HomeMy WebLinkAboutCon Con Amendment 5 finalKittitas Cou nty
Review Form
Grants & Contract Agreement
Today's Date Agenda Date If-\ \ ~ \ lP 01/11/2016
Fund/Department
116-Public Health
Contract/Grant Information
Contract /Grant Agency: Consolidated Contract Amendment 5
Period Begin Date: January 1, 2016 I 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 8-5 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 considerat ion of $209,287 .00
Recommendation for Board of Health and Board of Health Review on
Department Head Signatur~~ , Administrator Date: l {/J-O ({ b
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APPROVED AS TO FORM:
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#
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:
Budget Information
Budget Amendment Needed? Yes~ enter VTRCKS in budget No []I Why not
New Division Created? center Imms contract included in 2016 budget
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
Agency to Pass Through
Amount to Pass Through $
Sub-Contract Approved Date:
Prosecutor Review
I Has the Prosecutor reviewed this agreement? I YesD No D
County Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Submitted
I Signature:
Department:
I Date:
Assignment of Tracking Information
I Auditor's Office I
Grant/Contract Review Page 2
Human Resource
Prosecutor's Office
Who Signed the grant application
I 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 ofImmunization & Child Profile -Effective January 1,2016
• OICP-Prevention & Public Health Funds (PPHF) VTrckS-IIS -Effective January 1,2016
D Amends Statements of Work for the following programs:
D 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 .
D Decrease of for a revised maximum consideration of __
D 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
Date
Page 1 of 10
ST ATE OF WASHINGTON
DEPARTMENT OF HEALTH
~~dU~ 2-f-2_/lt
. Date
Fra ,nk Webley
APPR~~~ ~~pbRM ONLY
Assistant Attorney General
2015-2017 CONSOLIDATED CONTRACT
EXHIBIT A
STATEMENTS OF WORK
TABLE OF CONTENTS
DOH Program Name or Title: Office ofImmunization & Child Profile -Effective January 1,2016
DOH Program Name or Title: OICP-Prevention & Public Health Funds (PPHF) VTrckS-IIS -Effective December 1,2015
Exhibit A , Statements of Work
Revised as of November 16 , 2015
Page 2 of 10
AMENDMENT #5
3
9
Contract Number C 17114-5
Exhibit A
Statement of Work
Contract Term: 2015-2017
AMENDMENT #5
DOH Program Name or Title: Office of Immunization & Child Profile -
Effective January I, 2016
Local Health Jurisdiction Name: Kittitas County Public Health Department
Contract Number: C17114
SOW Type: Original Revision # (for this SOW) Funding Source Federal Compliance Type of Payment
~ Federal Subrecipient (check if applicable) ~ Reimbursement
D State ~ FFATA (Transparency Act) D Fixed Price
D Other D Research & Development
Period of Performance: January 1, 2016 through December 31, 2016
Statement of Work Purpose: The purpose of this statement of work is to define required immunization tasks, deliverables, and funding.
Revision Purpose: N/ A
Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change Total
Revenue Index (LHJ Use Only) Consideration Increase (+) Consideration
Code Code Start Date End Date
FFY 16 VFC Ops 93.268 333.93.26 74110263 01/01116 12/31116 0 828 828
FFY 16 VFC Ordering 93.268 333.93.26 74110264 01/01/16 12/31116 0 1,400 1,400
FFY16 317 OPS 93.268 333.93.26 74110261 01/01116 12/31116 0 1,232 1,232
FFY16 AFIX 93.268 333.93.26 74110265 01/01116 12/31116 0 4,293 4,293
TOTALS 0 7,753 7,753
Task *May Support PRAB Payment
Task! Activity /Description Deliverables/Outcomes Due Date/Time Frame Information and/or Number StandardslMeasures Amount
Perform accountability activities in accordance with state and federal requirements for the Vaccines for Children (VFC) Program as outlined in the Centers for Disease Control and
Prevention (CDC) VFC Operations Guide and as directed by the state administrators of the VFC program. Accountability requirements include, but are not limited to: provider
education, provider site visits and required corrective action, quality assurance activities, VFC screening, satisfaction survey, outside provider agreements, new provider
enrollment visits, fraud and abuse reporting, monthly accountability reports, and private provider report of vaccine usage.
