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EXHIBIT A-1, DOH CONTRACT GVL26649-I <br />Sub-recipient Statement of Work <br />KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT <br />Period of Performancefor 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 Perfonnance Reporting: <br />Subrecipient will submit a quarlerly progress <br />report using a template provided by DOH <br />rnanager. <br />Progress and Performance <br />reports are submitted in <br />accordance with CDC grant <br />requirements <br />Quarterly <br />6 Develop a plan for sustainability. <br />Sustainability plan includes but is not <br />lirnited to: <br />o Covid- 19 community recovery <br />strategiesr Emergency preparedness planning <br />Sustainability Plan in place <br />and shared DOH program <br />manager <br />12/3 1/2023 <br />Special Requirements: <br />This is a federally funded contract. All expenditures incurred and reimbursements made for performance under 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 referenced in; <br />2 CFR 200.313, Equipment at: https://www.gpo.gov/fdsys/granule/CFR-2014-title2-voll/CFR-2014- <br />title2-vol l-sec200-3 13, and <br />2 CFR 200.439, Equipment and other Capilal Expenditures at: <br />httos://www.sno.svs/eranule/CFR-20 I 4-title2-vol I /CFR-20 1 1 -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.. Additional backup documentation may be requested if needed. <br />Signed A-19 invoices must be received prior to approval and payment. A scanned copy of your A-19 with signature is <br />acceptable. Please email the signed A-l9s and backup documentation to: <br />Washington State Department of Health <br />ATTN: Eileen Kazura <br />Community Health Systems <br />PO Box 47850 <br />Olynpia, WA 98504-7850 <br />Ei leen. kazura@doh.wa. gov <br />DOH Anrendrn ent GYL26649 -| <br />Revision 04/2020 <br />Page 3 of4