Laserfiche WebLink
EXHIBIT "A" <br />Funding Information: <br />Chart. of Accounts Program <br />CFDA It <br />BARS <br />Funding Period <br />Current <br />Change <br />Total <br />Name or Title <br />Sep 29, <br />Revenue <br />(LHJ Use Only) <br />Consideration <br />:Increase <br />Consideration <br />actual expenditures, <br />Code <br />Start End Date <br />Sep 29, <br />not to exceed total <br />following month <br />2016 <br />Date <br />Monthly <br />State and Local Public <br />93.757 <br />333.93.75 <br />01/01/15 <br />09/29/16 <br />18,500 <br />actual expenditures, <br />20,203 <br />Health Actions to Prevent <br />by 8`h of the <br />Sep 29, <br />not to exceed total <br />(Component 41) <br />following <br />2016 <br />Obesity, Diabetes, Heart <br />month <br />9,500 <br />Disease and Stroke financed <br />solely by 2014 Prevention <br />and Public Health Funds <br />State and Local Public <br />93.757 <br />333.93.75 <br />09/30/15 <br />09/Z9/1 <br />0 <br />20,500 <br />20,500 <br />Health Actions to Prevent <br />Obesity, Diabetes, Heart <br />Disease and Stroke financed <br />solely by 2014 Prevention <br />and Public Health Funds <br />TOTALS <br />116,500 <br />1 22,203 <br />1 40,703 <br />* Only $10,703 of the $18,500 original consideration was bMed (thus $7,797 expired). Hovvever, <br />we have budgeted an, additional $9,500 from carry over request which nets to an increase of <br />$1,703 to year 1 funds. <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: <br />Tas <br />k # <br />Basle/Activity/l3eseripti®n <br />Deliverables/ <br />Outrornes <br />Due <br />Date/ <br />1lrne <br />Frame <br />Payment Information <br />and/or Amount <br />Work with a retail or community venue to strengthen healthier <br />Monthly <br />Sep 29, <br />Reimbursement for <br />1 <br />food access by increasing availability, improved pricing, placement, <br />progress report <br />X815 <br />actual expenditures, <br />and promotion. (Component #1—PS2) <br />by 8u of the <br />Sep 29, <br />not to exceed total <br />following month <br />2016 <br />funding consideration <br />Monthly <br />Sep 29, <br />Reimbursement for <br />Work with up to two worksites to promote physical activity through <br />progress report <br />20i5 <br />actual expenditures, <br />2 <br />signage, worksite policies, and shared use/joint use agreements. <br />by 8`h of the <br />Sep 29, <br />not to exceed total <br />(Component 41) <br />following <br />2016 <br />funding consideration <br />month <br />Interagency Agreement — Kittitas Amendment#1 <br />11/20/15 <br />Page 6 <br />