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AMENDMENT #11 Task Task! ActivitylDescription *May Support PHAB Deliverables/Outcomes Due DatelTime Frame Payment Information Number StandardslMeasures and/or Amount 3 Trained LHJ staff will provide direct Provide completed T A Report and Completed T A Report Upon acceptance ofthe technical assistance (T A) to small any supporting documents and must be received by the completed T A Report, community and non-community Group A photos to ODW Regional Office. ODW Regional Office the LHJ shall be paid for water systems identified by the ODW within 30 calendar days of each technical assistance Regional Office . providing technical activity as follows: assistance. • Up to 3 hours of work: See Special Instructions for task activity . I $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. I 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. 4 LHJ staff performing the activities under Prior to attending the training, submit Annually LHJ shall be paid tasks 1,2 and 3 must have completed the an "Authorization for Travel (Non-mileage, per diem, mandatory Sanitary Survey Training. Employee)" DOH Form 710-013 to lodging, and registration the ODW Program Contact below for costs as approved on the See Special Instructions for task activity . approval (to ensure that enough pre-authorization form in funds are available). accordance with the current rates listed on the OFM Website h!!Q:llwww.ofin.wa.gov/r esources/travel.asQ *For Information Only: Funding is not tied to the revised StandardslMeasures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a StandardlMeasure. More detail on these and/or other Public Health Accreditation Board (PHAB) StandardslMeasures that may apply can be found at: http://www.phaboard.orWwR~comen tl uploadsIPHA13-SLandards-and-Measures-Version-I .O,pdf Exhibit A, Statements of Work Revised as of March 15, 2017 Page 5 of 17 Contract Number C17114-11