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SOW Type: Original Revision # (for this SO$ <br />' <br />Period of Performan cel. lztryWJ$22 through June li0. 2024 <br />Statement of work purpose: The purpose of this statt :nent of work (Sow) is to provide funding to conduct CovID-l9 vaccine activities' <br />Revision Purpose: N/A <br />DOH Chart of Accounts Master Index Title <br />COVID19 <br />TOTALS <br />Activity <br />DOH ProgramName or Title: office oflmmunizati ncouD-l9 Vaccine - <br />Effective January 1.2 122 <br />Local Ilealth Jurisdiction Na me : Kittita s Countv Pub Lic Hea lth Deo artme nt <br />Contract Number: CLH31015 <br />Exhibit A <br />Statement of Work <br />Contract T erm: 2O22-2024 <br />Identify a ctivity/activities to supp o rt COVID a c c ine re sp onse <br />in youicommunity,using the examplesbelov as a guideline. <br />Example 1: Develop and implement commul ication strategies <br />with health care providers, community, and/c otherpartnen to <br />help build vaccine confidence broadlyand au onggroups <br />anticipated to receive early vaccination, as we il as dispel <br />vaccine misinformation. Document and provi .e a plan that <br />shows the communication strategies used witl health care <br />providers and other p artners and the loca lly id :rntified <br />population anticipated to reach. <br />Example 2: Engage in other vaccination plar <br />such ai partnership development, provider ed <br />ringactivities <br />lcation, <br />vaccination int of <br />Type of Payment <br />EI Reimbursement <br />! rixed Price <br />Federal Compliance <br />(check if applicable) <br />X ffefe (Iransparency Act) <br />n Research & Development <br />Funding Source <br />E Federal Subrecipientn state! other <br />0 <br />0 <br />0 <br />0 <br />0 <br />359,803 <br />Total <br />Allocation <br />3 59,803 <br />0 <br />0 <br />0 <br />0 <br />0 <br />3s9"803 <br />Allocation <br />Change <br />Increase (+) <br />359,8030 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />Current <br />Allocation <br />06130124 <br />LI{J Fund ing Period <br />Start Date End Date <br />01/01/22 <br />BARS <br />Revenue <br />Code <br />333.93.2693.268 <br />Assistance <br />Listing <br />Number <br />Master <br />Index <br />Code <br />74310230 <br />Task <br /># <br />3.A <br />Payment Information <br />and/or Amount <br />Reimbursement for actual <br />costs incurred, not to <br />exceed totalfunding <br />consideration amount. <br />Due Date/Time Frame <br />January 3l,AnnuallySummary of the engagement strategies to <br />be used with health care providers and <br />other partners, and the lo cally identified <br />population to be reached. <br />Deliverables/Outcome s <br />Exhibit A. Statement of Work Page I of3 ContractNumber CLH3 I 0 I 5