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AMENDMENT #19 Exhibit A, Statements of Work Revised as of January 15, 2021 Page 27 of 30 Contract Number CLH18249-19 Task Number Task/Activity/Description *May Support PHAB Standards/Measures Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount See Special Instructions for task activity. significant findings, observations, recommendations, and referrals for further ODW follow-up. 2. Completed Small Water System checklist. 3. Updated Water Facilities Inventory (WFI). 4. Photos of water system with text identifying features 5. Any other supporting documents. Upon ODW acceptance of the Final Sanitary Survey Report, the LHJ shall be paid $800 for each sanitary survey of a non-community system with four or more connections and each community system. Payment is inclusive of all associated costs such as travel, lodging, per diem. Payment is authorized upon receipt and acceptance of the Final Sanitary Survey Report within the 30-day deadline. *Final Reports reviewed and accepted by the ODW Regional Office. Late or incomplete reports may not be accepted for payment. 2 Trained LHJ staff will conduct Special Purpose Investigations (SPI) of small community and non- community Group A water systems identified by the ODW Regional Office. Provide completed SPI Report and any supporting documents and photos to ODW Regional Office. Completed SPI Reports must be received by the ODW Regional Office within 2 working days of the service request. Upon acceptance of the completed SPI Report, the LHJ shall be paid $800 for each SPI. Payment is inclusive of all associated costs such as travel, lodging, per diem. See Special Instructions for task activity. Payment is authorized upon receipt and acceptance of completed SPI Report within the 2 working day deadline. Late or incomplete reports may not be accepted for payment. 3 Trained LHJ staff will provide direct technical assistance (TA) to small community and non-community Group A water systems identified by the ODW Regional Office. See Special Instructions for task activity. Provide completed TA Report and any supporting documents and photos to ODW Regional Office. Completed TA Report must be received by the ODW Regional Office within 30 calendar days of providing technical assistance. Upon acceptance of the completed TA Report, the LHJ shall be paid for each technical assistance activity as follows: • Up to 3 hours of work: $250 • 3-6 hours of work: $500 • More than 6 hours of work: $750 Payment is inclusive of all associated costs such as consulting fee, travel, lodging, per diem.