HomeMy WebLinkAboutWashington State Department of Commerce Amendment # DAmendment
Department of Commerce
Contract Number: 22-46108-20
Amendment Number: D
Washington State Department of Commerce
Housing Division
Homelessness Assistance Unit
Consolidated Homeless Grant (CHG)
1. Contractor 2. Contractor Doing Business As (optional)
Mason County Public Health
415 N. 6th St
Shelton, WA 98584
3. Contractor Representative 4. COMMERCE Representative
Casey Bingham
Fiscal Manager
360-427-9670 ext . 562
caseyb@co.mason.wa.us
Megan Kendig
Grant Manager
(360) 401-5149
megan.kendig @commerce.wa.gov
PO Box 42525
1011 Plum St SE
Olympia, WA 98504-2525
5. Original Contract Amount
(and any previous amendments)
6. Amendment Amount 7. New Contract Amount
$3,528,847 $761,607 $4,290,454
8. Amendment Funding Source 9. Amendment Start Date 10. Amendment End Date
Federal: State: X Other: N/A: November 1, 2022 June 30, 2023
11. Federal Funds (as applicable):
N/A
Federal Agency:
N/A
CFDA Number:
N/A
12. Amendment Purpose: Adds CHG eviction prevention funds.
COMMERCE, defined as the Department of Commerce, and the Contractor, as defined above, acknowledge and accept the terms
of this Contract As Amended and attachments and have executed this Contract Amendment on the date below to start as of the date
and year referenced above. The rights and obligations of both parties to this Contract As Amended are governed by this Contract
Amendment and the following other docume nts incorporated by reference: CHG Guidelines (as they may be revised from time to
time), and Contract Terms and Conditions including Attachment “A” – Scope of Work, Attachment “B” – Budget. A copy of this
Contract Amendment shall be attached to and made a part of the original Contract between COMMERCE and the Contractor. Any
reference in the original Contract to the “Contract ” shall mean the “Contract as Amended”.
FOR GRANTEE FOR COMMERCE
Signature
___________________________________________
Print Name, Title
Date
Corina Grigoras , Assistant Director
Housing Division
Date
APPROVED AS TO FORM ONLY
Sandra Adix
Assistant Attorney General
3/20/2014
Date
DocuSign Envelope ID: 3A4512AB-6424-46CB-840B-618CC8717B58
11/17/2022 | 9:46 AM PST
Chair, BoCCKevin Shutty 11/18/2022 | 9:09 AM PST
Amendment
2
This Contract is amended as follows:
Attachment B
Budget
Budget Categories Current Contract
Amount
(and any previous
amendments and
revisions)
Amendment D New Total
CHG Standard
Admin $58,488.00 $0 $58,488.00
Rent/Fac Support Lease $150,628.00 $0 $150,628.00
Other Rent/Fac Support Lease and
Housing Costs
$90,101.00 $0 $90,101.00
Operations $124,000.00 $0 $124,000.00
PSH CHF
PSH CHF Rent/Fac Support Lease $39,000.00 $0 $39,000.00
PSH CHF Other Rent/Fac Support
Lease and Housing Costs
$1,000.00 $0 $1,000.00
PSH CHF Operations $10,000.00 $0 $10,000.00
HEN SFY 2022 (July 2021-June 2022)
HEN Admin 2022 $87,081.00 $0 $87,081.00
HEN Rent/Fac Support and Housing
Costs 2022
$867,722.00 $0 $867,722.00
HEN Operations 2022 $289,240.00 $0 $289,240.00
HEN SFY 2023 (July 2022-June 2023)
HEN Admin 2023 $87,081.00 $0 $87,081.00
HEN Rent/Fac Support and Housing
Costs 2023
$867,722.00 $0 $867,722.00
HEN Operations 2023 $289,240.00 $0 $289,240.00
Hotel Leasing and Rapid Re -Housing
Admin for Hotel Leasing/RRH $70,000.00 $0 $70,000.00
Hotel Leasing/RRH/Operations $399,446.00 $0 $399,446.00
Additional CHG
Additional CHG Funding $98,098.00 $0 $98,098.00
DocuSign Envelope ID: 3A4512AB-6424-46CB-840B-618CC8717B58
Amendment
3
Eviction Prevention
EP Admin $0 $133,312.00 $133,312.00
EP Rent $0 $422,135.00 $422,135.00
EP Operations $0 $206,160.00 $206,160.00
Total $3,528,847.00 $761,607.00 $4,290,454.00
ALL OTHER TERMS AND CONDITIONS OF THIS CONTRACT REMAIN IN FULL FORCE
AND EFFECT
DocuSign Envelope ID: 3A4512AB-6424-46CB-840B-618CC8717B58
Consolidated Homeless Grant (CHG)
Contract Number: 22-46108- 20
Contract Dates: July 1, 2021-June 30, 2023
Grantee Name: Mason County Public Health
Approval by:
(Before Executive signature)
Name: Date: Initials:
Todd Parker
Melissa Casey
DocuSign Order Approve/View/CC
1. Name/Email Todd Parker, tparker@masoncountywa.gov, approve
