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Exhibit A Statement of Work Contract Term: 2015-2017 AMENDMENT #7 DOH Program Name or Title: Office of Drinking Water Group A Program - Effective January 1,2015 Local Health Jurisdiction Name: Kittitas County Public Health Department Contract Number: CI7114 SOW Type: Revision Revision # (for this SOW) 2 Funding Source Federal Compliance Type of Payment [g] Federal Contractor (check if applicable) o Reimbursement [g] State o FF AT A (Transparency Act) [g] Fixed Price o Other o Research & Development Period of Performance: January I, 2015 through December 31, 2017 Statement of Work Purpose: The purpose of this statement of work is to provide funding to the LHJ for conducting sanitary surveys and providing technical assistance to small community and non-community Group A water systems. Revision Purpose: The purpose of this revision is to add language to the Description and Outcome in Task I and add the DOH Fiscal contact. Chart of Accounts Program Name or Title Drinking Water Group A -SS Drinking Water Group A -SS State Drinking Water Group A -TA TOTALS Task TaskiActivitylDescription Number 1 Trained LHJ staff will conduct sanitary surveys of small community and non- community Group A water systems identified by the DOH Office of Drinking Water (ODW) Regional Office. See Special Instructions for task activity . Exhibit A, Statements of Work Revised as of May 16,2016 CFDA# BARS Master Funding Period Current Cbange Irotal Revenue Index (LHJ Use Only) Consideration None Consideration Code Code Start Date End Date N/A 346.26.64 2421921C 01/01/15 12/31116 5,000 0 5,000 N/A 346.26.65 2421252C 01/01115 12/31/16 5,000 0 5,000 N/A 346.26.66 24219210 01/01115 12/31116 5,000 0 5,000 15,000 l ° 15,000 *May Support PHAB Deliverables/Outcomes Due Daterrime Frame Payment Information StandardslMeasures and/or Amount Provide Final* Sanitary Survey Final Sanitary Survey Upon ODW acceptance Reports to ODW Regional Office. Reports must be received of the Final Sanitary Complete Sanitary Survey Reports by the ODW Regional Survey Report, the LHI shall include: Office within 30 calendar shall be paid $400 for . 1. Cover letter identifying days of conducting the each sanitary survey of a significant deficiencies, sanitary survey. non-community system significant findings, with three or fewer observations, recommendations, connections. and referrals for further ODW follow-up. Upon ODW acceptance 2. Completed Small Water System of the Final Sanitary checklist. Survey Report, the LHJ 3. Updated Water Facilities shall be paid $800 for Inventory (WFI). each sanitary survey of a 4. Photos of water system with text non-community system identifying features with four or more Page 3 of7 Contract Number C 17114-7