HomeMy WebLinkAboutIGA - Mental Health SvcsDeschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org
AGENDA REQUEST & STAFF REPORT
For Board Business Meeting of March 5, 2008
Please see directions for completing this document on the next page.
DATE: February 26, 2008
FROM: Sherri Pinner Department: Deschutes County Mental Health (DCMH) Phone #322-7506
TITLE OF AGENDA ITEM:
Consideration and signature of document #2008-111, an amendment to an intergovernmental agreement
with the Oregon Department of Human Services for mental health, developmental disability, and
addiction services.
PUBLIC HEARING ON THIS DATE? no.
BACKGROUND AND POLICY IMPLICATIONS:
The 2007-09 Intergovernmental Agreement for the Financing of Mental Health, Developmental
Disability, and Addiction Services agreement sets forth the dollar amounts and guidelines for DCMH to
provide or coordinate provision of mental health and developmental disability treatment services to
individuals, as well as alcohol, other drug and problem gambling prevention and treatment services for
the 2007-2009 biennium. Amendment #119929-25 increases funding for Service element #37 - Special
Projects and Service element #38 - Supported Employment Services.
Amendment #119929-25 includes revisions for the following service elements:
1. Service element #37 - Special Projects - funding of $23,000 designated for the purchase of a vehicle
used to transport clients while seeking employment.
2. Service element #38 - Supported Employment Services - increase of $223,938 for the 2007-2009
biennium. These funds will be used to hire 1.75 additional clinicians for our supported employment
program.
FISCAL IMPLICATIONS:
The fiscal implication is $246,938 in revenue from the Oregon Department of Human Services for the
2007-2009 biennium. This revenue is not included in the current budget and a budget amendment will
be submitted to the Finance Dept.
RECOMMENDATION & ACTION REQUESTED:
Approval and signature of document #2008-111.
ATTENDANCE: Sherri Pinner
DISTRIBUTION OF DOCUMENTS:
Fax to April D. Barrett at (503) 378-4324, and fully executed copy to Loretta Gertsch, Mental Health
Department, (541) 322-7565.
DESCHUTES COUNTY DOCUMENT SUMMARY
(NOTE: This form is required to be submitted with ALL contracts and other agreements, regardless of whether the document is to be
on a Board agenda or can be signed by the County Administrator or Department Director. If the document is to be on a Board
agenda, the Agenda Request Form is also required. If this form is not included with the document, the document will be returned to
the Department. Please submit documents to the Board Secretary for tracking purposes, and not directly to Legal Counsel, the
County Administrator or the Commissioners. In addition to submitting this form with your documents, please submit this form
electronically to the Board Secretary.)
Date:
Please complete at sections above the Official Review line.
February 26, 2008
Contact Person:
Lori Hilli
Contractor/Supplier/Consultant Name:
Department:
Phone #:
Mental Health Dept.
322-7535
Oregon Department of Human Services
Goods and/or Services: Consideration and signature of document #2008-111, an
intergovernmental agreement, #119929-25, with the Oregon Department of Human
Services for mental health, developmental disability, and addiction services.
Background & History: The 2007-09 Intergovernmental Agreement for the Financing
of Mental Health, Developmental Disability, and Addiction Services agreement sets forth
the dollar amounts and guidelines for Deschutes County Mental Health (DCMH) to
provide or coordinate provision of mental health and developmental disability treatment
services to individuals, as well as alcohol, other drug and problem gambling prevention
and treatment services for the 2007-2009 biennium. Amendment #119929-25
increases funding for Service element #37 - Special Projects and Service element #38 -
Supported Employment Services.
Amendment #119929-25 includes revisions for the following service elements:
1. Service element #37 - Special Projects - funding of $23,000 designated for the
purchase of a vehicle used to transport clients while seeking employment.
2. Service element #38 - Supported Employment Services - increase of $223,938 for
the 2007-2009 biennium. These funds will be used to hire 1.75 additional clinicians for
our supported employment program.
Agreement Starting Date:
1/1/2008
Annual Value or Total Payment:
2007-2009 biennium.
