Contract Amendment #3 with Washington State Health Care Authority BEFORE THE BOARD OF COUNTY COMMISSIONERS
OF LEWIS COUNTY, WASHINGTON
IN RE
Approving Contract Amendment#3 between )
Washington State Health Care Authority and ) RESOLUTION No 19- 136
Lewis County )
WHEREAS, the Board of County Commissioners (BOCC), Lewis County,
Washington, has reviewed contract amendment#3 to Program Agreement#1763-94259
between Lewis County and Washington State Health Care Authority (HCA), for the
period of April 26, 2019, through September 30, 2019, AND
WHEREAS, additional funding in the amount of $7,500 is available through the
Division of Behavioral Health and Recovery (DBHR) to provide summer programming for
Morton area school-age youth by providing positive youth development programming
over the summer months when youth are not in school bringing a total amount to
$294,955, AND
WHEREAS, it appears to be in the best public interest to authorize the execution
of said contract for Lewis County,
NOW, THEREFORE BE IT RESOLVED that Contract 1763-94259, Amendment
#3 between HCA and Lewis County in the amount of $7,500 (for a total amount of
$294,955) from April 26, 2019 through September 30, 2019 is hereby approved and the
Director of Public Health & Social Services is authorized to sign the same
DONE IN OPEN SESSION this I day of , 2019
APPROVED AS TO FORM / 0A- OF COUNTY COMMISSIONERS
Jonathan Meyer, Prosecuting Attorney LEWI= COUNTY, WAS -INGTON
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By Cullen Gatten Ro•-rt C Jackson, Chair
Deputy Prosecuting Attorney
ATTEST G ry Sta per, Vice Chair
.111s CpUNTr�•• lj
Rieva Lester, Clerk of thr axd c /ti`o„ Edna J Fund , Co issioner
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Washington State A HCA CONTRACT NUMBER
Health Care utf'� horl CONTRACT AMENDMENT 1763-94259
Prevention Services
Amendment No 03
This Contract Amendment is between the State of Washington Health Care Program Contract Number
Authority(HCA)and the Contractor identified below Click here to enter text.
Contractor Contract Number
CONTRACTOR NAME CONTRACTOR doing business as(DBA)
Lewis County
CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS ACD INDEX NUMBER
360 NW North St IDENTIFIER(UBI) 1227
Chehalis,WA 98532- 212-002-978
CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS
Danette York (360)740-2774 Click here to enter text danette.york @lewiscountywa.g
ov
HCA PROGRAM AREA FICA CONTRACT CODE
Division of Behavioral Health and Recovery 1644CS-63
HCA CONTACT NAME AND TITLE HCA CONTACT ADDRESS
Julia Havens 4500 10th Avenue SE
Manager
Lacey, WA 98503
HCA CONTACT TELEPHONE HCA CONTACT FAX HCA CONTACT E-MAIL ADDRESS
(509)220-4752 Click here to enter text greesjr @dshs wa.gov
IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS
No
AMENDMENT START DATE CONTRACT END DATE
04/26/2019 06/30/2019
PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT
$287,455.00 $7,500.00 $294,955.00
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.
CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
Difelfe- b,, / /i .Df fr
HCA SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
HCA Contract Services Page 1
7024PF HCA Custom Contract Amendment(5-2-2018)
This Contract between the State of Washington Health Care Authority (HCA) and the Contractor is hereby
amended as follows
1 The Contract end date is extended to September 30 2019
2 The maximum Contract amount is increase from $287,455 to $294,955
3 The additional $7,500 funds are to be used for implementation of the following programs as described
in the Contractor submitted action plan
• Summer PYD Prevention Program
All other terms and conditions of this Contract remain in full force and effect
HCA Contract Services Page 2
7024PF HCA Custom Contract Amendment(5-2-2018)
BOCC AGENDk ITEI SUM. ARY
Resolution BOCC Meeting Date' May 13,2019
Suggested Wording for Agenda Item: Agenda Type Consent
Approving Contract Amendment#3 between Washington State Health Care Authority and Lewis County
Contact Danette York Phone. 2774
Department Public Health and Social Services
Action Needed Approve Resolution
Description
This targets underage dnnkmg and substance abuse in Morton by providmg positive youth development
programming over the summer months when youth are not m school Amendment Apnl 26-September 30,
2019
Approvals.
EMIGroup Status
York, Danette Pending
Gatten, Cullen Pending ` 'I
Whiton,Wayne Pending
Cover Letter To
Martha Williams,Prevention Project Coordinator
HCA/DBHR
626 8th Ave SE
PO Box 42730
Olympia,WA 98504-5330
Additional Copies
Sandi Andrus
Emily Killeen
Stacey Loflm
Wayne Whiton
Suzette Smith
Amanda Migliaccio
Tina Hemphill
•