HomeMy WebLinkAboutWashington State Department of Social & Health Services, Juvenile Justice & Rehab. Admin. - 081318oto J's, � - � -I
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DSHS CONTRACT NUMBER:
Washington state
stal
CONTRACT AMENDMENT
1763-93731
VDepartment
7 & Health Services
WSART Consultation
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.
Click dere to enter text.
Contractor Contract Number
CONTRACTOR NAME
CONTRACTOR doing business as (DBA)
Jefferson County
CONTRACTOR ADDRESS
WASHINGTON UNIFORM BUSINESS
DSHS INDEX NUMBER
1820 Jefferson St
IDENTIFIER (UBI)
1223
Port Townsend, WA 98368-
161-001-169
CONTRACTOR CONTACT
CONTRACTOR TELEPHONE
CONTRACTOR FAX
CONTRACTOR E-MAIL ADDRESS
Barbara Carr
360 385-9190
360 385-9191
bcarr@co.jefferson.wa.us
DSHS ADMINISTRATION
DSHS DIVISION
DSHS CONTRACT CODE
Rehabilitation Administration
Division of Treatment and
5000CC-63
Intergovernmental Pro
DSHS CONTACT NAME AND TITLE
DSHS CONTACT ADDRESS
Cory Redman
1115 Washington Street SE
Program Administrator
Olympia, WA 98504
DSHS CONTACT TELEPHONE
DSHS CONTACT FAX
DSHS CONTACT E-MAIL ADDRESS
(360)902-8079
cory.redman@dshs.wa.gov
IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT?
CFDA NUMBERS
No
AMENDMENT START DATE
CONTRACT END DATE
06/29/2018
06/30/2019
PRIOR MAXIMUM CONTRACT AMOUNT
AMOUNT OF INCREASE OR DECREASE
TOTAL MAXIMUM CONTRACT AMOUNT
$19,300.00
$1,500.00
$20,800.00
REASON FOR AMENDMENT;
CHANGE OR CORRECT MAXIMUM 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):
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 t y have read and understand this Contract Amendment, and have authority to enter into this Contract
Amendment.
CONTRACTOR SI TURE
PRINTED NAME AND TITLE
DATE SIGNED
DSHS SIGNATURE
PRINTED NAME AND TITLE
DATE SIGNED
Del Hontanosas
�*j •y .-r
Grants & Contracts Manager
vC as o, om}t/Q
Date:
Philip C. Hunsucker, Chief Civil Deputy ProsecutingAttorney
Jefferson County Prosecuting Attorney's Office
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:
Increase FY18 maximum consideration by $1,500 from $9,520 to $11,020.
2. In EXHIBIT A: Statement of Work - WSART Consultation for County Juvenile Courts, Section 3.a.
Consideration, is revised to read as follows:
Total consideration payable to Contractor for satisfactory performance of the work under this Contract
is up to a maximum of $20,800, including any and all expenses, and shall be based on the following:
a. The maximum consideration payable for Fiscal Year 2018 is $11,020 and for Fiscal Year 2019 is
$9,780. Funds not expended in Fiscal Year 2018 cannot be carried over to the following 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)
Consent Agenda
Regular Agenda
Jefferson County
Board of County Commissioners
Agenda Request
TO: Board of Commissioners
Philip Morley, County Administrator
FROM: Barbara Carr
DATE: August 13, 2018
RE: WSART Consultant Contract 1763-93731 - AMENDMENT
STATEMENT OF ISSUE:
Increase Contract amount by $1,500.00 - Funding for 7/2016 — 6/2018
ANALYSIS:
Shannon Burns, a Juvenile Probation Counselor in Jefferson County is currently
serving as one of five statewide consultants to perform consultant duties to WSART
programs. Jefferson County is reimbursed for Shannon's time pursuant to the
WSART Quality Assurance requirements.
FISCAL IMPACT:
None. These funds reimburse for salary, benefits and travel. This revenue increase
will complete and close out the contract ending 6/2018.
DEPARTMENT CONTACT:
Barbara Carr, Juvenile Court Administrator
RECOMMENDATION:
That the Board approve the Contract and sign 3 originals. A fully executed original
will be returned to the BOCC office.
Approved
b'Ph�' D
i ip Morley, C n dministra or Date
CONTRACT REVIEW FORM
CONTRACT WITH: DSHS - Juvenile Justice & Rehabilitation Administration
CONTRACT FOR: WSART — Juvenile Court
TERM: 07/01/16-06/30/18
AMOUNT: $1,500.00 - Contract increase PROCESS:
Revenue: 1,500.00
Expenditure: 1,500.00
Matching Funds Required:
Sources(s) of Matching Funds
Exempt from Bid Process
Consultant Selection Process
Cooperative Purchase
Competitive Sealed Bid
Small Works Roster
Vendor List Bid
RFP or RFQ
Other Sole source
Please Note: State will sully execute their portion once the State Budget is in ettect.
Step 1: REVIEW BY A E1T
Review by:S'�
Date Reviewed: j
APPROVED FORM F-1 Returned for revision (See Comments)
I Comments
Step 2: REVIEW BY PRyECUTjN9v ATTORNEY
Review by: C
Date Reviewed:
APPROVED AS TO FORNO
eturned for revision (See Comments)
Comments +j' Jfi-&je � �.--C.��,,t G=
Step 3: (If required) DEPARTMENT MAKES REVISIONS & RESUBMITS TO
RISK MANAGEMENT AND PROSECUTING ATTORNEY
Step 4: CONTRACTOR/CONSULTANT SIGNS APPROPRIATE NUMBER OF
ORIGINALS
Step 5: SUBMIT TO BOCC FOR APPROVAL
Submit originals and 9 copies of Contract, Review Form, and Agenda Bill to BOCC Office.
Place "Sign Here" markers on all places the BOCC needs to sign.
MUST be in BOCC Office by 5 p.m. TUESDAY for the following Monday's agenda.
(This form to stay with contract throughout the contract review process.)