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EXHIBIT A, DOH CONTRACT GVL26649-0 <br />Sub-recipient Statement of Work <br />KITTITAS COUNTY HEALTH DEPARTMENT <br />Period of Performance: March 15, 2021 through May 31, 2023 <br /> <br />DOH Contract GVL26649-0 Page 11 of 27 <br />Revision October 2021 <br />This table includes only active funding sources. <br />Federal Grant Information Sheet <br />Subrecipient/Contractor: Kittitas County Health Department DOH Contract Manager: Contact Information: <br />Contract Number: GVL26649 Eileen Kazura dohcon.mgmt@doh.wa.gov <br />DUNS Number: 010202547 Approved Indirect Rate: yes <br />Period of Performance: Start Date: End Date: <br />Limiting Indirect Cost Rate: <br />Research and <br />Development? <br />(If YES, check box) <br />July 1, 2021 May 31, 2023 <br />Project Description: National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic <br />Minority Populations and Rural Communities. <br />Federal Award <br />Identification Number <br />Federal <br />Award Date Federal Agency Name <br />Total Amount of the <br />Federal Award to <br />DOH <br />CFDA # CFDA Program Title Name of Pass-Through <br />Agency <br />Amount of Federal <br />Funds Obligated <br />by This Action <br />Total Amount of <br />Federal Funds <br />Obligated for This <br />Funding Source <br />1NHT5OT000042-01 05/27/2021 CDC $29,015,581 93.391 COVID-19 Health <br />Disparities <br />Washington State <br />Department of Health $300,000 $300,000 <br />Certifications and Assurances – all requirements imposed on the subrecipient by the federal awarding agency: <br />The contract boilerplate covers all standard certifications and assurances. <br />Are there any additional requirements imposed by the pass-through entity (DOH) to meet its own responsibilities to the awarding agency? Yes No If applicable, this is <br />identified by the DOH program staff writing the contract. This can also be found in the “Statement of Work” section of the contract. <br />All subrecipients are required to make their accounting records available and accessible to the awarding agency: <br />This requirement can be found in the “Records Maintenance” section of the contract. <br />Closeout Requirements: <br />(1) Submit all final billings within 60 days of the end of the contract (This is required per standard contract language.) <br />(2) Submit all required program reports and deliverables within 60 days (This is required per standard contract language.) <br />(3) Dispose of property purchased with subaward funds and dispose of or return government -furnished property no longer used for subaward related activities (If applicable DOH <br />must be contacted for disposal requirements.) <br />(4) Additional DOH program specific contract closeout requirements (If applicable, see statement of work for additional close out requirements.) <br />