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DOH ProgramName or Title: Emersencv Preparednr ;s. Resilience & Resoonse - <br />PHEP - Effective Janu ry 1.2022 <br />Period of Performance: January 1.2022 through June 3 J.2022 <br />Exhibit A <br />Statement of Work <br />Conhact Term: 2022:2024 <br />Local Health Jurisdiction Name: Kittitas Countv Public Health Department <br />Contract Number: CLH3 10 I 5 <br />SOW Type: Orieinal Revision # (for this SOW)Type of Payment <br />X Reimbunement <br />E Fixed Price <br />Federal Compliance <br />(check if appticable) <br />X nf'efn (Transparency Act) <br />I Research & Develooment <br />Funding Source <br />El Federal Subrecipient <br />E state <br />E othet <br />Statement of Work Purpose: The purpose of this stater ent of work is to establish funding and tasks to support and sustain LHJ public health emergency preparedness as part of <br />statewide public hea lth emergency preparedness, resilien c and response. <br />Revision Purpose: NA <br />DOH Chart of Accounts Masten Index Title <br />FFY21 PHEP BP3 LHJ <br />TOTALS <br />Acti 'itX <br />Across a <br />Complete repoding templates as requested by D( H to comply with program and federalgrant <br />requirem ents, in cludin g m id-yea r and end-of-ye r rep orts. <br />Across Domains and Capabilities <br />Exhibit A, Statement of Work <br />Template September202 I <br />Total <br />Allocation <br />29,492 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />29,492 <br />0 <br />29.492 <br />Allocation <br />Change <br />Increase (+) <br />29.492 <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 />0 <br />06/30122 <br />LHJ Funding Period <br />Start Date End Date <br />01/0U22 <br />BARS <br />Revenue <br />Code <br />333.93.06 <br />Assistance <br />T-isting <br />Number <br />93.069 <br />Master <br />Index <br />Code <br />3 I 102380 <br />4 <br />Task <br />I <br />2 <br />Payment <br />Information <br />and/or Amount <br />Reimbursement <br />for actualcosts <br />notto exceed <br />totalfunding <br />consideration <br />amount. <br />Due <br />Date/Time <br />Frame <br />June30,2022 <br />Within 30 <br />days ofthe <br />change. <br />Deliverables/Outco mes <br />End-of-yearreport on template <br />provided byDOH. <br />Additiona I reporting may be <br />required if federal requirernents <br />change. <br />Submit any changes to contact <br />information (submitted in 2 02 I ) <br />within 30 daysofthe change. <br />Page I of6 Contract Number CLH3 1 01 5