HomeMy WebLinkAboutCon Con 6 DOH KCPHKittitas County
Review Form
Grants & Contract Agreement
Today's Date Agenda Date 411 B Ii (P
02/29/2016
Fund/Department
116-Public Health
Contract/Grant Information
Contract /Grant Agency: Consolidated Contract Amendment 6
Period Begin Date: January 1, 2015 I I Period End Date: December 31, 2017
Total Grant/Contract Amount: Increase of $13,104 for a revised maximum consideration of $222,391
Grant/Contract Number: C17114
Contract/Grant Summary:
The Consolidated Contract amends the Statements of Work for the following programs:
• Emergency Preparedness and Response-Effective July 1, 2015
• Office of Drinking water Group A Program-Effective January 1, 2015
Exhibit B-6 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-5
Allocations as follows:
• Increase of $13,104 for a revised maximum consideration of $222,391
Recommendation for Board of Health and Board of Health Review on
Department Head Signature: ~ministrator Date:1 fo/10
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APPROVED AS TO FOR)i
Date
Date
Signature of Board of Health member Date
Financial Information ; , '
Grant/Contract Review Page 1
Total Amount $13,104 State Funds $5,400 Federal Funds $7,704
Percentage County Funds Matching Funds $ CFDA#93.069
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 0 attach budget form No []I Why not
New Division Created? Already in budget center or in 2016 budget
Revenue Code
116-612.88.5.333.93.069 -$7,704
116-615.02.2.346.26.64 -$2,200
116-615.02.2.346.26.65 -$2,200
116-615.02.2.346.26.66 -$1,000
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
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Grant/Contract Review Page 2
Reviewer Date
Grant/Contract Review Page 3
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2015 -2017 CONSOLIDATED CONTRACT
CONTRACT NUMBER: C17114 AMENDMENT NUMBER: 6
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:
D Adds Statements of Work for the following programs:
o Amends Statements of Work for the following programs :
• Emergency Preparedness & Response -Effective July 1, 2015
• Office of Drinking Water Group A Program -Effective January 1,2015
D Deletes Statements of Work for the following programs:
2 . Exhibit B-6 Allocations , attached and incorporated by this reference, amends and replaces Exhibit B-S Allocations as
follows:
o Increase of $13,104 for a revised maximum consideration of $222,391.
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-6 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces
Exhibit c-s.
Unless designated otherwise herein, the effective date ofthis 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
. ~!~ ~RT ~EN~ H:A.L,TH 11 I ( I ~~9,~/le 11 c9D (t0
Date
APPROVED AS TO FORM ONLY
Assistant Attorney General
2015-2017 CONSOLIDATED CONTRACT
EXHIBIT A
STATEMENTS OF WORK
TABLE OF CONTENTS
DOH Program Name or Title: Emergency Preparedness & Response -Effective July 1,2015
DOH Program Name or Title: Office of Drinking Water Group A Program -Effective January 1,2015
Exhibit A, Statements of Work
Revised as of January 15,2016
Page 2 of 10
AMENDMENT #6
3
6
Contract Number C17114-6
DOH Program Name or Title: Emergency Preparedness & Response-
Effective July 1, 2015
SOW Type: Revision Revision # (for this SOW)
Period of Performance: July 1,2015 through June 30 , 2016
Exhibit A
Statement of Work
Contract Term: 2015-2017
AMENDMENT #6
Local Health Jurisdiction Name: Kittitas County Public Health Department
Contract Number: C17114
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
Statement of Work Purpose: The purpose of this statement of work is to establish the funding and tasks for the Public Health Emergency Preparedness and Response program for
the 2015 grant period through June 30, 2016.
Revision Purpose: The purpose of this revision is to add a special project.
Chart of Accounts Program Name or Title
FFY 15 EPR PHEP BP4 LHJ Funding
FFY15 EPR PHEP BP4 Oper Readiness
TOTALS
Task Task! Activity /Description Number
I Attend emergency preparedness events , (e.g .
trainings, meetings, conference calls , and
confe rences) as necessary to advance LH J
preparedness or complete the deliverables in this
statement of work .
