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AMENDMENT #19 <br />Exhibit A, Statements of Work <br />Revised as of January 15, 2021 <br />Page 12 of 30 Contract Number CLH18249-19 <br /> <br /> <br />Task <br />Number <br /> <br />Task/Activity/Description *May Support PHAB <br />Standards/Measures <br /> <br />Deliverables/Outcomes <br /> <br />Due Date/Time Frame <br />Payment <br />Information and/or <br />Amount <br /> maintain all decisional authority around vaccination <br />planning and execution within their jurisdiction/district. <br /> <br />Provide any information as requested by the regional IMT. <br />4.B Funding for eligible Mass Vaccination activities are <br />reimbursed on actual costs as outlined in the DOH guidance <br />to provide the services and to carry out the mission. <br />Funding will be dependent on full participation in the LHJ <br />and IMT processes and all documentation will be required <br />to be provided to fully close out funding requests by the end <br />of the mission period of performance. <br /> Submit estimated budget <br />for the mass vaccination <br />plan. <br /> <br />Monthly Cost Summary <br />Spreadsheet to the <br />IMT/IMO by the fifth of <br />the following month. <br />Within 30 days of <br />contract amendment <br />execution. <br /> <br />Monthly <br /> Allowable costs include expenses such as facility rentals, <br />staff to conduct planning, management, support and <br />operation of the site, medical personnel for vaccinations, <br />site security personnel, wrap around services for staff <br />(meals, travel, lodging), equipment (which must be pre- <br />approved by IMT/DOH if it exceeds $5,000 each), supplies <br />for vaccinations and site operation. LHJs should provide <br />narratives to help assist IMT and DOH finance know what <br />expenditures were necessary to carry out the mission. <br /> <br />4.C Vaccination data – will be maintained according to current <br />state and federal requirements. <br /> Submission of vaccine use <br />into WA IIS database <br />within 24hrs of use. <br />Daily <br /> Vaccine Registration Systems – If a local jurisdiction or <br />region does not have a registration system(s) the include <br />internet based, phone option and other methods to ensure <br />equitable registration, the state PrepMod system and tools <br />will be available for use. <br />Jurisdiction/Regions will <br />ensure a fair and <br />equitable process for <br />registration of eligible <br />Washingtonians across all <br />available modalities. <br /> <br />4.D Regularly report on vaccinations sites and operational <br />activities (number of vaccinations, personnel to operate the <br />site, challenges, successes to share for learning across the <br />public health system). <br /> Provide monthly situation <br />report to IMT/IMO on <br />status of implementation <br />of mass vaccination plan, <br />or more frequently if that <br />is the LHJ procedure. <br />Sites operating for the <br />time period, vaccines <br />administered by site for <br />the time period, estimated <br />Monthly