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WSDOH Contract Amendment
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2023-06-20 10:00 AM - Commissioners' Agenda
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WSDOH Contract Amendment
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Last modified
6/28/2023 10:33:57 AM
Creation date
6/28/2023 10:33:52 AM
Metadata
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Template:
Meeting
Date
6/20/2023
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Fully Executed Version
Supplemental fields
Item
Request to Approve Amendment No. 2 to the Rural Health Equity Grant
Order
11
Placement
Consent Agenda
Row ID
104780
Type
Agreement
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EXHIBIT A-2, DOH CONTRACT GVL26649-2 <br />Sub-recipient Statement of Work <br />KITTITAS COUNTY PUBLIC HBALTH DEPARTMENT <br />Period of Performance for this Amendment; <br />Date of Execution through May 3l , 2024 <br />5 Progress and Perforrnance Reporting: <br />Subrecipient will subrnit a quarlerly progress <br />report using a template provided by DOH <br />Progress and Perfonnance <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 />limited to: <br />. Covid-19 community recovery <br />strategies <br />o Emergency preparedness planning <br />Sustainability Plan in place <br />and shared DOH program <br />rnanager <br />12/31/2024 <br />SDecial 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 equiprnent (including shipping, handling and associated costs) is $5,00b or,r',ore, the contractor shall <br />obtain written prior approval from the Washington State Deparlment of Health, and adhere to all federal requirements <br />as referenced in; <br />2 CFR 200.313, Equipment at: https://www.gpo.gov/fdsys/eranule/CFR-2014-title2-vollICFR-2014- <br />title2-vol 1 -sec200-3 I 3, arid <br />2 CFR 200,439, Equipment and other Capital Expenditares at: <br />4-tiIle2- <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 lirnited to; receipts, invoices, billing records, work orders, positive time, and attendance records (timesheets), <br />travel vouchers and accounting expense reports.. Additional backup docurnentation llay be requested if needed. <br />Signed A-19 invoices mltst 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 Deparlment of Health <br />ATTN: Eileen Kazura <br />Community Health Systems <br />PO Box 47850 <br />Olympia, WA 98504-7850 <br />Ei I een. k azura(@doh.wa. gov <br />DOH Anendnr ent GY L26649 -2 <br />Revision 04/2020 <br />Page 3 of 4
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