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Part One INITIAL COMMUNITY RELATIONS PLAN <br /> • <br /> Pertinent Contacts Telephone Number E-mail Address <br /> DBHR Certification Policy Manager: (360)725-3716 Jessica.blose@dshs.wa.gov <br /> Jessica Blose Toll free: 1-877-301-4557 <br /> Fax:(360)725-2279 <br /> BHO/MCO,if applicable <br /> REGULATORY REFERENCE: <br /> WAC 388-877B-0405(1): Documentation the provider has communicated with the county legislative authority and if applicable, <br /> the city legislative authority, in order to secure a location for the new opiate substitution treatment program that meets county, <br /> tribal or city land use ordinances. Identify the legislative authority by contacting: <br /> • Washington Association of County officials(360)943-1812, or <br /> • Association of Washington Cities(360) 753-4137, or <br /> • The Tribal Administrative office <br /> • (If proposed site is on a tribal reservation or tribal trust land,the county does not require notification) <br /> Legislative Authority Telephone Number E-mail Address Responsible <br /> Person <br /> City: <br /> County: <br /> Tribal: <br /> (For tribal program only) <br /> File name: f:\sharedlsections\cert1OTP\Provider Request Forms 2014+10TP Comm Rel Plan-App D-1/5/17 <br /> Page 2 of 15 <br />