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DOH Program Name or Title: Emergency Preparedness & Response- Effective July 1, 2015 SOW Type: Revision Revision # (for this SOW) Period of Performance: July 1,2015 through June 30 , 2016 Exhibit A Statement of Work Contract Term: 2015-2017 AMENDMENT #6 Local Health Jurisdiction Name: Kittitas County Public Health Department Contract Number: C17114 Funding Source Federal Compliance Type of Payment ~ Federal Subrecipient (check if applicable) ~ Reimbursement D State ~ FFATA (Transparency Act) D Fixed Price D Other D Research & Development Statement of Work Purpose: The purpose of this statement of work is to establish the funding and tasks for the Public Health Emergency Preparedness and Response program for the 2015 grant period through June 30, 2016. Revision Purpose: The purpose of this revision is to add a special project. Chart of Accounts Program Name or Title FFY 15 EPR PHEP BP4 LHJ Funding FFY15 EPR PHEP BP4 Oper Readiness TOTALS Task Task! Activity /Description Number I Attend emergency preparedness events , (e.g . trainings, meetings, conference calls , and confe rences) as necessary to advance LH J preparedness or complete the deliverables in this statement of work . 2 Complete reporting templates as requested by DOH to comply with program and federal grant requirements (e.g . performance measures , gap analysis, mid-year and end-of-year reporting templates , etc.) 3 Draft, review and/or update, the local comprehensive public health and emergency response plan. 3 .1) Train staff to the completed plan . Exhibit A, Statements of Work Revised as of January 15 ,2016 CFDA# BARS Master Funding Period Revenue Index (LHJ Use Only) Code Code Start Date End Date 93 .069 333 .93 .06 18101800 07 /01115 I 06 /30116 93.069 333.93 .06 18101740 07 /01 11 5 I 06 /30116 *May Support PHAB Deliverables/Outcomes StandardslMeasures Submit mid-year and end-of-year progress reports. Include name and contact information of all attendees and event agendas. Submit comp leted templates to DOH Submit mid-year and end-of-year progress reports . Submit copy of latest comprehensive public health and emergency response plan . Page 3 of 10 Current Change Total Consideration I ncrease (+) Consideration 55 ,000 0 55 ,000 0 7 ,704 7 ,704 55,000 7,704 62 ,704 Payment Due Date/Time Frame Information and/or Amount December 31 , 2015 and Reimbursement for June 30, 20 16 ac t ual costs , not to exceed total funding consideration amount. See mid-year and end-o f- year reporting templates for dates . December 31, 2015 and June 30 , 2016 June 30, 2016 Contract Number C 171 14-6 I