Ending Date:
6/30/2009
Increases contract revenue by $246,938 for the
® Insurance Certificate Received (check box)
Insurance Expiration Date:
Check all that apply:
[ RFP, Solicitation or Bid Process
Informal quotes (<$150K)
Exempt from RFP, Solicitation or Bid Process (specify — see DCC §2.37)
N/A County is Contractor
Funding Source: (Included in current budget? ❑ Yes ® No
If No, has budget amendment been submitted? ® Yes _ No
2/26/2008
Departmental Contact:
Title:
Lori Hill
Adult Treatment Program Manager
Department Director Approval:
Phone #:
ignature
322-7535
Date
Distribution of Document: Fax to April D. Barrett at (503) 378-4324, and fully
executed copy to Loretta Gertsch, Mental Health Department, (541) 322-7565.
Include complete information if document is to be mailed.
Official Review:
County Signature Required (check one): ❑ BOCC El Department Director (if <$25K)
❑ Administrator (if >$25K but <$150K; if >$150K, BOCC Order No.
Legal Review Date
U[;_ 1.1` - 11
Document Number
2/26/2008
For Recording Stamp Only
BEFORE THE BOARD OF COUNTY COMMISSIONERS
FOR DESCHUTES COUNTY, OREGON
A Resolution Appointing a Financial
Assistance Administrator for the 2007-2009
Intergovernmental Agreement for Financing
of Community Mental Health, Developmental
Disability and Addiction Services, and
Authorizing the Director of Mental Health
and the County Administrator to Approve
Certain Amendments to such Contract
RESOLUTION NO. 2007-107
WHEREAS, the State of Oregon acting by and through the Department of Human Services and
Deschutes County, acting through the Department of Mental Health have entered into an
intergovernmental agreement for the funding and performance of mental health, development
disability and addiction services and such agreement requires that the County appoint a Financial
Assistance Administrator; and
WHEREAS, the Financial Assistance Administrator should be a person knowledgeable about the
available mental health services and capable of dealing with a large volume of transactions in a timely
manner; now therefore:
BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF DESCHUTES
COUNTY, OREGON, as follows:
Section 1. Scott Johnson, the Director of the Deschutes County Mental Health Department, is duly
appointed as the Deschutes County Financial Assistance Administrator with respect to that
certain 2007-2009 Intergovernmental Agreement for the Financing of Community Mental
Health, Developmental Disability and Addiction Services (herein "DHS Agreement
No.119929"). Such appointment shall continue in effect so long as Scott Johnson is an
employee of Deschutes County and until a successor is appointed.
Section 2. The Financial Assistance Administrator is authorized to perform the functions of such
appointment as set forth in DHS Agreement No. 119929, except with respect to contract
amendments which exceed a dollar amount of $50,000, in which event such amendments
are subject to approval by the County Administrator for amendments which are less than
$150,000. Amendments to DHS Agreement No. 119929 which exceed $150,000 shall be
subject to prior approval by the Board.
Resolution No. 2007-107 Page 1 of 2
Oregon
Theodore R. Kulongoski, Governor
DATE: February 22, 2008
TO:
Scott Johnson, Director
Deschutes County
Department of Human Services
Administrative Services
Office of Contracts & Procurement
500 Summer Street NE, E-03
Salem, OR 97301-1080
(503) 945-5818
Purchasing Fax: (503) 373-7365
Contracts Fax: (503) 373-7889
TTY (503) 947-5330
)bHs
RE: Amendment #25 to the
2007-2009 Intergovernmental Agreement for the Financing
of Mental Health, Developmental Disability, and Addiction
Services Agreement #119929
Enclosed is an amendment to the Agreement.
The instructions for processing this amendment are as follows:
• Open and print the electronic file containing the amendment for signature by
the appropriate authorized County Official(s).
• Obtain the authorized signature(s) on the Amendment and the "Fax Back
Statement.
• Fax the amendment and "Fax Back Statement" to DHS at 503-373-7889 or
503-378-4324.
Following receipt by DHS of your signed amendment, DHS will route its copy of
amendment to the official(s) who is/are authorized to execute the amendment.
Once the amendment is signed DHS will scan the Amendment and transmit to the
appropriate County official.
