to paynranfs reportable an Form 1039•M1SC. The following codes identify payees dial are exempt from backup withholding. Enter the appropriate code in the spat- on line 4. 1 -An organrraaon c=xempt ffoin tax under 501 iaj, any IRA, or a :uslCdnal ac':*um under section •he account SaiisL95 tn? requirements of section 401{1 n Form W-s (Rev. a-2m4) Part If. Certification 'fo establish to the uiUtitofding agent that you area U.S, person, or restdent alien. sign Form YT•& yOu may ba requested to sign by the vrilhhofdir:g agent even it ilem 1. 4. or 5 b�3fov1 indicates other% -A", For a joint account. oftly 010 person %,Agse T1p1 is sho+vn In part I should sign {when r•7qurred), fn lite case of a disregarded entity, the parson identifies) on line I must sign. Exempt payees. see &emF: oyez Cad@, earlier. Signature requirements. Complete the certification as indicated in items 1 through 5 below. 1- interest, dividend, and barterexchange accounts opened hefore 1884 and broker accounts considered active during 1983. You must give Your correct TIN, but you do not have to sign the certificatiorL 2. Interest, dividend, broker. and barter exchange accounts Opened after t993 and broker accounts considered iiiactive during IS83. You must sign the cellificaflon or backup wilhholding wAI apply. If YOU ara subject to backup withholding and you are merely providing your correct VI to 111* requester. you must cross out item 2 in lhr certificado n before signing the form. 3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certificadon. a. Qther payments, YOU must give your corr.?ct TIN, but you do nor have to sign the :crli<rarion unless you have bean notified It+al you have previously given an incorrect TIN, 'Other paynlenrs' u1Clude paymsnts made in the course of the tvquesier's trade or bustness for rants, royallios, goods (ocher than belts for merchandise), rrt decal and health :.are seAlces (Pcluding paymenr5 to corpora lions), payments to a nor;-mplaye0 rrr services, payments made ;n seitlemeni a[ paymsnr ard and Ilved•party netrrorfl Iransactions. payments to t?rtam 5,1-.1 boat crew members and fisherman. and gross proceeds paid to attorneys lincludrr:g laayrr4nt5 to corr4ralionq 5, htOAgage inte►esl paid by you, acqulyition or abaurtanment or secured propart�j, canceltaiton of debt. qualfried tuition 1)rogiam payments (under section $29), A13LE accounts (under secriorr 529A), iRA. Coveroelf ESA, Art ILet MSA er HSA contribuZia ns or distributions, and pension distributions. You must give your coiraci TIN, but you do not have to sign the ceri6cation. What Name and (dumber To Give the Requester For this rypa of account Give name and SSN of. 1. Individual The individual 2. rt,; or more ndividua� h4pat account) The actual owner of the account or, other than an account maintained by if combined funds, the first individual n^ FFI on the account' 3. Two or more U.S, pension, Each holder of the account (joint account maintained by an FFI) 4. Custodial account of a minor The minorz (Unibrm Gift 10 Miners Ad) S. a. The usual revocable savings trust The grantor -trustee' (grantor is also trustee) b. So-called trust account that is not The actual owner' a legal or valid trust under state law 6. Sale P10Pncl0t5lcp or disregarded The owneia anlrly awndd by an iiffiWdual 7- Grylrw tusd firNu under Oplianal The grantor' Filing Uathod I (sou R"Lilalions :la]n 1.d71-J0,1X2j,Al)•• Kittitas County Agreement for Services (rev. 5/14/25) Page 17 of 19 For this type of account Give name and EIN of: 8. Oi:rtcprd_d _ntity not netted by an The owner individual 9. A valid trust; estate, or pension trust Legal entity' 10. Corporation or LLC c':r,`..ng corporate The corporation status an Forth BW at ;cm, 2553 11.A%ociatioo,dub, re69gous,rhwoble, The organization cducrtianal, or ather tsr-aenpl organi=tion 12. Partnership or mWb7nanber LLC The partnership 13. A broker or regetered nominee The broker or nominee 14. a._ccunt will the4epartment of The public entity Anr;ruth" in the name of a public entity (such as a state or local government, schooldrsvict, or pnson) that r*ceives agdeviturW program payments 15. Grantor trust afalg Form 10 41 or The trust under the 1306 l FXrQ (Keened 2. iequ nog farm 1099 (.ce Regulations section 1.671.4(b)(2) iM— ' List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person's number must be furnished. 