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Task Task/ Activity/Description *May Support PHAB Due Date/fime Number Standards/Measures Deliverables/Outcomes Frame Payment Information and/or Amount Payment is authorized upon receipt and acceptance of completed TA Report . within the 30-day deadline . Late or incomplete reports may not be accepted for payment. 4 UIJ staff performing the activities Prior to attending the Annually LHJ shall be paid mileage, per diem, under tasks I, 2 and 3 must have training, submit an lodging, and registration costs as completed the mandatory Sanitary "Authorization for Travel approved on the pre-authorization form in Survey Training. (Non-Employee)" DOH accordance with the current rates listed on Form 710--013 to the ODW the OFM Website See Special Instructions for task Program Contact below for h1tp://www.ofin. wa.goviresources.'travel.a activity. approval (to ensure that fil1. enough funds are avail.able). *For Information Only: Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a Standard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at: b.rm:/!wv..-w_ohaboard.on?/wp-c.onten t/uoload....;JPHAB-Standards-sand-M.tasures-Veis lon-1.0 .odf Program Specific Requirements/Narrative Special References (RCWs, WACs, etc) Chapter 246-290 WAC is the set of rules that regulate Group A water systems. By this statement of worlc, ODW contracts with the LIU to conduct sanitary surveys ( and SPis, and provide technical assistance) for small community and non-community water systems with groundwater sources. ODW retains responsibility for conducting sanitary surveys (and SPis, and provide technical assistance) for small community and non-community water systems with surface water sources, large water systems, and systems with complex treatment. LHJ staff a~igned to perform activities under tasks 1, 2, and 3 must be trained and approved by ODW prior to perlorming work. See special instructions under Task 4, below. Special Billing Requirements The lHJ shall submit quarterly invoices within 30 days following the end of the quarter in which work was completed, noting on the invoice the quarter and year being billed for. Payment cannot exceed a maximum accumulative fee ofS4,800 for Task 1, and $2,000 for Task 2, Task 3 and Task 4 combined during the contracting period, to be paid at the rates specified in the Payment Method/ Amount section abov:e. Whe .o invoicing-for sani.WY survevs~ biU h2.lf to BARS Revenue Code 346.26.64 -and half (0 BARS Aevenue-Code 346.26.65. When invoicing for Task 1, submit the list ofWS Name, ID#, Amount Billed, Survey Date and Letter Date that you are requesting payment. When invoicing for Task 2-3, submit the list ofWS Name, ID#, TA Date and description of TA work performed, and Amount Billed. When invoicing for Task 4, submit receipts and the signed pre-authorization form for non-employee travel to the ODW Program Contact below and a signed Al 9-lA Invoice Voucher to the DOH Grants Management, billing to BARS Revenue Code 346.26.66 under Technical Assistance (TA). Special Instructions Exhibit A, Statements of Work Page 8 of28 Contract Number CLlll 8249