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Exhibit A Statement of Work Contract Term: 2018-2020 DOH Program Name or Title: Office of lmmuniza1ion & Child Profile - Effective January l, 2018 Local Health .Jurisdiction Name: Kittitas County Public Health Department Contract Number: CLH18249 SOW Type: Original Revision # (for this SOW) Period of Performance: January 1, 2018 through June 30, 2018 Funding Source Federal Compliance Type of Payment 181 Federal Subrecipient (check if applicable) 181 Reimbursement 0 Stare ~ FFATA (Transparency Act) D Fixed Price 00ther D Research & Development Statement of Work Purpose: The purpose of this statement of work is to define required immunization tasks, deliverables, and funding for the period January 1, 2018 through June 30, 2018 . Revision Purpose: N/ A Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change f otal Revenue Index (LBJ Use Only) Consideration 1 (+) Consideration Code Code ncrease Start Date End Date FFYl 7 VFC Ons 93.268 333 .93 .26 74310211 l 01101118 I 06/30/18 1 0 1,1 14 I 1,114 FFY17 317 Dos 93.268 I 333 .93.26 74310270 01101118 I 06/30/18 l 0 616 I 616 FFY17 AFDC 93 .268 333 .93.26 I 74310212 01101118 I 0 6/3 0/18 0 1 2.226 I 2.226 TOTALS 0 3.956 I 3.956 Task *May Support PHAB I Due Date/Time I Payment Number Task/ Activity/Description Standards/l\1easures Deliverables/Outcomes Frame Information and/or Amount Perform accountability activities in accordance with state and federal requirements for the Vaccines for Children (VFC) Program as outlined in the Centers for Disease Control and Prevention (CDC) VFC Operations Guide and as directed by the state administrators of the VFC program. Accountability requirements include, but are not limited to: provider education, provider site visits and required corrective action, quality assurance activities, VFC screening, satisfaction survey, outside provider agreements, new provider enrollment visits. fraud and abuse reporting, monthly accountability rworts, and private provider report of vaccine usage. 1 Facilitate annual renewal of the provider agreement Provider Agreements for Receipt Annually, per Annual Reimbursement for for receipt of state supplied vaccine for all of Stare Supplied Vaccine received VFC Provider actual costs incurred, healthcare providers receiving state-supplied online via the Washington Agreement Update not to exceed total childhood vaccine Immunization Information System. Schedule funding consideration amowit Funds available for this task*: FFY17 AFIX 74310272 Exhibit A , Statements ofWork Page 16 of28 Conlract Number CUI 18249