HomeMy WebLinkAboutPK08-226 - Amendment - #01 - WA State Dept of Social & Health Services - Safe Havens Agreement # 08-64-31175 - 07/15/2008 Records Management
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CONTRACT COVER SHEET
This is to be completed by the Contract Manager prior to submission to City Clerks Office. All
portions are to be completed, if you have questions, please contact Mary Simmons, City
Clerks Office.
Vendor Name. Vendor Number:
JD Edwards Number
Contract Number: C)'9(O
This is assigned by Mary Simmons
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Description: �
Detail: sd` o0
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Project Name: Gz
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Contract Effective Date: 7 Al-ela' Termination Date:
Contract Renewal Notice (Days): u 4
Number of days required notice for termination or re al or amendment
Contract Manager: Department:
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Abstract:
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S Public\RecordsManagement\Forms\ContractCover\ADCL7832 07/02
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DSHS CONTRACT NUMBER
CONTRACT AMENDMENT 0864-31175
SAFE HAVENS VISITATION Amendment No 0864-31175-01
CENTER
This Contract Amendment is between the State of Washington Department of Program Contract Number
Social and Health Services(DSHS)and the Contractor identified below 1501
Contractor Contract Number
CONTRACTOR NAME CONTRACTOR doing business as(DBA)
City of Kent
CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS DSHS INDEX NUMBER
IDENTIFIER(UBI)
220 4th Ave South
173-000-002 22475
Kent,WA 98032-5895
CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS
Katherm Johnson 253 856-5073 Ext 253 856-6070 k ohnson ci kent wa us
DSHS ADMINISTRATION DSHS DIVISION DSHS CONTRACT CODE
Childrens Administration Program and Practice 2000-C-64
Improvement
DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS
Maureen Kelly PO Box 45710
Program Manager
OI m ia, WA 98504
DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS
360 902-7901 360 902-7903 keIm300 dshs wa gov
IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS
No
AMENDMENT START DATE CONTRACT END DATE
7/15/2008 6/30/2009
PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT
$50,000 00 $50,000 00 $100,000 00
REASON FOR AMENDMENT,
CHANGE OR CORRECT PERIOD OF PERFORMANCE AND MAX CONTRACT AMOUNT
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
CONT NATURE PRINTED NAME AND TITLE DATE SIGNED
D S RE PRINTED NAME AND TITLE JWATErSIGNED
og Cecelia Callison, DSHS/CA Contracts Manager 7 d
DSHS Central Contract Sermces Page 1
6024PF Contract Amendment(3-31-06)
This Contract between the State of Washington Department of Social and Health Services (DSHS)and the
Contractor is hereby amended as follows
1. Purpose. The purpose of this amendment is to extend the period of performance, increase the total
number of families served during this period, and increase the maximum consideration
2. Period of Performance. The period of performance of this Contract is revised, by an additional 12
months, to extend the period of performance through the new end date stated on page 1 of this
Amendment
The Special Terms and Conditions are amended as follows:
3. Section 4. Statement of Work, subsection c. is revised to read as follows:
"c Through the Safe Havens Visitation Center, the Contractor shall provide such services to 8
families during the period of this amendment, for a total of 16 families during the entire contract
period, with approximately 48 hours of services for each family"
4. Section 5. Consideration is amended as follows:
"a The maximum amount of total compensation payable to the Contractor for satisfactory
performance of the work under this Agreement is increased by$50,000 for this period of
performance, for a new total Maximum Agreement Amount as stated on page 1 of this
Amendment"
b Allotted Funds not expended during a contract period ending on June 30th shall not be carried
forward into the following fiscal year"
All other terms and conditions of this Contract remain in full force and effect
DSHS Central Contract Seances Paget
6024PF Contract Amendment(3-31-06)
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� REQUEST FOR MAYOR'S SIGNATURE
ICE2 Please Fill in All Applicable Boxes
Routing Information (ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAW DEPARTMENT) 7/Z
Originator: Katherin Johnson Phone (Originator): 5073
Date Sent: 7/2/08 Date Required: 7/8/08
Return Signed Document to: K Johnson CONTRACT TERMINATION DATE: June 30,
2009
VENDOR NAME: WA State DSHS DATE OF COUNCIL APPROVAL: 07/01/08
Brief Explanation of Document:
Amendment for an additional year of funding for Safe Havens Visitation and Exchange
Center. Funding is from CTED but is being administered by DSHS. The 2008/2009 State
of WA DSHS Grant funds will be used to provide services to low income families at the
Safe Havens Visitation and Exchange Center. Funds will be used for personnel costs.
All Contracts Must Be Routed Through The Law Department
(This area to be completed by the Law Department)
Received: RECEIVED
Approval of Law Dept.: JUL 0 2 2008 f
Law Dept. Comments: KENT LAW DEPT.
7�3w
Date Forwarded to Mayor:
Shaded Areas To Be Completed By Administration Staff
Received:
Recommendations and Comments:
Disposition:
Date Returned: ���
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