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EXHIBIT "A" <br />Funding Information: <br />Chart of Accounts Program Name <br />CFDA # <br />BARS <br />Funding Period <br />'Current <br />Change <br />Total <br />or Title <br />Sept 29, 2018 <br />Revenue <br />(LHJ Use Only) <br />Consideration <br />Increase (+) <br />Consideration <br />expenditures, not to <br />1 <br />Code <br />Start Date End Date <br />exceed total funding <br />State and Local Public <br />93.757 <br />333.93.75 <br />09/30/17 <br />09/29/18 <br />0 <br />15,000 <br />HealthActions to Prevent <br />Work with food banks and food pantries to increase the <br />Monthly <br />Sept 29, 2018 <br />Reimbursement for actual <br />2 <br />placement and promotion of healthy food and beverages. <br />Obesity, Diabetes, Heart <br />expenditures, not to <br />(Component #1—PS2) <br />by 81h of the <br />exceed total funding <br />Disease and Stroke financed <br />following month <br />consideration <br />solely by 2014 Prevention <br />and Public Health Funds <br />TOTALS <br />0 <br />15,000 <br />15,000 <br />* Only 1 <br />$10,703 $19,900 $7,797 7-'HrTcrr'v=c=v=c, <br />* $802.18 is related to what was billed in year 2 (yr 1 carry over funds) and $10,702.95 is what was billed <br />in year 1. <br />Billing Information: <br />All A-19 Invoice billings with original signatures and detailed documentation attached are to be sent to <br />Grant County Health District 1038 W Ivy Ave Suite 1, Moses Lake WA 98837 attn: Ryan Brimacombe. <br />Please indicate the costs for each separate component on your A-19. <br />Billings should be submitted monthly within 30 days after the close of a month. Exception: For the <br />month after a funding source's expiration date please have the billing submitted within 25 days after the <br />close of the month. <br />Statement of Work Information to be completed by September 29, 2018: <br />Task # <br />Community Choice- Task/Activity/Description <br />Deliverables/ <br />Due Date/ <br />Time Frame <br />Payment InformationOutcomes <br />and/or Amount <br />Continuously update resources related to healthy food access <br />Monthly <br />Sept 29, 2018 <br />Reimbursement for actual <br />that CHW's can use as a reference tool during client visits as <br />progress report <br />expenditures, not to <br />1 <br />well as continuously updating 2-1-. Make reference list of <br />by 8th of the <br />exceed total funding <br />healthy food access resources more readily accessible. <br />following month <br />consideration <br />(Component #1—PS2) <br />Work with food banks and food pantries to increase the <br />Monthly <br />Sept 29, 2018 <br />Reimbursement for actual <br />2 <br />placement and promotion of healthy food and beverages. <br />progress report <br />expenditures, not to <br />(Component #1—PS2) <br />by 81h of the <br />exceed total funding <br />following month <br />consideration <br />Interagency Agreement - Kittitas Amendment 43 <br />10/13/2017 <br />Page 6 <br />