2 Complete reporting templates as requested by
DOH to comply with program and federal grant
requirements (e.g . performance measures , gap
analysis, mid-year and end-of-year reporting
templates , etc.)
3 Draft, review and/or update, the local
comprehensive public health and emergency
response plan.
3 .1) Train staff to the completed plan .
Exhibit A, Statements of Work
Revised as of January 15 ,2016
CFDA# BARS Master Funding Period
Revenue Index (LHJ Use Only)
Code Code Start Date End Date
93 .069 333 .93 .06 18101800 07 /01115 I 06 /30116
93.069 333.93 .06 18101740 07 /01 11 5 I 06 /30116
*May Support PHAB Deliverables/Outcomes StandardslMeasures
Submit mid-year and end-of-year
progress reports.
Include name and contact
information of all attendees and
event agendas.
Submit comp leted templates to
DOH
Submit mid-year and end-of-year
progress reports .
Submit copy of latest
comprehensive public health and
emergency response plan .
Page 3 of 10
Current Change Total
Consideration I ncrease (+) Consideration
55 ,000 0 55 ,000
0 7 ,704 7 ,704
55,000 7,704 62 ,704
Payment
Due Date/Time Frame Information and/or
Amount
December 31 , 2015 and Reimbursement for
June 30, 20 16 ac t ual costs , not to
exceed total funding
consideration amount.
See mid-year and end-o f-
year reporting templates
for dates .
December 31, 2015 and
June 30 , 2016
June 30, 2016
Contract Number C 171 14-6
I
Task *May Support PHAB
Number Task! Activity/Description Standards/Measures Deliverables/Outcomes
Submit training records to DOH
4 Develop a decision making protocol to support Submit mid-year and end-of-year
Local Health Officer and the Public Health progress reports.
Administrator in making policy level decisions
during an emergency. Submit completed protocol to
DOH
5 Maintain registration of (at minimum) all critical Submit mid-year and end-of-year
LHJ positions within the Washington Secure progress reports.
Electronic Communication, Urgent Response and
Exchange System (W ASECURES) program. Submit list of registered users to
Registered users must log in quarterly at a include their title and role in the
minimum. emergency response plan.
5.1) Conduct a notification drill using Submit results of notification drill
WASECURES. to DOH
6 Develop procedures defining how LHJ will Submit mid-year and end-of-year
request assistance during disasters from the local progress reports.
Emergency Operations Center (EOC),
neighboring LHJs, and DOH. Submit procedures to DOH
7 Coordinate with existing programs to support pre-Submit mid-year and end-of-year
incident recruitment of volunteers and assure pre-progress reports.
incident volunteer screening.
Submit recruitment and screening
procedures to DOH
8 Create Volunteer Medical Reserve Corps (MRC) Submit mid-year and end-of-year
written plan to address following elements: progress reports.
• Identification of functional roles
• Skills, knowledge, or abilities needed for
each volunteer task or role Submit Volunteer MRC plan to
• Description of when the volunteer actions DOH.
will happen
• Identification of jurisdictional authorities
that govern volunteer liability issues and
scope of practice
FFY15 EPR PHEP BP4 Operational Readiness Special Project #15-16.17 Volunteer Management ($7,704)
1 Train volunteers in Psychological First Aid per
national standards
Exhibit A, Statements of Work
Revised as of January 15,2016
Submit training syllabus, dates of
training and sign-in sheet of
participants with contact
information.
Page 4 of 10
AMENDMENT #6
Payment
Due Date/Time Frame Information and/or
Amount
June 30, 2016
December 31, 2015 and
June 30, 2016
June 30, 2016
December 3 1, 2015 and
June 30, 2016
June 30, 2016
June 30, 2016
December 31, 2015 and
June 30, 2016
June 30, 2016
December 31, 2015 and
June 30, 2016
June 30, 2016
December 31, 2015 and
June 30, 2016
June 30, 2016
June 30, 2016 Reimbursement for
actual costs, not to
exceed total funding
consideration
Contract Number C 17114-6
AMENDMENT #6
Task *May Support PHAB Payment
Number Task! ActivitylDescription Standards/Measures Deliverables/Outcomes Due Date/Time Frame Information and/or
Amount
Submit a list of certified Kittitas June 30,2016 amount.
