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HomeMy WebLinkAboutAgreements/Contracts - GRISDocuSign Envelope ID: 882E1 2131 -ACC5-4229-AB54-8FC1 140D2F8F xzi-ios02D Washington State 00000CONTRACT HCA Contract No.: K3958 Auihorit 17, Heal'tLh Care y AMENDMENT Amendment No.: 3 THIS AMENDMENT TO THE CONTRACT is between the Washington State Health Care Authority and the party whose name appears below, and is effective as of the date set forth below. CONTRACTOR NAME CONTRACTOR doing business as (DBA) Grant County CONTRACTOR ADDRESS CONTRACTOR CONTRACT MANAGER 35 C Street NW Name: Dell Anderson PO Box 37 Email: daanderson@grantcounty.wa.gov Ephrata, WA 98823-0037 Amendment Start Date Amendment End Date Contract End Date July 1, 2021 June 30, 2023 June 30, 2023 Prior Maximum Contract Amount Amount of Increase Total Maximum Compensation $2371237 $3317956 $5697193 WHEREAS, HCA and Contractor previously entered into Contract for Criminal Justice Treatment Act (CJTA) Funded Treatment and Recovery Support Services, and; WHEREAS, HCA and Contractor wish to amend the Contract pursuant to Section 4.3 to: 1) extend the term; 2) update the total maximum compensation; and 3) update Deliverables Tables; NOW THEREFORE, the parties agree the Contract is amended as follows: 1. The Term of the Contract is amended to extend the end date from June 30, 2021 to June 30, 2023. 2. Section 3.3 Compensation, subsection 3.3.1 is amended to include the following new section: 3.3.1.3 Schedule A-1, Statement of Work (2021-2023) is $331,956, and includes any allowable expenses. The Maximum Compensation includes $180,054 CJTA funding, $151,902 Supplemental CJTA funding, and $0 State Drug Court funding. 3. Section 3.3 Compensation, subsection 3.3.2, Deliverables Tables for July 1, 2021 through June 30, 2023 are added as follows: HCA Contract No. K3959 Amendment No. 3 Dated this _ _ U I v" day of 20 Board of County Coinrni�sio ere n s) Grant CoUnty. Washington A p' L�rove Disapprove. Abs iii Grist # 1 A Dist #I I Dist #I Dist #2 1Dist #02 Dist #2 [Ast #3 Diss #3 Dist -#3 R E C EIa ED Jh 2 9 2021 C -GRANT 0011"INTY CUNIMISSIONERO- Page 1 of 3 DocuSign Envelope ID: 882E12131-ACC5-4229-AB54-8FC1140D2F8F Deliverables Table July 1, 2021 through June 30, 2022 # Deliverable Due Date (Quarterly) Maximum Amount 1 Submit an updated county Criminal October 1, 2021 $41,494.50 Justice Treatment Account (CJTA) 1 Submit an updated county Criminal October 1, 2022 Plan that was approved by the local Justice Treatment Account (CJTA) CJTA panel and signed by County Plan that was approved by the local Legislative Authority that indicates CJTA panel and signed by County how the CJTA Supplemental will be Legislative Authority that indicates utilized. how the CJTA Supplemental will be 2 Submit quarterly progress reports January 1, 2022 $41,494.50 3 Submit quarterly CJTA Revenue and April 1, 2022 $41,494.50 January 1, 2023 Expenditure Reports 3 Submit quarterly CJTA Revenue and 4 Submit monthly and/or quarterly July 1, 2022 $41,494.50 Programmatic Treatment Reports 4 Submit monthly and/or quarterly July 1, 2023 through Secure File Transfer (SFT) Programmatic Treatment Reports process through Secure File Transfer (SFT) State Fiscal 2022 Total Maximum Compensation $165,978 Deliverables Table July 1, 2022 through June 30, 2023 # Deliverable Due Date (Quarterly) Maximum Amount 1 Submit an updated county Criminal October 1, 2022 $41,494.50 Justice Treatment Account (CJTA) Plan that was approved by the local CJTA panel and signed by County Legislative Authority that indicates how the CJTA Supplemental will be utilized. 