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Exhibit A Statement of Work Contract Term: 2018-2020 DOH Program Name or Title: Office of Drinking Water Group A Program- Effective January l, 2018 Local Health Jurisdiction Name: Kittitas County Public Health Department Contract Number: CLHI8249 SOW Type: Original Revision # (for this SOW) Period of Performance: January I. 2018 through December 31, 2020 Funding Source Federal Compliance Type of Payment ~ Federal Contractor (check if applicable) D Reimbursement ~ State D FF ATA (Transparency Act) [g) Fixed Price • Other D Research & Development Statement of Work Purpose: The purpose of this statement of work is to provide funding to the LHJ for conducting sanitary surveys and providing technical assistance to small community and non-community Group A water systems. Revision Purpose: NI A Chart of Accounbi Program Name or Title CFDA# BARS Master Funding Period Current Change :rotal Revenue Index (LBJ Use Only) Consideration Increase (+) Consideration Code Code Start Date End Date Yr 20 SRF -Local Asst {15%) (FS) ss NIA I 346.26.64 24139220 ovo1118 I 12131120 0 2,400 I 2,400 Sanitary Survey Fees (FO-E) SS-State NIA 346.26.65 24242522 01101118 I 12131120 0 2.400 2.400 Yr 20 SRF -Local Asst (15%) (FS) TA NIA l 346.26.66 24139220 01101118 I 12131120 0 2.000 2~000 TOTALS 0 6,800 ! 6.800 Task Task/Activity/Description *May Support PHAB Deliverables/Outcomes Due Date/Time I Payment Information and/or Amount Number Standards/Measures Frame 1 Trained LHJ staff will conduct I Provide Final* Sanitary Final Sanitary Survey I Upon ODW acceptance of the Final sanitary surveys of small community Survey Reports to ODW Reports must be Sanitary Survey Report, the LHJ shall be and non-community Group A water Regional Office. Complete received by the ODW paid $400 for each sanitary survey of a systems identified by the DOH Office Sanitary Survey Reports shall Regional Office non-community system with three or of Drinking Water (ODW) Regional include: within 30 calendar fewer connections. Office. 1. Cover letter identifying days of conducting significant deficiencies, the sanitary survey. Upon ODW acceptance of the Final See Special Instructions for task significant fmdings, Sanitary Survey Report, the LHJ shall be activity. observations, paid $800 for each sanitary survey of a recommendations,and non-community system with four or more referrals for further connections and each community system. ODW follow-up. 2. Completed Small Water Payment is inclusive of all associated System checklist. costs such as travel, lodging, per diem. 3. Uodated Water Facilities Exhibit A, Statements of Work Page 6 of28 Contract Number CLHI8249