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Exhibit A <br />Statement of Work <br />Contract Term: 2022-2024 <br />DOH Program Name or Title: Foundation Pnhlic_fiealth ServicesfFPHS) - <br />Local Health Jurisdiction Name: Kitt i s County. nt <br />Public Health Mpadment <br />Effec'Ye_July 1,2023 <br />Contract Number: CLH31015 <br />SOW Type: Revision Revision 9 (for this SOW) 2 <br />Funding Source <br />Federal Compliance <br />Type of Payment <br />❑ Federal <Select One> <br />(check if applicable) <br />❑ Reimbursement <br />Period of Performance: July 1, 2023 through �rrr�303 202? <br />® State <br />❑ Other <br />ElFFATA (Transparency Act) <br />® Periodic Distribution <br />n Research & DevelODment <br />Statement of Work Purpose: Per RCW 43.70,512, Foundational Public Health Services (FPHS) funds are for the governmental public health system: local health jurisdictions <br />Department of Health, state Board of Health, sovereign tribal nations and Indian health programs. These funds are to build the systJm's capacity and increase the availability of <br />FPHS services statewide. <br />Revision Purpose: Correcting BARS expenditure code typo and updating Master Index Code Chart of Accounts Title to match the title in the new 2025 biennium chart of <br />accounts. <br />DOH Chart of Accounts Master Index Title <br />Master <br />Index <br />Code <br />Assistance <br />Listing <br />Number <br />BARS <br />Revenue <br />Code <br />LHJ Funding Period <br />Start Date End Date <br />Current <br />Allocation <br />Allocation <br />Change <br />None <br />Total <br />Allocation <br />SFY24 FPHS-LHJ FUNDS-GFS <br />99210840 <br />N/A <br />336.04.25 <br />07/01/23 <br />06/30/24 <br />1,783,000 <br />0 <br />1,783,000 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0. <br />TOTALS <br />1,783 000 <br />0 <br />1 783 000 <br />Task <br />Payment <br /># <br />Activity <br />Deliverables/Outcomes <br />Due Date/Time Frame <br />Information and/or <br />Amount <br />FPHS funds to each LHJ — See below in Pmgmm Specific <br />See below in Program Speegiftc <br />See below in Proeram <br />1 <br />Ltt lil.iremcnts — Activity Special Tnstructinnr for details <br />R i -m •nta - v !es <br />SpecitcReouirements- <br />$575,000 <br />Deliveables <br />2 <br />Assessment Reinforcing Capacity— See below in Program Sxcific <br />See below in I�tpgram Sprcifie <br />See bebw in Program <br />SMcifi:Requrrerrients- <br />Requirements — Ac:tLyilySneciallnstructiotisfordetails <br />e m <br />Oyu re eq[��jwerahles <br />$60,000 <br />Deliverables <br />3 <br />Assessment — CHA/CHIP — See below in Program Specific <br />P P <br />See below in Pr Sp <br />See below in Pr ,ram <br />Requirements —Activity Special I nstructiaas for details <br />Deliverables <br />es <br />Requirements -Deliverables <br />Snccifi-:Requirements- <br />$30,000 <br />Deliverables <br />Exhibit A, Statement of Work Page 1 of 5 Contract Number CLH31015-Amendment 17 <br />