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HomeMy WebLinkAboutCon Con Amendment 5Kittitas County Review Form Grants & Contract Agreement Today's Date 01/11/2016 Fund/Department 116 -Public Health Contract/Grant Information Agenda Date Contract /Grant Agency: Consolidated Contract Amendment 5 Period Begin Date: January 1, 2016 Ln�c'M1Pi^^�—`-�pNp r L+ t r F I I I IN 4 1 P t I Period End Date: December 31,2017 Total Grant/Contract Amount: Increase of $8,840.00 for a total maximum of $209,287.00 Grant/Contract Number: C17114 Contract/Grant Summary: The Consolidated Contract Amendment 5 Adds Statements of Work for the following program: • Office of Immunization and Child Profile- Effective January 1, 2016 • OICP- Prevention and Public Health Funds (PPHF) VTrckS-IIS- Effective January 1, 2016 Exhibit B-5 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-4 Allocations as follows: • Increase of $8,840.00 for a revised maximum consideration of $209,287.00 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 Comi APPROVED AS TO FORM: Signature of Prosecutor's Office Date Signature of Auditor's Office Date Signature of Board of Health member Date Financial Information Grant/Contract Review Page 1 Total Amount $8,840 State Funds $ Federal Funds $8,840 Percentage County Funds Matching Funds $ CFDA# Sub -Contract Approved 93.268 93.733 In -Kind $ Explain Is Equipment being purchased? Who owns equipment? New Personnel being hired? Contact HR hiring — reporting requirements Future impacts or liability to Kittitas County: Information Budget Amendment Needed?' Yes © enter VTRCKS in budget New Division Created? center Revenue Code 116-612.32.2.333.93.268 - $1,232 116-612.32.3.333.93.268 - $828 116-612.32.11.333.93.268 - $4,293 116-612.32.14.333.93.268 - $1,400 116-612.32.7.333.93.733 - $1,087 Pass Through Information No ❑x Why not Imms contract included in 2016 budget Agency to Pass Through 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 Treasurer Submitted Signature: Department: Date: 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 2015 — 2017 CONSOLIDATED CONTRACT CONTRACT NUMBER: C17114 AMENDMENT NUMBER: 5 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, are amended as follows: ® Adds Statements of Work for the following programs: Office of Immunization & Child Profile - Effective January 1, 2016 OICP-Prevention & Public Health Funds (PPHF) VTrckS-IIS - Effective January 1, 2016 ❑ Amends Statements of Work for the following programs: ❑ Deletes Statements of Work for the following programs: 2. Exhibit B-5 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-4 Allocations as follows: ® Increase of $8,840 for a revised maximum consideration of $209,287. ❑ Decrease of for a revised maximum consideration of ❑ No change in the maximum consideration of Exhibit B Allocations are attached only for informational purposes. 3. Exhibit C-5 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces Exhibit C-4. 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 STATE OF WASHINGTON DEPARTMENT OF HEALTH Date Date APPROVED AS TO FORM ONLY Assistant Attorney General Page 1 of 10 kn z Q z M C1 :o : N N Ei a� U U Q H N � N H w N 04 wdwz ti� 0 N H ) 7:1 N � � i c U U x N Q � o a N � o 0 0., �a 00 w 0 0 o � 3 o U zz E o �z as ¢� yb Le E: 0 N cl cz N U W 4. W C p L 0 0 + � U C � ee L � u U 00 N 00 00 N 00 O O � O O N M N N M N M all N M C N � M In t` M t` r C o 0 0 0 0 O Q�0xE A;b>_ "� x 00 rn N O d C YO b O O Y O o U O� E o w L O O CISc 4. cv r.+ C u b E r- C „ �T' a� ami c Q E sL. C u O V] U U cc ¢» E� O ami >> �. o E 0 .1 M M M M Cd C C N N N N UE�0E>3� u gi.��� 4. on E O �. 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