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Home My WebLink AboutAgreements/Contracts - New Hope DV/SAK19-090 1110DSHS IFWashfopton S tialAtS Department of Social&HealthSemces CONTRACT AMENDMENT CONTRACT NUMBER: 1863-31475 Domestic Violence Prevention Account - Intervention 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. 1709 - Contractor Contract Number CONTRACTOR NAME CONTRACTOR doing business as (DBA) Grant County New Hope Domestic Violence & Sexual Assault Servic CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS DSHS INDEX NUMBER 311 West Third Avenue IDENTIFIER(UBI) 1221 136-000-784 Moses Lake, WA 98837 - CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS Suzi Fode 509 764-8402 I 509 766-6574 sfodepgrantcouritywa.gov DSHS ADMINISTRATION DSHS DIVISION DSHS CONTRACT CODE Economic Services Administration Community Services Division 3000CC-63 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 ADDRESS (360)790-8794 Cliok here to enter text. earlyme@dshs.wa.gov IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS No AMENDMENT START DATE CONTRACT END DATE07/01/2G19 06/30/2020 PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT $131,836.00' $137,645.00 $269,481.00 REASON FOR AMENDMENT; CHANGE OR CORRECT PERIOD OF PERFORMANCE AND MAX CONTRACT AMOUNT ATTACHMENTS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into this Contract Amendment by reference: ® Additional Exhibits (specify): Exhibit A-1 Statement of Work, Exhibit D-1 Budget This Contract Amendment; including all Exhibits and other ;documents Incorporated: by reference,contains all of the terms and; nditions agreed upon by the parties as changes to the o`rig'inal Contract.:. No' other; understandi congs or representations, oral er.otherwise, regarding the subject matter of this ContractAmendment shat[ be deemed to exist or blvd the paities. AI other terms and -conditions of the ori66ai. Contract remain in full force and effect The parties signing below warrant that they have read and tinderstand'this Contract Amendment and have'authonty to_enter into this Contract Amendment CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED __� :4 --ti I�Wll �191 Torn Taylor, BOCC Chair &1Z-41197 DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED Caleb Clark, Contracts Officer 2 `�uNZo1� DSHS/ESA - Community Services Division DSHS Central Contract Services Page 1 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: Period of Performance. The period of performance of this contract is extended as indicated on page 1 of this Amendment. Revisions stated herein are effective for this amended period of performance. 2. Exhibit A— Statement of Work is deleted and replaced in its entirety by the revised Exhibit A-1 — Statement of Work, attached to this Amendment below. All references to the Statement of Work Exhibit are hereby amended to Statement of Work Exhibit A-1 for the period of this Amendment. 3. Exhibit D — Budget is deleted and replaced in its entirety by the revised Exhibit D-1 — Budget. All references to the Budget — Exhibit D are hereby amended to Budget — Exhibit D-1 for the period of this Amendment. 4. Section 8., Consideration, Subsection a. is amended as follows: a. Maximum Contract Amount. The maximum amount of total compensation payable to the Contractor for satisfactory performance of this work under this Contract is the amount stated on page 1 of this Contract under "Amount of Increase or Decrease." 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) EXHIBIT A-1 STATEMENT OF WORK Domestic Violence Prevention Account (DVPA) Intervention Services Contractor shall provide the following services and activities as described in this Statement of Work. In performing the services, requirements and activities covered by this Contract, the Contractor shall comply with all applicable requirements of RCW 70.123 and Washington Administrative Code (WAC) 388-61A. Services. Contractor shall increase and expand its bi-lingual/bicultural services to a minimum of 60 unduplicated Latinx victims of domestic violence with a special emphasis on outreach to under/un- served victims in rural areas of Grant and Adams Counties, including Quincy, Mattawa, Othello, and Royal City. Contractor shall provide the following services: a. Advocacy b. Information and Referral c. Safety Planning d. Medical Advocacy e. Legal Advocacy f. Community Education and Awareness g. Accompaniment and advocacy through/with systems such as legal, financial immigration, and medical 2. Prevention. Contractor shall expand its prevention readiness activities in Royal City, Othello, and Mattawa. Contractor shall engage in community conversations and meetings with existing partners with the goal of reaching a minimum of five 5 stakeholders per community. Contractor and stakeholders in each community will develop plans for ways to introduce prevention ideas at established community gatherings and events. 3. Emergency Financial Assistance a. Provide emergency financial assistance (EFA) to survivors of domestic violence in accordance with the Contractor's plan, policy and procedures. The plan, policy, and procedures must be approved by DSHS prior to incurring any costs for these services to be charged against this Contract. Costs for emergency financial assistance must be connected to the victimization and should address immediate health and safety needs. b. By July 31, 2019, Contractor shall provide to DSHS copies of all forms that will be used in connection with the provision of emergency financial assistance, including, but not limited to, screening and/or intake form, assessments, and expense tracking tool(s). 4. Incorporated by Reference a. The following documents are incorporated by reference into this Contract: DSHS Central Contract Services Page 3 6024PF Contract Amendment (1-26-2018) b. DSHS's Competitive Solicitation #1813-682 and related documents. c. Contractor's FY19 Application and Proposal for Culturally Specific Community -Based Services for Victims of Domestic Violence. d. Contractor's FY20 Renewal Application. DSHS Central Contract Services Page 4 6024PF Contract Amendment (1-26-2018) Exhibit D-1 Budget Domestic Violence Prevention Account (DVPA) Intervention Services LINE ITEM AMOUNT SALARIES BENEFITS SUBCONTRACTED SERVICES DSHS Central Contract Services Page 5 6024PF Contract Amendment (1 -26-2018)