HomeMy WebLinkAboutAgreements/Contracts - GRIS (002)$k,.*'-�;,
_Depaftie CONTRACT AMENDMENT
Community Res-ideritf rAces
al Se
Tramfor ming Jives.
This -coiltra ' tf:Am-e ' ndmeht.Js between -the State of waShihgtbh De0art ment of-
-Soc.i�al and Health 8eN-Iaies (P8HS) .and the Co*ntraclar identified below.
,s
C ' '7
K19-152 zl�
' H
DS' S. -CONTRACT NUM
.Arnehdm-e,n`t.-No.. 01
Pfogram Contract Nu'inbe_f'_
C fid.hire -t
vo emjar-t�x,L.
contractorContract--N,UM&ar
C.ONTRACTOR -NAME*
- Gran.t-.Co un ty- 'CONTRACTOR * doing businoss as..(DBA)
'CONTRACTOR ADQ� -E$S. GRANT COUNTY -.01'
WASHIN-(3TON.UNIFORM B.US1.N.E$S �DS�� INDEX.NUMS-ER.
.P08 -ox 1057 IDENTIFIER (QB;l) 1.221
-78
13.6-00 . 4
Voses Ldke, WA... 8.837-
JNTRACT ? CONTACT CONTRACTOR.: E�-MAIL AD. ' RESS
:CONTRACTOR' CONTRACTOR FAX,
Gail Goodwin' '50-9') 764-2644
765,4124 _qqoodVvf
grantsountvwa-.qov
WLM
D-S-.H*S- AD -MINI STRATION DSHS iDIVISION -DSHS CONTRACT CODE,
Devel:6prne-htia.l D-isa'.b.iflities.-Admin Di Tsi
_h
v-1 oq'ofDev'e10pr:hehta1 -1 750XP- 12 T
Disabilities
DSH&CQNTACT'N,;tv1E AND TITLE 'DSHIS-CONTACTADDRESS
Olg'a. Ldts`yk, 4
1-620.. S. neer Wa
Case Pio' y
Manager
'W'Ses Lla,keiW-A -99 7
H
DSHS Q0NTi1kCT E -; MAI L,ADDR SS-
E
DSHS.-CONTACT TELEPHONE FPC sli . t. k -hc�r-e.
5::G0NTAQT FAK
-,QHCk`.'h0r-e tci cit-er -juts, 'k.'(j@ S.
1-8 THE CONTRACTOR XS
'40 UB.R EC -1-PIENT FOR -PURPOSES. -OF THIS -CONTRACT? _.CFDA__ N_UMB'ERS
AMEND MENT"-$TART';DATE
ND. -DATE:
CONTRACT E
'.06/301202 1'
-PR-1-0:R.1vTA.)a-M,U1J1 CONT R_ A -C TANIOUNT Afv10UNT 0-FlNGREASE OR -DEQRFASE,
TOTAL MAXIMU
M CONTRACT.-..o:N
T
.REASO'N FOR AMEN M
D ..ENTi'
HANGE OR CORRE*C CT* TERMS OR S* OW, SEE PAGE TVW''
-CT 0 0 N! _R' A
ATTACHMENTS-. -hen the -box be] o,vv
IS--:M;a.rke'd`W4'th 8n:X thef6l[dw[ng Z-.xh1ib_i_t_ ---- --- a- --r-o" 18ched: and -,are ip
s. e at. :a :.c hto
'th-'ts...C-ontract.Ame-n-dment-by refern
EI-Addltlan.,2it Exhibits Vis. eoi
This. Cantract Amendment I.::i.nci.d.-di:ng'cill.Exh.i'bitsand'-.other-,d-o*cu-m-en*tsi'noorporatedbyrefi�rence,.�,-onta'n,s,- I]
I a P
it con I 4d' b��:r�i�$to
a.d." ditop�i.ljagrpO. U -�,the, as -han -e -o 1-glihal Contract. -No -other, under-sta' ndlin'.gs- or.
pon .
C
ge th n.
ropr6s.ehtat' 'th'
4ons, pra br-,,b " ' ".1 '- - " '' d
e se -0
.9-8r. JhgAhe:8 `b- 'It. bia- d
r -n t Co''
ts
..0 1�80't 'a e�*-ol th" ..Otr eh.t sha eeme .q. xjs�T,.,o
bin"d'the 'parffes.- All btHerl'. r #A d. e.
biefqwWarrapt. eYha-ve,-.*r,--e*c�,id. and Obder tn
d -th'lls- Cbmtract-Amndment,'p' d."have".aWhoriY'
tb Jnt6thjs
on otAmenftent.
...O.NTRACTO..
P-R.WTEP'NAME AND TITLE
DATE SIGNED
Chal
Td Ta�,Ior SOC:. 117
MOP .1zo/nat
D-S'H&SIGNATURE PRI NTE NA. M -E -AND TITLE
DATA, SIGNED
Melissa Diebert
Uontract
anager
DSHS Central -.Coni.tri�4 S.Orvtce ' S
1756XP -Oo.ntrac.t Act (8-21 -Zo 19) Rage
This O -cin tractbefween the State--&Wet*�§h-b-
.9ton Depa:rtm.en-t Of:S--O.-0jaJ -aOd Health i
Set c
:Contra(jtO.r -he;�ey amended as. fdflows- -V es. (Ds H -an d the
'Ex hfit -A, D-ata'.S.-e-curity Reqti,irernent-8.js, r
emcd in its-entiret -
All other terms c and.' bndl-I t4bns of this Contr-act'mai.n in'.. U11 fbrce andbffeft
re.,
DsHS. C'entral �Pntra.ct,S` v'
en ices
1755XP Contriact Amendment (8-2172019)
page 2.