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AMENDMENT #17 <br />Exhibit A, Statements of Work Page 11 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: LSPAN-Local Strategies for Physical Activity & <br />Nutrition - Effective February 19, 2019 <br />Local Health Jurisdiction Name: Kittitas County Public Health Department <br /> Contract Number: CLH18249 <br />SOW Type: Revision Revision # (for this SOW) 3 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: February 19, 2019 through September 29, 2021 <br />Statement of Work Purpose: The purpose of this statement of work is to establish funding for Local Strategies for Physical Activity and Nutrition (LSPAN ), a project of the <br />State Physical Activity and Nutrition Program (SPAN). <br />Revision Purpose: The purpose of this revision is to extend the period of performance from September 29, 2020 to September 29, 2021 and add funding and due dates for <br />Year 3-FFY20 activities. <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 />FFY18 PHYS ACTVTY & NUTRITION PROG 93.439 333.93.43 77440248 02/19/19 09/29/20 60,000 0 60,000 <br />FFY19 PHYS ACTVTY & NUTRITION PROG 93.439 333.93.43 77440239 09/30/19 09/29/20 60,000 0 60,000 <br />FFY20 PHYS ACTVTY & NUTRITION PROG 93.439 333.93.43 77440240 09/30/20 09/29/21 0 60,000 60,000 <br />TOTALS 120,000 60,000 180,000 <br /> <br />Task <br />Number Task/Activity/Description *May Support PHAB <br />Standards/Measures Deliverables/Outcomes Due Date/Time Frame <br />Payment <br />Information <br />and/or Amount <br />1a PROGRAM ADMINISTRATION: <br />Participate in calls, at a minimum of once <br />every month, with DOH contract manager. <br />Dates and time for calls are mutually agreed <br />upon between DOH and Kittitas County <br />Public Health Department (KCPHD). <br /> Designated KCPHD staff <br />will participate in contract <br />management calls. <br />February 19, 2019-September 29, 2020 <br />2021 <br />Reimbursement <br />for actual costs, <br />not to exceed <br />total contract <br />funding. See <br />Program Specific <br />Requirements <br /> <br />1b PROGRAM ADMINISTRATION: <br />Participate in DOH-sponsored LSPAN <br />related quarterly conference calls and/or <br />webinars, including up to one (1) in-person <br />meeting. <br /> Designated KCPHD staff <br />will participate in calls, <br />webinars, and meetings. <br />February 19, 2019-September 29, 2020 <br />2021 <br />Reimbursement <br />for actual costs, <br />not to exceed <br />total contract <br />funding. See