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RR CONTRACT AMENDMENT DSHS CONTRACT NUMBER: <br /> —visa tor,Trate <br /> 7C 7�OCIAL&HEALTH Camp Patterson - <br /> ` SERV ICES <br /> 0364-32126 <br /> Amendment No. 01 - <br /> Program Contract Number <br /> This Contract Amendment is between the State of Washington Department <br /> of Social and Health Services (DSHS) and the Contractor identified below. Contractor Contract Number <br /> 157229 <br /> CONTRACTOR NAME CONTRACTOR doing business as(DBA) <br /> City of Everett Camp Patterson <br /> CONTRACTOR ADDRESS WASHINGTON UNIFORM DSHS INDEX NUMBER <br /> BUSINESS IDENTIFIER(UBI) <br /> 802 East Mukilteo Blvd <br /> 1428 <br /> Everett, WA 98203 <br /> CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS <br /> Jane Lewis (425) 257-8369 Ext: (425) 257-8314 jlewis@ci.everett.wa.us <br /> DSHS ADMINISTRATION DSHS DIVISION I DSHS CONTRACT CODE <br /> Aging and Disability Services Administration Division of Developmental 1 1776LS <br /> Disabilities <br /> DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS <br /> Jan Hickman-Moran 810 North Broadway <br /> Case/Resource Manager Ste 100 <br /> Everett, WA 98201-1296 <br /> DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS <br /> 425-339-5090 425-339-4856 hickmja@dshs.wa.gov <br /> IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS <br /> No <br /> AMENDMENT START DATE CONTRACT END DATE <br /> 06/21/2004 06/30/2006 - <br /> PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT <br /> $0.00 $0.00 $0.00 <br /> REASON FOR AMENDMENT; <br /> CHANGE OR CORRECT OTHER: SEE PAGE TWO <br /> ATTACHMENTS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into <br /> this Contract Amendment by reference: <br /> ® Additional Exhibits (specify): <br /> This Contract Amendment, including all Exhibits and other documents incorporated by reference, contains all of the terms and <br /> conditions agreed upon by the parties as changes to the original Contract. No other understandings or representations,oral or <br /> otherwise,regarding the subject matter of this Contract Amendment shall be deemed to exist or bind the parties. All other terms and <br /> conditions of the original Contract remain in full force and effect. The parties signing below warrant that they have read and understand <br /> this Contract Amendment,and have authority to enter into this Contract Amendment. <br /> CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED <br /> DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED <br /> Christy R. Hoosier. ADSA Contracts Manager <br /> 20 <br /> DSHS Central Contract Services Page 1 <br /> Contract Amendment #6024PF(2-25-99)Rev. 12-13-00 <br />