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DSHS Central Contract Services 1:( L Page >t� E D
6024PF Contract Amendment (1-26201 B)
GRANT cOUNTy COMMISSIONERS
DSHS CONTRACT NUMBER:
s`•al
CONTRACT AMENDMENT
1912-61860
7
De tMento
Department of Social
a HealthSemces
Onsite Family Violence Services
Amendment No. 03
Transforming lives
This Contract Amendment is between the State of Washington Department ofProgram
Contract Number
Social and Health Services (DSHS) and the Contractor identified below.
Click here to enter text.
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
PO Box 37
IDENTIFIER (UBI) 1221
136-000-784
Ephrata, WA 98823
CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS
Suzi Fade 509 764-8402 509 766-6574 sfode0granteountywa.gov
I
DSHS ADMINISTRATION
DSHS DIVISION DSHS CONTRACT CODE
Economic Services Administration
Community Services Division I 3003XS-12
DSHS CONTACT NAME AND TITLE
DSHS CONTACT ADDRESS
John Vasquez
8517 E Trent Ave
WorkFirst Coordinator
Ste 202
S okane Valley, WA 992122329
DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS
09 961-1688 (509)227-2822 vasquiacadshs.wa.gov
(509)961_1
IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS
No I
AMENDMENT START DATE
CONTRACT END DATE
11101/2020
06/30/2021
PRIOR MAXIMUM CONTRACT AMOUNT
AMOUNT OF INCREASE OR DECREASE
TOTAL MAXIMUM CONTRACT AMOUNT
$62,000.00
$0.00
$62,000.00
REASON FOR AMENDMENT:
CHANGE OR CORRECT CHOOSE ONE:
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):
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
Amendment.
R IGNA
NAME AND TITLE
DATE SIGNED
�00NTJ APRINTED
CI ,goy G> r-�2 �xc C>`ra,�
D •[�/ . %0
DSHS SIGNATURB
PRINTED NAME AND TITLE
DATE SIGNED
Alice Hildebrant, Contracts Officer
t�
DSHS/ESA/Community Services Division
10-21-20
DSHS Central Contract Services 1:( L Page >t� E D
6024PF Contract Amendment (1-26201 B)
GRANT cOUNTy COMMISSIONERS
This Contract between the State of Washington Department of Social and Health Services (DSHS) and the
Contractor is hereby amended as follows:
Exhibit B, Statement of Work, Section 4, Subsection (a), Staffing, is amended to read as follows:
a. The Contractor shall provide the services of a qualified Domestic Violence Advocate to the Moses
Lake Community Service Office for up to 774 hours per state fiscal year.
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)