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EXIIIBIT A, DOH CONTRACT GVL26649-0Sub-recipient Statement of WorkKITTITAS COUNTY HEALTH DEPARTMENTPeriod of Performance: March 15, 2021 through May 3/,, 2023This table includes only active funding sources.Certifications and Assurances - all requirements imposed on the subrecipient by the federal awarding agencyThe contract boilerplate covers all standard certifications and assurances.Are there any additional requirements imposed by the pass-through entity (DOH) to meet its own responsibilities to the awarding agency? Yes ! No I If applicable, this isidentified by the DOH program staff writing the contract. This can also be found in the "statement of Work" section of the contract.All subrecipients are required to make their accounting records available and accessible to the awarding agency:This requirement can be found in the "Records Mairrtenance" section of the contract.Closeout Requirements:(l) Submit all final billings within 60 days ofthe end of the contract (This is required per standard contract language.)(2) Submit all required program reports and deliverables within 60 days (This is required per standard contract language.)(3) Dispose of properfy purchased with subaward funds and dispose of or return govemment-fumished property no longer used for subaward related activities (If applicable DOHmust be contacted for disposal requirements.)(4) Additional DOH program specific contract closeout requirements (If applicable, see statement of work for additional closeout requirements.)DoH Contract GVL26649-ORevision October 2021Federal Grant Information SheetSubrecipient/Contractor:Contract Number:DUNS Number:Period of Performance:Project Description:Kittitas County Health DepartmentGVL26649010202547DOH Contract Manager:Eileen KazuraApproved Indirect Rate: yesContact Information:dohcon.msmt@doh.wa.govResearch andLimiting Indirect Cosf Rate: Development?Start Date: End Date: (rf yES, check box) trIuly 1,2021 May 31,2023National Initiative to Address COVID-I9 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and EthnicMinority Populations and Rural Communities.Totd Amount ofFederal FundsObligated for ThisFundins Source$300,000Amount ofFederalFunds Obligatedby This Action$300,000Name ofPass-ThroughAgencyWashington StateDepartment of HealthCFDA Program TitleCOVID-19 HealthDisparitiesCFDA#93.391Total Amount oftheFederal Award toDOH$29,015,581Federal Agency NamecDcFederalAward Date05/27t2021Federal AwardIdentification Number1NHT5OT000042-01Page 17 of27