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Exhibit A <br />Statement of Work <br />Contract Term: 2015-2017 <br />AMENDMENT #14 <br />DOH Program Name or Title: FPHS Communic able D isease & S upport <br />Capabilities -Effective July 1, 2017 <br />Local Health Jurisdiction Name: Ki ttitas County P ublic Health De partment <br />Contract Number: C17114 <br />SOW Type: Revision Revision # (for this SOW) 1 Funding Source Federal Compliance Type of Payment <br />D Federal <Select One> (check if applicable) D Reimbursement <br />~ State D FFATA (Transparency Act) ~ One-Time Distribution <br />D Other D Research & Development <br />Period of Performance: July 1, 2017 through December 31, 2017 <br />Statement of Work Purpose: The purpose of this statement of work is to specify how Foundational Public Health Services (FPHS) state funds will be used during this interim <br />period of July 1, 2017 -June 30, 2018. <br />Note: The total lump sum payment is for the period of July 1, 2017 through June 30, 2018. Deliverable due dates after December 31, 2017 are included in this statement <br />of work for informational purposes only. Tasks and deliverables with due dates after December 31, 2017 will be included in a new statement of work under the new <br />2018-2020 consolidated contract term beginning January 1, 2018. <br />Revision Purpose: The purpose of this revision is to change the Type of Payment and Payment Information and/or Amount from reimbursement to one-time lump-sum <br />distribution and remove Special Billing Requirements. <br />Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change frotal <br />Revenue Index (LHJ Use Only) Consideration None Consideration <br />Code Code Start Date End Date <br />FPHS FUNDING FOR LHJS DIR N/A 336 .04 .25 91106102 07/01117 I 12 /31117 42 ,000 0 42,000 <br />TOTALS 42 ,000 0 42,000 <br />Note : New BARS Revenue Code listed above. See Special Instructions below for more information. <br />Task *May Support PHAB Payment <br />Number Task! Activity illescription StandardslMeasures Deliverables/Outcomes Due DatelTime Frame Information and/or <br />Amount <br />These funds are for delivering ANY or all of the FPHS communicable disease service (listed below) and can also be used for the FPHS capabilities that support FPHS <br />communicable disease services as defined in the most current version of F£lIS Definitions -VCJ's ion 1.2 <Mnrch 2016} <br />G, Control of Communicable Disease and Other Notifiable Conditions <br />l. Provide timely, statewide, locally relevant and <br />accurate information statewide and to <br />communities on communicable disease and <br />other notifiable conditions and their control. <br />Exhibit A, Statements of Work <br />Revised as of September 15 ; 2017 <br />Brief report on how funding will <br />be used to support the FPHS <br />communicable disease services <br />listed in tasks 1-6 or FPHS <br />capabilities in support of <br />communicable disease services <br />Page 3 of 10 <br />October 1, 2017 R-eimiJlH'!>t!meRlj9 F <br />eeRi~ <br />Lump sum payment as <br />follows: <br />July 2017: $42,000 <br />Contract Number C 17114-14