1 Facilitate annual renewal of the provider
agreement for receipt of state supplied vaccine
for all healthcare providers receiving state-
supplied childhood vaccines
Exhibit A, Statements of Work
Revised as of November 16,2015
Provider Agreements for Receipt of
State Supplied Vaccine received
online via the Washington
Immunization Information System
(WA lIS).
Page 3 of 10
Annually, per Annual Reimbursement for
VFC Provider Agreement actual costs incurred,
Update Schedule not to exceed total
funding consideration
amount.
Funds available for
this task*:
FFY16 AFIX,
74110265
Contract Number C 17114-5
Task
Number Task! Activity/Description
2 Enroll new providers. Conduct an enrollment
site visit to all new providers, and gather
information needed to complete Program
enrollment
3 Use and facilitate provider use of the WA lIS to
place and approve provider vaccine orders.
Monitor provider orders for appropriateness
(including: accuracy of shipping information,
order frequency, timing, quantity and type) and
approve vaccine order online after assuring the
appropriateness of the order.
4 Monitor and assure electronic or paper
submission of vaccine accountability reports for
compliance with Provider Agreement related to
vaccine management (ordering, inventory
Exhibit A, Statements of Work
Revised as of November 16 ,2015
*May Support PHAB
Standards/Measures Deliverables/Outcomes
a) Provider Agreement for Receipt
of State Supplied Vaccine with
original signature -DOH 348-
002 (NOTE: a photocopy will
not be accepted)
Electronic submission of provider
vaccine orders via the WAilS.
a) Monthly Vaccine
Accountability Report
(DOH 348-006), submitted by
email or online in the WAilS.
Page 4 of 10
AMENDMENT #5
Payment
Due Date/Time Frame Information and/or
Amount
*See Restrictions on
Funds below
Within ten (10) days after Reimbursement for
the date of the provider actual costs incurred,
enrollment visit not to exceed total
funding consideration
amount.
Funds available for
this task*:
FFY16 AFIX,
74110265
*See Restrictions on
Funds below
Based on provider order Reimbursement for
schedules actual costs incurred,
not to exceed total
funding consideration
amount.
Funds available for
this task*:
FFY16 VFC Vaccine
Ordering
74110264
FFY 16 VFC Ops
74110263
FFY 16 317 Ops
74110261
*See Restrictions on
Funds below
a) By the 15th of each Reimbursement for
month actual costs incurred,
not to exceed total
funding consideration
Contract Number C17114-5
Task
Number Task! Activity/Description
management, reconciliation, compliance with
storage and handling, and reporting of all
vaccine incidents and returns).
5 Provide communication, technical assistance,
consultation, and education to providers about
vaccine quality assurance, accountability,
program participation and vaccine management.
6 Conduct VFC compliance site visits at two (2)
enrolled provider site(s) within your jurisdiction.
Site visits should address all requirements
outlined in the Provider Agreement, the CDC
Vaccines for Children (VFC) Operations Guide,
and as directed by the state administrators of the
Vaccines for Children program.
Conduct VFC Compliance Site Visit Follow-Up
to assure providers resolve all corrective actions
identified during the initial VFC compliance site
visit. Follow-up may include another physical
site visit or verification by email, phone, fax, or
Exhibit A, Statements of Work
Revised as of November 16,2015
*May Support PHAB
Standards/Measures Deliverables/Outcomes
b) Inclusion in the online ordering
system of doses used in the last
month and inventory on hand.
c) Report of Vaccine Storage
Incidents (DOH 348-154)
complete with reason and
corrective action as needed .
d) Report all cases (or suspected
cases) of vaccine fraud or
abuse.
Summary of LHJ Technical
Assistance Form (DOH 348-257)
a) VFC Site Visit Selection
Planning tool (will be supplied
by DOH)
b) Enter responses from the VFC
Provider Compliance Site Visit
questionnaire into the VFC
Provider Education,
Assessment, and Reporting
(VFC-PEAR) online system for
each provider site visit. Follow
all corrective action and follow-
up guidance provided by VFC-
Page 5 of 10
AMENDMENT #5
Payment
Due Date/Time Frame Information and/or
Amount
b) based on provider amount.
order schedules
Funds available for
this task*:
c) within seven (7) days
of the incident FFYI6 AFIX,
74110265
*See Restrictions on
d) within seven (7) days Funds below
of the incident
December 31 st Reimbursement for
actual costs incurred,
not to exceed total
funding consideration :
amount.
