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6024PF Contract Amendment (1-26-2018)
DSHS CONTRACT NUMBER:
Washington State
Department of Social
CONTRACT AMENDMENT
2112-22136
711fV
7 & Health ServicesWorkFirst
Family Violence
Services
Amendment No. 01
Transforming lives
This Contract Amendment is between the State of Washington Department of
Program Contract Number
Social and Health Services (DSHS) and the Contractor identified below.
Click here to enter text.
Contractor Contract Number
CONTRACTOR NAME
CONTRACTOR doing business as (DBA)
Grant County
New Hope
CONTRACTOR ADDRESS
WASHINGTON UNIFORM BUSINESS
DSHS INDEX NUMBER
311 W. Third Ave.
IDENTIFIER (UBI)
1221
132-001-884
Moses Lake, WA 98837 -
CONTRACTOR CONTACT
CONTRACTOR TELEPHONE
CONTRACTOR FAX
CONTRACTOR E-MAIL ADDRESS
SuziFode
(509) 764-8402
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sfode@grantcount=a.Uov
DSHS ADMINISTRATION
DSHS DIVISION DSHS CONTRACT CODE
Economic Services Administration
Community Services Division 3003XS-1 2
DSHS CONTACT NAME AND TITLE
DSHS CONTACT ADDRESS
John Vasquez
8517 E Trent Ave
WorkFirst Coordinator
Ste 202
Spokane Valley, WA 99212-2329
DSHS CONTACT TELEPHONE
DSHS CONTACT FAX
DSHS CONTACT E-MAIL ADDRESS
(509)961-1688
(509)921-2458
vasqqja@dshs.wa.gov
IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT?
CFDA NUMBERS
No
,AMEN DMENTSTART DATE....-'.:..:
...CONTRAC.T.END.DATE
47/0'1 /202.2
028"
PRIORA_,MAXIMUM. CONTRAqT.- MP N..
. Q
.
--AMO`UNT,OF--INCREASE-OR DECREASE'
-'
TOTAL MAXIMUM RACT
C
31 000.
!7. oo
000.00
$3MOUNT1o:o
$62 00
'R 'EASON FOR AMENDMENT:
0 E.
C AN E -'OR, CORRECT.. THER,'.-S�t`-PAG T -V V 0'
ATTACHMENTS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into
this Contract Amendment by reference:
El Additional Exhibits (specify):
'..'Th'is. me ll* Exhibits d6c*u
.ht-A.hcl(1dIh`'axh1bits*and:Qther m.erts j0rdorpora-te;d by'refer.econtains." 6tf1 0 1erms. .
nce,-'..."'.
and, ,coh itiohs.agree upon -6y rties.aschanges Aothe ori gina1Contract.: No'other.understardiigs:or.
-0---6n:tra'b*Am6n'd
re tationsbra.d or otherwisregarding ctma er.fontraci men nthall be.dee edoexst orl
'
bindtepart other ermsand conditions e original Contract remalh in full -forceafid,`6 The artier
*" .'. - ghng
?si
".belowwarantth6t"t e have read and A. en h6n and have .authority to enter int' Ahi',ContracA.
...".. ....
Amendrn ' ' e` t...
n
CONTRACTOR SIGNATURE
PRINTED NAME AND TITLE
-wCC r
DATE SIGNED
5 2% 2 1-
DSHSfIGNATURE
PRINTED NAME AND TITLE
DATE SIGNED
Alice Hildebrant, Contracts Officer
6/1 /22
DSHS Central Contract Services Page I
6024PF Contract Amendment (1-26-2018)
This Contract between the State of Washington Department of Social and Health Services (DSHS) and the
Contractor is hereby amended as follows:
1. The Contract period of performance is extended through June 30, 2023.
2. The Contract Maximum amount is increased by $31,000. The new Contract Maximum amount is
$62)000.
3. The Special Terms and Conditions Section 4. Consideration, subsection is updated as follows:
4. Consideration.
Total consideration payable to Contractor for satisfactory performance of the work under this Contract,
shall be paid in accordance with the fees set forth in the attached Exhibit(s).
Total consideration payable for the contract period to the Contractor for satisfactory work performance
including any and all expenses under this Contract is up to a maximum of $62,000.
Unspent funds designated for any State Fiscal Year shall remain unspent and may not be carried
forward into the following State Fiscal Year.
Consideration payable per State Fiscal Year:
State Fiscal Year 2022 (July 1, 2021 through June 30, 2022) = $31,000
State Fiscal Year 2023 (July 1, 2022 through June 30, 2023) = $31,000
All other terms and conditions of this Contract remain in full force and effect.
DSHS Central Contract Services Page 2
6024PF Contract Amendment (1-26-2018)