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DOH Program Name or Title: Climate & Health Wildfire Smoke Indoor Air OualityPilot Study - Effective September 1.2020SOW Type: Revision Revision # (for this SOW) 2Period of Performance: September 1. 2020 through December 3 I . 202 IAMENDMENT #23Exhibit AStatement of WorkContract Term: 2018-2021Local Health Jurisdiction Name: Kittitas countv public Health DepartnentContract Number: CLHI8249Type ofPaymentX Reimbursementn Fixed PriceFederal Compliance(check if applicable)FFATA (Transparency Act)Research & DevelopmentFunding Source[l Federal Subrecipientn stut"f]o*rerStatement of work Purpose: The purpose of this statement of work is to respond to declared wildfire disasters in washington state by identiffing the most vulnerableareas where indoor air quality needs improvement. This pilot study will be done as part of the centeiof Disease contof and irevention's grant..strengthening environmentalDOH on September 1,2020.Kittitas county Public Health Department (KCPTID) will support the DoH led wildfre Smoke Indoor Air euality pilot Study, as Kittitas county was the selected study area. Thisstatement of work provides KCPHD $90,000 to perform community outreach and implement.Revision Purpose: The purpose of tJds revision is to extend the period of performance and funding from Novemb er 30, 2021to December 31, 2021 ,change the MI code, updateactivities, decrease firndiog consideration, and extend due dates to match eitension of project timeline through 2021.Exhibit d Statements of WorkRevised as of Septemb er 15, 202I(-)Change-21-21CurrentConsiderationlll11l2l3U21Start Date EndFunding Period(LHJ Use Only)09/01/20MasterIndexCode25440100BARSRevenueCode333.93.07CFDA #93.070of Accounts Program Name or TitleNCEACITY-CFFY2O ENVIRHEALTH CAPTOTALSPaymentInformation and/orAmountReimbursement foractual costs not toexceed $42,000Due Date/TimeFramew@+December 31.2021Deliverables/Outcomes*LHJ presents to DOH communityhealth and disparity status andgeneral prioritiesLHJ presents to DOH selection ofpriority at-risk target populationfor pilot project and criteria forparticipant eligibility of based onneed*May Support PHABStandards/lVleasuresTask/ActivityiDescriptionCollaborate with DOH to identi$r individuals andtheir location ofresidence for residential pilotintervention within the selected target vulnerablepopulafion to include:. Identi&ing vulnerable population based onhealth risk and county needr Establishing selection criteria for participationr Identi&ing target individuals for interventionand enrolling participants in residential pilotTaskNumberIPage 3 of39Contract Numb er CLHI 8249 -23