Funds available for
this task*:
FFY 16 VFC Ops
74110263
FFYI6 317 Ops
74110261
*See Restrictions on
Funds below
a) January 15th Reimbursement for
actual costs incurred,
not to exceed total
funding consideration
b) At the time of the amount.
VFC Compliance
Site Visit or within Funds available for
ten (10) business this task*:
days of the site visit.
(NOTE: All VFC FFYI6 AFIX,
compliance site 74110265
visits and the
required site visit
Contract Number C17114-5
Task
Number Task! Activity/Description
mail that corrective actions were completed.
Documentation that all VFC Site Visit
corrective actions have been completed must be
available to DOH upon request.
All VFC compliance site visits and the
required site visit follow-ups must be
completed by September 30th•
Participate in all DOH/CDC trainings required
for site visit reviewers and supervisors (a list of
required trainings will be provided by DOH).
7 a) Conduct AFIX (Assessment, Feedback,
Incentive, and Exchange) visits with one (I)
provider site(s) in your jurisdiction per
instructions at this link. Visits can be
conducted in-person, by telephone, or by
webinar. All AFIX visits must be
conducted by August 31st.
b) Conduct initial AFIX follow-up visits with
all provider sites receiving an AFIX visit.
Follow-up visits can be conducted in-
person, by telephone, or by webinar. All
AFIX follow-up visits must be conducted
by November 30th•
Continue following up with provider sites
until they fully implement their selected
quality improvement activities.
8 a) In coordination with hospitals, health
care providers, and health plans (if
applicable), conduct activities to
prevent perinatal hepatitis B infection
in accordance with the Perinatal
Hepatitis B Prevention Program
Guidelines, including the following:
Exhibit A, Statements of Work
Revised as of November 16, 2015
*May Support PHAB
StandardslMeasures Deliverables/Outcomes
PEAR for each incorrect
response.
c) Submit copy of signed
Acknowledgement of Receipt
d) Document completion of each
required training
a) Enter the following data in the
AFIX Online Tool:
• General Site Visit Information.
• Questionnaire responses.
• Coverage assessment results
(from CoCASA reports).
• Feedback visit information.
b) Enter the following data in the
Exchange tab of the AFIX Online
Tool for follow-up visits:
• Clinic progress on implementing
quality improvement strategies.
• Follow-up coverage assessment
results (from CoCASA reports).
a) Enter information for each case
identified into the Perinatal
Hepatitis B module of the W A
lIS.
b) Annual Perinatal Hepatitis B
Outreach Summary
Page 6 of 10
AMENDMENT #5
Payment
Due Date/Time Frame Information and/or
Amount
follow-ups must be *See Restrictions on
completed by Funds below
September 30th.)
c) Within ten (10) days
of the visit
(NOTE: All VFC
compliance site
visits and the
required site visit
I follow-ups must be ,
completed by
September 30th.)
d) Within ten (10) days
from the completion
of each training
a) Within ten (10) days Reimbursement for
of visit. actual costs incurred,
(NOTE: All AFIX not to exceed total
visits must be funding consideration
conducted by amount.
August 31st
Funds available for
this task*:
b) Within ten (10) days
I
of visit. FFY16 AFIX,
(NOTE: All initial 74110265
AFIX follow-up
visits must be *See Restrictions on
conducted by Funds below
November 30th
a) by the last day of each Reimbursement for
month actual costs incurred,
not to exceed total
funding consideration
amount.
b) December 15th
Funds available for
Contract Number C17114-5
AMENDMENT #5
Task *May Support PHAB Payment
Number Task! Activity /Description StandardslMeasures Deliverables/Outcomes Due Date/Time Frame Information and/or
Amount
I) identification of HBsAg-positive (DOH 348-268 ) this task*:
pregnant women, and pregnant women
with unknown HBsAg status FFY 16 317 Ops
2) reporting of HBsAg-positive women 74110261
and their infants
3) case management for infants born to *See Restrictions on
HBsAg-positive women to ensure Funds below
administration ofHBIG and hepatitis B
vaccine within 12 hours of birth, the
completion of the 3-dose hepatitis B
vaccine series, and post-vaccination
serologic testing.
b) Provide technical assistance to birthing
hospitals to encourage administration of the
hepatitis B birth dose to all newborns within
12 hours of birth, in accordance with
Advisory Committee on Immunization
Practices (AClP) recommendations.
c) Report all perinatal hepatitis B
investigations, including HBsAg-positive
infants, in the Perinatal Hepatitis B Module
of the WA lIS.
