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AMENDMENT #l3 <br />Exhibit A <br />Statement of Work <br />Contract Term: 2015-2017 <br />DOH Program Name or Title: Supplemental Nutrition Assistance Program-Education <br />Effective October I. 2017 <br />SOW Type: Original Revision # (for this SOW) <br />Period of Performance: October 1, 2017 through December 31, 2017 <br />Local Health Jurisdiction Name: Kittitas County Public Health Department <br />Contract Number: CI7114 <br />Funding Source Federal Compliance Type of Payment <br />[8l Federal Subrecipient (check if applicable) [8l Reimbursement o State [8J FFATA (Transparency Act) D Fixed Price o Other o Research & Development <br />Statement of Work Purpose: The purpose of this statement of work is to provide Supplemental Nutrition Assistance Program-Education (SNAP-Ed) to improve the likelihood <br />that persons eligible for SNAP (Food Stamps) will make healthy food choices within a limited budget and choose active lifestyles consistent with the current USDA dietary <br />guidance system. <br />Revision Purpose: NI 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 />FFY18 CSS IAR SNAP ED PROG MGNT 10.561 333 .10.56 76211981 10/01/17 I 12/31/17 0 9 ,902 9,902 <br />FFY17 CARRY-IN DSHS SNAP-ED IAR 10.561 333 .10.56 TBD 10/01/17 I 12/31/17 0 400 400 <br />TOTALS 0 10 ,302 1~ - <br />Task *May Support PHAB Payment <br />Task! Activity /Description Deliverables/Outcomes Due Date/Time Frame Information and/or Number StandardslMeasures Amount <br />1.0 For SNAP-Ed, the LHJ will perform work as • Project qualified target For the Period: Reimbursement upon <br />described in their approved FFY18 SNAP-audiences reached 10/01117-12 /31117 receipt and approval <br />Ed project description and work plans • Project activities completed (# Due: Per the approved work of deliverables for the <br />approved by DOH, Department of Social direct education, PSE, Etc .) plan and no later than funding period will <br />and Health Services (DSHS), and United noted in project plans and 12/31117 not exceed $10,302 . <br />States Department of Agriculture (USDA) workbook <br />that was submitted to them via DOH email. • Required demographic data The LHJ will be paid <br />collected the allowable costs <br />• Evaluation activities completed incurred based on <br />per the state evaluation team their approved budget <br />(pre and post surveys , PSE and program <br />tracking, success stories etc .) allowability. See <br />Special Billing <br />Requirements <br />section. <br />---I <br />Exhibit A, Statements of Work <br />Revised as of July 17 , 2017 <br />Page 11 of 17 Contract Number C 17114-13