If you have questions regarding this financial assistance award, please contact
Stanislav Leaderman, Mental Health & Addiction Services, at (503) 945-5879 or
April D. Barrett at (503) 945-5821.
Sincerely,
April D. Barrett, OPBC
Contracts Specialist
Enclosure
"Assisting People to Become Independent, Healthy and Safe"
An Equal Opportunity Employer
Oregon
Theodore R Kulongoski, Govemor
Department of Human Services
Administrative Services
Office of Contracts & Procurement
500 Summer Street NE, E-03
In compliance with the Americans with Disabilities Act, this Salem, OR 97301-1080
document is available in alternate formats such as Braille, (503) 945-5818
large print, audio tape, oral presentation, and electronic Purchasing Fax: (503) 373-7365
format. To request an alternate format call the State of Contracts Fax: (503) 373-7889
Oregon, Department of Human Services, Office of' Forms TTY (503) 947-53:10
and Document Management at (503) 373-0333..
TWENTY-FIFTH AMENDMENT TO
DEPARTMENT OF HUMAN SERVICES
2007-2009 INTERGOVERNMENTAL AGREEMENT FOR THE
FINANCING OF MENTAL HEALTH, DEVELOPMENTAL DISABILITY
AND ADDICTION SERVICES AGREEMENT #119929
y(DHS
This Twenty -Fifth Amendment to Department of Human Services 2007-
2009 Intergovernmental Agreement for the Financing of Mental Health,
Developmental Disability and Addiction Services as amended, is entered into, as of
the date of the last signature hereto, by and between the State of Oregon acting by
and through its Department of'Human Services ("Department" or "DHS") and
Deschutes County ("County").
RECITALS
WHEREAS, the Department and County wish to modify the Financial
Assistance Award set forth in Exhibit C-1 of the Agreement..
NOW, THEREFORE, in consideration of the premises, covenants and
agreements contained herein and other good and valuable consideration the receipt
and sufficiency of which is hereby acknowledged, the parties hereto agree as
follows:
AGREEMENT
1. The financial and service information in the Financial Assistance Award are
hereby amended as described in Exhibit 1 attached hereto and incorporated
herein by this reference,. Exhibit 1 must be read in conjunction with the
portion of Exhibit C-1 of the Agreement that describes the effect of an
amendment of' the financial and service information.,
REVIEWED
tl: GQLIN SEL
ing People to Become Independent, Healthy and Safe"
An Equal Opportunity Employer
DC.2O(L 1
Capitalized words and phrases used but not defined herein shall have the
meanings ascribed thereto in the Agreement..
3. County represents and warrants to Department that the representations and
warranties of County set forth in section 2 of Exhibit E of the Agreement are
true and correct on the date hereof with the same effect as if made on the date
hereof,
4. Except as amended hereby, all terms and conditions of the Agreement remain
in full force and effect.,
This Amendment may be executed in any number of counterparts, all of
which when taken together shall constitute one agreement binding on all
parties, notwithstanding that all parties are not signatories to the same
counterpart,. Each copy of this Amendment so executed shall constitute an
original.
IN WITNESS WHEREOF, the parties hereto have executed this amendment as of
the dates set forth below their respective signatures.
