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EXHIBIT "A" <br />Funding Information: <br />Chart. of Accounts Program <br />CFDA V <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 />(+� <br />following month <br />2016 <br />Date <br />iMonthly <br />State and Local Public <br />93.757 <br />333.93.75 <br />01701/15 <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 #1) <br />*(7,797) <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 />93.157 <br />333.93.75 <br />09/30/3.5 <br />09127)11:, <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 />119,500 <br />122,203 <br />1 40,703 <br />* Only $10,703 of the $18,500 original consideration was billed (thus $7,797 expired). However, <br />we have budgeted an additional $9,500 from carry over request which nets to an increase of <br />$1,70.3 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 />Task/Ac#ave#y/�eser�p#�®n <br />Deliverables/ <br />Outcomes <br />Due <br />Date/ <br />Time <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,ch <br />progress report <br />Nis <br />actual expenditures, <br />and promotion. (Component #1—PS2) <br />by 8 of the <br />Sep 29, <br />not to exceed total <br />following month <br />2016 <br />funding consideration <br />iMonthly <br />Sep 29, <br />Reimbursement for <br />Work with up to two worksites to promote physical activity through <br />progress report <br />2(45 <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 #1) <br />following <br />2016 <br />funding consideration <br />month <br />Interagency Agreement — Kittitas Arnendment#1 <br />11/20/15 <br />Page 6 <br />