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Kittitas County
Review Form 77
Grants & Contract Agreement
Today's Date Agenda Date
08/12/2009
Fund/Department
116-Pulbic Health Department
Contract/Grant Information
Contract /Grant Agency: 2007-2011 Consolidated Contract Amendment #18
Period Begin Date:2007
IPeriod
End Date:2011
Total Grant/Contract Amount: Increase of $62,942.00 for a revised maximum of $1,614,321.00
Grant/Contract Number: C14952
Contract/Grant Summary:
The Consolidated Contract Amendment #18 is amended as follows:
Adds a Statements of Work for the following programs:
• HCCW Child Care Health Consultations—effective July 1,2009
Amends Statements of Work for the following programs:
• Nutrition and Physical Activity (Obesity)- effective July 1,2008
• Office of Drinking Water Group A Program- Effective January 1, 2007
• Public Health Emergency Preparedness and Response (PHEPR)- effective August 9,2008
Exhibit B-18 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-17
Allocations as follows:
• Increase of $62,942 for a revised maximum consideration of $1,614,321.00
Recommendation for Board of Health and Board of Health Review on
Department Head Signature: Administrator Date:
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APPROVED AS TO FORM:
:24-
SigMfture of Prosecutor's Office Date
tO-b Del (K -
Signature of Auditor's Office Date
Signature of Board of Health member Date
Grant/Contract Review Page 1
Financial Information
Total Amount $62,942.00
State Funds $5,000 (GFS)
$250 (Grp A Water)
Federal Funds $12,692 (HCCW)
$45,000 (Shape Up)
Percentage County Funds
Matching Funds $
CFDA# 93.575 (HCCW)
93.283 (Shape Up)
In -Kind $
Explain
Is Equipment being purchased? No
Who owns equipment?
New Personnel being hired? No
Contact HR hiring—reporting requirements
Future impacts or liability to Kittitas County:
Budget Information
Budget Amendment Needed?
Yes ❑ attach budget form
No ❑x Why not These Funds were anticipated
during the 2009 budget process
New Division Created?
Revenue Code 61292433395750 (HCCW)
6123633404910 (GFS), 6123633392830 (Shape Up),
61502233404980 (Grp A Water)
Date:
Pass Through Information
Agency to Pass Through
n/a
Amount to Pass Through
$
Sub -Contract Approved
Date:
Prosecutor Review
Has the Prosecutor reviewed this agreement? Yes El No ❑
County Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor I ITreasurer
Submitted
Signature: Date:
Department:
Assignment of Tracking Information
Auditor's Office
Grant/Contract Review Page 2
Human Resource
Prosecutor's Office
Who Signed the grant application
Reviewer I Date
Grant/Contract Review Page 3
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2007-2011 CONSOLIDATED CONTRACT
CONTRACT NUMBER: C14952 AMENDMENT NUMBER: 18
PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as
"DOH", and KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT hereinafter referred to as " LHJ", pursuant to the
Modifications/Waivers clause, and to make necessary changes within the scope of this contract and any subsequent
amendments thereto.
IT IS MUTUALLY AGREED: That the contract is hereby amended as follows:
1. Exhibit A Statements of Work, attached and incorporated by this reference, is amended as follows:
® Adds Statements of Work for the following programs:
• HCCW Child Care Health Consultation — Effective July 1, 2009
® Amends Statements of Work for the following programs:
• Nutrition & Physical Activity (Obesity) — Effective July 1, 2008
• Office of Drinking Water Group A Program — Effective January 1, 2007
• Public Health Emergency Preparedness & Response (PHEPR) — Effective August 9, 2008
❑ Deletes Statements of Work for the following programs:
2. Exhibit B-18 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-17 Allocations
as follows:
® Increase of $62,942 for a revised maximum consideration of $1,614,321.
❑ Decrease of $ for a revised maximum consideration of $
❑ No change in the maximum consideration of S
Allocations are attached only for informational purposes.
Unless designated otherwise herein, the effective date of this amendment is the date of execution.
ALL OTHER TERMS AND CONDITIONS of the original contract and any subsequent amendments remain in full force
and effect.
IN WITNESS WHEREOF, the undersigned has affixed his/her signature in execution thereof.
