HomeMy WebLinkAboutAmend IGA - 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 April 9, 2008
Please see directions for completing this document on the next page.
DATE: April 1, 2008
FROM: Sherri Pinner Department: Deschutes County Mental Health (DCMH) Phone #322-7509
TITLE OF AGENDA ITEM:
Consideration and signature of document #2008-167, 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 #119929-30 increases funding for Service element #20 - Non -
Residential Adult Mental Health Services and Service element #37 - Mental Health Services Special
Projects.
Amendment #119929-30 includes revisions for the following service elements:
1. Service element #20 - Non -Residential Adult Mental Health Services. This funding is provided to
begin a program for early psychosis intervention. Psychosis treatment services include; outreach .Ind
engagement; assessment and treatment using a team consisting of a psychiatrist, social worker,
occupational therapist, nurse, and vocational specialist; multi -family psycho education; cognitive
behavioral therapy; vocational and educational support; prescribing medication using low dose
protocol; and support for the individual in home, community, school and work setting. This funding
will be used to hire 1.50 FTE Mental Health Specialist II, .50 FTE Public Health Nurse, and .25 Mental
Health Specialist I.
2. Service element #37 - Mental Health Services Special Projects. This funding is provided for si art up
costs associated with beginning the early psychosis intervention program. These funds will be used for
community education and outreach, and minor office equipment.
FISCAL IMPLICATIONS:
The fiscal implication is $535,993 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 amendmen will
be submitted to the Finance Dept.
RECOMMENDATION & ACTION REQUESTED:
Approval and signature of document #2008-167.
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.)
Please complete all sections above the Official Review line.
Date: April 1, 2008
Contact Person:
Barrett Flesh
Contractor/Supplier/Consultant Name:
Department:
Mental Health Dept.
Phone #:
322-7591
Oregon Department of Human Services
Goods and/or Services: Consideration and signature of document #2008-167, an
intergovernmental agreement, #119929-30, 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 #119929-30
increases funding for Service element #20 - Non -Residential Adult Mental Health
Services and Service element #37 - Mental Health Services Special Projects.
Amendment #119929-30 includes revisions for the following service elements:
1. Service element #20 - Non -Residential Adult Mental Health Services. This funding is
provided to begin a program for early psychosis intervention. Psychosis treatment
services include; outreach and engagement; assessment and treatment using a team
consisting of a psychiatrist, social worker, occupational therapist, nurse, and vocational
specialist; multi -family psycho education; cognitive behavioral therapy; vocational and
educational support; prescribing medication using low dose protocol; and support for the
individual in home, community, school and work setting. This funding will be used to
hire 1.50 FTE Mental Health Specialist II, .50 FTE Public Health Nurse, and .25 Mental
Health Specialist I.
2. Service element #37 - Mental Health Services Special Projects. This funding is
provided for start up costs associated with beginning the early psychosis intervention
program. These funds will be used for community education and outreach and minor
office equipment.
Agreement Starting Date:
7/1/2007
Annual Value or Total Payment:
2007-2009 biennium.
Ending Date:
6/30/2009
Increases contract revenue by $535,993 for the
® Insurance Certificate Received (check box)
Insurance Expiration Date:
N/A County is Contractor
3/28/200
Check all that apply:
❑ RFP, Solicitation or Bid Process
❑ Informal quotes (<$150K)
❑ Exempt from RFP, Solicitation or Bid Process (specify — see DCC §2.37)
Funding Source: (Included in current budget? ❑ Yes ® No
If No, has budget amendment been submitted? ® Yes ❑ No
Departmental Contact:
Title:
Barrett Flesh
Child and Family Program Manager
Department Director Approval:
Phone #:
322-7591
4.l .g
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 ❑ Department Director (if <$25K)
❑ Administrator (if >$25K but <$150K; if >$150K, BOCC Order No. )
Legal Review
Document Number
CC _. 2
Date
3/28/2008
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 oft
Oregon
Theodore R. Kulongoski, Governor
DATE: March 27, 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
)(DHS
RE: Amendment #30 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 Joan
Wan, Mental Health & Addiction Services, at (503) 947-5395 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 Department of Human Services
Administrative Services
Theodore R. Kulongosld, Governor ice 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) 947-5330
and Document Management at (503) 373-0333.
