HomeMy WebLinkAbout052118_ca04 <V 615 Sheridan Street
�.' Port Townsend, WA 98368 eeffersort www.JeffersonCountyPublicHealth.org
Public Healt
Consent Agenda
May 10, 2018
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Vicki Kirkpatrick, Director
Susan Parke, Financial Operations Coordinator
DATE: O ��
(
SUBJECT: Agenda Item – Amendment No. 1 to program agreement with DSHS
for Long-term Payables; July 1, 2018—June 30, 2019
STATEMENT OF ISSUE:
Jefferson County Public Health requests Board approval of Amendment No. 1 to the program agreement
with DSHS for Long-term Payables; July 1, 2018 - June 30, 2019.
ANALYSIS/STRATEGIC GOALS/PRO'S and CON'S:
This amendment extends the agreement date twelve months from June 30, 2018 to June 30, 2019. The
purpose of the original agreement is to advances funds, in anticipation of the actual approval of those plans
filed by the Contractor (JCPH) with DSHS for the Division of Developmental Disabilities (DDD) program
operated during the contract period.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
This contract has no fiscal impact.
RECOMMENDATION:
Jefferson County Public Health requests Board approval of Amendment No. 1 to the program agreement
with DSHS for Long-term Payables; July 1, 2018 - June 30, 2019.
REVIEWED BY:
rl I de$IP,
�7l 77/5
Philip Morley, Cow ty Administrator> Date
Community Health Environmental Health
Developmental Disabilities Water Quality
360-385-9400 360-385-9444
360-385-9401 (f) Always working for a safer and healthier community (f) 360-379-4487
DSHS CONTRACT NUMBER:
Washington State COUNTY PROGRAM or INTERLOCAL 1763-88836
At2
Department of Social
&Health Services Amendment No. 01
LONG-TERM PAYABLE AGREEMENT
Transforming lives
AMENDMENT
This Amendment is between the State of Washington Department of Social and Program Contract Number
Health Services (DSHS) and the Contractor identified below. Click here to enter text.
Contractor Contract Number
CONTRACTOR NAME CONTRACTOR doing business as(DBA)
Jefferson County
CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS DSHS INDEX NUMBER
IDENTIFIER(UBI)
615 Sheridan St
Port Townsend, WA 98368- 161-001-169 1223
CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS
Susan Parke (360) 385-9400 (360) 385-9401 sparke@co.jefferson.wa.us
DSHS ADMINISTRATION DSHS DIVISION DSHS CONTRACT CODE
Services and Enterprise Support Central Contracts & Legal 8030CS-63
Administration Services
DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS
William Taplin 1111 Washington St South
Contracts Manager
Olympia, WA 98504-5811
DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS
(360)664-6046 Click here to enter text. tapliwh@dshs.wa.gov
IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS
No
AMENDMENT START DATE CONTRACT END DATE
07/01/2018 _ 06/30/2019
PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT
$0.00 N/A Based on Annual Review
REASON FOR AMENDMENT;
CHANGE OR CORRECT PERIOD OF PERFORMANCE
ATTACHMENTS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into
this Amendment by reference:
❑ Additional Exhibits(specify):
This 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 County Program Agreement or Interlocal Agreement. No
other understandings or representations, oral or otherwise, regarding the subject matter of this Amendment shall be
deemed to exist or bind the parties. All other terms and conditions of the original County Program Agreement or Interlocal
Agreement remain in full force and effect. The parties signing below warrant that they have read and understand this
Amendment, and have authority to enter into this Amendment.
CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
bavIeR Sikli��kcv-, ( st4to a
j?�JGIi i k �. el�Cv�c t,0 nttY1•zoo(
DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
Laura Wood, Contract Manager
DSHS Central Contracts and Legal Services
Approved asfo
t Date: 516 l8
* �•
Philip C. Hunsucker,Chief Civil Deputy Prosecuting ttorney
Jefferson County Prosecuting Attorney's Office
DSHS Central Contracts and Legal Services Page 1
6046 LF Long-Term Payable Amendment(5-2-18)
This Agreement between the State of Washington Department of Social and Health Services (DSHS) and the
Contractor is hereby amended as follows:
1. DSHS extends the Agreement End Date twelve months from June 30, 2018, to June 30, 2019, as
stated on Page One of this Amendment.
All other terms and conditions of this Agreement remain in full force and effect.
DSHS Central Contracts and Legal Services Page 2
6046 LF Long-Term Payable Amendment(5-2-18)