KITTITAS COUNTY PUBLIC HEALTH
DEPARTMENT
(Date)
Page 1 of 22
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
(Date)
APPROVED AS TO FORM ONLY
Assistant Attorney General
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EXHIBIT B-18
Contract Number:
CI4952
Kittim, Counh- Public Health Department
ALLOCATION'S
Date:
duly 15, 2009
Contract Term:
2007-2011
BARShart
DOH URM177-
Funding
Chart of
oftAccounts
Revenue
Funding Period
Period
Accounts
Chart of Accounts Program' Fide
Amendment Code*
CFDA-* Start Date End Date
.Amount
Sub Total
Total
NIC/USDA Fanners Markel Admin
Amend ^_
333.10.52
10.572
01/01/07
09/30/07
$144
$144
WICNSDA Farmers Market Admin
Amend 10
333.1052
I0.572
10101/07
09/30/08
$181
$181
$325
WK /USDA Breastfeeding
333.1057
((1.557
01/01/07
09/30/07
$1,317
$1,317
WIC/USDA Breastfeeding
333.10.57
10.557
10/01/07
09/30/08
$1,756
$1,756
WIC/USDA Breastfeeding
333.10.57
10.557
10/01/08
12/31/08
$439
$439
$3,512
WI('/USDANLS
333 10.57
101 557
01/01/07
09/30/07
$64,380
Wl('/USDANLS
Amend
333.10.57
10.557
01/01/07
09/30/07
SI,I50
WICNSDANLS
Amend4
333.1057
10.557
01/01/07
09/30/07
$11100
$66,630
WIC/USDANLS
333.1(157
10.557
10/01/07
09/30/08
$85,840
W ICNSDA NLS
Amend 4
333.1057
10.557
10/01/07
09/30/08
$2,220
WIC /USDA
Amend 11
3331057
10.557
10/01/07
09/30/08
54,556
$92,616
WIC/USDANLS
333.1057
10.557
10/01/08
12/31/08
$21,460
WICNSDANLS
Amend
333.10.57
10557
10/01/08
12/31/08
$555
WIC/USDA NLS
Amend 11
333.10.57
10.557
10/01/08
12/31108
S2,278
524,293
5183,539
13FNEP
Amends
333.10.61
10.561
10/01/07
09/30/08
513,467
513,467
$13,467
EH Drinking Water SS
333.66.48
66.468
01/01/07
06/30/07
5750
EH Drinking Water SS
Amend 1
333.66.48
66.465
01/01/07
06/30/07
$750
El Drinking Water SS
Amend 9
333.66.48
66.468
01/01/07
06/30/07
($.500)
SO
EH Drinking Water SS
Amend 9
333.66.48
66.468
01/01/07
12131N8
$5,250
EH Drinking Water SS
Amend 16
333.66.48
66.468
01/01/07
12/31/08
5250
$5,500
EH Drinking Water SS
333.66.48
66.468
07/01/07
12/31/08
52,250
EH Drinking Water SS
Amend 1
333.66.48
66.468
07/01/07
12/31/08
51,000
EH Drinking Water SS
.Amend 9
333.66.48
66.468
07/01/07
12131/08
($3,250
$Il
EH Drinking Water SS
Amend 14
333.66.48
66.468
01/01/09
06/30/09
52,500
Ell Drinking Water SS
Amend 16
333.66.48
66.468
01/01/09
06/30/09
($1,250)
$1,250
EH Drinking Water SS
.Amend 16
333.66.48
66.468
07/01/09
06/30/11
$4,750
$4,750
511,500
EH Drinking Water 'IA
333.66.48
66.468
01/01/07
06/30/07
$F000
EH Drinking Water TA
Amend 9
333.66.48
66.468
01/01/07
06/30/07
($1,000)
SO
EH thinking Water TA
Amend 9
333.66.48
66.468
01/01/07
12/31/08
52,000
EH Drinking Water TA
Amend 14
333.66.48
66.468
01/01/07
12/31/08
($2,000)
SO
Ell Drinking Water TA
333.66.48
66.468
01101/07
12/31/08
53,000
EH Drinking Water TA
Amend
333.66.48
66.465
01/01/07
12/31/08
(53,000)
$0
EH Drinking Water TA
.Amend 14
333.66.48
66.468
01/01/09
06/30/09
52,000
EFI Drinking Water TA
Amend 16
333.66.48
66.468
01/01/09
06/30/09
($1,000)
Sf,000
EH Drinking Water TA
Amend 16
