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DOH Program Name or Title: Emergency Preparedness & Response - <br />Effective July 1, 2017 <br />SOW Type: Original Revision # (for this SOW) <br />Period of Performance: July 1,2017 through December 31,2017 <br />Exhibit A <br />Statement of Work <br />Contract Term: 2015-2017 <br />AMENDMENT #13 <br />Local Health Jurisdiction Name: Kittitas County Public Health Department <br />Contract Number: C17114 <br />Funding Source Federal Compliance Type of Payment <br />f8l Federal Subrecipient (check if applicable) f8l Reimbursement <br />D State f8l FF AT A (Transparency Act) D Fixed Price <br />D Other D Research & Development <br />Statement of Work Purpose: The purpose of this statement of work is to establish the funding and tasks for the Public Health Emergency Preparedness and Response program <br />for the 2017 grant period. <br />Revision Purpose: N/ A <br />Chart of Accounts Program Name or Title <br />FFY17 EPR PHEP BPI LHJ FUNDING <br />TOTALS <br />Task Task! ActivitylDescription Number <br />1 Attend emergency preparedness events, (e .g . <br />trainings, meetings, conference calls, and <br />conferences) as necessary to advance LHJ <br />preparedness or complete the deliverables in this <br />statement of work. <br />2 Complete reporting templates as requested by <br />DOH to comply with program and federal grant <br />requirements (e.g. performance measures, gap <br />analysis, mid-year and end-of-year reporting <br />temj)lates, etc.) <br />3 Develop or update written procedures to activate <br />a comprehensive emergency response plan within <br />the jurisdiction. Include: <br />• Describe how the command structure is <br />utilized to manage emergency response <br />• Describe the relationship between the LHJ <br />and the county Emergency Operations <br />Center (EOC) during a response. <br />Exhibit A, Statements of Work <br />Revised as of July 17 ,2017 <br />CFDA# BARS Master Funding Period Current Change rotal <br />Revenue Index (LHJ Use Only) Consideration Increase (+) Consideration <br />Code Code Start Date End Date <br />93.069 333 .93.06 18101380 07/01/17 I 12/31/17 0 29,749 29,749 <br />0 29,749 29,749 <br />*May Support PHAB Deliverables/Outcomes Due Date/Time Payment Information <br />StandardslMeasures Frame and/or Amount <br />Submit summary of progress on December 29,2017 Reimbursement for <br />mid-year report. actual costs not to <br />exceed total funding <br />consideration amount. <br />Submit completed templates to DOH December 29 ,2017 <br />Submit deliverable/s, or a summary December 29,2017 <br />of progress on the activity and <br />deliverable/s, in the mid-year report. . <br />Submit the most recent Emergency <br />Response Plan. <br />Page 3 of17 Contract Number C 17114-13