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AMENDMENT #23Exhibit A, Statements of WorkRevised as of September 15,2021PaymentInformation and/orAmountDue Date/Time FrameWithin 30 days ofcontract amendmentexecution.MonthlyDailyMonthlyDeliverables/Outcomesregional map ofsites/locations.Submit estimated budgetfor the mass vaccinationplan.Monthly Cost SummarySpreadsheet to theIMT/IMO by the fifth ofthe following month.Submission of vaccineuse into WA IIS databasewithin 24hrs of use.Jurisdiction/Regions willensure a fair and equitableprocess for registration ofeligible Washingtoniansacross all availablemodalities.Provide monthly situationreport to IMT/IMO onstatus of implementationof mass vaccination plan,or more frequently if thatis the LHJ procedure.Sites operating for thetime period, vaccinesadministered bv site for*May Support PHABStandards/lVleasuresTask/Activity/Descriptionregionally coordinate efforts. Local jurisdictions willmaintain all decisional authority around vaccinationplanning and execution within their jurisdictior/district.Provide any infonnation as requested by the regional IMTFunding for eligible Mass Vaccination activities arereimbursed on actual costs as outlined in the DOH guidanceto provide the services and to carry out the mission.Funding will be dependent on full participation in the LHJand IMT processes and all documentation will be requiredto be provided to frrlly close out funding requests by the endof the mission period of performance.Allowable costs include expenses such as facility rentals,staffto conduct planning, management, support andoperation ofthe site, medical personnel for vaccinations,site security personnel, wrap around services for staff(meals, travel, lodging), equipment (which must be pre-approved by IMT/DOH if it exceeds $5,000 each), suppliesfor vaccinations and site operation. LHJs should providenarratives to help assist IMT and DOH finance know whatexpenditures were necessary to carry out the mission.Vaccination data - will be maintained according to currentstate and federal requirements.Vaccine Registration Systems - If a local jurisdiction orregion does not have a registration system(s) the includeinternet based, phone option and other methods to ensureequitable registration, the state PrepMod system and toolswill be available for use.Regularly report on vaccinations sites and operationalactivities (number ofvaccinations, personnel to operate thesite, challenges, successes to share for learning across thepublic health system).TaskNumber4.84.C4.DPage l5 of39Contract Number CLHI 8249 -23