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DOH Program Name or Title: Maternal & Child Health Block Grant- <br />Effective January 1. 2018 <br />SOWType: ~ Revision # (for this SOW) <br />Period of Performance: January 1. 2018 through September 30, 2018 <br />Exhibit A <br />Statement of Work <br />Contract Term: 2018-2020 <br />Local Health Jurisdiction Name: Kittitas County Public Health Department <br />Contract Number: CLH18249 <br />Funding Source Federal Compliance ~ofPa~ot ~ Federal Subrecipient (check if applicable) Reimbunement 0 State ~ FFATA (Transparency Act) 0 Fixed· Price <br />D Other 0 Research & D evelopment <br />Statement of Work Purpose: The purpose of this statement of work is to support local interventions that impact the target population of the Maternal and Child Health Block <br />Grant. <br />Revision Purpose: NIA <br />Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current <br />Cb>nge r•tal Revenue Index (LHJ Use Only) Consideration Increase (+) onsideration <br />Code Code Start Date End Date <br />FFY18 MCHBG LHJ CONTRACTS 93.994 333.93 .99 78120281 01101118 I 09130118 0 33.147 I 33 ,147 <br />TOTALS o I 33,147 ] 33.147 <br />Task *May Support PHAB I Due Dateffime Frame <br />Payment <br />Task/ Activity/Description Deliverables/Outcomes Information and/or Number Standards/Measures Amount <br />Maternal and Child Health Block Grant (MCHBG) Administration <br />la Participate in calls, at a minimum of every Designated LHJ staff will September 30, 2018 Reimbursement for <br />quarter, with DOH contract manager. Dates and participate in contract management actual costs, not to <br />time for calls are mutually agreed upon between calls. exceed total funding <br />DOHandLHJ consideration. <br />lb Report actual expenditures for October 1, 20 I 7 Submit actual expenditures using May 26, 2018 Action Plan and <br />through March 31, 2018 the MCHBG Budget Workbook to Progress Reports <br />DOH contract mana2er must only reflect <br />le Develop 2018-2019 MCHBG Budget Workbook Submit MCHBG Budget I September 5, 2018 activities paid for <br />for October 1, 2018 through September 30, 2019 Workbook to DOH contract with funds provided <br />using DOH provided template. manager in this statement of <br />work for the <br />specified funding <br />period. <br />See Program <br />Exhibit A, Statements of Work Page2 of28 Contract Number CLH18249