THIRTIETH AMENDMENT TO
DEPARTMENT OF HUMAN SERVICES
2007-2009 INTERGOVERNMENTAL AGREEMENT FOR THE
FINANCING OF MENTAL HEALTH, DEVELOPMENTAL DISABILITY
AND ADDICTION SERVICES AGREEMENT #119929
)rDHS
This Thirtieth 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. The Department and
County also wish to modify the Specialized Service Requirements set forth in
Exhibit B-2 of the Agreement by adding a new Specialized Service Requirement,
MHS 20D, Early Psychosis Project.
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 "As
IIO'A! COUNSEL
fisting People to Become Independent, Healthy and Safe"
An Equal Opportunity Employer
2. Exhibit B-2 of the Contract is hereby amended to add the Specialized Service
Requirement for MHS 20D, Early Psychosis Project (EPP), in the form
attached hereto and incorporated herein by this reference.
3. Capitalized words and phrases used but not defined herein shall have the
meanings ascribed thereto in the Agreement.
4. 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.
5. Except as amended hereby, all terms and conditions of the Agreement remain
in full force and effect.
6. 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: Date:
Name: Title:
Document date: 03/27/2008
Reference #026
Amendment #30 Page 2
Exhibit 1 to the 30th 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: 03/27/2008
Reference #026
Amendment #30 Page 3
MHS 20D/2007-2009
Page 1 of 1
Service Names(s): Non -Residential Adult Mental Health Services (General)
Service Element I.D. Code: MHS 20
Specialized Service: Early Psychosis Prosect (EPP)
Exhibit B Code: 20D
I. Service Description (exceeding Exhibit B-1)
Funds awarded for MHS 20 Services that are identified in the Financial Assistance
Award as subject to this Specialized Service Requirement may only be expended on
MHS 20 Services that are delivered in the Early Psychosis Project (EPP). MHS 20
Services delivered with funds provided under this agreement and subject to this
Specialized Requirement include the following, in addition to the services otherwise
described in the MHS 20 Service Description:
A) Psychosis treatment services and intervention are provided to reduce
long-term disability associated with psychosis to uninsured individuals
(non -Medicaid clients) following the EPP guidelines.
Psychosis treatment services include:
1. Outreach and engagement.
2. Assessment and treatment using a multi -disciplinary team
consisting of a psychiatrist, social worker, occupational
therapist, nurse, and vocational specialist.
3. Multi -family psycho -education.
4. Cognitive behavioral therapy.
5. Vocational and educational support.
6. Prescribing medication using a low dose protocol.
7. Support for the individual in home, community, school, and
work settings.
II. Performance Standards (exceeding Exhibit B-1)
None
III. Reporting Requirements (exceeding Exhibit B-1)
A) Maintain the client's CPMS record for MHS 20D Services provided,
using a dedicated provider number assigned for the Early Psychosis
Project (EPP).