2 Submit quarterly progress reports January 1, 2023 $41,494.50 3 Submit quarterly CJTA Revenue and April 1, 2023 $41,494.50 Expenditure Reports 4 Submit monthly and/or quarterly July 1, 2023 $41,494.50 Programmatic Treatment Reports through Secure File Transfer (SFT) process State Fiscal Year 2023 Total Maximum Compensation $165,978 HCA Contract No. K3958 Page 2 of 3 Amendment No. 3 DocuSign Envelope ID: 882E12131-ACC5-4229-AB54-8FC1140D2F8F 4. This Amendment will be effective July 1, 2021 ("Effective Date"). 5. All capitalized terms not otherwise defined herein have the meaning ascribed to them in the Contract. 6. All other terms and conditions of the Contract remain unchanged and in full force and effect. The parties signing below warrant that they have read and understand this Amendment and have authority to execute the Amendment. This Amendment will be binding on HCA only upon signature by both parties. CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED Dell Anderson Executive Director HCA SIGNATURE PRINTED NAME AND TITLE DATE SIGNED DocuSigned by: -,4,nU41-t1�, Rachelle Amerine, Contracts Administrator 6/18/2021 N 71 E17FEBBC774E7... HCA Contract No. K3958 Page 3 of 3 Amendment No. 3 Certificate ®f Completion Envelope Id: 882E12131ACC54229AB548FC1140D2F8F Status: Delivered Subject: DocuSign Notice: K3958 -03 -GSR -Grant County.pdf, K3958 -03 -Grant County-CJTA.pdf Source Envelope: Document Pages: 9 Signatures: 1 Envelope Originator: Certificate Pages: 5 Initials: 0 Lisa Nelson AutoNav: Enabled 626 8th Ave SE Envelopeld Stamping: Enabled Olympia, WA 98501 Time Zone: (UTC -08:00) Pacific Time (US & Canada) Lisa. Nelson@HCA.WA.GOV IP Address: 198.239.16.24 Record Tracking Status: Original Holder: Lisa Nelson Location: DocuSign 6/16/2021 9:44:37 AM Lisa. Nelson@HCA.WA.GOV Signer Events signature Timestamp Rachelle Amerine Status DOCUSigned by: Z CJ71E17FEBBC774E7... Sent: 6/16/2021 10:03:18 AM rachelle.amerine@hca.wa.gov Intermediary Delivery Events Viewed: 6/18/2021 6:38:55 AM Contracts Administrator .Certified, Delivery Events Signed: 6/18/2021 6:39:34 AM CloudPWR OBO Washington State Health Care Authority -Sub Account Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Dell Anderson daanderson@grantcountywa.gov Executive Director Grant Integrated Services Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 6/18/2021 7:29:56 AM D: df27c4a9-103a-48ba-9cc1-aed86b8c6465 Signature Adoption: Pre -selected Style Using IP Address: 198.239.15.254 Sent: 6/18/2021 6:39:36 AM Viewed: 6/18/2021 7:29:56 AM In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status,,Timestamp Intermediary Delivery Events Status Times tamp .Certified, Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Jerry NicholsSent: 6/16/2021 10:03:19 AM jerry.nichols@hca.wa.gov 'er ov COX)PSI E L @ Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Carbon Copy Events Status Timestamp Tony Walton Sent: 6/16/2021 10:03:18 AM ov ton .walton hca.wa. LUPIED Y @ g Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Certified Delivered Security Checked 6/18/2021 7:29:56 AM Payment Events Status Tirr'estamp s _ Electronic Record and Signature Disclosure.,.,- Electronic Record and Signature Disclosure created on: 5/22/2019 6:49:33 AM Parties agreed to: Dell Anderson ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, C1oudPWR OBO Washington State Health Care Authority -Sub Account (we, us or Company) may be required by law to provide to you certain written notices or disclosures. Described below are the terms and conditions for providing to you such notices and disclosures electronically through the DocuSign system. 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