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DOH Program Name or Title: LSPAN-Local Strategies for physical Activitv &Nutrition - Effective February 19. 2019SOW Type: Revision Revision # (for this SOW) 2Period ofPerformance: February 19. 2019 through September 29. 2020Exhibit A, Statements of WorkRevised as of May 15,2020Type of Paymentn Reimbursement! Fixed PriceFederal Compliance(check if applicable)[l nfefe (Transparency Act)I Research & DevelopmentFunding SourceI Federal Subrecipientn staten otherAMENDMENT #15Local Health Jurisdiction Name: Kittitas CounW Public Health DepartmentContract Number: CLH18249Exhibit AStatement of WorkContract Term: 2018-2020Statement of Work Purpose: The purpose of this statement of work is to establish funding for Local Strategies for Physical Activify and Nutrition (LSpAN), a project of theState Physical Activity and Nutrition Program (SPAN).Revision Purpose: The purpose of this revision is to extend funding period for FFY18 funds from September 29,2019 to September 29,2020.IotalConsideration60,00060,000120,000ChangeNone000CurrentConsideration60.00060,000120,000Funding Period(LHJ Use Only)Start Date End Date09129t2009/29t20TOTALS02/19t1909/30t19MasterIndexCode7744024877440239BARSRevenueCode333.93.43333.93.43CFDA #93.43993.439Chart of Accounts Program Name or TitleFFYI8 PHYS ACTVTY & NUTRITION PROGFFY19 PHYS ACTVTY & NUTRITION PROGPaymentInformationand/or AmountReimbursementfor actual costs,not to exceedtotal contractfunding. SeeProgram SpecificRequirementsReimbursementfor actual costs,not to exceedtotal contractfunding. SeeProgram SpecificRequirementsDue Date/Time FrameFebruary 1 9, 2019-September 29,2020February 19, 20 l9-September 29,2020Deliverables/OutcomesDesignated KCPHD staffwill participate in contractmanagement calls.Designated KCPHD staffwill participate in calls,webinars, and meetings.*May Support PHABStandards/-lVleasuresTas k/Activity/DescriptionPROGRAM ADMINISTRATION :Participate in calls, at a minimum of onceevery month, with DOH contract manager.Dates and time for calls are mutually agreedupon between DOH and Kittitas CountyPublic Health Department (KCPHD).PROGRAM ADMINISTRATION:Participate in DOH-sponsored LSPANrelated quarterly conference calls and/orwebinars, including up to one (1) in-personmeeting.TaskNumber1albPage 5 of21Contract Number CLHI8249 -1 5