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AMENDMENT #17 <br />Exhibit A, Statements of Work Page 27 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: OICP-Promotion of Immunizations to Improve <br />Vaccination Rates - 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 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, add funds, and mod ify the statement of work. <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 VFC Ops 93.268 333.93.26 74310202 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 improve immunization <br />coverage rates for a target population by increasing <br />promotion activities and collaborating with <br />community partners. The proposal must meet <br />guidelines outlined in the Local Health Jurisdiction <br />Funding Opportunity, Promotion of Immunizations <br />to Increase Vaccination Rates announcement. <br /> <br /> Written proposal and a report that <br />shows starting immunization rates <br />for the target population <br />August 1, 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 />November 30, 2020 <br /> <br />March 31, 2021 <br />3 Perform data collection necessary to enable a <br />comparison of immunization rates from the start of <br />the project. <br /> Final written report, including a <br />report showing ending <br />immunization rates for the target <br />population (template will be <br />provided) <br />June 15, 2021