333.66.48
66.468
07/01/09
06/30/11
$3,000
$3,000
54,000
AFIX Immun ConCon Fed
Amend 1
333.92.68
93.268
01/01/07
12/31/07
$11,425
$11,425
AFIX Imman ConCon Fed
Amend 1
333.92.68
93.268
01/01/08
12/31/08
$11,425
811,425
AFIX Immun ConCon Fed
Amend W
333.92.68
93265
01/01/09
12/31/09
$11,382
511,382
534,232
FA317 hnmun ConCon Fed
333.92.68
93.268
01/01/07
12/31/07
54,533
FA317Immun ConCon Fed
Amend 1
33392.68
93.268
01/01/07
12/31/07
(52,593)
$1,940
FA317 hmrmin ConCon Fed
333.92.68
93.268
01101/08
12/31/08
54,533
FA3I71mmun Con( on Fed
Amend 1
333.92.68
93.268
01/01108
12/31/08
(52,593)
$1,940
FA317 Immun CanCon Fed
Amend 14
333.92.68
93:168
01/01/09
12/31/09
$1,636
$1,636
$5,516
VPC Immun ConCon Fed
333.92.68
93.268
OI/01/07
12/31/07
$4,925
VF(' Immun Con 'im Fed
Amend 1
333.92.68
93.268
01101/07
12/31/07
(54,643)
$282
VFC Immun ConCon Fed
333.92.68
93.268
01/01/08
12/31/08
54,925
VFC Immun Con('on Fed
Amend 1
333.92.68
93.268
01/01/08
12/31/08
(54,643)
5282
VF(' Immun('on('on I-' ed
Amend 14
333.92.68
93.268
01/01/09
12/31/09
$576
$576
51,140
CIA'Ohcsity YRl
Amend 12
333.92.83
93.283
06/30/08
06/29/09
545,750
$45,750
545,750
CD( NPAO }'122
Amend 18
333,92.83
93.283
06/30/09
06/29/10
545,110(1
$45,000
545,11011
F-SHIBFI D -I8
Contract Number:
C14952
Kittitas County Public Health Department
ALLOCATIONS
Date:
July 15, 2009
Contract Term:
2007-2011
BARShart�ounts
DOH USE ONLY
Funding
Chart of
Revenue
Funding Period
Period
Accounts
Chart of Accounts Program Title
Amendment Code*
CFDA-* Start Date End Date
Amount
Sub Total
Total
CDC "Cobacco Prevention
333.92.83
93.283
01/01/07
06/30/07
52,950
CDCTobacco Prevention
Ancnd2
333.92.83
93.283
01101/07
06/30/07
SI,890
$4,840
CDC Tobacco Prevention
Amend 3
333.92.83
93.283
07/01/07
06/30/08
S5,900
55,900
CDC Tobacco Prevention YR5
Amend 11
333.92.83
93.283
07/01/08
03/29/09
$4,425
54,425
CDC Tobacco Prevention YRI
Amend 17
3339_2.83
93.283
03/29/09
03/28/10
$1,180
CDC'Iobacco Prevention YR l
Amend 17
333.92.83
93.283
03/29/09
03/28/10
S3,550
54,730
S19,S95
Obesity Prevention
333.92.83
93.283
01/01/07
06/30/07
325,000
525900
Obesity Prevention
Amend 6
333.92.83
93.283
07/01/07
06/30/08
$45,000
$45,000
$70,000
PHGPR - LHJFunding
333.92.83
93283
01/01/07
08/31/07
$59,075
PIIEPR- LHJFunding
Amend
33392.83
93.383
01/01/07
08/30/07
516,550
$75,625
PHEPR- LHJFunding
Amend
333.92.83
93.293
08/31/07
08/09/08
55,442
PHEPR- LHJFunding
Amend
333.92.83
93.293
08/31/07
08/09/08
517,966
PIIEPR- LIUFunding
Amend
333.92.83
93.283
08/31/07
08/09/08
$54,617
$75,025
PHEPR- LHJ Funding
Amend 13
333.92.83
93.283
08/10/08
08/09/09
572,088
PHGPR - LHJ Funding
Amend 14
333.92.83
93.293
08/10/08
08/09/09
$3,000
575,085
$225,738
PHEPR-Pandemic Influenza
333.92.83
93.283
01/01/07
08/31/07
513,696
PHEPR-Pandemic Mae=
Amend 3
3' 3,92.83
93.283
01/01/07
08/31/07
$2,730
516,426
PHGPR-Pandemic InOuenm
Amend 6
333.92.83
93,283
08/31/07
08/09/08
$4,977
PIIEPR-Pandemic Influenza
Amend
333.92.83
93.283
08/31/07
08/09/08
S11,6I2