STATE OF OREGON ACTING BY AND THROUGH
ITS DEPARTMENT OF HUMAN SERVICES
By: Date:
Name: Jeremy Emerson
Title: Administrator, DHS Office of Contracts & Procurement
Deschutes County
By:
Name:
Date:
Title:
Document date: 02/22/2008 Amendment #25 Page 2
Reference #022
Exhibit 1 to the 25th Amendment to
Department of Human Services
2007-2009 Intergovernmental Agreement for the
Financing of Mental Health, Developmental Disability
And Addiction Services Agreement #119929
Document date: 02/22/2008 Amendment #25 Page 3
Reference #022
DEPARTMENT OF HUMAN SERVICES
Financial Assistance Award Amendment (FAAA)
2007-2009
CONTRACTOR: DESCHUTES COUNTY Contract #: 119929
DATE: 02/21/2008 Reference#: 022
MENTAL HEALTH SERVICES
SECTION: 1
SERVICE REQUIREMENIS MEET EXHIBIT B AND, IF INDICATED, EXHIBIT D
Start/End CPMS Approved Approved Serv.. Unit. EXHIB D Spec
Part Dates Name Service Funds Start-up Units Type Codes Condk
SE# 37 MHS SPECIAL PROJECTS
C 1/2008- 6/2009 N/A $0 $23,000 0.. NA N/A M0327 1
SUBTOTAL SE# 37 $0 $23,000
SE# 38 SUPPORTED EMPLOYMENT SERVCS
A 1/2008- 6/2008 N/A $74,646 $0 0. NA N/A
A 7/2008- 6/2009 N/A $149,292 $0 0. NA N/A
SUBTOIAL SE# 38
TOTAL SECTION 1
$223,938 $0
$223,938 $23,000
TOTAL AUTHORIZED FOR MENIAL HEALTH SERVICES $246,938
TOTAL AUTHORIZED FOR THIS FAAA: $246,938
DEPARTMENT OF HUMAN SERVICES
Financial Assistance Award Amendment (FAAA)
CONTRACTOR: DESCHUTES COUNTY Contract#: 119929
DATE: 02/21/2008
REASON FOR FAAA (for information only):
REF#: 022
Supported Employment Services - Extended Services (MHS 37) new funds are
awarded for the 07-09 Biennium..
MHS Special Projects (MHS 37) funds are awarded for the Start -Up of
Supported Employment Services.
The following special condition(s) apply to funds as indicated by the
special condition number in column 9. Each special condition set forth
below may be qualified by a full description in the Financial Assistance
Award.
M0327 1 The Special Projects, Start -Up (MHS 37) financial assistance
subjectt.o this special condition may only be used for start-up
activities related to development of a new MHS 38 program..
Exhibit 37 - Start -Up Special Projects to Service Description MHS
37 applies t.o the financial assistance subject to this special
condition.
DHS, Office of Mental Health and Addiction Services, Evidence -Based Practices Unit
Explanation of Changes in County Financial Assistance Contract Amendment
Contract #
DESCHUTES
Contractor:
( "O
0
0. 0
CO .0
I I
— 0101
o
o 0 0 0 0
Tr a o r°Di
CO N 0 0>
ti .-- N N
N
.
C T
W
On
11
a)
N
a:
oL
co
>. W
m
O
0 `v 2
a)
0
w
O
1-
E
2
LL
a)
a)
0 a )
O E
c
Z
a
0
a)
a)E
U
Z
m
E a
Boa
z
v
50
2 0
a
0)
a
pZ
a
w
co
O
0
O•
r •
CV:
O
CO
O
N
00 rn
0 0
(OPV 0
M M
to
W
0
w
N
1--
z
O
J
03 CO
W
W
O O
N N a:
0a
r irr a
co
I
0
a
W
w
re
O
u,
i 0
>->- w
W W 0
ZZ
ww a
W
Z z
J;J
a Ia C/)
2i w 0z
0 0 a.
W W
0I0 v)
a:a:=
a 2
V) N V)
0
a) w
N. I 0
o o
CO 0 a
J
coco W
MIM 0.
S
O
CIO
rn
O
O
N
O
CO
4
O
r-
>-
0 }0
w
z
-J
a
o'.
w
ixl
0''..
as
N.
m
o!
r.;
N
M
GRAND TOTAL
rr
a. CO
I-
o
Z
Fa- — to
OI
IL
❑w
Lu ❑
w
LU
CC
J w
o)
00
Q (n
2 0
U
Z w
Oa
P O
❑ 0.