*For Information Only:
Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a
Standard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at:
http://www .phaboard.orglwp-content/uploads/PHAB-Standards-and-Measures-Version-l .0 .pdf
Program Specific Requirements/Narrative
• All LHJ staff who conducts VFC Compliance Site Visits and AFIX visits must participate in an annual VFC and AFIX training, conducted by DOH Office of Immunization
and Child Profile (OlCP) staff or their designee.
• All new LHJ site visit reviewers are required to have at least one (1) observational visit conducted by DOH OICP staff or their designee . DOH OlCP staff (or designee) will
periodically conduct observational VFC/AFIX site visits with all other LHJ reviewers who conduct VFC Compliance Site Visits .
• LHJ staff that conducts VFC Compliance Site Visits must participate in at least one (1) joint (observational) VFC compliance visit with DOH staff every other year. The
observational visit will occur during a regularly scheduled site visit conducted by the LHJ reviewer. DOH will determine the Observational visit.
• Tasks in this statement of work may not be subcontracted without prior written approval from DOH OICP.
Exhibit A, Statements of Work
Revised as of November 16,2015
Page 7 of 10 Contract Number C17114-5
AMENDMENT #5
Special Requirements
Federal Funding Accountability and Transparency Act (FFATA)
This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FF AT A or the Transparency Act).
The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent.
To comply with this act and be eligible to perform the activities in this statement of work, the LH] must have a Data Universal Numbering System (DUNS®) number .
Information about the LH] and this statement of work will be made available on USASpending.gov by DOH as required by P .L. 109-282.
Program Manual, Handbook, Policy References
Office of Immunization and Child Profile References and Resources for vaccine management, VFC compliance site visits , AFIX visits , and Perinatal Hepatitis B activities can be
found at this link to our website.
VFC Operations Guide - A copy will be provided by the Office ofImmunization and Child Profile. (Note: All site visit reviewers are required to have access to the most current
CDC VFC Operations Guide at every VFC compliance site visit).
Staffing Requirements
Provide notification via email to oicpcontracts@doh.wa.gov within fifteen (15) days of any changes to staffing for those who conduct work outlined in this statement of work.
Restrictions on Funds (what funds can be used for which activities, not direct payments, etc)
Allowable expenses with 317 and VFC FA Operations Funds (dated September 7,2011) document is posted on the DOH Consolidated Contract website at this link . In addition to
the funding listed in the Payment Information and/or Amount column for each task, FFY 13 317 Ops funding may be used for any activity in this statement of work, per funding
availability.
These federal funds may not be used for expenses related to travel or attendance at any CDC-sponsored conference, training, or event without prior written approval from the DOH
Office of Immunization and Child Profile.
DOH Program Contact
Tawney Harper, MP A
Budget and Operations Manager
Office of Immunization and Child Profile
Department of Health
PO Box 47843, Olympia WA 98504-7843
tawney.harper@doh.wa.gov , 360-236-3525
DOH Fiscal Contact
Sonja Morris
Contracts and Budget Coordinator
Office of Immunization and Child Profile
PO Box 47843 , Olympia W A 98504-7843
sonja.morris@doh.wa.gov, 360-236-3545
Exhibit A, Statements of Work
Revised as of November 16 ,2015
Deliverables may be sent electronically via email at oicpcontracts@doh.wa.gov,
by fax to 360-236-3590, or by mail to PO Box 47843 , Olympia WA 98504 -7843
Page 8 of 10 Contract Number C17114-5
Exhibit A
Statement of Work
Contract Term: 2015-2017
AMENDMENT #5
DOH Program Name or Title: OICP-Prevention & Public Health Funds (PPHF)
VTrckS-IIS -Effective December 1, 2015
Local Health Jurisdiction Name: Kittitas County Public Health Department
Contract Number: C17114
SOW Type: Original Revision # (for this SOW) Funding Source Federal Compliance Type of Payment
[8J Federal Subrecipient (check if applicable) [8J Reimbursement
D State [8J FF A T A (Transparency Act) D Fixed Price
D Other D Research & Development
Period of Performance: December 1, 2015 through August 31, 2016
Statement of Work Purpose: The purpose of this statement of work is to provide funding to local public health to provide support and technical assistance to health care providers
using the Immunization Information System (US) to conduct vaccine management-related activities.
