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Exhibit A <br />Statement of Work <br />Contract Term: 2018-2020 <br />AMENDMENT #3 <br />DOH Program Name or Title: FPHS Communicable Disease & Support <br />Capabilities -Effective January 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 />D Federal <Select One> (check if applicable) D Reimbursement <br />Period of Performance: January 1, 2018 through August 15, 2019 [8J State D FFATA (Transparency Act) [8J One-Time <br />D Other D Research & Develo_pment Distribution <br />Statement of Work Purpose: The purpose of this statement of work is to specify how Foundational Public Health Services (FPHS) state funds will be used. <br />Note: The total lump sum payment for SFY18 (07/01/17-06/30/18) was distributed to LHJs in their 2015-2017 Consolidated Contracts that ended 12/31/17. This statement of <br />work is to include tasks and deliverables for the remainder ofSFY18 (01/01/18-06/30/18) and SFY19 (07/01/18-06/30/19) in the 2018-2020 Consolidated Contracts. <br />Revision Purpose: NI A <br />Chart of Accounts Program Name or Title <br />FPHS FUNDING FOR LHJS DIR (Funding for SFY18 was <br />distributed to LHJs in 2015-2017 Consolidated Contracts. The <br />funding amount shown as Current Consideration in this <br />Statement of Work is for Informational Purposes Only.) <br />FPHS FUNDING FOR LHJS DIR <br />TOTALS <br />Task Task/ Activity/Description Number <br />1 These funds are for delivering ANY or all of the <br />FPHS communicable disease service and can also <br />be used for the FPHS capabilities that support <br />FPHS communicable disease services as defined <br />in the most current version of FPHS Definitions - <br />Version 1.3 (November 2017} <br />Control of Communicable Disease and Other <br />Notifiable Conditions <br />1-1. Provide timely, statewide, locally relevant <br />and accurate information statewide and to <br />Exhibit A, Statements of Work <br />Revised as of May 15, 2018 <br />CFDA# BARS Master Funding Period Current Change Total <br />Revenue Index (LHJ Use Only) Consideration Increase(+) Consideration <br />Code Code Start Date End Date <br />NIA 336 .04.25 91106102 01/01/18 06/30/18 42,000 0 42,000 <br />NIA 336.04.25 91106102 07/01/18 06/30/19 0 42,000 42,000 <br />42,000 42,000 84,000 <br />Impact Measures Deliverables/Outcomes Due Date/Time Payment Information <br />Frame and/or Amount <br />Percent of toddlers and SFY18 (07/01/17-06/30/18) By 08/15/18 SFY19 (07/01/18-06/30/19) <br />school age children that Report: Actual Activities funds are available <br />have completed the and Estimated Expenditures beginning July 1, 2018 and <br />standard series of the full year allocation will <br />recommended vaccinations. SFY19 (07/01/18-06/30/19) By 08/15/18 be dispersed upon receipt of <br />Work Plan: Planned the SFY18 Report and <br />Percent of new positive Activities and Projected SFY19 Work Plan. <br />Hepatitis C lab reports that Spending <br />are received electronically <br />which have a completed SFY19 (07/01/18-06/30/19) <br />case report. Report: Actual Activities <br />and Estimated Expenditures By 08/15/19 <br />Page 3 of 13 Contract Number CLH18249-3