County volunteers with completed
Psychological First Aid training.
2 Create a template that addresses incident Submit a completed template June 30,2016
conditions which include the elements suggested included in the MRC written plan.
in the national standards. Include this template
in the MRC written Plan.
3 Develop a process to manage spontaneous Submit a completed process June 30,2016
volunteers that include the elements in the documented in the MRC written
national standards. Include this process in the plan.
MRC written plan.
4 Attend regional Assistant Secretary for Submit dates of workshops June 30,2016
Preparedness and Response (ASPR) MRC attended and agendas.
Workshop in order to share and network with
other MRCs in regard to written MRC plans jrom Submit updates to written plan June 30,2016
neighboring areas. based on lessons learnedjrom
neighboring or established units
in attendance at the workshop.
----
*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.org/wp-contentluploads/PHAB-Standards-and-Measures-Version-I. O. pdf
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 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
Jennifer Moore, Contract & Finance Specialist
Department of Health
PO Box 47960
Olympia, W A 98504-7960
360-236-4596
jennifer.moore@doh.wa.gov
PHEP/HPP Deliverable Submission: concondeliverables@doh.wa.gov
Exhibit A, Statements of Work
Revised as of January 15,2016
Page 5 of 10 Contract Number C 17114-6
Exhibit A
Statement of Work
Contract Term: 2015-2017
AMENDMENT #6
DOH Program Name or Title: Office of Drinking Water Group A Program -
Effective January 1,2015
Local Health Jurisdiction Name: Kittitas County Public Health Department
Contract Number: C17114
SOW Type: Revision Revision # (for this SOW) 1 Funding Source Federal Compliance Type of Payment
~ Federal Contractor (check if applicable) D Reimbursement
~ State D FFATA (Transparency Act) ~ Fixed Price
D Other D Research & Deyelopment
Period of Performance: January 1, 2015 through December 31,2017
Statement of Work Purpose: The purpose of this statement of work is to provide funding to the LHJ for conducting sanitary surveys and providing technical assistance to small
community and non-community Group A water systems.
Revision Purpose: The purpose of this revision is to extend the Funding Period from 12/31115 to 12/31116, increase Contract Consideration, and revise Special Billing
Requirements and Special Instructions.
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
Drinking Water Group A -SS N/A 346.26.64 2421921C 01/01/15 12/31116 2,800 2,200 5,000
Drinking Water Group A -SS State N/A 346.26.65 2421252C 01/01115 12/31116 2,800 2,200 5,000
Drinking Water Group A -TA N/A 346.26.66 24219210 I 01/01115 12/31116 4,000 1,000 5,000
TOTALS 9,600 5,400 15,000
------------------------------------------------------------------
Task Task! Activity/Description Number
1 Trained LHJ staff will conduct sanitary
surveys of small community and non-
community Group A water systems
identified by the DOH Office of Drinking
Water (ODW) Regional Office.
See Special Instructions for task activity.
Exhibit A, Statements of Work
Revised as of January 15,2016
*May Support PHAB
Standards/Measures Deliverables/Outcomes
Provide Final* Sanitary Survey
Reports to ODW Regional Office.
Complete Sanitary Survey Reports
shall include:
1. Cover letter identifying
significant deficiencies,
significant findings,
observations, recommendations,
and referrals for further ODW
follow-up.
2. Completed Small Water System
checklist.
3. Updated Water Facilities
Inventory (WFI).
Page 6 of \0
Due Date/Time Frame Payment Information
and/or Amount
Final Sanitary Survey Upon ODW acceptance
Reports must be received of the Final Sanitary
by the ODW Regional Survey Report, the LHJ
Office within 30 calendar shall be paid $400 for
days of conducting the each sanitary survey of a
sanitary survey . non-community system
with three or fewer
connections.
