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EXHIBIT A-1,DOH CONTRACT GVL26649-1 <br />Sub-recipient Statement of Work <br />KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT <br />Period of Performance for this Amendment: <br />Date of Execution through December 31,2023 <br />underserved populations <br />disproportionately impacted by <br />Covid-19 and health disparities <br />5 Progress and Performance Reporting:Progress and Performance Quarterly <br />Subrecipient will submit a quarterly progress reports are submitted in <br />report using a template provided by DOH accordance with CDC grant <br />manager.requirements <br />6 Develop a plan for sustainability·12/31/2023 <br />Sustainability plan includes but is not Sustainability Plan in place <br />limited to:and shared DOH program <br />•Covid-19 community recovery manager <br />strategies <br />•Emergency preparedness planning <br />Special Requirements: <br />This is a federally funded contract.All expenditures incurred and reimbursements made for performanceunder this <br />contract shall be based on actual,allowable,and allocable costs.See Exhibit C for further detail. <br />For activities that require the purchase of equipment:For purchases of pieces of equipment in which the aggregate <br />unit price of the equipment (including shipping,handling and associated costs)is $5,000 or more,the contractor shall <br />obtain written prior approval from the Washington State Department of Health,and adhere to all federal requirements <br />as referencedin; <br />2 CFR 200.313,Equipment at:https://www.epo.gov/fdsys/granule/CFR-2014-title2-vol l/CFR-20 14- <br />title2-voll-sec200-313 ,and <br />2 CFR 200.439,Equipment and other Capital Expenditures at: <br />https://www.epo.gov/fdsys/granule/CFR-2014-title2-voll/CFR-2014-title2-voll-sec200-439 <br />Invoicing must include backup documentation as described in the statement of work deliverables: <br />Billings/invoices shall include copies of backup documentation for all expenses.Backup documentation can include, <br />but is not limited to;receipts,invoices,billing records,work orders,positive time,and attendance records (timesheets), <br />travel vouchers and accounting expense reports. <br />•Additional backup documentation may be requested if needed. <br />Signed A-19 invoices must be receivedprior to approvaland payment.A scanned copy of your A-19 with signature is <br />acceptable.Please email the signed A-19s and backup documentation to: <br />Washington State Departmentof Health <br />ATTN:Eileen Kazura <br />Community Health Systems <br />PO Box 47850 <br />Olympia,WA 98504-7850 <br />Eileen.kazura@doh.wa.cov <br />DOH Amendment GVL26649-1 Page 3 of 4 <br />Revision 04/2020