516,589
S33,015
PHEPR-ProgF
Amend
33392.83
93583
01/01/07
08130/07
S730
S730
S730
HCC'W Infant Toddler IAR
33395.75
93.575
01/01/07
06/30/07
S6,424
S6,424
HCCW Infant Toddler IAR
Amend
333.95.75
93.575
07/01/07
06/30/08
$12,847
512,847
HCCl1/Infant Toddler IAR
Amend 12
333.95.75
93.575
07/01/08
06/30/09
S12,847
SI2,847
IICC'$i Infant Toddler IAR
Amend 18
333.95.75
93.575
07/01/09
06/30/10
$12,692
$12,692
$44,8111
PHEPRH(-Systems - CFH
Amend 13
33 98.89
93.889
08/09/08
08/08/09
$1,000
51,000
$1,000
PHEPRW Systems -Prep
Amend 13
333.98.89
93.889
08/09/08
08/08/09
51,800
$1,8110
SI,S00
PHEPR Hospital - Prep
333.98.89
93.989
01/01/07
08/31/07
$1,340
PHEPR Hospital - Prep
Amend 3
333.98.89
93.889
OMI/07
08/31/07
$660
$2,000
PHEPR Hospital - Prep
Amend 6
33 3.98.99
93.589
09/01/07
08/08/08
$2,000
$2,1100
54.000
PHBG - LHD
Amend 2
333.99.91
93.991
01/01/07
12/31/07
$4,240
$4,240
$4,240
MCHBG MCH (-onC'on Fed
333.99.94
93.994
01/0I/07
09/30/07
$33,521
533.521
MCHBG MCH ConCon Fed
33399.94
93.994
10/01/07
09/30/08
544,695
$44,695
MCHBG MCH ConCon Fed
333.99.94
93.994
10/01/08
12/31/08
$11,174
SI1,174
MCHBG MCH ('on('on Fed
Amend 13
333.99.94
93.994
01/01/09
09130/09
$32,713
532,713
MCI IBG MCH ConCon Fed
Amend 13
333.99.94
93.994
10/01/09
09/30/10
$43,617
$43,617
MCHBG MCH ConCon Fed
Amend 13
333.9994
93.994
10/01/10
12/31/10
$10904
SIQ904
$176,624
GIS sulaFoom r ,
Amend
334.04.91
N/A
07/01/07
06/30/08
SO
GFS CDP Admin(I iOc Correction)
Arnend 12
334.114.91
N/A
07/01/07
06/30/08
$5,000
55,000
GFS CDP Admin
Amend 12
334.94.91
N/A
07/01/08
06/30/10
$5,000
GPS CDP Admin
Amend 18
334.114.91
N/A
07/01/08
06/30/10
85.11011
$10,0011
515,000
Group B Systems
334.04.91
N/A
01/01/07
06/30/07
$4,000
Group B Systems
Amend 2
33404.91
N/A
01101/07
06/30/07
S1,000
55,000
Group B Systems
Amend 6
334.04.91
N/A
07/01/07
06/30/08
SS,575
5K175
Group 135ystems
Amend 11
334.04.91
N/A
07/01/08
06/30/09
54,000
$4,000
S17,575
** Catalog of Federal Domestic Assistance
EXHIBIT R -I8
Contract Number:
CI4952
Bittitas County Public Hcalth Department
ALLOCATIONS
Date:
July 15, 2009
Contract Term: 2007-2011
BARSharf�nt
DOH USE ONLY
Funding
Chart of
Revenue
Funding Period
Period
Accounts
Chart of Accounts Program fine Amendment Code*
CFDA** Start Date End Date
Amount
Sub Total
Ictal
Oral Health State
334.04.91
N/A
01/01/07
06/30/07
54500
$4,500
Oral Health Slate
334.04.91
N/A
07/01/07
06/30/08
S9,000
$9,000
Oral Health State
334.0491
N/A
07/01/08
12/31/08
54,500
54,500
Oral Health State Amend 14
334.04.91
N/A
07/01107
06/30/09
56,048
$6,048
Oral health State Amend 14
334.0491
N/A
07/01/09
06/30/10
S12,097
S12,097
Oral Health State Amend 14
33404.91
N/A
07/01/10
06/30/11
56,049
56,049
S42-194
PHEPR- Pandemic Influenza
334.04.91
N/A
01/01/07
06/30/07
$6,089
$6,089
$6.089
Correction in amendment =I of the reduction of S12
(previoulsly $6,077)
Hepatitis C Awareness Amend 14
3340492
N/A
07/01107
06/30/09
58500
$8,500
S8,500
Local Capacity Dei. Funds - GPS & HSA
334(14.92
N/A
