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AMENDMENT #19 <br />Exhibit A, Statements of Work <br />Revised as of January 15, 2021 <br />Page 28 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 Due Date/Time <br />Frame <br /> <br />Payment Information and/or Amount <br /> Payment is authorized upon receipt and <br />acceptance of completed TA Report <br />within the 30-day deadline. <br /> <br />Late or incomplete reports may not be <br />accepted for payment. <br />4 LHJ staff performing the activities <br />under tasks 1, 2 and 3 must have <br />completed the mandatory Sanitary <br />Survey Training. <br /> <br />See Special Instructions for task <br />activity. <br /> Prior to attending the <br />training, submit an <br />“Authorization for Travel <br />(Non-Employee)” DOH <br />Form 710-013 to the ODW <br />Program Contact below for <br />approval (to ensure that <br />enough funds are available). <br />Annually LHJ shall be paid mileage, per diem, <br />lodging, and registration costs as <br />approved on the pre-authorization form <br />in accordance with the current rates <br />listed on the OFM Website <br />http://www.ofm.wa.gov/resources/travel <br />.asp <br /> <br /> <br />*For Information Only: <br />Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how prog ram activities might contribute to meeting a <br />Standard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at: <br />http://www.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf <br /> <br />Program Specific Requirements/Narrative <br /> <br />Special References (RCWs, WACs, etc) <br />Chapter 246-290 WAC is the set of rules that regulate Group A water systems. By this statement of work, ODW contracts with the LHJ to con duct sanitary surveys (and SPIs, and <br />provide technical assistance) for small community and non -community water systems with groundwater sources. ODW retains responsibility for conducting sanitary surveys (and <br />SPIs, and provide technical assistance) for small community and non -community water systems with surface water sources, large water systems, and systems with complex <br />treatment. <br />LHJ staff assigned to perform activities under tasks 1, 2, and 3 must be trained and approved by ODW prior to performing work . See special instructions under Task 4, below. <br /> <br />Special Billing Requirements <br />The LHJ shall submit quarterly invoices within 30 days following the end of the quarter in which work was completed, noting on the invoice the quarter and year being billed for. <br />Payment cannot exceed a maximum accumulative fee of $18,000 $28,400 for Task 1, and $2,000 $4,000 for Task 2, Task 3 and Task 4 combined during the contracting period, <br />to be paid at the rates specified in the Payment Method/Amount section above. When invoicing for sanitary surveys, bill half to BARS Revenue Code 346.26.64 and half to BARS <br />Revenue Code 346.26.65. <br /> <br />When invoicing for Task 1, submit the list of WS Name, ID #, Amount Billed, Survey Date and Letter Date that you are requesting payment. <br />When invoicing for Task 2-3, submit the list of WS Name, ID #, TA Date and description of TA work performed, and Amount Billed. <br />When invoicing for Task 4, submit receipts and the signed pre-authorization form for non-employee travel to the ODW Program Contact below and a signed A19-1A Invoice <br />Voucher to the DOH Grants Management, billing to BARS Revenue Code 346.26.66 under Technical Assistance (TA).