'Circle the minor's name and furnish the minor's SSN. ' Yotr must shiny your mdi',riCual name on fine I, and enter your nusiness or GOA name, if any, on fine 2 You nlay use ellher your SSN or EIN (if you have aae1, but 111e IFIS encourages you to use your SRI. `List first and cirtie the narrte of the trust ?srate, or pension trust. (Do not fumish the TIN of file personal representa Ova or trustee unless the legal enuly itself is not designated in the aeeount title.) 'Note. The grantor must also provide a Form W-9 to the trustee of the trust. "For more information on optional filing methods for grantor busts, see lha Instructions for Form 1a41. Note: If no name is cilcied when more than one name is listed, the number will be considi', a to be that of the first name listed. Secure Your Tax Records From Identity Theft U?r•.tr ,- In .2.-. x.;urs vrheo Sosn1 -,; -- :,s=s yrrur Y'rarso,-.ai aiiu m i atfgn, YIICn as yuttr nam3 Wt. Ar+,N er IQanhtying tnfor..•rtaiion, :lithout your pemtrssion to _ammit fraud er other cnrt�, An identity thi3i may use VOW SSN rn oat a ;ob of may 81s a tax return us % ycur WJ !e, eeca:vF a refund. To reduce your risk • Protect your SSN, • Ensure your employer is protecting your SSN, and • a? •-arafvl wher. choosing a iax Nbini prepaf%f If your iax rr7rds ]r: a eCtzc by Identity theft and you a not:cc rota tlrw lf?$, r3spond helm at-1ay ro !it ham? and ppdn_ number primed 4n ttl?'.RSr.Op,e or letter. If your tax :arordsall? :urenI1�- alf9c!ed b{,demitf:teff but you think ;vju are at rfak du- to a foss or stoten pursa yr vrall-w, questro rnacie Curti! ^Ord acrerty. or a qua tlionable credit f4pryr. conuicl t" IRS r?obey Theft knttin_ at wo-goe-:ego orsubmrt i•afm tsa39• For rnore infornation. sc-? Pub 3027_ IdenttP/ Theft In(ormalran r"or Taxpayers. ATTACHMENT "E" RETIREMENT STATUS FORM ** All Contractors who are individuals must complete and sign ** SECTION 1: CONTRACTOR COMPLETES THIS SECTION: Did you retire from one of the State of Washington Retirement Systems? Yes _ No Did you retire before age 65 using the 2008 early retirement factors (ERF)? Yes No Will you be receiving direct compensation for these services? Yes No Will you be receiving indirect compensation for these services? Yes No CONTRACTOR (Full name of contractor as in DRS filings -Please Print): Signature __ Last Four Digits of Social Security No. Date: SECTION 1: COUNTY COMPLETES THIS SECTION: [Use Member Reporting Verification (MRV) to verify the past retirement membership and document below] 1. Has Contractor been a member of a Washington State Retirement System? _ Yes _ No If yes, which system and plan? _ Teachers' Retirement System (TRS) —Plan 1 Plan 2 Plan 3 _ School Employees' Retirement System (SERS) _ _ _ Plan 2 Plan 3 _ Public Employees' Retirement Systems (PERS) _ Plan 1 _ Plan 2 Plan 3 _ Public Safety Employees' Retirement System (PSERS) _ _ Plan 2 _ Law Enforcement Officers' & Fire Fighters' Retirement System (LEOFF) _ 1 Plan 2 _ Washington State Patrol Retirement System (WSPRS) _ Plan 1 —Plan _ Plan 2 _ Judicial Retirement System (JRS) _ 2. Is Contractor a retiree of a Washington State Retirement System? ` Yes _ No 3. Did Contractor retire before age 65 using the 2008 ERF? Yes No I have verified the information above using MRV or by contacting DRS. COUNTY REPRESENTATIVE (Please Print): Signature: Date: COUNTY RETAINS THIS FORM Kittitas County Agreement for Services (rev. 5/14/25) Page 19 of 19