Revision Purpose: N/ A
Chart of Accounts Program Name or Title
FFY14 Enhance IIS and VTrckS
TOTALS
Task
Number Task! Activity/Description
I Provide outreach, education, support, and training
to providers during the implementation of
Immunization Information System (liS)
enhancements and development of new liS
functionality. This includes:
• Participating in web cast and conference calls
conducted by DOH Office of Immunization
and Child Profile (OICP) on liS
enhancements and new lIS functionality as
they are developed and implemented;
• Providing training (in-person, online,
telephone, fax, or other), support, and
technical assistance to providers on liS
functionality and quality assurance tools;
• Monitoring provider adoption and use of
enhanced and new lIS tools
Exhibit A, Statements of Work
Revised as of November 16, 2015
CFDA# BARS Master Funding Period
Revenue Index (LHJ Use Only)
Code Code Start Date End Date
93.733 333 .93.73 74110241 12/01115 I 08/31116
*May Support PHAB
Standards/Measures Deliverables/Outcomes
1. Submit the Immunization
Information System Vaccine
Management Enhancement Project
Report (DOH 348-525) for the
reporting period:
December 1, 20 15-March 31, 2016
2. Submit the Immunization
Information System Vaccine
Management Enhancement Project
Report (DOH 348-525) for the
reporting period:
April 1, 20 I 6-July 31, 2016
Page 9 of 10
Current Change Total
Consideration Increase (+) Consideration
0 1,087 1,087
0 !~087 1,087
Payment
Due Date/Time Frame Information and/or
Amount
1. April 15,2016 Reimbursement for
actual costs incurred,
not to exceed total
funding consideration
amount
Funds available for
2. August 15,2016 this task:
FFY14 Enhance liS
and VTrckS
74110241
-------
Contract Number C 171 14-5
AMENDMENT #5
*For Information Only:
Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a
Standard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at:
http://www .phaboard.orglwp-content/uploads/PHAB-Standards-and-Measures-Version-l .O.pdf
Program Specific Requirements/Narrative
Special Requirements
Federal Funding Accountability and Transparency Act (FF AT A)
This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FF A T A or the Transparency Act).
The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent.
To comply with this act and be eligible to perform the activities in this statement of work, the LHJ must have a Data Universal Numbering System (DUNS®) number.
Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P .L. 109-282.
DOH Program Contact
Adefemi Adeleke
VTrckSIIIS Project Coordinator
Office of Immunization and Child Profile
Department of Health
PO Box 47843, Olympia, WA 98504-7843
360-236-3647, Adefemi.adeleke@doh.wa.gov
DOH Fiscal Contact
Sonja Morris
Contracts and Budget Coordinator
Office ofImmunization and Child Profile
PO Box 47843, Olympia W A 98504-7843
sonja.morris@doh.wa.gov, 360-236-3545
Exhibit A, Statements of Work
Revised as of November 16,2015
