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AMENDMENT #17 <br />Exhibit A, Statements of Work Page 25 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 Titl e: OICP CARES Enhanced Influenza Coverage Project - <br />Effective July 1, 2020 <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 contract with local health to conduct activities to improve influenza immunization coverage rates. <br />Revision Purpose: The purpose of this revision is to extend the period of performance and funding from 12/31/20 to 06/30/21 and add funds. <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 />FFY21 Enhanced Influenza Coverage CARES 93.268 333.93.26 74310219 07/01/20 06/30/21 2,800 2,800 5,600 <br />TOTALS 2,800 2,800 5,600 <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 Develop a proposal to work with partners on <br />activities that implement evidence-based strategies <br />to increase influenza immunization coverage rates <br />for adult population, increase immunization and <br />promotion activities targeted at populations at <br />higher risk for COVID-19 and those that support <br />them, uninsured and underinsured populations, and <br />improve collaboration with community <br />partners. The proposal must include a line-item, <br />object-based budget and must meet the goals and <br />objectives outlined in the Local Health Jurisdiction <br />Enhanced Influenza Coverage Funding <br />Opportunity Guidelines. <br /> Written proposal, to include a line- <br />item, object-based budget <br />(template will be provided) and a <br />report that shows starting <br />immunization rates for the target <br />population <br />July 28, 2020 Reimbursement for <br />actual costs incurred, <br />not to exceed total <br />funding consideration <br />amount. <br /> <br />*See Restrictions on <br />Funds below. <br />2 Upon approval of proposal, implement the plan to <br />increase immunization coverage rates with the <br />target population identified. <br /> Written report describing the <br />progress made on reaching <br />milestones for activities identified <br />in the plan (template will be <br />provided) <br />December 31, 2020