IV. Financial Assistance Calculation, Disbursement and Settlement Procedures
(exceeding Exhibit B-1)
None
MHS 20D GT0047-08 Approved 03/20/2008
DEPARTMENT OF HUMAN SERVICES
Financial Assistance Award Amendment (FAAA)
2007-2009
CONTRACTOR: DESCHUTES COUNTY Contract#: 119929
DATE: 03/26/2008 Reference#: 026
MENTAL HEALTH SERVICES
SECTION: 1
SERVICE REQUIREMENTS MEET EXHIBIT B AND, IF INDICATED, EXHIBIT D
Start/End CPMS
Part Dates Name
Approved
Service Funds
SE# 20 NON-RESIDENTIAL ADULT MH SERV
Approved Serv. Unit EXHIB D Spec
Start-up Units Type Codes Cond4
A 12/2007- 6/2008 N/A $46,060 $0 0. NA 20D
A 7/2008- 6/2009 N/A $414,933 $0 0. NA 20D
SUBTOTAL SE# 20
SE# 37 MHS SPECIAL PROJECTS
C 12/2007- 6/2009 N/A
SUBTOTAL SE# 37
TOTAL SECTION 1
$460,993 $0
$0 $75,000 0. NA N/A M0182 1
$0 $75,000
$460,993 $75,000
TOTAL AUTHORIZED FOR MENTAL HEALTH SERVICES $535,993
TOTAL AUTHORIZED FOR THIS FAAA: $535,993
DEPARTMENT OF HUMAN SERVICES
Financial Assistance Award Amendment (FAAA)
CONTRACTOR: DESCHUTES COUNTY Contract#: 119929
DATE: 03/26/2008
REASON FOR FAAA (for information only):
REF#: 026
Non -Residential Adult Mental Health (General) (MHS 20) and Early Psychosis
(EPP) (MHS 20D) funds are awarded for new EPP project that serves up to 28
clients.
MHS Special Projects (MHS 37) funds are awarded for Start -Up of the EPP
program. Mid -Valley Behavioral Care Network (MVBCN) will act as consultant
for this project.
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.
M0182 1 The Special Projects, Start -Up (MHS 37) financial assistance
subject to this special condition may only be used for start-up
activities related to Development of a new MHS 20D program.
Exhibit 37 -Start -Up Special Projects to Service Description MHS
37 applies to the financial assistance subject to this special
condition.
2007-2009
0) X.0 wr mo
N N cn H in N
m o H O -
m 9E. odl
H W lD N-
H
H Cx rr O
ri
r
PROPOSED
U
zz
a
t/r
$1,535,698
M O M
m 41} rn
rn m
O ri
i/i H
dl
DESCRIPTION
$1,074,294
in-
4/2 -
$1,601,141
O
in -
$1,601,141
O
411-
$1,159,631
O1 01 O O N N co
N N to to sN dl r*1
N r- N N U•) Ln 0)
N N LO N CO CO M
(.1 M ri ri H ri N
r- r- ri ri ;/)- {h N
in- {A ill -
0
O
4/A
O
rn-
O
1/}
O
4/Y
0
4/1.
O
H
0
O
0
z
H
W
E1
0
W
ur z tr1
U 0
c
N U
lam- 7,
.r{
E
CO
TS u
ej
41
0 0
:? ¢r to
S�r lll
tn
E
ca
b
H
U
d
p
0 0
U ?a
Qi
GL
ai
'0
O a)
H 4J
in c.n
? H ra
(I/r A
a)
0
4)
d m
0 al
ai
rd
a3
H t.
-4 01 01 0 0 N N CO
M N N lO XS) 11 .o m
LD t- r N N In in O1
01 r r` In In w co rh
In m m ri ri ri 1-I N
ri N h r-1 H i/? f/} N
i))- 4/1- VI-
H
W W H 9 C)
04
H U O £
Q
(1) U H H ,a W
FC (1111 a A W
a Q
o
N z a La1 w Cu H
W W gIG H Q W
ca
Ui U) N N ' d' HN 1:4 u) z 0 H In W
R14 A Z
U N1:.-4 N
o
,t a Xk H A4 W # a
z z W H Z1 0 W W (x w A W a
Z z 0 Cil = a 0 N a O o W ca
O O E N dl E LL) F. 0 E-'-' In L. m H
N N H N O N 0 N 0 M O M 0 M 0
Therefore,
c
U 'd
H g+
WAC
co co
rd
Fa�
0I. U rT W
0 0r14
N
w
A U
q
G
.r{
W
2007-2009
DESCRIPTION
CO 0 0 N N
M 0 0 U lfl
m 0 0 H r -f
M O O W li
N til lf) ri rl
N if} if} ri ri
0
O
0
0
0
0
i!}
0
0
if}
0
0
m 0 0 N N
M 0 0 lfl l!1
On 0 0 H rl
M O O l0 l0
N to Ln ri rl
N if} L} H rl
VI- ih
VI -
co
M
TOTAL SE#
CSS -HOMELESS
rn
M
NON -RES DESIGNATED SVCS
$4,896,598
$3,993,684
rI
0
U
C7
z
H
Az
a
a •
W )
0 01
v U
rt
E
Ti
O
iD id
H
al S4
'd O
F
0 O
SA
04
04
td
O )
F J)
R.�
A N
CA U
Cr)
H id
C4 m
4J
1.) N
•ri .0
) 0
1--1
7 7
0 eA
td
yJ
N it
E-1
4)
CI
0
N
w a,$
La 16
'b
cd
4 F
0�
W W
H
4
ro
A U
.r{
2007-2009
m 1.0 W 10 1.0 M M
01 O H Q N N 0 0
of > F (71 01 H H
H W N N N N
H a H r-1 rl H
W
g
0 w �z
* O rC
# a �pM4CC
# O 0
#
0
z 0 w
0
H
0
H
PR
0
0
0
0
0
ifl-
O
ifl-
0
0
H Q M m m m
W M M
W y N N 0 0
F4+
m m H r3
F4 N N N N
0 F4 rl rl rl rl
•/ {/). {/} i?