Page 10 of 10 Contract Number C17114-5
EXHIBIT B-5
Kittitas County Public Health Department ALLOCATIONS Contract Number: CI7114
Contract Term: 2015-2017 Date: November 16,2015
Indirect Rate as of January 2015: 40.25%
DOH Use Only
BARS Statement of Work Cbart of Accounts Funding Chart of
Federal Award Revenue F unding Period Funding Period Period Accounts
Chart of Accounts Program Title Identification # Amend # CFDA* Code** Start Date End Date Start Date End Date Amount Sub Total Total
FFYI4 EPR LHJ Funding U90TPOOOSS9 Amend 2 93.069 333.93.06 OIlO II1 S 06/30/lS 07/01/14 06/30/15 $528 $23,574 $23 ,S74
FFYI4 EPR LHJ Funding U90TPOOOSS9 N/A 93.069 3339306 OI/OII1 S 06/30 /l S 07/01/14 06 /30115 $23 ,046
FFYIS EPR PHEP BP4 LHJ Funding U90TPOOOSS9 Amend 4 93.069 333.93.06 07 /01 /i S 06/30 /16 07/01115 06130116 $S ,OOO $SS ,OOO $55 ,000
FFYIS EPR PHEP BP4 LHJ Funding U90TPOOOSS9 Amend 3 93.069 333.93.06 07 /0 1l1S 06/30/16 07/01115 06/30116 1 $SO ,OOO
FFYI4 EPR Planning & Exercises U90TPOOOSS9 Amend I 93.069 3339306 OIlO II1 S 06 /30l1S 07/01114 06/30115 $24,078 $24,078 $24,078
FFY16 317 Ops H23IPOO0762 Amend 5 93.268 333.93.26 0110 1/16 12/3 1116 01101116 12/31116 1 $1,232 $1,232 $2,685
FFYIS 317 Ops H231POO0762 Amend I 93.268 333.93.26 OI /OI /I S 12/3 1/1S 01101115 12/31115 $193 $1,453
FFYIS 317 Ops H231POO0762 N/A 93.268 333.93.26 OIlO II1S 12 /3 1/1S 011011 15 12131115 $1,260
FFYI6 AFIX H23IPOO0762 AmendS 93.268 333.93.26 0 1/0 1/16 12 /3 1116 01/01116 12/31116 $4,293 $4,293 $9,306
FFYIS AFIX H231POO0762 N/A 93.268 333.93.26 OIlOI I1S 12 /31 /1S 01101115 12131115 $S ,013 $S ,013
FFYI6 VFC Ops H23IPOO0762 Amend 5 93.268 333.93.26 0 1/0 1/16 12/3 1/16 01/01/16 12/31/16 $828 $828 $2,337
FFY 15 VFC Ops H231POO0762 Amend I 93.268 333.93 .26 OIlO II1S 12/3 1/1S 01l01/1S 12/31115 $380 $1 ,S09
FFYIS VFC Ops H231POO0762 N/A 93.268 333.93.26 OIlO II1S 12/3 1/1S 01/01115 12/31115 $1 ,129
FFY16 VFC Ordering H23IPOO0762 Amend 5 93.268 333.93.26 0 1/0 1/16 12/3 1/16 01/01116 12/31116 1 $1,400 $1,400 $2 ,554
FFY IS VFC Ordering H231POO0762 N/A 93.268 333.93.26 OI /O I /I S 12/3 1/1S 01101115 12/31115 $1 ,IS4 $1 ,IS4
FFYI4 Enhance lIS and VTrckS H23IPOOO922 Amend 5 93.733 333.93.73 12/0 1/i S 08 /3 1/16 09/30/14 09129116 $1,087 $1,087 $1,087
FFY IS MCHBG CBP ConCon B04MC28134 Amend 3 93.994 333.93.99 OIlO II1S 09 /30l1S 10101/14 09/30/15 $1 ,723 $34,870 $34,870
FFYIS MCHBG CBP Con Con B04MC28134 N/A 93 .994 333.93.99 OI /OI I1S 09/30l1S 10/01114 09130/15 . $33 ,147
FFYI6 MCHBG LHJ & Other Contracts B04MC29364 Amend 3 93.994 333.93.99 1010 1/iS 09/30116 10/01115 09130/16 1 $44,196 $44,196 $44,196
Drinking Water Group A -SS N/A N/A 346.26.64 OIlO II1S I2 ntl lS I 07101113 121311 ~ $2 ,800 $2 ,800 $2 ,800
Drinking Water Group A -SS State N/A N/A 346.26.6S OI /OI /I S 12 /3 1/1S 07/01113 12/31115 $2 ,800 $2 ,800 $2 ,800
Drinking Water Group A -TA N/A N/A 346.26.66 OIlO II1S 12/3 111S .....Q1101 LIL.l2LliLI 5 $4 ,000 $4,000 $4 ,000