Upon ODW acceptance
of the Final Sanitary
Survey Report, the LHJ
shall be paid $800 for
each sanitary survey of a
Contract Number C17114-6
I
Task Task! ActivitylDescription Number
2 Trained LHJ staff will conduct Special
Purpose Investigations (SPI) of small
community and non-community Group A
water systems identified by the OOW
Regional Office.
See Special Instructions for task activity.
Exhibit A, Statements of Work
Revised as of January 15,2016
*May Support PHAB
StandardslMeasures Deliverables/Outcomes
4. Photos of water system with text
identifying features
5. Any other supporting
documents.
*Final Reports have been reviewed
and accepted by the OOW Regional
Office.
Provide completed SPI Report and
any supporting documents and
photos to OOW Regional Office.
Page 7 of 10
AMENDMENT #6
Due Date/Time Frame Payment Information
and/or Amount
non-community system
with four or more
connections and each
community system.
Payment is inclusive of
all associated costs such
as travel, lodging, per
diem.
Payment is authorized
upon receipt and
acceptance of the Final
Sanitary Survey Report
within the 30 day
deadline.
Late or incomplete
reports may not be
accepted for payment.
Completed SPI Reports Upon acceptance of the
must be received by the completed SPI Report,
OOW Regional Office the LHJ shall be paid
within 2 working days of $800 for each SPI.
the service request.
Payment is inclusive of
all associated costs such
as travel, lodging, per
diem.
Payment is authorized
upon receipt and
acceptance of completed
SPI Report within the 2
working day deadline.
Late or incomplete
reports may not be
accepted for payment.
Contract N umber C 1 7114-6
AMENDMENT #6
Task Task! Activity/Description *May Support PHAB Deliverables/Outcomes Due Date/Time Frame Payment Information
Number Standards/Measures and/or Amount
3 Trained LHJ staff will provide direct Provide completed T A Report and Completed T A Report Upon acceptance of the
technical assistance (T A) to small any supporting documents and must be received by the completed T A Report,
community and non-community Group A photos to ODW Regional Office. ODW Regional Office the LHJ shall be paid for
water systems identified by the ODW within 30 calendar days of each technical assistance
Regional Office . providing technical activity as follows:
assistance. • Up to 3 hours of work:
See Special Instructions for task activity . $250
• 3-6 hours of work:
$500
• More than 6 hours of
work: $750
Payment is inclusive of
all associated costs such
as consulting fee, travel,
lodging, per diem .
Payment is authorized
upon receipt and
acceptance of completed
T A Report within the 30-
day deadline.
Late or incomplete
reports may not be
accepted for payment.
4 LHJ staff performing the activities under Prior to attending the training, submit Annually LHJ shall be paid
tasks 1,2 and 3 must have completed the an "Authorization for Travel (Non-mileage, per diem , and
mandatory Sanitary Survey Training. Employee)" DOH Form 71O-0l3 to lodging costs in
the ODW Program Contact below for accordance with the
See Special Instructions for task activity. approval (to ensure that enough current rates listed on the
funds are available). OFM Website
h!!Q://www.ofm .wa.gov/r
, esources/trave1.asI:>
~~ .... -------------------
*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-contentluploads/PHAB-Standards-and-Measures-Version-l.O.pdf
Program Specific Requirements/Narrative
Exhibit A, Statements of Work
Revised as of January 15,2016
Page 8 of 10 Contract Number C 17114-6
AMENDMENT #6
Special References (RCW~, WACs, etc)
Chapter 246-290 WAC is the set of rules that regulate Group A water systems. By this statement of work, ODW contracts with the LHJ to conduct sanitary surveys (and SPIs, and
provide technical assistance) for small community and non-community water systems with groundwater sources. ODW retains responsibility for conducting sanitary surveys (and
SPls, and provide technical assistance) for small community and non-community water systems with surface water sources, large water systems, and systems with complex
treatment.
