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2 <br /> INTERLOCAL AGREEMENT • <br /> DSHS Agreement Number. <br /> ��ppy�WashloRroe smv� 1164-26142 <br /> 7c �1BPARTf�ENT H <br /> SOQAL bHEALTH <br /> SERVICES Individual and Family Services Program • <br /> RECREATIONAL OPPORTUNITIES <br /> This Agreement is by and between the State of Washington Department Program Contract Number. <br /> of Social and Health Services (DSHS) and the Contractor identified Contractor Contract Number: <br /> below, and is issued pursuant to the Interlocal Cooperation Act, chapter SSPS#157229 <br /> 39.34 RCW. <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 1428 <br /> Everett,WA 98203- <br /> CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS <br /> Jane Lewis (425)257-8369 Ext: (425)257-8374 jlewis@ci.everett.wa.us <br /> DSHS ADMINISTRATION DSHS DIVISION DSHS CONTRACT CODE <br /> Aging and Disability Services Division of Developmental Disabilities 1760LP-64 _ <br /> Administration • <br /> DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS <br /> Jerrye Ralston 840 N Broadway Bldg A Ste 100 <br /> Contracts Manager <br /> Everett,WA 98201 <br /> DSHS CONTACT TELEPHONE DSHS.CONTACT FAX • DSHS CONTACT E-MAIL ADDRESS <br /> (425) 339-4840 (425) 339-4856 ralstja@dshs.wa.gov <br /> IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBER(S) • <br /> No <br /> AGREEMENT START DATE AGREEMENT END DATE MAXIMUM AGREEMENT AMOUNT <br /> 7/1/2011 7/1/2014 Fee For Service <br /> EXHIBITS. The following Exhibits are attached and are incorporated into this Agreement by reference: <br /> Exhibits (specify): <br /> ® No Exhibits. <br /> The terms and conditions of this Agreement are an integration and representation of the final, entire and exclusive <br /> understanding between The parties superseding and merging all previous agreements,writings, and communications, oral <br /> or otherwise regarding the subject matter of this Agreement, between the parties. The parties signing below represent <br /> they have read and understand this Agreement, and have the authority to execute this Agreement. This Agreement shall <br /> be binding on DSHS only upon signature by DSHS. <br /> CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED <br /> 1. <br /> DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED <br /> DSHS Central Contract Services <br /> 1760LP IFS Recreational Opportunities(10-27-08) Page I <br /> 4 <br />