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DOH Program Name or Title: LSPAN-Local Strateeies for physical Activify &Nutrition - Effective February 19. 2019AMENDMENT #I7Exhibit AStatement of WorkContract Term: 2018-2021Local Health Jurisdiction Name: Kittitas countv Public Health DepartmentContract Number: CLH18249SOW Type: Revision Revision # (for this SOW) 3Type of PaymentE Reimbursement! Fixed PriceFederal Compliance(check if applicable)XnFFATA (Transparency Act)Research & DevelopmentFunding SourceFederal SubrecipientStateE otherPeriod ofPerformance: February 19.2019 through September 29.2021Statement 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 theState Physical Activity and Nutrition Program (SPAN).Revision Purpose: The purpose of this revision is to extend the period of performance from September 29,2020 to September 29,2021and add funding and due dates forYear 3-FFY20 activities.Exhibit A, Statements of WorkRevised as ofSeptember 15,2020TotalConsideration60,00060,00060,000t80,000ChangeIncrease (+)0060.00060.000CurrentConsideration60.00060,0000120,000Funding Period(LHJ Use Only)Start Date End Date0912912009129/2009129121TOTALS021191190913011909/30120MasterIndexCode774402487744023977440240BARSRevenueCode333.93.43333.93.43333.93.43CFDA#93.43993.43993.439Chart of Accounts Program Name or TitleFFYl8 PHYS ACTVTY &NUTRITION PROGFFYI9 PHYS ACTVTY & NUTRITION PROGFFY2O PHYS ACTVTY &NUTRITION PROGPaymentInformationand/or AmountReimbursementfor actual costs,not to exceedtotal contractfunding. SeeProgram SpecificRequirementsReimbursementfor actual costs,not to exceedtotal contractfundins. SeeDue Date/Time FrameFebruary 1 9, 20 I 9-September 29,1e24202 rFebruary I 9, 20 19-September 29, 2e24202 IDeliverables/OutcomesDesignated KCPHD staffwill participate in contractmanagement calls.Designated KCPHD staffwill participate in calls,webinars, and meetings.*May Support PHABStandards/MeasuresTask/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 ll of 42Contract Number CLHI 8249 - 1 7