LHJ staff assigned to perform activities under tasks I, 2, and 3 must be trained and approved by ODW prior to performing work. See special instructions under Task 4, below.
Special Billing Requirements
The LHJ shall submit quarterly invoices within 30 days following the end of the quarter in which work was completed, noting on the invoice the quarter and year being billed for.
Payment cannot exceed a maximum accumulative fee of $S,fJO() $10,000 for Task 1, and $4,0()() $5,000 for Task 2, Task 3 and Task 4 combined during the contracting period, to
be paid at the rates specified in the Payment Method/Amount section above. When invoicing for sanitary surveys, bill half to BARS Revenue Code 346.26.64 and halfto BARS
Revenue Code 346.26.65.
When invoicing for Task 4, submit receipts and the signed pre-authorization form for non-employee travel to the ODW Program Contact below and a signed A 19-1 A Invoice
Voucher to the DOH Consolidated Contracts Office, billing to BARS Revenue Code 346.26.66 under Technical Assistance (T A).
Special Instructions
Task 1
Trained LHJ staff will evaluate the water system for physical and operational deficiencies and prepare a Final Sanitary Survey Report which has been accepted by ODW. Detailed
guidance is provided in the Field Guidefor Sanitary Surveys, Special Purpose Investigations and Technical Assistance (Field Guide). The sanitary survey will include an
evaluation of the following eight elements: source; treatment; distribution system; finished water storage; pumps, pump facilities and controls; monitoring, reporting and data
verification; system management and operation; and certified operator compliance. If a system is more complex than anticipated or other significant issues arise, the LHJ may
request ODW assistance.
• No more than 4 surveys of non-community systems with three or fewer connections to be completed between January 1,2015 and December 31, 2015.
• No more than 5 surveys of non-community systems with four or more connections and all community systems to be completed between January 1,2015 and
December 31, 2015.
• No more than 1 surveys of non-community systems with three or fewer connections to be completed between January 1,2016 and December 31,2016.
• No more than 5 surveys of non-community systems withfour or more connections and all community systems to be completed between January 1,2016 and
December 31,2016.
The process for assignment of surveys to the LHJ, notification of the water system, and ODW follow-up with unresponsive water systems; and other roles and responsibilities of
the LHJ are described in the Field Guide.
Task 2
Trained LHJ staff will perform Special Purpose Investigations (SPIs) as assigned by ODW. SPIs are inspections to determine the cause of positive coliform samples or the cause of
other emergency conditions. SPls may also include sanitary surveys of newly discovered Group A water systems. Additional detail about conducting SPls is described in the Field
Guide . The ODW Regional Office must authorize in advance any SPI conducted by LHJ staff.
Task 3
Trained LHJ staff will conduct Technical assistance as assigned by ODW. Technical Assistance includes assisting water system personnel in completing work or verifYing work
IhtH has been addressed as required, requested, or advised by the ODW to meet applicable drinking water regulations, fiNd .... erifjlirJg H1f1t work H1f1t hfls eeen required, requested, or
fldvised ey tlw ODW to meet Clj3j3licfllJ/e driNking wflter regutfitial'lS hflve eee,"l flddressed. Examples of technical assistance activities are described in the Field Guide. The ODW
Regional Office must authorize in advance any technical assistance provided by the LHJ to a water system.
Exhibit A, Statements of Work
Revised as of January 15,2016
Page 9 of 10 Contract Number C17114-6
AMENDMENT #6
Task 4
LHJ staff assigned to perform activities under tasks 1, 2, and 3 must be trained and approved by OOW prior to performing work. LHJ staff performing the activities under tasks 1,
2 and 3 must have completed, with a passing score, the OOW Online Sanitary Survey Training and the OOW Sanitary Survey Field Training. LHJ staff performing activities under
tasks 1,2, and 3 must attend the Annual OOW Sanitary Survey Workshop, and are expected to attend the Regional OOW LHJ Drinking Water Meetings.