DESCRIPTION
W
0)
CHILD & ADOLES MH SERVICES
o E-, N
N O N
TOTAL SE#
$1,049,516
0
0
$1,049,516
$1,049,516
0
ifl-
M c r -I O H tf1 Lfl H
d4 tli Sr Vi .4 l0 l0 LD
m m O o co co to
d1 =r r1 ri m al r
H H S S ri rl 0
M M 111 Ln L} •l- N
4.6- 46-
N
46.
0
0
0
O
0 0
O
O
0
0
0
0
O
O
W m M H O r -I (1) Lfl -1
H d+ W dl :h Tr w 10 10
Ln 01 01 0 o co ao w
01 di Tt. M M 01 a1 r -
TN rl H r N H rl 0
0 M M U) LA i/} Li N
LI- 41) 4/)- :?
H N
U)
PEI
0
H5
a
w
0)
0)
E -i PI r6 c6z
F H
R GI
0)) a a
0 0 v
H W
124
WWa
0 E H 0)
H U) c/a
Et co W H w a°, M M
A07L E-1
a tri VI rzI
4*
w�3 `1) w a Aa m w
� E. H F d' W l0 t,
N 0-� In en
M M 0
M HO
in the "REVISED TOTAL"
2007-2009
m W
N N
m
C71
0
# U
0
0
H
O
etiz
H
W
q 0 0 0
01 E o 0 0
H O
H co m co
a) a) at
f:4 VI t? t!}
PROPOSED
0 0 0
0 0 0
0 0 0
N
th
0
trr
0
th
0
A 0 0 o
0 0
hLI M M M
irk
DESCRIPTION
F
WU
0H
H
U N
w M
P4
ui
N
M
TOTAL SE#
2
0
0
U
C9
W
W
15)N U
criE
N
'Cj J-1
U1 p
0
Di
1t
0
al • 0
'CS N
H
• v
U
0y
O 0
U .r
Ra
• Ri
ro
H \d
O 0
H 1)
Ri
• 0
W
co
H to
a' N
• N
0
•ri
.1• -)
0
IR
g>
0 rd
E .0
of ro
H
H
0
G)
to E
b
a
cnbIn
(13
0 r0
a) EE
U
0 M W
Hmw
.�
rn
Firy
a r5
A
fd
L-1
!i+
2007-2009
ON 0 H O
a1 F
H W
H W
* a
3
+ F
+ 0 Ea W
1• U W U`
it
H
* O U
d
3
3
3
it
3
3
•
�+ zz
0
z u
0
H
1.4
PR
5
a
4
3
3
11
3
3
3
oH
t/1-
rI
ih
$1,664,961
rn
rn
0
10
t/}
0 0
in- in -
0 0
-01-
0
0
$1,601,141
0
$1,601,141
0
A o N r M M NO H
W > 1Nr1 441 Lil 0 0 H0
IT, 0 0 N a\ r1 111
U P1 N N H d+ 10 H
In- i/} VI-
{fI• ih LO-
>>
?
