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, , <br /> to <br /> 1 DSHS Agreement Number: <br /> INTERLOCAL AGREEMENT 1764-87576 <br /> FlagiffErvi <br /> f1Slf! fOR SfIIfe <br /> 7F„'T� Community Settings Respite CareEALTHICES <br /> i (excluding IFS Program Participants) <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 SSL: 1029707 01 <br /> 39.34 RCW. <br /> CONTRACTOR NAME CONTRACTOR doing business as(DBA) <br /> City of Everett Everett Parks& Community Services <br /> CONTRACTOR ADDRESS WASHINGTON UNIFORM DSHS INDEX NUMBER <br /> BUSINESS IDENTIFIER(UBI) <br /> 802 East Mukilteo Blvd <br /> Everett, WA 98203 1428 <br /> CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS <br /> Jane Lewis (425) 257-8369 (425) 257-8374 jlewis@ci.everett.wa.us <br /> DSHS ADMINISTRATION DSHS DIVISION DSHS CONTRACT CODE <br /> Developmental Disabilities Division of Developmental Disabilities 1803LP-64 <br /> Admin <br /> DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS <br /> Gina M. Thomas 840 N Broadway A100 <br /> Program Specialist II <br /> Everett, WA 98201 <br /> DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS <br /> (425)339-4840 (425)339-4856 Thomagm@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 /> 07/01/2017 06/30/2020 Fee For Service <br /> EXHIBITS. The following Exhibits are attached and are incorporated into this Agreement by reference: <br /> ® Exhibits (specify): Exhibit A-Rate Table <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 /> C' • 'RACTO' SIGNATURE PRINTED NAME AND TITLE DATE SIGNED <br /> ' <br /> / le i - '0 Mayor Ray Stephanson a/1201 - <br /> . - •.T RE j PRINTED NAME AND TITLE DATE SIGNED <br /> Joseph F. Carter, Operations Manager DDA R2 ('' l(.2 - Z�l7 <br /> Rm `� EQ ATT' 4T: I <br /> / A N T / Ai AP ROVED . ITO 1'M <br /> L I ///,t..' • - <br /> JUN 1 2 2017 J City Clerk JAMES D.ILES,City torney <br /> DDA REGION 2 <br /> DSHS Central Contract ServicesR <br /> 1803LP DDD Respite in Community Settings <br /> E(5-6 11) Page 1 <br />