If required trainings, workshops or meetings are not available, OF not scheduled, or if the LHJ staff person is unable to attend these activities prior to conducting assigned tasks, the
LHJ staff person may, with OOW approval, substitute other training activities to be determined by OOW. Such substitute activities may include one-on-one training with OOW
staff, co-surveys with OOW staff, or other activities as arranged and pre-approved by OOW. LHJ staff may not perform the activities under tasks 1,2, and 3 without completing
the training that has been arranged and approved by OOW.
Program Manual, Handbook, Policy References
http://www.doh.wa.gov/Portals/1/DocumentslPubs/331-486.pdf
DOH Program Contact
Oanielle Russell
DOH Office of Drinking Water
16201 E. Indiana Ave, Suite 1500
Spokane Valley, WA 99216
Oanielle.Russell@doh.wa.gov
(509) 329-2136
Exhibit A, Statements of Work
Revised as of January 15,2016
Page 10 of 10 Contract Number C 17114-6
EXHIBIT B-6
Kittitas County Public Health Department ALLOCA nONS Contract Number: C17114
Contract Term: 2015-2017 Date: January 15,2016
Indirect Rate as of January 2015: 40.25%
DOH Use Only
BARS Statement of Work i Chart of Accounts I Funding Chart of
Federal Award Revenue Funding Period Funding Period Period Accounts
Chart of Accounts Program Title Identification # Amend # CFDA* Code** Start Date End Date IStart Date End Date Amount Sub Total Total
FFY14 EPR LHJ Funding U90TPOO0559 Amend 2 93069 333.93.06 01101115 06/30115 1 07/01114 06/30/15 i $528 $23,574 $23 ,574
FFYI4 EPR LHJ Funding U90TPOO0559 N/A 93.069 333.93.06 01101115 06/30/15 I 07/01/14 06/30/15 $23,046
FFYI5 EPR PHEP BP4 LHJ Funding U90TPOO0559 Amend 4 93.069 333.93.06 07/01115 06/30/16 07/01115 06/30/16 1 $5,000 $55,000 $55 ,000
FFYI5 EPR PHEP BP4 LHJ Funding U90TPOO0559 Amend 3 93.069 333.93.06 07/01115 06/30/16 07/01/15 06/30/16 . $50,000
FFY15 EPR PHEP BP4 Oper Readiness U90TPOO0559 Amend 6 93.069 333.93.06 07/01115 06/30/16 07/01115 06/30/16 1 $7,704 $7,704 $7,704
FFY 14 EPR Planning & Exercises U90TPOO0559 Amend 1 93.069 333.93.06 01101115 06/30/15 07/01114 06/30/15 $24,078 $24,078 $24,078
FFY16 317 Ops H231POO0762 Amend 5 93.268 333.93.26 01101116 12131/16 01101116 12/31116 1 $1,232 $1,232 $2,685
FFYI5 317 Ops H23IPOO0762 Amend I 93.268 333.93.26 01101115 12/31115 '01/01115 12/31/15 $193 $1 ,453
FFY 15 317 Ops H23IPOO0762 N/A 93.268 333.93.26 01/01115 12/31115 1 01/01/15 12/31115 1 $1,260
FFY16 AFIX H23IPOO0762 Amend 5 93.268 333.93.26 01101116 12/31/16 01101116 12131/16 1 $4 ,293 $4,293 $9,306
FFYI5 AFIX H23IPOO0762 N/A 93.268 333.93.26 01101115 12/31115 I 01/01115 12/31115 $5,013 $5,013
FFY 16 VFC Ops H23IPOO0762 Amend 5 93.268 333.93.26 01/01116 12/31116 1 01/01/16 12/31116 $828 $828 $2,337
FFYI5 VFC Ops H231POO0762 Amend I 93.268 333.93.26 01101115 12/31115 1 01/01/15 12/31/15 $380 $1 ,509
FFY15 VFC Ops H23IPOO0762 N/A 93 .268 333.93.26 01101115 12/31115 1 01101115 12131/15 $1,129
FFY16 VFC Ordering H23IPOO0762 Amend 5 93 .268 333.93.26 01101116 12/31116 1 01/01/16 12/31/16 ' $1,400 $1,400 $2,554
FFY15 VFC Ordering H23lPOO0762 N/A 93.268 333.93.26 01101115 12/31/15 01101115 12131/15 , $1,154 $1,154
