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Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount 4. Photos of water system with text the Final Sanitary Survey Report within the 30 -day identifying features deadline. 5. Any other supporting documents. Late or incomplete reports may not be accepted for *Final Reports reviewed and accepted payment. by the ODW Regional Office. 2 Trained LHJ staff will conduct Special Provide completed SPI Report and Completed SPI Reports Upon acceptance of the completed SPI Report, the Purpose Investigations (SPI) of small any supporting documents and photos must be received by the LHJ shall be paid $800 for each SPI. community and non -community Group A to ODW Regional Office. ODW Regional Office water systems identified by the ODW within 2 working days Payment is inclusive of all associated costs such as Regional Office. of the service request. travel, lodging, per diem. See Special Instructions fortask activity. Payment is authorized upon receipt and acceptance of completed SPI Report within the 2 -working day deadline. Late or incomplete reports may not be accepted for payment. 3 Trained LHJ staff will provide direct Provide completed TA Report and any Completed TA Report Upon acceptance of the completed TA Report, the technical a ssistance(TA) to small supporting documents and photos to must be received by the LHJ shall be paid for each technical assistance community and non -community Group A ODW Regional Office. ODW Regional Office activity as follows: water systems identified by the ODW within 30 calendar • Up to 3 hours of work: $250 Regional Office. days of providing . 3-6 hours of work: $500 technical assistance. . More than 6 hours of work: $750 See Special Instructions fortask activity. Payment is inclusive of all associated costs such as consulting fee, travel, lodging, per diem. Payment is authorized upon receipt and acceptance of completed TA Report within the 30 -day deadline. Late or incomplete reports may not be accepted for payment. 4 LHJ staff performing the activities under For training attended in person, prior Annually For training attended in person, LHJ shall be paid tasks 1, 2 and attend periodic required to attendingthe training, submit an mileage, per diem, lodging, and registration costs as survey training as directed by DOH. "Authorization for Travel (Non- approved on the pre -authorization form in accordance Employee)" DOH Form 710-013 to with the current rates listed on the OFM Website See Special Instructions fortask activity. the ODW Program Contact for http://www.ofm.wa.,2ov/resources/travel.aW approval (to ensure enough funds are available). DOH Program and Fiscal Contact Information for all ConCon SOWS can be found on the DOH Finance SharePoint site. Questions related to this SOW, or any other finance -related inquiry, may be sent to financendoh.wa.gov. Exhibit A, Statement of Work Page 2 of 4 Contract NumberCLH31015 Template September2021