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Consent Agenda
JEFFERSON COUNTY PUBLIC HEALTH
615 Sheridan Street · Port Townsend · Washington · 98368
www.jeffersoncountypublichealth.org
April 12, 2010
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Jean Baldwin, Director
DATE: tv\f\'f 31 ~0I0
SUBJECT: Agenda Item - Agency Agreement - Long Term Payable, #0863-
38313, Amendment #2 with the Department of Social and Health
Services; July 1, 2010 - June 30, 2011; time extension and contact
name change only
STATEMENT OF ISSUE:
Jefferson County Public Health is requesting Board approval of the Agency Agreement - Long Term Payable,
#0863-38313, Amendment #2 with the Department of Social and Health Services; July 1, 2010-
June 30, 2011; time extension and contact name change only
ANALYSIS/STRATEGIC GOALS/PRO'S and CON'S:
This contract advances funds in anticipation of the actual approval of those plans filed by the Contractor,
(JCPH) with DSHS for Substance Abuse, (DASA) and Division of Developmental Disabilities, (DDD) programs
operated during the contract period. This agreement is governed by terms in accordance with the General
Terms and Conditions between DSHS and the Contractor.
DSHS calculates and advances to the Contractor two months average anticipated expenditures from the
DASA and DDD programs filed by the Contractor. This calculation is based upon the Contractor's cash flow
documentation for the amount needed to maintain the Contractor's current payments to sub-contractors.
The revenue for this contract is reflected in each annual budget as restricted reserve.
FISCAL IMPACT I COST BENEFIT ANALYSIS:
This amendment is a time extension and a contact name change ONLY. There is no fiscal impact to the
department.
COMMUNITY HEALTH
DEVELOPMENTAL DISABILITIES
MAIN: (360) 385-9400
FAX: (360) 385-9401
PUBLIC HEALTH
ALWAYS WORKING FOR A SAFER AND
HEALTHIER COMMUNI"
ENVIRONMENTAL HEALTH
WATER QUALITY
MAIN: (360) 385-9444
FAX: (360) 379-4487
Consent Agenda
RECOMMENDATION:
JCPH management request approval of the Agency Agreement - Long Term Payable, #0863-38313,
Amendment #2 with the Department of Social and Health Services; July 1, 2010 - June 30, 2011; time
extension and contact name change only
REVIEWED BY:
~~~~
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Date
(Routed to all Public Health Managers)
~DE~it+'lr~"'&
SOCIAL &HEALTH
SERVICES
COUNTY PROGRAM or INTERLOCAL
DSHS CONTRACT NUMBER:
0863-38313
LONG-TERM PAYABLE AGREEMENT
Amendment No, 0863-38313-02
AMENDMENT
This Amendment is between the State of Washington Department of Social and
Health Services (DSHS) and the Contractor identified below,
Program Contract Number
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
161-001-169
1223
Port Townsend, WA 98368-
CONTRACTOR CONTACT
CONTRACTOR TELEPHONE CONTRACTOR FAX
CONTRACTOR E-MAIL ADDRESS
Susan Parke
DSHS ADMINISTRATION
Executive Mana ement and 0
DSHS CONTACT NAME AND TITLE
(360 385-9400 Ext: 360 385-9401
DSHS DIVISION
erations Financial Services
DSHS CONTACT ADDRESS
Maria Aviles
Financial Coordinator
DSHS CONTACT TELEPHONE
No
AMENDMENT START DATE
TOTAL MAXIMUM CONTRACT AMOUNT
$0.00
7/1/2010
PRIOR MAXIMUM CONTRACT AMOUNT
$0.00
REASON FOR AMENDMENT;
CHANGE OR CORRECT PERIOD
ATTACHMENTS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into
this Amendment by reference:
o Additional Exhibits s eci
This Amend all Exhibits and other documents incorporated by reference, contains all of the terms and
conditions agreed by the parties as changes to the original Courtty Program Agreement or Interlocal Agreement. No
other understandings or repf1 . oral or oth di subject matter of this Amendment shall be
deemed to exist or bind th sr terms s original County Program Agreement or Interlocal
Agreement remain in full f The parties signing below warrant that they have read and understand this
Amendment, and have autho.:. Jo enter into this Amendment.
CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
DSHS SIGNATURE
PRINTED NAME AND TITLE
DATE SIGNED
Angie Williams, Contract Consultant
DSHS Central Contract Services
DSHS Central Contract Services
6046 LF Long-Term Payable Amendment (2-4.09)
'.....j as to form c:~." "
1hr/}o
Page 1
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, 2010, to June 30, 2011, as
stated on Page One of this Amendment.
2. DSHS revises the DSHS Contact Name and Contact Address to Maria Aviles, DSHS Financial
Coordinator, as stated on Page One of this Amendment.
All other terms and conditions of this Agreement remain in full force and effect.
DSHS Central Contract Services
6046 LF Long-Term Payable Amendment (2-4-09)
Page 2