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Task Task! ActivitylDescription *May Support PHAB Deliverables/Outcomes Due DatelTime Payment Information and/or Amount Number StandardslMeasures Frame 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 Prior to attending the Annually LHJ shall be paid mileage, per diem, under tasks 1,2 and 3 must have training, submit an lodging, and registration costs as completed the mandatory Sanitary "Authorization for Travel approved on the pre-authorization form in Survey Training. (Non-Employee)" DOH accordance with the current rates listed on Form 710-013 to the ODW the OFM Website See Special Instructions for task Program Contact below for ht!Il://www.ofm.wa.gov/resources/travel.a I activity. approval (to ensure that ~ enough funds are available), *For Information Only: Funding is not tied to the revised Standards/Measures 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: htto jlwww .phaboard. org/wp-contentluBloadsIPHAB-Standards-and-Measures-Version-I. O. pdf Program Specific Reguirements/Narrative Special References (RCWs, WACs, etc) Chapter 246-290 WAC is the set ofmles that regulate Group A water systems. By this statement of work, ODW contracts with the LHJ to conduct sanitary surveys (and SPIs, and provide technical assistance) for small community and non-community water systems with groundwater sources. ODW retains responsibility for conducting sanitary surveys (and SPIs, and provide technical assistance) for small community and non-community water systems with surface water sources, large water systems, and systems with complex treatment. LHJ staff assigned to perform activities under tasks I , 2 , and 3 must be trained and approved by ODW prior to performing work. See special instructions under Task 4, below. Special Billing Requirements The LHJ shall submit quarterly invoices within 30 days following the end of the quarter in which work was completed, noting on the invoice the quarter and year being billed fo r. Payment cannot exceed a maximum accumulative fee of $4,800 for Task 1, and $2,000 for Task 2, Task 3 and Task 4 combined during the contracting period, to be paid at the rates specified in the Payment Method/Amount section above. When invoicing for sanitarY survevs, bill halfto BARS Revenue Code 346.26.64 and half to BARS Revenue Code 346.26.65. When invoicing for Task 1, submit the list ofWS Name, ID #, Amount Billed, Survey Date and Letter Date that you are requesting payment. When invoicing for Task 2-3, submit the list ofWS Name, ID #, TA Date and description ofTA work performed, and Amount Billed. When invoicing for Task 4 , submit receipts and the signed pre-authorization form for non-employee travel to the ODW Program Contact below and a signed A19-IA Invoice Voucher to the DOH Grants Management, billing to BARS Revenue Code 346.26.66 under Technical Assistance (TA). Special Instructions Exhibit A, Statements of Work Page 8 of28 Contract Number CLHl8249