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Task # <br />1 <br />2 <br />EXHIB IT "A" <br />Funding Information: <br />Chart of Accounts Program Name CFDA# BARS Funding Period Current Change Total <br />or Title Revenue (LHJ Use Only) Consideration Increase (+) Consideration <br />Code Start Date End Date <br />S tat e and Lo cal Pub l ic 93.757 333.93.75 09/301 I 7 09/29118 1) 15,000 1 5 ,000 <br />Hea l t h Ac tio n s t o P revent <br />Obes i ty , Dia betes, Heart <br />Di sease and Stroke finan c ed <br />sol ely by 20 1 4 Prevention <br />and Public He a l t h Funds <br />TOTALS 0 15,000 <br />'" Gnl'l $10,7G3 o~ tl=le $18,500 original GOAsidcratioR '",as Billed (t~I:lS $7,797 expired). i-Iowe",er, <br />we have bYElgeted aA-3ddlotiena l $9,500 from carry o\tcr req1:lest which nets to an increa5c of <br />$1,703 to year 1 f!:lAds. <br />* $802.18 is related to what was billed in year 2 (yr 1 carryover funds) and $10,702.95 is what was billed <br />in year 1. <br />Billing Informa tion : <br />All A-19 Invoice billings with original signatures and detailed documentation attached are to be sent to <br />Grant County Health District 1038 W Ivy Ave Suite 1, Moses Lake WA 98837 attn: Ryan Brimacombe. <br />Please indicate the costs for each separate component on your A-19. <br />Billings should be submitted monthly within 30 days after the close of a month. Exception : For the <br />month after a funding source's expiration date please have the billing submitted within 25 days after the <br />close ofthe month. <br />Statement of Work Information to be completed by September 29, 2018~ <br />15,000 <br />Community Choice-Task/Activity/Description Deliverables/ Due Date/ Payment Information <br />Continuously update reso urce s related to healthy food acce ss <br />that CHW's can use as a reference tool during client vi sits as <br />well as continuously updating 2-1-. Make reference li st of <br />healthy food access resources more readily accessible . <br />(Component #1-PS2) <br />Work with food banks and food pantries to increase the <br />placement and promotion of healthy food and beverages . <br />(Component #1-PS2) <br />Interagency Agreement -Kittitas Amendment #3 <br />10/13/2017 <br />Outcomes <br />Monthly <br />progress r epo rt <br />by 8th of the <br />following month <br />Monthly <br />progress report <br />by 8t h of the <br />following month <br />Time Frame and/or Amount <br />Sept 29, 2018 Reimbursement for actual <br />expenditures, not to <br />exceed total funding <br />consideration <br />Sept 29, 2018 Reimbursement for actual <br />expenditures, not to <br />exceed total funding <br />consideration <br />Page 6