Laserfiche WebLink
DOH Program Name or Title: Maternal & Child Health Block Grant - <br />Effective January 1, 2018 <br />SOW Type: Revision Revision # (for this SOW) l <br />Period of Performance: January 1, 2018 through September 30, 2018 <br />Exhibit A <br />Statement of Work <br />Contract Term: 2018-2020 <br />AMENDMENT #2 <br />Local Health Jurisdiction Name: Kittitas County Public Health Department <br />Contract Number: CLH18249 <br />Funding Source Federal Compliance ~pe of Payment <br />~ Federal Subrecipient (check if applicable) Reimbursement <br />D State ~ 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 support local interventions that impact the target population of the Maternal and Child Health Block <br />Grant. <br />Revision Purpose: The purpose of this revision is to shift unspent FFY18 funds from October-December 2017 to the Consolidated Contract that began in January 2018 . <br />Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period <br />Revenue Index (LHJ Use Only) <br />Code Code Start Date End Date <br />FFYl 8 MCHBG LHJ CONTRACTS 93.994 333.93.99 78120281 01101/18 l 09/30/18 <br />TOTALS <br />Task *May Support PHAB <br />Number Task/ Activity/Description Standards/Measures Deliverables/Outcomes <br />Maternal and Child Health Block Grant (MCHBG) Administration . <br />la Participate in calls, at a minimum of every Designated LHJ staff will <br />quarter, with DOH contract manager. Dates and partic ipate in contract management <br />time for calls are mutually agreed upon between calls. <br />DOH and LHJ <br />lb Report actual expenditures for October 1, 2017 Submit actual expenditures using <br />through March 31, 2018 the MCHBG Budget Workbook to <br />DOH contract manager <br />le Develop 2018-2019 MCHBG Budget Workbook Submit MCHBG Budget <br />for October 1, 2018 through September 30, 2019 Workbook to DOH contract <br />using DOH provided template. manager <br />Exhibit A, Statements of Work <br />Revised as of March 15, 2018 <br />Page 3 of 18 <br />Current Change !Total <br />Consideration Increase(+) Consideration <br />33,147 893 34,040 <br />33,147 893 34,040 <br />Payment <br />Due Date/Time Frame Information and/or <br />Amount <br />September 30, 2018 Reimbursement for <br />actual costs, not to <br />exceed total funding <br />consideration. <br />May 26, 2018 Action Plan and <br />Progress Reports <br />must only reflect <br />September 5, 2018 activities paid for <br />with funds provided <br />in this statement of <br />work for the <br />specified funding <br />period. <br />See Pro_gram <br />Contract Number CLH18249-2