Z J
0<
0
119929 INPUT M0327 080125.XLS
JJ
G
a)
E
'0
U Ct
i -•1
a)
fY
( 4 <
X U 4 W
w 0
o ro
H rn
z
aH <
U
w
2007-2009
[a :.fW M M H
m N W O1 m CO O V'
N N ui H N N 0 0 H
01 m > O OE -i d. d. OD CO H
H W N N m m 0
H (1,' 0 0 d, 11 10
in- in -
H H H
H w
W
4 g
+ E(
* • 0 fal CA
0
4 i
# 0
* a x
O (-1
* a
i[ a
11
t
4
4
4
4
4
t
44
O
O
N
t
a
4
i
4
*
k
4
4
4
4
4
4
4
4
4
4
O
O
0
H 0 N N m
Z z H H m
W H CO OD 111
c4 (21
O W in in H
N N H
O a 4.rr in- u)-
E.
r
H R N
N.1i. • r.1 co
co
d'
w
u 01 O
H
ifl
DESCRIPTION
$1,048,482
a
a
D
H • O
W N
d
N
TOTAL SE#
0
In
H
H
0
$1,601,141
0
m m O O N N CO
N N la 10 d4 d4 M
1. N N N tf1 In 01
N N in in co op m
m m H H H H N
N N H H i? in- N
0
{1}
0
in -
N N N N
in in m m
O O m m
H H m 0
O 0 H H
ln in-
in- in
0
0
0
N
in
0
0
N
1n
d4 d1 d1 d' N N 1D 10 N N
CO CO CO CO 00 OD H H N N
d+ d' 0 0 r N N N m m
W %0 0 0 CO CO H H N N
co co o o H H H H H H
d' dl H H N N H H (1)- in-
in- 411- in- U? 11)- in
H H
SERVICES
CHILD & ADOLES
ACUTE PSYCH INPATIENT
0
p 5
H U)
O Z
0
ui H
H
Q a
W
O
i U) co
a
E
N E1 co
d. H U1 0 H 111
N MN M 0 M
0
a
0GI
)i 0 0) w 0 a
TOTAL
0
M
TOTAL
TOTAL SE#
C
SUPPORTED EMPLOYMENT SERVOS
0 W
O 0
(.3 S1
04
= a
H '0
O a)
• .P
a
u
G
a)
a)
A
41
a)
1.1
0
03 0
a)
E • A
A
H �
in the "REVISED
co H
m 0
z
ua
E
uH
w ▪ �C
Ht
rtrti
4
O 4 H
• U) rd
O
E
Z
� N
a
w �
A u
d
m
w
2007-2009
PR
DESCHUTES COUNTY
02/21/2008
DESCRIPTION
00 0 0 r- L-
M O O in in
rn o o rl r-1
M O O l9 1/40
N N u1 rl ,-i
N U1• (? ri ri
co
M
m
N
O
LI}
O
-V1-
o
M
TOTAL SE#
O
O
-UT
O
O
O
-VI-
CO
Ir
CO -
o O r- L-
O O -1 ,-i
O 0 M m
O O r M
LI" in ,-i -1
H
CSS -HOMELESS
rn
M
TOTAL SE#
NON -RES DESIGNATED SVCS MHS
0
$4,435,194
m
M
rn
N
N
$3,646,837
0
✓ l
O
U
C9
rX
zA
bl
U
cvrd
E
ri
N 0
ai
is al
O
41
N
N
0
rt
0)
C-14
v
U
4.3
U
td
N
N
O
11
Ea gO
1)
J-7
4 4J
H 1�
in the "REVISED TOTAL" column include amounts
Therefore,
Cc,
4)
0
En a)
w E
U ro
H
� v
C.1 4
En 0
b b
rouoa
x4E.
