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Exhibit A <br />Statement of Work <br />Contract Term: 2018-2020 <br />AMENDMENT #3 <br />DOH Program Name or Title : O[CP-Promotion oflmmunizations 16 lmprove <br />Vaccination Rates -Effective July 1. 2018 <br />Local Health Jurisdiction Name: Kittitas County Public Health Department <br />Contract Number: CLH18249 <br />SOW Type: Original Revision # (for this SOW) Funding Source Federal Compliance Type of Payment <br />lz;J Federal Subrecipient (check if applicable) lz;J Reimbursement <br />Period of Performance: July 1. 2018 through June 30. 2019 0 State lz;J 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 contract with local health to conduct activities to improve immunization coverage rates. <br />Revision Purpose: N/ A <br />Chart of Accounts Program Name or Title <br />FFY18 Increasing Immzs Rates ConCon <br />TOTALS <br />Task <br />Number Task/Activity/Description <br />1 Develop a proposal to improv e immunization <br />coverage rates for a target population by increasing <br />promotion activities and collaborating with <br />community partners. The proposal must meet <br />guidelines outlined in the Local Health Jurisdiction <br />Funding O1mortunity, Promotion oflmmunizations <br />to Increase Vaccination Rates announcement. <br />2 Upon approval of proposal, implement the plan to <br />increase immunization coverage rates with the <br />target population identified. <br />3 Conduct an evaluation of the interventions <br />implemented. <br />Exhibit A , Statements of Work <br />Revised as of May 15, 2018 <br />CFDA# BARS Master Funding Period <br />Revenue Index (LHJ Use Only) <br />Code Code Start Date End Date <br />93.268 333 .93.26 74310285 07101 118 I 06/30119 <br />*May Support PHAB <br />Standards/Measures Deliverables/Outcomes <br />Written proposal and a report that <br />shows starting immunization rates <br />for the target population <br />Written report describing the <br />progress made on reaching <br />milestones for activities identified <br />in the plan (template will be <br />provided) <br />Final written report, including a <br />report showing ending <br />immunization rates for the target <br />Page 12 of 13 <br />Current Change Total <br />Consideration Increase(+) Consideration <br />0 5,600 5 ,600 <br />0 5,600 5,600 <br />Due Date/Time Payment <br />Frame Information and/or <br />Amount <br />August 1, 2018 Reimbursement for <br />actual costs incurred, <br />not to exceed total <br />funding consideration <br />amount. <br />See Restrictions on <br />Funds below. <br />November 30 , 2018 Reimbursement for <br />actual co sts incurred, <br />March 31, 2019 not to exceed total <br />funding consideration <br />amount. <br />See Restrictions on <br />Funds below <br />June 15 , 2019 Reimbursement for <br />actual costs incurred, <br />not to exceed total <br />Contract Number CLH18249-3