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Exhibit A <br />Statement of Work <br />Contract Term: 2022-2024 <br />DOH Program Name or Title: <br />SOW Type: Original Revision # (for this SOW) <br />Period of Performa nce: Ianuary | " 2022 through June 30. 2022 <br />Local Health Jurisdiction Name: Kittitas counlv public Health Departrnent <br />Contract Number: CLH3 l0l5 <br />Type ofPayment <br />X Reimbursement <br />! Fixed Price <br />Federal Compliance <br />(check if applicable) <br />X prere (Transparency Act) <br />Research &Development <br />Funding Source <br />X Federal Subrecipient <br />n stut" <br />I oth.t <br />statement of work Purpose: The purpose of this statement of work is to contact with local health to conduct activities to improve immunization coverage rates. <br />Revision Purpose: N/A <br />** IMPORTANT: It is inherent on the LHJ to have awareness of their respective llll2}z2carry--forward balance(s) based on expenditures through l2/3ll202lfor continuingstatements of work' The funding for this 2022-2024 contract statement of work (sow) is to be determined (TBD) and cuoently shows ..None,, in the funding table - intended as aplaceholder only' The total allocation was obligated in the 2018-2021contract Sow and wilt be adjusted and added in the nexi 2022-20z4amendment cycle based on the actualamount of unspent funds after closeout of the contract ending l2/3llz0zl. <br />Total <br />Allocation <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />Allocation <br />Change <br />None <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />Current <br />Allocation <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />06130t22 <br />LHJ Funding Period <br />Start Date End Date <br />0t/01/22 <br />BARS <br />Revenue <br />Code <br />333.93.26 <br />Assistance <br />Listing <br />Number <br />93.268 <br />Master <br />Index <br />Code <br />743t0212 <br />DOH Chart of Accounts Master Index Title <br />FFY22 VFC <br />TOTALS <br />Payment Informafion <br />and/or Amount <br />Reimbursement for actual <br />costs incurred, not to <br />exceed total funding <br />consideration amount. <br />Reimbursement for actual <br />costs incurred, not to <br />exceed total flrnding <br />consideration amount. <br />Due Date/Time Frame <br />March 31 <br />June 30 <br />D eliverables/Outcomes <br />report describing the progress <br />made on reaching milestones for activities <br />identified in the plan (template will be <br />provided) <br />Written <br />Written report describing the progress <br />made on reaching milestones for activities <br />identified in the plan (template will be <br />Activity <br />coverage <br />commumtyby <br />contract1 <br />immunization <br />202 <br />submitted <br />rncreaseto <br />December <br />proposalsthe <br />July <br />ln <br />activities <br />'thefrom <br />ongomg <br />( <br />identifiedAS <br />Conduct <br />rates <br />partners <br />coverage <br />communityby <br />contract)I <br />immunization <br />202 <br />submitted <br />lncreaseto <br />December <br />proposalsthe <br />July <br />1n <br />activities <br />the <br />ongomg <br />(from <br />identifiedas <br />Conduct <br />rates <br />partners <br /># <br />Task <br />I <br />2 <br />Exhibit A, Statement of Work <br />Template September 202 I <br />Page I of2 Contract Number CLH3 1 015