FFY14 Enhance lIS and VTrckS H23IPOOO922 Amend 5 93.733 333.93.73 12/01115 08/31/16 09 /30/14 09129/16 1 $1,087 $1,087 $1,087
FFY15 MCHBG CBP ConCan B04MC28134 Amend 3 93.994 333.93.99 01/01115 09/30115 10 /01/14 09/30/15 $1 ,723 $34 ,870 $34,870
FFYI5 MCHBG CBP ConCan B04MC28134 N/A 93 .994 333.93.99 01101115 09/30/15 10101114 09/30/15 1 $33 ,147
FFYI6 MCHBG LHJ & Other Contracts B04MC29364 Amend 3 93.994 333.93 .99 10101115 09/30/16 1 10/01/15 09/30/16 ' $44,196 $44,196 $44,196
Drinking Water Group A -SS Amend 6 NIA 346.26.64 01101115 12/31116 ~ 01101115 06/30/17 $2,200 $5 ,000 $5,000
Drinking Water Group A -SS N/A,Amend 6 N/A 346.26.64 01101115 12131116 ~I/oII" 06/30/17 $2,800
Drinking Water Group A -SS State Amend 6 NIA 346.26.65 01101115 12/31116 01101/15 06/3~g J $2,200 $5,000 $5,000
Drinking Water Group A -SS State N/A ,Amend 6 N/A 346.26.64 01101115 12/31/16 1101115 OW $2,800
Page I of I
Kittitas County Public Health Department
Indirect Rate as of January 2015: 40.25%
Chart of Accounts Program Title
Drinking Water Group A -TA
Drinking Water Group A -TA
TOTAL
Total consideration:
GRAND TOTAL
'Catalog of Federal Domestic Assistance
Federal Award
Identification #
$209,287
$13,104
$222,391
Amend #
Amend 6
N/A, Amend 6
"Federal revenue codes begin with "333". State revenue codes begin with "334".
EXHIBIT B-6
ALLOCATIONS
Contract Term: 2015-2017
DOH Use Only
BARS Statement of Work Chart of Accounts
Revenue Funding Period Funding Period
CFDA* Code** Start Date End Date Start Date End Date
NIA 346.26.66 01101115 12/31116 1 01/01115 06/30/17
N/A 346.26.64 01101115 12/31/16 • 01101/15 06130/17
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Contract Number: C17114
Date: January 15,2016
Funding Chart of
Period Accounts
Amount Sub Total Total
$1,000 $5 ,000 $5 ,000
$4,000
$222,391 $222,391
GRAND TOTAL $222,391
Total Fed $207,391
Total State $15 ,000
Exhibit e-6 Schedule of Federal Awards
KITTITAS COUNTY HEALTH DEPT-SWV0010475-07
CONTRACT C17114-Kittitas County Public Health Department
CONTRACT PERIOD 1/112015-12/3112017
Chart of Accounts Program Title BARS
FFY14 EPR LHJ FUNDING 333.93.06
FFY14 EPR PLANNING & EXERCISES ~ 333.93.06
FFY15 EPR PHEP BP4 LHJ FUNDING 333.93.06
'FFY15 EPR PHEP BP4 OPER READINESS 333.93.06
FFY15 317 OPS 333.93.26
FFY15AFIX 333.93 .26
FFY15 VFC OPS 333.93.26
FFY15 VFC ORDERING 333.93.26
FFY16 317 OPS 333.93.26
,FFY16AFIX 333.93.26
FFY16 VFC OPS 333.93.26
FFY16 VFC ORDERING ".-;-333.93.26
FFY14 ENHANCE liS AND VTBCKS 333.93.73
FFY15 MCHBG CBP CONCaN 333.93.99
FFY15 MCHBG LHJ & OTHER CONTRACTS 333.93.99
DOH
Federal
Award Date
06/30/14
06/30/14
06/26/15
06130/14
12/17/14
12117/1 4
12/17/14
12/17/14
NGA Not
Received
NGA Not
Received
NGA Not
Received
NGA Not
Received
09/16/14
10121114
10/22/15
TotalAmt Allocation Period
Federal Start End
Award Date Date
$12,663,227 01/01/15 06/30/15
$12,663,227 01/01/15 06130/15
$12,132,694 07/01/15 06/30/16
$11,064,407 07/01/15 06130116
$3 ,437,046 01/01/15 12/31/15
$3,437,046 01/01/15 12131/15
$3,437,046 01/01/15 12 /3 1/15
$3,437,046 01/01/15 12131/15
NGA Not 01/01/16
Received 12/31/16
NGA. Not 01/01/16
Received 12131/16
