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AMENDMENT #6 Task Task! Activity/Description *May Support PHAB Deliverables/Outcomes Due Date/Time Frame Payment Information Number Standards/Measures and/or Amount 3 Trained LHJ staff will provide direct Provide completed T A Report and Completed T A Report Upon acceptance of the technical assistance (T A) to small any supporting documents and must be received by the completed T A Report, community and non-community Group A photos to ODW Regional Office. ODW Regional Office the LHJ shall be paid for water systems identified by the ODW within 30 calendar days of each technical assistance Regional Office . providing technical activity as follows: assistance. • Up to 3 hours of work: See Special Instructions for task activity . $250 • 3-6 hours of work: $500 • More than 6 hours of work: $750 Payment is inclusive of all associated costs such as consulting fee, travel, lodging, per diem . Payment is authorized upon receipt and acceptance of completed T A Report within the 30- day deadline. Late or incomplete reports may not be accepted for payment. 4 LHJ staff performing the activities under Prior to attending the training, submit Annually LHJ shall be paid tasks 1,2 and 3 must have completed the an "Authorization for Travel (Non-mileage, per diem , and mandatory Sanitary Survey Training. Employee)" DOH Form 71O-0l3 to lodging costs in the ODW Program Contact below for accordance with the See Special Instructions for task activity. approval (to ensure that enough current rates listed on the funds are available). OFM Website h!!Q://www.ofm .wa.gov/r , esources/trave1.asI:> ~~ .... ------------------- *For Information Only: Funding is not tied to the revised Standards/Measures listed here . This information may be helpful in discussions of how program activities might contribute to meeting a Standard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at: http://www .phaboard.orglwp-contentluploads/PHAB-Standards-and-Measures-Version-l.O.pdf Program Specific Requirements/Narrative Exhibit A, Statements of Work Revised as of January 15,2016 Page 8 of 10 Contract Number C 17114-6