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Exhibit A <br />Statement of Work <br />Contract Term: 2022-2024 <br />DOH Program Name or Title: Emergency Preparedness. Resilience & Response - <br />PHEP - Effective January 1, 2022 <br />SOW Type: On�alal Revision # (for this SOW) <br />Period of Performance: January 1 202 through June 30, 2022 <br />Local Health Jurisdiction Name: Kittitas County Public Health Department <br />Contract Number: CLH31015 <br />Funding Source Federal Compliance Type of Payment <br />® Federal Subrecipient (check if applicable) ® Reimbursement <br />❑ State 0 FFATA (Transparency Act) ❑ Fixed Price <br />❑ Other ❑ Research & Development <br />Statement of Work Purpose: The purpose of this statement of work is to establish funding and tasks to supportand sustain LHJ public health emergency preparedness as partof <br />statewide public health emergency preparedness, resilience and response. <br />Revision Purpose: NA <br />Master <br />Index <br />DOH Chart of Accounts Master Index Title Code <br />Assistance <br />Listing <br />Number <br />BARS <br />Revenue <br />Code <br />LHJ Funding Period <br />Start Date End Date <br />Current <br />Allocation <br />Allocation <br />Chan e <br />g <br />Increase (+) <br />Total <br />Allocation <br />FFY21 PHEP BP3 LHJ Funding 31102380 <br />93.069 <br />333.93.06 <br />01/01/22 06/30/22 <br />0 <br />29,492 <br />29,492 <br />for actual costs <br />Complete reporting templates as requested by DOH to comply with program and federa Igra nt <br />0 <br />0 <br />0 <br />requirements, including mid -year and end -of -year reports. <br />Additional reporting maybe <br />totalfunding <br />0 <br />0 <br />0 <br />consideration <br />0 <br />0 <br />0 <br />2 <br />Across Domains and Capabilities <br />Submit any changes to contact <br />Within 30 <br />0 <br />0 <br />0 <br />days of the <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />TOTALS <br />0 <br />1 29,492 <br />1 29,492 <br />Task <br /># <br />Activity <br />Deliverables/Outcomes <br />Due <br />Date/Time <br />Frame <br />Payment <br />Information <br />and/or Amount <br />1 <br />Across Domains and Capabilities <br />End-of-yearreport on template <br />June 30, 2022 <br />Reimbursement <br />provided by DOH. <br />for actual costs <br />Complete reporting templates as requested by DOH to comply with program and federa Igra nt <br />not to exceed <br />requirements, including mid -year and end -of -year reports. <br />Additional reporting maybe <br />totalfunding <br />required if federal requirements <br />consideration <br />change. <br />amount. <br />2 <br />Across Domains and Capabilities <br />Submit any changes to contact <br />Within 30 <br />information (submitted in 202 1) <br />days of the <br />within 30 days of the change. <br />change. <br />Exhibit A, Statement of Work Page 1 of 6 Contract NumberCLH31015 <br />Template September2021 <br />