TOTAL $209,287 $209,287
Total consideration: $200,447 GRAND TOTAL $209,287
$8,840
GRAND TOTAL $209,287 Total Fed $199,687
Total State $9,600
*Catalog of Federal Domestic Assistance
**Federal revenue codes begin with "333". State revenue codes begin with "334".
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Exhibit C-5 Schedule of Federal Awards AMENDMENT #5
Date: November 16, 2015
KITTITAS COUNTY HEALTH DEPT-SWV0010475-07
CONTRACT C17114-Kittitas County Public Health Department
CONTRACT PERIOD 11112015-12/31/2017
DOH TotalAmt Allocation Period
Chart of Accounts Program Title BARS Federal Federal Start End Contract Amt CFDA CFDA Program Title Federal Agency Name Federal Award Federal Grant Award Name Award Date Award Date Date Identification Number
Public Health Emergency Department of Health and Human TP12-1201 HPP AND PHEP FFY14 EPR LHJ FUNDING 333.93.06 06/30/14 $12 ,663,227 01/01/15 06/30/15 $23,574 93.069 Services Centers for Disease Control U90TPOO0559 Preparedness and Prevention COOPERATIVE AGREEMENTS
Public Health Emergency Oapartment 01 Health and Human TP12-1201 HPP AND PHEP FFY14 EPR PLANNING & EXERCISES 333.93.06 06/30/14 $12,663,227 01101/15 06l30I15 $24,078 93.069 Services Centers lor 0isea5e Control U90TP000559 Preparedn ... and Prevention COOPERAnVEAGREEMENTS
Public Health Emergency Department of Health and Human TP12-1201 HPP AND PHEP FFY15 EPR PHEP BP4 LHJ FUNDING 333.93.06 06/26/15 $12,132 ,694 07101/15 06/30/16 $55,000 93 .069 Preparedness Services Centers for Disease Control U90TPOO0559 COOPERATIVE AGREEMENTS and Prevention
Immunization CoopefaUve Department 01 Health and Human IMMUNIZATION GRANT AND
FFY15 317 OPS 333.93.28 12117/14 $3,437,048 01101/15 12131115 $1 ,453 93.288 Services Centers lor Dis_ Control H231POOO762 VACCINES FOR CHILDREN'S Ag~ and Prevention PROGRAM
Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
FFY15AFIX 333.93.26 12/17/14 $3,437 ,046 01/01/15 12/31 /15 $5 ,013 93.268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM
Immunization Coopetdve Department 01 Health and Human IMMUNIZATION GRANT AND
FFY15 VFC OPS 333.93.28 12117114 $3,437,048 01101/15 12131115 $1 ,509 93.288 Service. Cenl8fs for Disease Control H23IPOOO762 VACCINES FOR CHILDREN'S Ag~ and Prevention PROGRAM
Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
FFY15 VFC ORDERING 333.93.26 12/17/14 $3,437 ,046 01/01/15 12/31/15 $1 ,154 93.268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM
NGANot ~::: 01101118
Immunization CoopefaUve Department 01 Health and Human IMMUNIZATION GRANT AND
FFY183170PS 333.93.28 12131/18 $1 ,232 93.288 ServIces Centers lor 0isea5e Control H23IPOOO762 VACCINES FOR CHILDREN'S Received Agreements and Prevention PROGRAM
NGA Not NGANot 01/01/16 Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
FFY16AFIX 333.93.26 12/31/16 $4 ,293 93.268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S Received ReceIved Agreements and Prevention PROGRAM
NGA Not NGA Not 01101/16 Immunization Cooperative Department 01 Health and Human IMMUNIZA nON GRANT AND
FFY16 VFC OPS 333.93.28 12131/16 $828 93.288 ServIces Centers lor Oiseesa Control H231POOO762 VACCINES FOR CHILDREN'S Received Received Agreements and Prevention PROGRAM
NGA Not NGA Not 01/01/16 Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
FFY16 VFC ORDERING 333.93.26 12/31 /16 $1,400 93 .268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S
Received Received Agreements and Prevention PROGRAM
\AlP8CHY I:JUHOtf1V I\satSlaf1C8 10 I"'l"'nr 'u , .. : IMMUI't'LI\ I IV .... CNnI'\M...C
Streng1hen PublIc Health Department 01 Health and Human AN IMMUNIZATION INFORMATION
FFY14 ENHANCE liS AND VTRCKS 333.93.73 09116114 $700,000 12101/15 08131116 $1 ,067 93.733 Immunization Infrntruc:ture & Services Centers lor Disease Control H231P000922 SYSTEM (liS) TO INTERFACE WITH
Performance -FINnced In part and Prevention COC'S VTRCKS VACCINE ORDERING
.buJh""'O.-~.~~I_·,. • UA"IA~~UC"IT gV~TC'"
Maternal and Child Health Department of Health and Human MATERNAL AND CH ILD HEALTH FFY15 MCHBG CBP CONCON 333.93 .99 10/21/14 $8,846 ,149 01/01/15 09/30/15 $34,870 93 .994 Services Block Grant to the Services Health Resources and B04MC28134 SERVICES States Services Administration
_ and Child Health Department 01 Health and Human MATERNAL AND CHILD HEALTH FFY15 MCHBO UU & OntER CONTRACTS 333.93.99 10122115 $1 ,739,609 10101/15 09l30I16 $44,196 93.994 ServIces Block Grant to the ServIces Health Resources and B04MC29364 SERVICES S_. Services Admlnistr8tion
TOTAL $199,687
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