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Exhibit A <br />Statement of Work <br />Contract Term: 2018-2020 <br />AMENDMENT #3 <br />DOH Program Name or Title: Office of Drinking Water Group B Program - <br />Effective January 1, 2018 <br />Local Health Jurisdiction Name: Kittitas County Public Health Department <br />Contract Number: CLH18249 <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 />Period of Performance: January 1, 2018 through June 30, 2019 r8J State D FFATA (Transparency Act) r8] Fixed Price <br />D Other D Research & Development <br />Statement of Work Purpose: The purpose of this statement of work is to provide financial support to LHJ s implementing local Group B water system programs. <br />Revision Purpose: The purpose of this revision is to extend the Period of Performance from June 30, 2018 to June 30, 2019, increase Current Consideration, and revise Special <br />Billing Requirements. <br />Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change Total <br />Revenue Index (LBJ Use Only) Consideration Increase(+) Consideration <br />Code Code Start Date End Date <br />GFS -Group B (FO-E) NIA 334.04.90 24240103 01101118 I 06130/18 5,000 0 5,000 <br />FY2 Group B Programs for DW (FO-E) NIA 334.04.90 24240105 01101118 I 06/30/19 0 10,000 10,000 <br />TOTALS 5,000 10.000 15,000 <br />Task *May Support PHAB Memorandum of Payment <br />Task/ Activity/Description Deliverables/Outcomes Information and/or Number Standards/Measures Agreement Number Amount <br />1 Implement a full Group B water system program. An executed joint plan of Reference DOH JPR Lump sum payment <br />responsibility (JPR) with DOH #Nl9411 (See Special Billing <br />identifying responsibilities of a full Requirements) <br />Group B. <br />*For Information Only: <br />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 <br />Standard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at: <br />http ://www.pha board .org/wp-con-1ent/upl0ad s/PHAB-Standar<ts-and-Measures -V ers ion -l .O .pdf <br />Program Specific Requirements/Narrative <br />Special Billing Requirements <br />Exhibit A, Statements of Work <br />Revised as of May 15, 2018 <br />Page 10 of 13 Contract Number CLH18249-3