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Exhibit A <br />Statement of Work <br />Contract Term: 2018-2020 <br />AMENDMENT #4 <br />DOH Program Name or Title: Suppl emental Nutri tion Assistance Program- <br />Education -Effective October 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 />igJ Federal Subrecipient (check if applicable) r8J Reimbursement <br />Period of Performance: October 1, 2018 through September 30, 2020 0 State r8] FFATA (Transparency Act) D Fixed Price <br />0 Other D Research & Development <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: N/ A <br />Chart of Accounts Program Name or Title <br />FFY18 CSS IAR SNAP ED PROG MGNT CF <br />FFY19 CSS IAR SNAP ED PROG MGNT <br />TOTALS <br />:it Task/ Activity/Description .:c <br />"' = E--, <br />1.0 For SNAP-Ed, the LHJ will <br />perform work as described in their <br />approved: <br />• FFY19 SNAP-Ed project <br />description and work plans <br />approved by DOH, <br />Department of Social and <br />Health Services (DSHS), and <br />United States Department of <br />Agriculture (USDA) that was <br />submitted to them via DOH <br />email. <br />Exhibit A, Statements of Work <br />Revised as of July 16, 2018 <br />I <br />*May <br />Support <br />PHAB <br />Standards/ <br />Measures <br />• <br />• <br />• <br />• <br />CFDA# BARS Master Funding Period Current Change rrotal <br />Revenue Index (LHJ Use Only) Consideration Increase(+) Consideration <br />Code Code Start Date End Date <br />10.561 330.10.56 76211993 10101118 I 09 /30/19 0 858 858 <br />10.561 330.10.56 76211991 10101118 I 09 ;30;19 0 19 ,745 19,745 <br />0 20,603 20,603 <br />FFY19 FFY20 Payment Information Deliverables/Outcomes Due Date/Time Frame Due Date/Time Frame and/or Amount <br />Project qualified target For the Period: For the Period: Reimbursement upon <br />audiences reached 10/01/18 to 09/30/19 10/01/19 to 09/30/20 receipt and approval of <br />Project activities deliverables for the <br />completed(# direct Due: per the approved Due: per the approved funding period will not <br />education, PSE, Etc.) work plan and no later work plan and no later exceed $20,603. <br />noted in project plans and than 09 /30/19 than 09 /30/20 <br />workbooks. Kittitas County <br />Required demographic Public Health <br />data collected. Department will be <br />Evaluation activities paid the allowable <br />completed per the costs incurred based <br />implementing agency and on their approved <br />state evaluation team fore budget and program <br />Page 25 of32 Contract Number CLH18249-4