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Task T ask! ActivitylDescription Number 3 Trained LHJ staff will provide direct technical assistance (T A) to small community and non-community Group A water systems identified by the ODW Regional Office. See Special Instructions for task activity . 4 LHJ staff performing the activities under tasks 1, 2 and 3 must have completed the mandatory Sanitary Survey Training. See Special Instructions for task activity . Exhibit A, Statements of Work Revised as of November 15,2016 *May Support PHAB Deliverables/Outcomes StandardslMeasures Provide completed T A Report and any supporting documents and photos to ODW Regional Office. . I Prior to attending the training, submit an "Authorization for Travel (Non- Employee)" DOH Form 710-013 to the ODW Program Contact below for approval (to ensure that enough funds are available). I Page 10 of21 AMENDMENT #10 Due Date/Time Frame Payment Information and/or Amount Completed T A Report Upon acceptance of the must be received by the completed T A Report, ODW Regional Office the LHJ shall be paid for within 30 calendar days of each technical assistance providing technical activity as follows: assistance. • Up to 3 hours of work: $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. Annually LHJ shall be paid mileage, per diem, lodging, and eIhff misceUcmee'bts travel expenses registration costs as approved on the pre-authorization form in accordance with the current rates listed on the OFM Website hrm:/fwww.ofm . wa.gov/r esources/travel.ast! Contract Number C 1 7114-1 0