2. Name/Email Lydia Buchheit, lydiab@masoncountywa.gove, review
3. Name/Email Melissa Casey, mcasey@masoncountywa .gov, approve
4. Executive End Signer Name/Title/Email Kevin Shutty, Commissioner BOCC Chair,
KShutty@masoncountywa.gov, sign
DocuSign Envelope ID: 3A4512AB-6424-46CB-840B-618CC8717B58
11/7/2022 | 11:35 AM PST
11/16/2022 | 12:08 PM PST
Certificate Of Completion
Envelope Id: 3A4512AB642446CB840B618CC8717B58 Status: Completed
Subject: Complete with DocuSign: 22-23 Mason CHG Amendment D Eviction Prevention.pdf, Routing memo Mason.pdf
Division:
Community Services and Housing
Program: CHG
ContractNumber: 22-46108-20
DocumentType:
Contract Amendment
Source Envelope:
Document Pages: 4 Signatures: 2 Envelope Originator:
Certificate Pages: 6 Initials: 2 Megan Kendig
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-08:00) Pacific Time (US & Canada)
1011 Plum Street SE
MS 42525
Olympia, WA 98504-2525
megan.kendig@commerce.wa.gov
IP Address: 198.239.10.160
Record Tracking
Status: Original
11/1/2022 5:47:41 PM
Holder: Megan Kendig
megan.kendig@commerce.wa.gov
Location: DocuSign
Security Appliance Status: Connected Pool: StateLocal
Storage Appliance Status: Connected Pool: Washington State Department of Commerce Location: DocuSign
Signer Events Signature Timestamp
Todd Parker
tparker@masoncountywa.gov
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 216.235.103.241
Sent: 11/7/2022 10:45:38 AM
Viewed: 11/7/2022 11:33:28 AM
Signed: 11/7/2022 11:35:53 AM
Electronic Record and Signature Disclosure:
Accepted: 11/7/2022 11:33:28 AM
ID: 4739f5a0-99f8-4559-8a8b-eef68f395d2b
Melissa Casey
mcasey@masoncountywa.gov
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 216.235.103.241
Sent: 11/16/2022 12:04:07 PM
Resent: 11/16/2022 12:05:24 PM
Viewed: 11/16/2022 12:07:38 PM
Signed: 11/16/2022 12:08:02 PM
Electronic Record and Signature Disclosure:
Accepted: 11/16/2022 12:07:38 PM
ID: 3e03c5ec-1fbf-48fc-8c70-3fbb3df0eab2
Kevin Shutty
kshutty@masoncountywa.gov
Chair, BoCC
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 216.235.103.241
Sent: 11/16/2022 12:08:04 PM
Viewed: 11/17/2022 9:46:24 AM
Signed: 11/17/2022 9:46:33 AM
Electronic Record and Signature Disclosure:
Accepted: 11/17/2022 9:46:24 AM
ID: d2c8fcc6-9287-46dc-90d4-30d41113703a
Signer Events Signature Timestamp
Corina Grigoras
corina.grigoras@commerce.wa.gov
Assist. Director
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 147.55.134.36
Sent: 11/17/2022 9:46:36 AM
Viewed: 11/18/2022 9:09:22 AM
Signed: 11/18/2022 9:09:28 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Jessica Simon
jessica.simon@commerce.wa.gov
Security Level: Email, Account Authentication
(None)Using IP Address: 147.55.134.19
Sent: 11/1/2022 5:56:48 PM
Viewed: 11/4/2022 8:54:01 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Kathy Kinard
Kathy.Kinard@commerce.wa.gov
Security Level: Email, Account Authentication
(None)Using IP Address: 198.239.10.179
Sent: 11/4/2022 8:54:01 AM
Viewed: 11/7/2022 10:45:37 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Carbon Copy Events Status Timestamp
Haley Foelsch
haley@masoncountywa.gov
Security Level: Email, Account Authentication
(None)
Sent: 11/18/2022 9:09:32 AM
Viewed: 11/18/2022 9:10:28 AM
Electronic Record and Signature Disclosure:
Accepted: 7/13/2022 7:59:40 AM
ID: c7f644d3-59e4-4cc4-9a05-6e6620213dad
Todd Parker
tparker@masoncountywa.gov
Security Level: Email, Account Authentication
(None)
Sent: 11/18/2022 9:09:34 AM
Electronic Record and Signature Disclosure:
Accepted: 11/7/2022 11:33:28 AM
ID: 4739f5a0-99f8-4559-8a8b-eef68f395d2b
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 11/1/2022 5:56:48 PM
Envelope Summary Events Status Timestamps
Certified Delivered Security Checked 11/18/2022 9:09:22 AM
Signing Complete Security Checked 11/18/2022 9:09:28 AM
Completed Security Checked 11/18/2022 9:09:34 AM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
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Electronic Record and Signature Disclosure created on: 8/11/2020 4:44:12 PM
Parties agreed to: Todd Parker, Melissa Casey, Kevin Shutty, Haley Foelsch, Todd Parker
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