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Exhibit A <br />Statement of Work <br />Contract Term: 2018-2020 <br />AMENDMENT #4 <br />DOH Program Name or Title: Supplemental Nutrition Assistance Program- <br />Education -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) 2 Funding Source Federal Compliance Type of Payment <br />cgJ Federal Subrecipient (check if applicable) !ZI Reimbursement <br />Period of Performance: January 1, 2018 through September 30, 2018 0 State !ZI FFATA (Transparency Act) D Fixed Price <br />D Other D Research & Develo_pment <br />Statement of Work Purpose: The purpose of this statement of work is to provide Supplemental Nutrition Assistance Program-Education (SNAP-Ed) to improve the likelihood <br />that persons eligible for SNAP (Food Stamps) will make healthy food choices within a limited budget and choose active lifestyles consistent with the current USDA dietary <br />guidance system. <br />Revision Purpose: The purpose ofthis revision is to add FFY18 CSS IAR SNAP ED funding to complete approved FFY18 activities, shorten the Period of Performance from <br />09/30/20 to 09/30/18 and revise deliverable due dates. <br />Chart of Accounts Program Name or Title <br />FFY18 CSS IAR SNAP ED PROG MGNT <br />FFYl 7 CSS IAR SNAP ED PROG MGNT CF <br />TOTALS <br />Task <br />Number Task/ Activity /Description <br />1.0 For SNAP-Ed, the LHJ will perform work as <br />described in LHJ's approved FFY18 SNAP-Ed <br />project description and work plans approved <br />by Department of Health (DOH), Department <br />of Social and Health Services (DSHS), and <br />United States Department of Agriculture <br />(USDA) that was submitted to them via DOH <br />email. <br />Exhibit A, Statements of Work <br />Revised as of July 16, 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 />10.561 333.10.56 76211981 01101118 I 09130118 19,855 3,000 22,855 <br />10.561 333.10.56 76211971 01101118 I 09130118 1,472 0 1,472 <br />21 ,327 3~000 24,327 <br />*May Support PHAB Payment <br />Standards/Measures Deliverables/Outcomes Due Date/Time Frame Information and/or <br />Amount - <br />• Project qualified target For the Period: Reimbursement upon <br />audiences reached. 01/01/18-09/30/:z?.O 18 receipt and approval <br />• Project activities completed Due: per the approved work of deliverables for the <br />(# direct education, PSE, plan and no later than funding period will <br />etc.) noted in project plans 09/30/:z?.O I 8. not exceed $21,327 <br />and workbook. $24,327. <br />• Required demographic data <br />collected. Kittitas County <br />• Evaluation activities Public Health <br />completed per the state Department will be <br />evaluation team (pre and paid the allowable <br />post surveys, PSE tracking, costs incurred based <br />success stories etc.). on their approved <br />budget and program <br />allowability. See <br />Page 18 of32 Contract Number CLH18249-4