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Exhibit A <br />Statement of Work <br />Contract T erm: 2022-2024 <br />Local Health Jurisdiction Name Kittita s Countv Public Health Department <br />Contract Number: CLH3 l0 15 <br />SOW Type: Original Revision # (for this SOW)Type of Payment <br />E Reimbursement <br />E Fixed Price <br />Federal Compliance <br />(check if applicable) <br />El Prere (Transparency Act) <br />Ll Research & Development <br />Fundine Source <br />ElE"aJrr Subrecipient <br />E state <br />t]othe. <br />Statement of \ilork Purpose: The purpose of this statement <br />State Physical Activity andNutririon program (SPAN). <br />of work is to establish funding for Local Strategies for Physical Activity and Nutrition (LSPAN), a project of the <br />Revision Purpose: N/A <br />DoH ProgramName or Tifle: LSpAN-Locar Strategies forphysicalActivity & <br />Nutrition - Effective Januarv 1.2022 <br />Period of Performa nce: I anuaw l -2022 through Seotember 29. 2022 <br />Exhibit A, Statement of Work <br />Template Created Septe mber 2021 <br />Total <br />Allocation <br />03 <br />0 <br />0 <br />0 <br />0 <br />0 <br />00 <br />Allocation <br />Change <br />Increase (+) <br />34 <br />0 <br />0 <br />0 <br />0 <br />0 <br />3 <br />Current <br />Allocation <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />LHJ Funding Period <br />Start Date End Date <br />0L/01/22 <br />BARS <br />Revenue <br />Code <br />333.93.43 <br />Assistance <br />Listing <br />Number <br />93.43 <br />Illlaster <br />Index <br />Code <br />440241 <br />DOH Chart of Accounb Master Index Title <br />FFY2I PHYS ACTVTY NUTRITION <br />TOTALS <br />Payment Information <br />and,/or Amount <br />Reimbursement for <br />actualcosts, notto <br />exceed totalcontract <br />funding. See Program <br />Specific Requirements <br />Reimbursement for <br />actualcosts, notto <br />exceed totalcontract <br />funding. See Program <br />Specific Requiements <br />Due Date/Time Frame <br />January 1,2022 - September 29 ,2U22 <br />January - Septem 2022 <br />Deliverables/Outcomes <br />Desigrated KCPHD <br />staff will participate in <br />contract management <br />calls. <br />Designated KCPHD <br />sta ff will participate in <br />calls, webinars, and <br />meetings. <br />Activity <br />STRA <br />Participate in calls, at a minimum of <br />once everymonth,with DOH contract <br />manager. Dates andtime for calls are <br />mutually agreed upon between DOH <br />and Kittitas County Public Health <br />ent <br />TION: <br />Particip ate in DOH-sponsored LSPAN <br />related quarterly conference calls <br />andlorwebinars, including up to one <br />Task <br /># <br />I <br />Page I of3 ContractNumberCLH3 I 0 I 5