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DSHS Central Contract Services Page 1
6024PF Contract Amendment (1-26-2018)
DSHS CONTRACT NUMBER:
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a
Department of Social
CONTRACT AMENDMENT
1863-31475
7 &Health Services
Domestic Violence Prevention
Account -Intervention
Services
Amendment No. 02
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 and Sexual Assault Sery
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
1 sfode@grantcountywa.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
Click 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 DATE
07/01/2020
06/30/2021
PRIOR MAXIMUM CONTRACT AMOUNT
AMOUNT OF INCREASE OR DECREASE
TOTAL MAXIMUM CONTRACT AMOUNT
$269,481.00
$137,645.00
$407,126.00
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-2, EXHIBIT D-2
This Contract Amendment, including all Exhibits and other documents incorporated by reference, contains all of the terms
and conditions agreed upon by the parties as changes to the original Contract. No other understandings or
representations, oral or otherwise, regarding the subject matter of this Contract Amendment shall be deemed to exist or
bind the parties. All other terms and conditions of the original Contract remain in full force and effect. The parties signing
below warrant that they have read and understand this Contract Amendment, and have authority to enter into this Contract
AMsndMent.
0
RAC
SIG ATUR,
PRINTED NAME AND TITLE
DATE SIGNED
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Cindy Carter, BOCC Chair,
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DSHS SIGNATUq
PRINTED NAME AND TITLE
DATE SIGNED
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:
Purpose. The purpose of this Amendment is to extend the period of performance, increase the
maximum consideration for services provided under this extension, and amend the statement of work
and budget.
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.
The Special Terms and Conditions are amended as follows:
3. Exhibit A — Statement of Work is deleted and replaced in full by the revised Exhibit A-2 — Statement
of Work. All references to the Statement of Work Exhibit are hereby amended to Statement of Work
Exhibit A-2 for the period of this Amendment.
4. Exhibit D — Budget is deleted and replaced in full by the revised Exhibit D-2 — Budget. All references
to the Budget — Exhibit D are hereby amended to Budget — Exhibit D-2 for the period of this
Amendment.
5. 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-2
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:
Advocacy
Information and Referral
Safety Planning
Medical Advocacy
Legal Advocacy
Community Education and Awareness
Accompaniment and advocacy through/with systems such as legal, financial immigration, and
medical
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.
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. Changes to the Contractor's approved plans, policies, procedures and forms are subject to approval
by the DSHS Program Manager listed on page 1 of this Contract.
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 FY21 Renewal Application.
DSHS Central Contract Services Page 4
6024PF Contract Amendment (1-26-2018)
EXHIBIT D-2
BUDGET
Domestic Violence Prevention Account (DVPA)
Intervention Services
LINE ITEM AMOUNT
SALARIES
$77,755
BENEFITS
$35,953
SUBCONTRACTED SERVICES
GOODS AND SERVICES
$23,937
INDIRECT
CONTRACT TOTAL
$137,645
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6024PF Contract Amendment (1-26-2018)