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DOH ProgramName or Title: Climate& HealthWildfire Smoke IndoorAir Ouality <br />Project - Effective January 1.2022 <br />Period of Performance : J anuary | . 2022 through Au$st 3 l. 2022 <br />Exhibit A <br />Statement of Work <br />Contract T erm: 2022-2024 <br />Local rrealth Jurisdiction Name: Kittitas county public Health Department <br />Contract Number: CLH3 1015 <br />SOW Type: Original Revision # (for rhis SOW)Type of Payment <br />El Reimbunement <br />I Fixed Price <br />Federal Compliance <br />(check if applicable) <br />El PPere (rransparency Act) <br />lJ Research & Development <br />Fundine Source <br />Elr"aJ*t Subrecipient <br />E stat" <br />I oth"t <br />Statement of Work Purpose: The pulpose of this statement <br />supplementa I grant "Strengthening environmentalhealth capa <br />approaches" initially awarded to DOH on September 1,2020. <br />of work provides KCPHD $21 ,00 to continue this work of the original grant. <br />residential cleaner air room project from the original grantwith improvements and incorporation of heat. This statement of work provides KCpHD $g3,000 to perform theseactivities of the supplementalgrantthatwasawardedtoDoH onsiptember 1,2021. <br />Revision Purpose: N/A <br />ofworkis two-fold andis being doneaspart ofthe Centerof Disease ContolandPrevention,s (CDC's) original andcity (EHC) to detect, prevent, and control environmentalhealth ha zards in through data-driven, evidence-based <br />Total <br />Allocation <br />0 <br />0 <br />0 <br />0 <br />0I <br />Allocation <br />Change <br />Increase (+) <br />21 <br />0 <br />0010 <br />Current <br />Allocation <br />0 <br />0 <br />0 <br />0 <br />0 <br />LIIJ Funding Period <br />Sfart Date End Date <br />t/0r/22 <br />1/22 <br />BARS <br />Revenue <br />Code <br />333.9 <br />333.93 <br />Assistance <br />Listing <br />Number <br />Master <br />Index <br />Code <br />100 <br />0222 <br />NCE <br />DOH Chart of Accounts Master Index Tifle <br />O ENIVIRO CAP <br />CDC EHC <br />TOTALS <br />Payment Information <br />and/or Amount <br />Reimbursement for actual <br />costs not to exceed <br />$21,000 on Master Index <br />Code 25440 I 00. <br />Due Date/Time Frame <br />August 31,2022 <br />Deliverables/Outcomes <br />LHJ presents selected long-term care <br />facitty (2) and school (2) <br />A written protocol for conducting <br />consultation in larger facilities <br />Activity <br />Collaborate with DOH to identify larger facilities for indoor air <br />quality consultation pilot within the selected target vulnerable <br />population to include: <br />Task <br /># <br />I <br />Exhibit A, Statement of Work Page 1 of5 ContractNurfr berCLH3 I 0 I 5