DESCRIPTION
13
W
as
m� rn� H
E ,4
^y H H Z
H
0
a s E E a
HH cn co EA
aG
E.
A R d
W W N N Z N p: N
zz w H A w w E w0
Z z cn 0 U �nG� a cn] Cs
0 u�
0 O E N N H d. L -I m E-4 co
N N O N N 0 N 0 N 0 N El
V
V
$1,159,631
0
r/r
0
+/f
0
$1,049,516
0
0
$1,049,516
0
ur
0
0
N
In
0
0
i
0
0
01 01 lO ;O 0 0 m
r r ri H 10 l0 cP
r r 1n I11 N N a\
r r a1 rn In 1f1 q'
M M W d' -1 e -I r1
C-- N 0 0 r1 r1 '1
r1 H
9
H
U
C
TREATMENT SERVICES
RESIDENTIAL
a3
N
TOTAL SE#
PSRB TMNT & SUPERVISION
0
M
TOTAL SE#
Trp amounts in the "REVISED TOTAL" column include
Therefore, these
CONTRACT#:
W
a
Cu
DESCRIPTION
rl O rl N N In Lf) 0 0 co 03 0
L} di '•N LO LO O 0 M M 0
01 0 0 Lf) in CO CO 0 0 01 01 O
d� M M CO co Ot 01 co co m m 0
rl N NHHHH 01 01 N N Lf)
Lf) L11 VI in- i? Lf in- VI N N VI
LI
0
in -
0 0
i/} VI -
0 0
VI- VI -
0
if}
0
0
i!t
0
O
O
4n.
0
1/}
O
i!}
M ri 0 H N N Lf)
V cti Z? V' ...at d' to
01 o O !f) in co
cre M M CO CO 01
rl b N HI H H
M In V) VI- if} if}
U
en en
crl
0 U 0
H Htn
rC
Mex, W M H
M
n 0
0
d' �r LO
M M 0 m
E1
TOTAL SE#
TOTAL SE#
0
VI -
O
4n.
0
O
O
VI-
ri
0
U
H
4
•
z
(1)
�' ro
U
y • �
(cl
• E
r
(1)
)) ▪ 0
VI aro
)1 a)
4
0
b N
H a)
U.1~
O E
E b
H
O 0
U }�
rd
o a)
H �
w
U
U
id
0
N
aJ
.0
a)
J-)
m 0
0 al
td
v ro
H
O 0 co co o
O O m m 0
O O 01 01 O
M M M M O
N N N N In
if? VI N N VI-
VI- VI-
PROJECTS
M o m
T
TOTAL SE#
SUPPORTED EMPLOYMENT SERVOS
0)
M
TOTAL SE#
CSS -HOMELESS
m
M
in the "REVISED
0
U W
itit
* E-,
it Z
* °U wtw7
it ta
it
a
it*
a
* U
Pt
it
*
1J it
O it
rn a) *
U 4 it*
a }, z
En
W z
0
1: iiii -4 • > , 0 0 U
r. 4 >•i to H
Z N E N H
0 c w o p0y
z w W N t
tin H E+ A
m *
FC PG O
PI it * 0 a
A .H * U
U *
0
ni *
O *
-rl *
k, *
*
*
*
it
*
*
*
it
*
PENDING
h
CO
PG0 EA
0
U
DESCRIPTION
to
0
0
ih
0
0
ih
0
0
ih
$7,202,259
o
a ui 4(4
o ,-1 HI rn
w 1.3
�1 H rI N
L} H H N
in- M.
ih
m
TOTAL SE#
NON -RES DESIGNATED SVCS
r�
0
o ▪ Ei
N 0
E1
W H
El
H
0 0 0
E-+ U z
Y(DHS
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 #30 to Agreement #119929, between
the State of Oregon, acting by and through the Department of Human Services and
Deschutes County, from Connie Thies on March 27, 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, 2005