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EXHIBIT "A" <br />Funding Information: <br />Chart of Accounts Program CFDA # BARS Funding Period Current Change Total <br />Name or Title Revenue (LHJ Use Only) Consideration Increase Consideration <br />Tas <br />k# <br />1 <br />2 <br />Code Start End Date (+) <br />Date <br />State and Local Public 93.757 333 .93 .75 01/01/15 09/29/16 18,500 <br />Health Actions to Prevent *(7,797) <br />Obesity, Diabetes, Heart 9,500 <br />Disease and Stroke financed <br />solely by 2014 Prevention <br />and Public Health Funds <br />State and Local Public 93 .757 333 .93.75 09/30/15 09129116 0 20,500 <br />Health Actions to Prevent <br />Obesity, Diabetes, Heart <br />Disease and Stroke financed <br />sol e ly by 2014 Prevention <br />and Public Health Funds <br />TOTALS 18,500 22,203 <br />* Only $10,703 of the $18,500 origi n a l co n side r atio n was bi ll ed (thU S $7,797 exp ired ). How eve r, <br />we have budgeted an add itional $9,500 from carryove r req u es t w h ic h nets to an in crease 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 exp iration date please have the billing submitted within 25 days after the <br />close of the month. <br />Statement of Work Information: <br />Due <br />20,203 <br />20,500 <br />40,703 <br />Task/ Activity/Description Deliverab les / Date/ Payment Information <br />Work with a retail or community venue t o strengthen healthier <br />food access by increasing availability, improved pricing, placement, <br />and promotion. (Component #1-PS2) <br />Work with up to two worksites to promote physical activity through <br />sign age, worksite po licies, and shared use/joint use agreements . <br />(Component #1) <br />Interagency Agreement -Kittitas Amendment#l <br />11/20/15 <br />Outcomes <br />Monthly <br />progress report <br />by 8th of the <br />following month <br />Monthly <br />progress report <br />by 8 th of the <br />following <br />month <br />Time and/or Amount <br />Frame <br />~ Reimbursement for <br />~ actual expenditures, <br />Sep 29, not to exceed total <br />2016 fund i ng considerat ion <br />~ Reimbursement for <br />~ actual expenditures, <br />Sep 29, not to exceed total <br />2016 funding consideration <br />Page 6