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AMENDMENT #17 <br />Exhibit A, Statements of Work Page 2 of 42 Contract Number CLH18249-17 <br />Revised as of September 15, 2020 <br />Exhibit A <br />Statement of Work <br />Contract Term: 2018-2021 <br /> <br />DOH Program Name or Title: Division of Emergency Preparedness & Response <br />PHEP - Effective July 1, 2020 <br /> <br />Local Health Jurisdiction Name: Kittitas County Public Health Department <br />Contract Number: CLH18249 <br />SOW Type: Revision Revision # (for this SOW) 1 Funding Source <br /> Federal Subrecipient <br /> State <br /> Other <br />Federal Compliance <br />(check if applicable) <br /> FFATA (Transparency Act) <br /> Research & Development <br />Type of Payment <br /> Reimbursement <br /> Fixed Price Period of Performance: July 1, 2020 through June 30, 2021 <br />Statement of Work Purpose: The purpose of this statement of work is to establish funding and tasks to support and sustain LHJ pu blic health emergency preparedness as part of <br />statewide public health emergency preparedness and response. <br />Revision Purpose: The purpose of this revision is to extend the period of performance, add the remainder of the annual allocation, ad d an end-of-year report, revise the budget <br />due date, add a training and exercise task, and remove activities no longer required. <br /> <br />Chart of Accounts Program Name or Title CFDA # BARS <br />Revenue <br />Code <br />Master <br />Index <br />Code <br />Funding <br />(LHJ Use <br />Start Date <br /> Period <br /> Only) <br />End Date <br />Current <br />Consideration <br />Change <br />Increase (+) <br />Total <br />Consideration <br />FFY20 PHEP BP2 LHJ Funding 93.069 333.93.06 31102280 07/01/20 06/30/21 29,480 19,653 49,133 <br />TOTALS 29,480 19,653 49,133 <br /> <br />Task <br />Number Task/Activity/Description *May Support PHAB <br />Standards/Measures Deliverables/Outcomes Due Date/Time <br />Frame <br />Payment <br />Information and/or <br />Amount <br />1 Across Domains and Capabilities <br /> <br />Complete reporting templates as requested by <br />DOH to comply with program and federal grant <br />requirements, including mid -year and end-of-year <br />reports. <br /> Mid-year report on template <br />provided by DOH. <br /> <br />End-of-year report on template <br />provided by DOH. <br /> <br />Additional reporting may be <br />required if federal requirements <br />change. <br />December 31, 2020 <br /> <br /> <br />June 30, 2021 <br />Reimbursement for <br />actual costs not to <br />exceed total funding <br />consideration amount. <br />2 Across Domains and Capabilities <br /> <br />Participate in an evaluation of LHJ response <br />capabilities, upon request from DOH. <br /> DOH will maintain documentation <br />of evaluation participation. <br />Upon request.