01/01/07
06/30/07
522,696
S21696
Local Capacity Dei. Funds - GFS & HSA
334.0492
N/A
07/01/07
12/31/07
$223.696
$22,696
Local Capacity Iki. Funds- GPS & H6 Amend 7
334.04.92
N/A
01/01/08
06/30/08
522,787
$22,787
Local Capacity Dev. Funds - Ci FS & H` Amend 7
334.04.92
N/A
07/01/08
12/31/08
$22,787
$22,787
Local Capacity Des. Funds - GFS &H'Amend14
334.04.92
N/A
07/01/07
06/30/09
$22,978
$22,978
Local Capacity Doc, Funds - GFS & H' Amend 14
334.04.92
N/A
07/01/09
06/30/11
S22,978
$22,978
S 136,92_^_
Local Capacity HSA Partnership Amend 3
334.04.92
N/A
05/01/07
06/30/07
$2,900
52,900
$2,900
Child Death Review (Proviso) Amend 13
334.0493
N/A
07/01/08
06130/09
S750
S75o
5750
Youth Tobacco Prevention
334.04.93
N/A
01/01/07
06/30/07
53.750
53,750
Youth Tobacco Prevention Amend 3
334.0493
N/A
07/01/07
06/30/08
$6,400
56,400
Youth "tobacco Preicntion Amend 11
334.0493
N/A
07/01/08
06/30/09
$6,400
S6A00
Youth Tobacco Prevention Amend 17
334.04.93
N/A
07/01/09
06/30/11
S12,8CIt1
$12,800
529,350
TPC Account
334.04.97
N/A
01/01/07
06/30/07
$19,125
1 PC Account Amend 2
334.04.97
N/A
01/01/07
06/30/07
5890
$20,015
TPC .Account Amend
334,04.97
N/A
07/01/07
06/30/08
538,250
$39250
TPC Account Amend II
334.04.97
N/A
07/01/08
06/30/09
538,250
$38,250
TPC Account Amend 17
334.04,97
N/A
07/01/09
06/30/11
$61,200
$61,200
5157,715
EH Drinking Water - SSState Amend
334.04,98
N/A
01/01/07
06/30/07
$1,500
$1500
Ell Drinking Water - SS State .Amend 14
334.04.98
N/A
07/01/07
06/30/09
53,250
EH Drinking Water - SS State Amend 14
33414.98
N/A
07/01/07
06/30/09
$500
EH Drinking Water- SS State Amend 14
334.04.98
N/A
07/01/07
06/30/09
$1,250
EH Drinking Water- SS State Amend 16
334.04.98
N/A
07101/07
06/30/09
611000
EI I Drinking Water - SSState Amend 17
334.0498
N/A
07/01/07
06/30/09
$1,000
Eli Drinking 3N'atrr-tiff State Amend 18
334.04.98
N/A
07/01/07
06/30/09
S250
$4,250
EH Drinking Water - SS Slate Amend 14
334.04.98
N/A
07/01/09
06/30/11
$1,250
EH Drinking Water - SS Slate kinend 16
33404.98
N/A
07/01/09
06/30/11
$3,500
54,750
511,500
Multi -State l_eaming Collaborative 2 Amend 3
334.114.98
N/A
07101/07
12/31/07
$2.100
52.100
52,100
Blue Ribbon Local Health Funds Amend 8
3340499
N/A
00/00/00
00/00/00
5113,314
SI 13,314
Blue Ribbon Local Health Funds Amend 14
334.04.99
N/A
00/00/00
00/00/00
5113,579
$113,579
$226,893
Multi -State Learn Collaborative YRI ,Iunend 14
367.11.88
N/A
04/15/08
04/14/09
58,000
$8,0110
Multi -Stale Learn Collaborative YR2 .Amend 14
367.11.88
N/A
04/15/09
04/14/10
S12,000
512,000
Multi -Stale Learn Collaborative YR3 Amend 14
367.11.88
N/A
04/15/10
04/14/11
$4,000
54,000
$24,000
TOTAL
$1,614121
$1,614,321
Total consideration prior to this amendment:
$1,551,379
GRAND 101
AL
$1,614„321
Change in consideration in this amendment:
$62,942
GRAND TOTAL
$1,614,321
'Total Fed
$932,833
Total State
$657,488
*Federal revenue codes begin with "333". State reeenue codes begin with "334".
Total Other
$24,000
** Catalog of Federal Domestic Assistance