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SOW Type: Revision Revision # (for this SOW) 2 <br />Period of Performance: Julv l. 2019 through June 30. 2021 <br />AMENDMENT #I8 <br />Exhibit A <br />Statement of Work <br />Contract Term: 2018-2021 <br />DOH Program Name or Title: Foundational Public Health Services <br />(FPHS) - Ellective July 1.2019 <br />Local Health Jurisdiction Name: Kittitas Countv public Health Department <br />Contract Number: CLHl8249 <br />Funding Source <br />! Federal <Select One> <br />X state <br />fl other <br />Federal Compliance <br />(check if applicable) <br />FFATA (Transparency Act) <br />Research & Development <br />Type of Payment <br />LJ Reimbursement <br />fi Periodic <br />Distribution <br />StatementofWorkPurpose: ThepurposeofthisstatementofworkistospecifyhowstatefundsforFoundationalpublicHealthServices(FpHS)willbeusedfortheperiodof <br />July 1, 201 9 through June 30, 2021. <br />Note: The total consideration is for the period ofJuly 1,2019 through June 30,2021. 2019-2021 biennial funding allocations will be divided into four six-month tumpsum amounts that will be disbursed at the beginning ofeach six month period as follows: July, 1,2019; January-I,2020; July l,2}2}iJanuary 1,2021. <br />FPHSfundsmustbespentinthestatefiscal year(SFY)inwhichtheyaretlisbursed: SFY2007/01il9-06/30/20andsFy21 07/01/20-0613012l- <br />2019-2021 Biennial Allocation: $200,000 <br />Annual Allocation: $100,000 <br />Six Month Disbursement: $50,000 <br />RevisionPurpose: ThepurposeofthisrevisionistoextendtheperiodofperfonnanceandfundingfromDecember3l,2020toJune30,202l. <br />Exhibit A, Staternents of Work <br />Revised as ofNovember 16,2020 <br />Page 3l of34 Contract Number CLH18249-I 8 <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 End Date <br />Current <br />Consideration <br />Change <br />None <br />Total <br />Consideration <br />FPHS FTINDINC FOR LHJS N/A 336.04.2s 99202101 07 ljt/19 06/30/20 100.000 0 100.000 <br />FOR LHJS N/A 336.04 2s 99202101 07/01t20 06/30/21 100,000 0 100.000 <br />TOTALS 200.000 0 200.000 <br />Task <br />Number Task/Activity/Description Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount <br />1 These funds are for delivering ANY or all ofthe FPHS <br />communicable disease, environmental public health or <br />assessment service and can also be used for any ofthe <br />other FPHS capabilities that support these FPHS as <br />defined in the most current version of FPHS Definitions. <br />Annual Report (template <br />provided by DOH) for <br />sFY20 (07101/19 - 06/30t20) <br />By 09/15/20 <br />Note: January 2021 <br />payment is dependent <br />on submission of this <br />annual report. <br />Funds are available beginning July l, 201 9. <br />Halfofthe annual allocation will be <br />disbursed each July upon receipt ofthe <br />Annual Report and the second halfwill be <br />disbursed each January.