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Exhibit A <br />Statement of Work <br />Contract Term: 2015-2017 <br />AMENDMENT #11 <br />DOH Program Name or Title: Office ofImmunization & Child Profile -Diamond <br />Project -Effec ti ve-January I, 2017 <br />Local Health Jurisdiction Name: Kittitas County Public Health Department <br />Contract Number: Cl7114 <br />SOW Type: Original Revision # (for this SOW) Funding Source Federal Compliance Type of Payment <br />~ Federal Subrecipient (check if applicable) ~ Reimbursement o State ,l8] FF A T A (Transparency Act) o Fixed Price o Other Period of Performance: January 1, 2017 through March 31, 2017 o Research & Development <br />Statement of Work Purpose: The purpose of this statement of work is to identifY tasks, deliverables, and funding related to the DOH/LHJ Engagement Process (Diamond <br />Project). <br />Revision Purpose: N /A <br />Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change Total <br />Revenue Index (LHJ Use Only) Consideration Increase (+) Consideration <br />Code Code Start Date End Date <br />FFY16 AFIX 93.268 333.93.26 74110265 01101117 I 03 /31/17 0 1,100 1,100 <br />JOTALS 0 1,100 1,100 <br />------- <br />Task Task! ActivitylDescription *May Support PHAB Deliverables/Outcomes Due DatelTime Frame Payment Information <br />Number Standards/Measures and/or Amount <br />I Participate in conference calls, webinars, and Submit evaluation form at the Within three (3) business Reimbursement for actual <br />in-person meeting(s) conducted by OICP conclusion of March in-person days after the training costs incurred, not to exceed <br />related to the DOHILHJ Engagement Process training total funding consideration <br />(Diamond Project). amount. <br />Funds available for this task: <br />FFYl6 AFIX <br />MI74110265 <br />*For Information Only: <br />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 <br />StandardlMeasure. More detail on these and/or other Public Health Accreditation Board (PHAB) StandardslMeasures that may apply can be found at: <br />http ://www .phaboard ,orglwp-comen tiuploadsfP H A B-Standards-and-Measures-Ver'si on-I . a .pdf <br />Exhibit A, Statements of Work <br />Revised as of March 15, 2017 <br />Page 16 of 17 Contract Number C17114-11