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AMENDMENT #10 *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.org!wp-conrontiuploadstpHAB-Standards-and-Measures-V tlrsion-I .O .pd f Program Specific Reguirements/Narrative Special References (RCWs, WACs, etc) Chapter 246-290 WAC is the set ofmles that regulate Group A water systems. By this statement of work, ODW contracts with the LHJ to conduct sanitary surveys (and SPIs, and provide technical assistance) for small community and non-community water systems with groundwater sources. ODW retains responsibility for conducting sanitary surveys (and SPIs, and provide technical assistance) for small community and non-community water systems with surface water sources, large water systems, and systems with complex treatment. LHJ staff assigned to perform activities under tasks 1, 2, and 3 must be trained and approved by ODW prior to performing work. See special instructions under Task 4, below. Special Billing Requirements The LHJ shall submit quarterly invoices within 30 days following the end of the quarter in which work was completed, noting on the invoice the quarter and year being billed for. Payment cannot exceed a maximum accumulative fee of $13,2()() $19,600 for Task 1, and $J,4OO $5,400 for Task 2, Task 3 and Task 4 combined during the contracting period, to be paid at the rates specified in the Payment Method/Amount section above. Whe n invoicing for sanitary surveys. bill half to BARS Revenue Code 346.26.64 and half to BARS Revenue Code 346.26.65. When invoicing for Task 4, submit receipts and the signed pre-authorization form for non-employee travel to the ODW Program Contact below and a signed A19-1A Invoice Voucher to the DOH Consolidated Contracts Office, billing to BARS Revenue Code 346.26.66 under Technical Assistance (T A). Special Instructions Task 1 Trained LHJ staff will evaluate the water system for physical and operational deficiencies and prepare a Final Sanitary Survey Report which has been accepted by ODW. Detailed guidance is provided in the Field Guide for Sanitary Surveys, Special Purpose Investigations and Technical Assistance (Field Guide). The sanitary survey will include an evaluation of the following eight elements: source; treatment; distribution system; finished water storage; pumps, pump facilities and controls; monitoring, reporting and data verification; system management and operation; and certified operator compliance. If a system is more complex than anticipated or other significant issues arise, the LHJ may request ODW assistance. • No more than 4 surveys of non-community systems with three or fewer connections to be completed between January 1,2015 and December 31,2015. • No more than 5 surveys of non-community systems with four or more connections and all community systems to be completed between January 1,2015 and December 31, 2015. • No more than 1 surveys of non-community systems with three or fewer connections to be completed between January 1,2016 and December 31,2016. • No more than 910 surveys of non-community systems with four or more connections and all community systems to be completed between January 1,2016 and December 31,2016. • No more than 2 surveys of non-community systems with three or fewer connections to be completed between January 1, 2017 and December 31,2017. • No more than 6 surveys of non-community systems withfour or more connections and all community systems to be completed between January 1, 2017 and December 31,2017. The process for assignment of surveys to the LHJ, notification of the water system, and ODW follow-up with unresponsive water systems; and other roles and responsibilities of the LHJ are described in the Field Guide. Exhibit A, Statements of Work Revised as of November 15,2016 Page 11 of2I Contract Number C 1 7114-1 0