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Exhibit AStatement of WorkContract T erm: 2022-2024DOH ProgramName or Title:Effective Januarv 1. 2022SOW Type: Original Revision # (for this SOW)Period of Performance: January 1.2022 through September30. 2022Statement of work Purpose: The purpose of this statement of work (Sow)Block Grant.Revision Purpose: N/AExhibit A, Statement of WorkTemplate Created Septemb er202lLocal Health Jurisdiction Name: Kittitas countv public Health DeoartmentConfract Number: CLH3 l0t5Type of PavmentEl ReimbunementE rixed PriceFederal Compliance(check if applicable)El rFnrn (Transparency Act)IJ Research & DeveloomentFunding SourceEl f"aJrt SubrecipientE stut.E oth"tis to support local interyentions that impact the target population of the Matemaland Child HealthTotalAllocation14730007ChangeIncrease (+)14700CurrentAllocation0009t3LHJ Funding PeriodStart Date End DateBARSRevenueCode93.99AssistanceListingNumber93.994MasterIndexCodeDOH Chart of Accounb Master Index TifleFFY22Information and/orPaymentAmountReimbursement for actual costs,not to exceed totalfundingconsideration. Action PIan andProgress Reports must only reflectactivities paid for with fundsprovided in this statement of workfor the specified funding period.See Program SpecificRequirements and Special BillingDue Date/Time tr'rameMay27,2022September9,2022Deliverables/Outco mesSubmit actua I expenditures using theMCHBGBudget Workbook to DOHcontractMCHBG Budget Workbook toDOH contractmanagerSubmitActivityReport actualOctober l, 20expenditures forthe six-month period2 I through March 3 l, 20222022 -2023 MCHB G Budger Workbook forOctober 1,2022 through September 30, 2023 using DOHprovided template.DevelopTask#AdminishationGrantBlockHealthchitdandternalMalalbImplementationPage I of3Contract NumberCLH3 I 0 I 5