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Exhibif A <br />Statement of Work <br />Contract T erm: 2022-2024 <br />DOII ProgramName or Tifle COWD-I9 MassVac rination-FEMA - <br />Effective Januarv 1.2 l22 <br />Local Health Jurisdiction Name: Kittitas County Public Health Department <br />Contract Number: CLH3 1 015 <br />SOW Type: Original Revision # (for this SOV ) <br />Type of Payment <br />X Reimbursement <br />I Fi*"d Ptice <br />Federal Compliance <br />(check if applicable) <br />X nnnfe ffransparencyAct)! Research & Development <br />Funding Source <br />El Federal Contractor <br />I state <br />! oth.tPeriod of Performan ce; January l.2022through Apri l' 2022 <br />mass vaccination clinics in Washington state <br />Revision Purpose: N/A <br />DOII Chart of Accounts Master Index Title <br />l0IYo <br />OT <br />Activity <br />Task r Mass ,n in this <br />statement ofwork are NOT CONSIDEREI <br />SUBRECIPIENT but are as a CONTRAC] OR of DOH' <br />DOH reimbursement provided forlocalm: rss vaccination <br />clinic (see definition below) planning, impl mentation and <br />operations in coordination between Unifier Command and <br />the Regional Incident Management Team t IMT) to <br />adminilster the vaccine efficienfly, quickly, rquitably, and <br />safelyin all regions of Washington State. I i:ate Supported, <br />Regionally Coordinated" Locally Implemer ted. <br />Definition: Mass vaccination clinics defined i s those outside of <br />the usualhealthcare delivery. method such as pop-up clinics, <br />mobile c non- clinical <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />Total <br />Allocation <br />0 <br />0 <br />0 <br />0 <br />0 <br />Allocation <br />Change <br />None <br />0 <br />0 <br />0 <br />Current <br />Allocation <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />a4t0Ll220I/01/22 <br />LIIJ Fund ing Period <br />Start Date End Date <br />333.91 .03 <br />BARS <br />Revenue <br />Code <br />97.036 <br />Assistance <br />Listing <br />Number <br />Master <br />Index <br />Code <br />934V0200 <br /># <br />Task <br />I <br />Payment Information <br />and/or Amount <br />*Reimbursement of <br />eligible costs. <br />MASS VACCINATION <br />FEMA 100% Funding <br />(Mr 934V0200) <br />(See Program Specific <br />Requirements below) <br />Due Date/Time FrameDeliverables/Outcomes <br />Exhibit A, Statement of Work <br />etc <br />Page I of4 Contract Number CLH3 10 1 5