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AMENDMENT #19 <br />Exhibit A, Statements of Work <br />Revised as of January 15, 2021 <br />Page 16 of 30 Contract Number CLH18249-19 <br /> <br /> <br />Exhibit A <br />Statement of Work <br />Contract Term: 2018-2021 <br /> <br />DOH Program Name or Title: Division of Emergency Preparedness & Response- <br />COVID-19 - Effective January 20, 2020 <br />Local Health Jurisdiction Name: Kittitas County Public Health Department <br />Contract Number: CLH18249 <br />SOW Type: Revision Revision # (for this SOW) 2 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 />One-Time <br />Distribution <br /> <br />Period of Performance: January 20, 2020 through December 31, 2021 <br />Statement of Work Purpose: The purpose of this statement of work is to establish funding and tasks for LHJs to prevent, prepare for, and respond to the COVID-19 disease <br />outbreak. <br />Revision Purpose: The purpose of this revision is to extend the period of performance from June 30, 2021 to December 31, 2021, extend the fundi ng period for federal <br />COVID-19 funds, and add report deliverables and due dates. The funding period end date for the state Disaster Response funds remains June 30, 2021. <br />NOTE: Pending execution of a new contract or an extension to the 2018 -2021 consolidated contracts which currently end December 31, 2021, program plans to extend the period <br />of performance and funding in this statement of work through March 15, 2022. Deliverable due dates after December 31, 2021 are referenced for informational purposes only and <br />will be updated in a new or revised statement of work effective January 1, 2022. <br /> <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 />None <br />Total <br />Consideration <br />FFY20 CDC COVID-19 Crisis Resp LHJ-Tribe 93.354 333.93.35 31104102 01/20/20 12/31/21 78,522 0 78,522 <br />FY20/21 COVID-19 Disaster Response N/A 334.04.92 934A0101 01/20/20 06/30/21 71,478 0 71,478 <br />TOTALS 150,000 0 150,000 <br /> <br /> <br />Task <br />Number <br /> <br />Task/Activity/Description *May Support PHAB <br />Standards/Measures <br /> <br />Deliverables/Outcomes Due Date/Time <br />Frame <br />Payment Information <br />and/or Amount <br />1 Federal Funds <br />Participate in public health emergency preparedness <br />and response activities for COVID-19. This may <br />include surveillance, epidemiology, laboratory <br />capacity, infection control, mitigation, <br />communications, and or other preparedness and <br />response activities for COVID-19. <br /> <br />Activities must address one or more of the following <br />six domains: <br /> Activity report(s) on template <br />to be provided DOH. <br />June 30, 2020 <br />December 31, 2020 <br />March 15, 2021 <br />June 30, 2021 <br />December 31, 2021 <br />March 15, 2022 <br /> <br /> <br />Frequency and due <br />dates of reports may <br />change based on <br />Reimbursement for actual <br />costs not to exceed total <br />funding consideration <br />amount <br /> <br />Note: Per Federal <br />funding requirements, <br />prior approval from <br />DOH is required for <br />reimbursement of <br />expenses incurred on or