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Task <br />Due <br />Payment <br /># <br />Activity <br />Deliverables/Outcomes <br />Date/Time <br />Information <br />Frame <br />and/or Amount <br />2.1 Submit names, position titles, email addresses and phone numbers of key LHJ staff <br />End-of-yearreport on template <br />responsible for this statement of work, including management, Emergency Response <br />provided by DOH. Note any <br />June 30, 2022 <br />Coordinator, and accounting and/or financial staff. <br />changes or no change. <br />2.2 Submit emergency contacts to be published in the confidentialYellow Book, including but <br />not limited to Administrator, Health Officer, and Emergency Response Coordinator. For each <br />contact include name, role, email, daytime phone number and after-hours phone number. <br />3 <br />Across Domains and Capabilities <br />DOH will maintain <br />Upon request <br />documentation of site visit <br />from DOH. <br />Participate in a site visit with DOH staff to discuss LHJ response capabilities, upon request from <br />participation. <br />DOH. Site visit may be held virtually due to pandernic restrictions. <br />4 <br />Across Domains and Capabilities <br />Budget, using template provided <br />Upon request <br />by DOH. <br />from DOH. <br />Develop a budget demonstratinghow the LHJ plans to spend funds during this period of <br />performance, using a budget template provided by DOH. <br />Note: 20% of the LHJ's annual allocation will be withheld until this requirement is met. Failure <br />to meet this requirement may result in DOH redirecting funds from the LHJ. <br />5 <br />Across Domains and Capabilities <br />End-of-yearreport on template <br />June 30, 2022 <br />provided by DOH. <br />Review and provide input to DOH on public health emergency preparedness plans developed by <br />DOH, upon request from DOH. <br />Input provided to DOH upon <br />request from DOH. <br />6 <br />Domain 1 Community Resilience <br />End-of-yearreport on template <br />June 30, 2022 <br />Capability 1 Community Preparedness <br />provided by DOH. <br />Participate in emergency preparedness events (for example, tra inings, meetings, conference <br />Documentation of training <br />calls, and conferences) to advance LHJ, regional, or statewide public health preparedness. <br />available upon request. <br />7 <br />Across Domains and Capabilities <br />End-of-yearreport on template <br />June 30, 2022 <br />provided by DOH. Note training <br />DOH/EPR anticipates many changes in the next months to years as we incorporate lessons <br />and briefly describe key learning <br />learned from the COVID-19 response. In preparation forthese changes, the LHJ may use PHEP <br />and any resulting changes in <br />funding to participate in training and/orleaming discussions in the following areas: <br />practice and/orpolicy. <br />• Adaptive Leadership <br />• Change Management <br />• Trauma -Informed Change Management <br />• Outward Mindset <br />• Growth Mindset <br />• RacialEquity and/orSocial Justice <br />• Community Resilience <br />• Related topics — prior approval from EPR required. <br />Exhibit A, Statement of Work Page 2 of 6 Contract NumberCLH31015 <br />Template September2021 <br />