NGA Not 01/01/16
Received 12/31/16
NGA Not 01/01/16
Received 12/31116
$700,000 12/01/15 08/31/16
$8,846,149 01101/15 09130/15
$1,739,609 10/01/15 09/30/16
TOTAL
AMENDMENT #6
Date: January 15, 2016
Contract Amt CFDA CFDA Program Title Federal Agency Name Federal Award Federal Grant Award Name Identification Number
Public Health Emergency Department of Health and Human TP12-1201 HPP AND PHEP $23,574 93.069 Preparedness Services Centers for Disease Control U90TPOO0559 COOPERATIVE AGREEMENTS and Prevention
Public Health Emergency Department 01 Health and Human TP12-1201 HPP AND PHEP $24,078 93.069 Preparedness Services Centers for Disease Control U90TPOO0559 COOPERATIVE AGREEMENTS and Prevention
Public Health Emergency Department of Health and Human TP12-1201 HPP AND PHEP $55,000 93.069 Preparedness Services Centers for Disease Contral U90TPOO0559 COOPERATIVE AGREEMENTS and Prevention
Public Health Emergency Department 01 Health and Human TP12-1201 HPP AND PHEP $7,704 93.069 Services CentelS for Disease Control U90TPOO0559 Preparedness and Prevention COOPERATIVE AGREEMENTS
-------~ ---
Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
$1,453 93.268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM
Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
$5,013 93.268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM
immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
$1,509 93.268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM
Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
$1 ,154 93.268 Services Centers lor Disease Control H231POO0762 VACCINES FOR CHILDREN'S Agreemenls and Prevention PROGRAM --~
Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
$1,232 93.268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM
Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
$4,293 93.268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM ---------
Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
$828 93 .268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM
Immunization Ccoperative Department of Health and Human IMMUNIZATION GRANT AND
$1 ,400 93.268 Agreements Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S
and Prevention PROGRAM
--t apacwr-.J:)uuclng-AsSlstClncelo-----PPHr-~OT4~IVlIVlOI'''l"lA'tI C)f~E:1''MI-\T·~C't:.
Strengthen Publi:: Health Department of Health and Human AN IMMUNIZATION INFORMATION
$1,087 93.733 Immunization Inf"astructure & Services Centers for Disease Control H231POO0922 SYSTEM (liS) TO INTERFACE WITH
Performance • Financed in part and Prevention CDC'S VTRCKS VACCINE ORDERING
h .. ~ho O~",,,on+i,,~ "'n ..... 0, ,hli ... iI ,,~""_"lflr!t:::I\~C:.l\tT C:YC:TC:~~
Maternal and Ch Id Health Department of Health and Human MATERNAL AND CHILD HEALTH $34,870 93.994 Services Block Grant to the Services Health Resources and B04MC28134 SERVICES States Services Administration
Maternal and Chid Health Department of Health and Human MATERNAL AND CHILD HEALTH $44,196 93.994 Services Block Grant to the Services Health Resources and B04MC29364 SERVICES States Services Administration
$207,391
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