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DSHS Central Contract Services
6017CF County Program Agreement (10-31-2017) Page 1
DSHS Agreement Number
Washington Stats
COUNTY PROGRAM AGREEMENT
Department Of 90cial
2263-44087
Heaitk�r ices SeM
DV Advocates and Services — SFY 23
Transforming lives
This Program Agreement is by and between the State of Washington
Administration or Division
Department of Social and Health Services (DSHS) and the County identified
Agreement Number
below, and is issued in conjunction with a County and DSHS Agreement On
General Terms and Conditions, which is incorporated by reference.
County Agreement Number
1783-86421
DSHS ADMINISTRATION
DSHS DIVISION
DSHS INDEX NUMBER
DSHS CONTRACT CODE
Economic Services
Community Services Division
1221
3000CC-63
Administration
DSHS CONTACT NAME AND TITLE
DSHS CONTACT ADDRESS
Mette Earlywine
ESA CSD HQ
Program Manager
712 Pear Street SE
Olympia, WA 98501
DSHS CONTACT TELEPHONE
DSHS CONTACT FAX
DSHS CONTACT E-MAIL
(360)790-8794
Click here to enter text.
earl ymeadshs.wa.gov
COUNTY NAME
COUNTY ADDRESS
Grant County
PO Box 37
New Hope
Ephrata, WA 98823-0037
COUNTY FEDERAL EMPLOYER IDENTIFICATION
COUNTY CONTACT NAME
NUMBER
SuziFode
COUNTY CONTACT TELEPHONE
COUNTY CONTACT FAX
COUNTY CONTACT E-MAIL
(509) 764-8402
L
sfodeagrantcountywa.2ov
IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM
ASSISTANCE LISTING NUMBERS
AGREEMENT?
No
PROGRAM AGREEMENT START DATE
PROGRAM AGREEMENT END DATE
MAXIMUM PROGRAM AGREEMENT AMOUNT
.08/01/2022
1 06/3012023
$851360.00
EXHIBITS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into this
County Program Agreement by reference:
Z Exhibits (specify): No Data Security Exhibit Exhibit A - Statement of Work; Exhibit B - Program Requirements;
Exhibit C - InfoNet Requirements; Exhibit D - Budget
❑ No Exhibits.
The -terms a"n'd conditions ,of*thIs Contrbdt'are—an iniegration'-and representation"of the' final, e'ti* d -1
n rean exc.usive
Under'sta' 6di'n"g between the: parties' superseding mb.q
erse merging and''previous agreementscommunications oral
ingand1:writings; '
or otherwise,, regarding the subjectmatte: matter this Contract. The parties signingbe''low rep th '' tre s ein' t ' a. .they have. read and
.
understand. this. Contract, and. hbv'e' the authority to execute this -'Contract.,. This Contract . shall be binding -o'h DS . HS only
Upon' sig*natu're'by.DSHS.
COU TY SIGNATURE
'4
7
PRINTED NAME(S) AND TITLE(S)
DATE(S) SIGNED
Danny E Stone, BOCC Chair
R] I
DSHS SIGNATURE
PRINTED NAME AND TITLE
DATE 8IGNED
Sandra Daniels, Business Infrastructure Lead
8/1/2022
1 DSHS/ESA Community Services Division
DSHS Central Contract Services
6017CF County Program Agreement (10-31-2017) Page 1