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AMENDMENT#I8 <br />Exhibit A <br />Statement of Work <br />Contract Term: 2Ol8-2O21 <br />DOH Program Name or Title: Division of Emersency preparedness & Response_ <br />COVID-19 - Effective January 20. 2020 <br />Local llealth Jurisdiction Name: Kittitas County public Health Department <br />Contract Number: CLHI 8249 <br />SOW Type: Revision Revision # (for this SOW) I xX <br />Funding Source <br />tr <br />Federal Subrecipient <br />State <br />Other <br />Federal Compliance <br />(check if applicable) <br />Xfl FFATA (Transparency Act) <br />Research & Develonment <br />Type ofPayment <br />X Reimbursement <br />X One-Time <br />Distribution <br />Period of Performance: January 20. 2020 through June 30, 2021 <br />StatementofWorkPurpose: ThepurposeofthisstatementofworkistoestablishfundingandtasksforLHJstoprevent,preparefor,andrespondtotheCOVID-lgdisease <br />outbreak. <br />Revision Purpose: The purpose ofthis revision is to extend the period ofperformance from December 31,2020 to June 30,2021 andextend funding periods and add reportdeliverable due dates for 2021. <br />A, Statements of Work Page 16 Number CLHI 8249- I 8 <br />Revised as ofNovember 16,2020 <br />Chart of Accounts Program Name or Title CFDA #BARS <br />Revenue <br />Code <br />Master <br />Index <br />Code <br />Funding Period <br />(LHJ Use Only) <br />Start Date f,,nd Date <br />Current <br />Consideration <br />Change <br />None <br />total <br />Consideration <br />FFY20 CDC COVID-19 Crisis Resp LHJ-Tribe 93.354 333.93.35 31104102 0t/20t20 $/tsu 78.s22 0 78.522FY20i2 I COVID-l 9 Disaster Response N/A 334.04.92 934A01 0r ot/20/20 06130121 71,478 0 71.478 <br />ALS 150.000 0 150.000 <br />Task <br />Number Task/Activity/Description *May Support PIIAB <br />Standards/Measures Deliverables/Outcomes Due Date/Time <br />Frame <br />Payment Information <br />and/or Amount <br />Federal Funds <br />Participate in public health emergency preparedness <br />and response activities for COVID-19. This rnay <br />include surveillance, epidemiology, laboratory <br />capacity, infection control, mitigation, <br />communications, and or other preparedness and <br />response activities for COVID-19. <br />Activities tnust address one or more ofthe following <br />six domains: <br />o Incident management for early crisis <br />response <br />a Jurisdictional recovery <br />Information management <br />Countermeasures and mitigation <br />Activity report(s) on template <br />to be provided DOH. <br />June 30, 2020 <br />December 3 l, 2020 <br />Mcrch 15,2021 <br />Frequency and due <br />dates ofreports may <br />change based on <br />federal requirements. <br />DOH will notiS/ LHJ <br />ofany changes via <br />email. <br />A final activity report <br />is required prior to <br />DOH releasing the <br />Reimbursement for actual <br />costs not to exceed total <br />funding consideration <br />amount <br />Note: Per Federal <br />funding requirements, <br />prior approval frorn <br />DOH is required for <br />reimbursement of <br />expenses incurred on or <br />after January 20,2O2O <br />through March 4,2020.