W O 0+
o 0 g
zv
w H
p
U
0
m
0
2007-2009
Q1 N W LO W M M
N N 01 H N N 0 0
M O H O
01 .j F 01 01 ,H H
Hi a H H H ,
3
3
3
3
3
3
a
0
0
H
4
a
3
3
3
3
3
a
3
0
U
0) 0
4.1
D
X H
0 0
NO FC
• A
z
O
U
PROPOSED
C7
zz
W H
O
in -
O
J)
to
h
01
M
0
in-
O
E-. Q c0 co N N
M O N N M M
5 ▪ 0: u, u, h
W N N rl H-1
U 0, -I ,-1 H H
a Zr irr in- it
DESCRIPTION
W
CA
TOTAL SE#
SERVICES
$1,049,516
0
W M M H O H ul to H
H d' cr cr VI- cr W W W
in 01 m 0 0 m m io
01 a 1' M M Q1 01 r-
'44
d' H H h S r.{ H O
O M r) in in in- :? N
+h
H N
O
in -
$1,017,248
0
0
h
b
01
0 0
vl '.0
H
S
61 N
O 01
M N
O
• in -
0
0
J)
CO M M l0 W N d, d'
d' h S N 01 N in in
N N N M O d' N N
r u, Ln M N in 01 01
H 0 0 l0 01 in H H
O M M N N in :? in
H
{ in-�
ur
SERVICES
U
N 0)
U U
xx
CO LO
N Zi N W in C=, rza m M
01 fil U) W (1) zM Cq L]• � 07 FC fil (
a r� w
N E-. m N HI H ar a. LD H F
N 0 ▪ N 0 r)0 r) mm O 0 00
E
0
$2,139,797
O
U
W
LL
• a)
A
al U
rd
C3 E
d)
ro u
a) 0
a)
• 0
O E
a�
a)
111
1J
N
Q)
ro
0
E • rd
O • i.l
•
O roa)
H
a
0 a)
En
H ELI
W 0
0
A
u a)
0
0
H J1
U) 0
E • rd
ltl
F
Therefore, these
2007-2009
o o 0
01 N W 0 0 0
N N CO F 0 0 0
O) 0 H 0
01 > E-4 m m re)
ri W N N N
ri g +h V}
CONTRACT#:
Wrtl
e 0 0 0
cnz 0 0 0
ax ri r) in')
O U N N N
a
DESCRIPTION
It
0
0
+rr
PROJECTS
0
0
4fr
TOTAL SE#
0
0
the "CURRENT PENDING" column
a)
tnU
fd
b
a) 0
O
O E
aQi ro
a)
4
-0a) 14-1
H
U
H
•0 a)
0 0
v
rt
b
04
(1)
ro
a)
(1)
A
a) 0
w
O rdd
E;
rd
rd
H 1�
in the "REVISED TOTAL"
O
z
#
#
#
#
N #
W • d #
U A #
as
mO 0
1.4
Q' H
O rd N
x u H
o • or
Z •H H
N
H
#
and• r-1 4g
A C $
ro #
w
#
#
m N W In in rel co H V'
N N fn E-+ kr) rfl O 0 H Hi
m 0 H O
m > H 01 01 H CO m H
ri W O 0 N T H 0
H A N N H d. lD 1.0
VI- ir!
H H H
U? tr} i?
CONTRACT#:
0
irr
0
+n
0 0
th
0
yr
0
$1,601,141
0
irr
0
0
tr>•
$1,049,516
0
trr
$1,049,516
0
r r -I m o r r r r �co
� CO N O1 N 111 it) m 01 l0 1.0
• H r r r 1.11 M 0 0 m m N N
a m m m ri N H H W CO N N
• W N N ;h H H 0 0 H H M M
U Pl i!} tel• -or 4J 111 LO th +fr trtVI- VI-
ir}
• A
M
A
U
DESCRIPTION
$1,173,770
0 N cr lD V' Vi N N CO
r H CO ON CO CO CO CO Cr
N m VV r 0 0 r r N
Col r to 01 o 0 CO CO r—
N r -I CO 0 0 0 H H H
ri H V l0 H ri r r 0
VI. in- in- trt in-
, -1 H ri Hi
in- in. i? Lf
TOTAL SE#
CHILD & ADOLES MH SERVICES
En
W
H H U v] Z
O U]
0] U H H H
A W W
W
R4 M
M
H r m w ra
Q U] H E'ms�,-,+� 0Oi
i..3N 0. N • a N Fy N F M rz] rd
H CH7 W E W a] W W x H
O • O a rn 0 0] Wc>+ v] w u] Z
w
N 0 N O N 0 el 0 • m 0
Ea H H H Z
$1,017,248
0 o rl
to b V'
N N m
0) N <r
ri H� H
Ul. (0. ▪ :?
