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EXHIBIT A-1, DOH CONTRACT GVL26649-ISub-recipient Statement of WorkKITTITAS COUNTY PUBLIC HEALTH DEPARTMENTPeriod of Performance for this Amendment:Date of Execution through December 31, 2023Certifications and Assurances - all requirements imposed on the subrecipient by the federal awarding agency:The contract boilerplate covers all standard certifications and assurances.Are there any additional requirements imposed by the pass-through entity (DOH) to meet its own responsibilities to the awarding agency Yes E No X:If applicable, this is identified by the DOH program staff writing the contract. This can also be found in the "statement of Work" section ofthe contract.All subrecipients are required to make their accounting records available and accessible to the awarding agency.You can find this requirement in the "Records Maintenance" section of the contract.Closeout Requirements:(1) Submit all final billings within 60 days of the end ofthe contract (This is required per standard contract language)(2) Submit all required program reports and deliverables within 60 days (This is required per standard contract language)(3) Dispose of property purchased with subaward funds and dispose of or retum government-fumished property no longer used for subaward related activities(If applicable DOH must be contacted for disposal requirements)(4) Additional DOH program specific contract closeout requirements: (lf applicable, see SOW for additional closeout requirements)DOH Amendm ent GVL26649 -lRevision 04/2020This table includes only active funding sources.Federal Grant Information SheetKittitas County Health Dept26649DOH Contract Manager:Eileen KazuraApproved Indirect Rate: yes X No nWQ23XPBSAU44 Contact Information: Limiting Indirect Cost Rate? yes n No XStart Date: End Date: dohcon.mgmt@doh.wa.gov Research and Development? yes n No X3t1st202r 12/31/2023National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and EthnicMinority Populations and Rural Communities.Total Amount of FederalFunds Obligated for ThisFundins Source$300,000Amount of FederalFunds Obligated byThis Artion$300,000Name of Pass-Through AgencyWashingtonState DepartmentolHealthCFDA ProgramTitleCovid l9 HealthDisparitiesCFDA No.93.391Total Amountoff the FederalAward to DOH$29,0 1 5,58 rFederal AgencyNameCDCFederalAward Date5/21n021Subrecipient/Contractor:Contract No.UEI No.Period ofPerformance:Project Description:Federal Award ldentificationNumber1NH750T000042-0 lPage 4 of 4