0
m
0
to
lD 10 CO
H H r
r r- N
H-1 HI 10
H H 0
H r1 el
E
in the "REVISED TOTAL"
C
E
N N
N N
TOTAL
*
DESCHUTES COUNTY
02/21/2008
DESCRIPTION
Gq
to
O
rh
0 0
m ur
N 10
H
r O
O1 N
0 01
m N
in- -til-
1
H N N 111 Ln 0 O co co O 0
dr dr, d• 10 10 0 O m m 0 r1
O 1n 111 co co O 0 a1 01 0 0
U
in CO CO m a1 m m m m O
N H ri ri H N N N N 111
1f1 t/} 44 V} 41} 41} 41} N N 41}
411- V}
O
L11-
41}
0
41}
O
411-
%.3)
1}
m 10 10 N N N d1 TV
r N al N N N to al
N m O 'c' 01 T N N
1fl m N uul r r 01 Ol
o 4.0 01 111 HI ,-f H H
m N N 1f) i/} if} t/} i4
t/} i/} i/} ifr
m
U
W
to to
E
NI
x x paq
EWA H U)
m w0 Ga m A
H
W
rC A 0
TOTAL SE#
T
TOTAL SE#
0 o co
o O m
0 o
Cr/
•
m m m
N N N
ih t/} N
ih
0
;h
PROJECTS
0
i?
0
10 E- N H
m 0 m 0
SUPPORTED EMPLOYMENT SERVOS
m
N
N
0
i?
0
TOTAL SE#
CSS -HOMELESS
"REVISED TOTAL"
W
m z
m N W
N N CO H
m O H O
m > H
H W
H cx
0303
U W
t p.'
t
t
al
t 0 W 0
t UJ
3
4.
t u
W t
3
3
LI t
F.'
(n 0) t
U 'Ed +
aE >1 ZZ
W FC W H
-0 0
,.,
ai
3 �y O U Zo a.
g JJ H O H
0 rd
fr.U H 5 N F
O F. l O
� o 0
z N w z
W •rt H �7
Ha 4 4 W
a ri t a
r:.
.H
t U P4. a+
u t FC
Z t
rd 3
0 t
•rl t
Gy t
t
t
3
3
t
t
t
t
t
0
0
m
cno
(z]
N
,7!
xH
U N
W N
A o
a w
H d
C]
DESCRIPTION
o N s• In
0 In In In
O H H CO
O 1O kr, In
Ifl H H 10
i? H H 1O
ifk 4a.
1/40
VI
O
th
O
ih
O
0
0o
N
in -
(0
NON -RES DESIGNATED SVCS
O
N
TOTAL SE# 201
CO
m
1/40
TA
N
m
oo
N
N
O
C7
a
U 0
m
N
ri
E
m
a)
a .13
a)
N
W
1/40
$5,786,634
g4j
O
td
0
4-1
QJ
►4
v
"REVISED TOTAL" column include
accepted/approved.
0
U
UI
U)
.4 iJ
tJ N
A
.rl 1J
0
CA 0
irk
0 it
E
0 +l
E .0 .0
UH iJ
E. Cr]
O 0
U Z
)rDHS
Oregon Department
of Human Services
Office of Contracts & Procurement.
500 Summer St. NE, E-03
Salem, OR 97301-1080
Phone: (503) 945-5818
Fax: (503) 378-4324
Alternate Fax: (503) 373-7889
TTY: (503) 947-5330
FAX BACK STATEMENT
Please complete the following statement and return it along with the completed
signature page. If any changes are made to the Amendment, please return the
Amendment in its entirety. Thank you.
I
(Name) (Title)
received a copy of Amendment #25 to Agreement #119929, between
the State of Oregon, acting by and through the Department of Human Services and
Deschutes County, from Connie Thies on February 22, 2008.
On , I signed the printed form of the Amendment without change
(Date)
from the electronically transmitted document.
A copy of the signature page pertaining to the above listed Amendment containing
my signature is included with this facsimile transmission.
(Signature) (Date)
After all parties have signed, you will receive a copy of the Amendment for your
records. If you have any questions, please call April D. Barrett at (503) 945-5821.
Enclosure(s)
Fax Back Statement.doc Revised: May 16, 20( 5