HomeMy WebLinkAbout20160826101731KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2015 -2017 CONSOLIDATED CONTRACT
CONTRACT NUMBER: C17114 AMENDMENT NUMBER: 7
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 "LH1", pursuant to the
Modifications/Waivers clause, and to make necessary changes within the scope ofthis 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:
IZI Amends Statements of Work for the following programs:
• Office of Drinking Water Group A Program -Effective January 1,2015
D Deletes Statements of Work for the following programs:
2. Exhibit B-7 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-6 Allocations as
follows:
D
D
Increase of
Decrease of
for a revised maximum consideration of __
for a revised maximum consideration of __
IZI No change in the maximum consideration of $222,391.
Exhibit B 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 I of7
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
~II~ Date
APPROVED AS TO FORM ONLY
Assistant Attorney General
2015-1017 CONSOLIDATED CONTRACT
EXHIBIT A
STATEMENTS OF WORK
TABLE OF CONTENTS
AMENDMENT #7
DOH Program Name or Title: Office of Drinking Water Group A Program -Effective January 1,2015 ........................................................................................... 3
Exhibit A, Statements of Work
Revised as of May 16,2016
Page 2 of7 Contract Number C17114-7
Exhibit A
Statement of Work
Contract Term: 2015-2017
AMENDMENT #7
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: CI7114
SOW Type: Revision Revision # (for this SOW) 2 Funding Source Federal Compliance Type of Payment
[g] Federal Contractor (check if applicable) o Reimbursement
[g] State o FF AT A (Transparency Act) [g] Fixed Price o Other o Research & Development
Period of Performance: January I, 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 add language to the Description and Outcome in Task I and add the DOH Fiscal contact.
Chart of Accounts Program Name or Title
Drinking Water Group A -SS
Drinking Water Group A -SS State
Drinking Water Group A -TA
TOTALS
Task TaskiActivitylDescription 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 May 16,2016
CFDA# BARS Master Funding Period Current Cbange Irotal
Revenue Index (LHJ Use Only) Consideration None Consideration
Code Code Start Date End Date
N/A 346.26.64 2421921C 01/01/15 12/31116 5,000 0 5,000
N/A 346.26.65 2421252C 01/01115 12/31/16 5,000 0 5,000
N/A 346.26.66 24219210 01/01115 12/31116 5,000 0 5,000
15,000 l ° 15,000
*May Support PHAB Deliverables/Outcomes Due Daterrime Frame Payment Information
StandardslMeasures and/or Amount
Provide Final* Sanitary Survey Final Sanitary Survey Upon ODW acceptance
Reports to ODW Regional Office. Reports must be received of the Final Sanitary
Complete Sanitary Survey Reports by the ODW Regional Survey Report, the LHI
shall include: Office within 30 calendar shall be paid $400 for .
1. Cover letter identifying days of conducting the each sanitary survey of a
significant deficiencies, sanitary survey. non-community system
significant findings, with three or fewer
observations, recommendations, connections.
and referrals for further ODW
follow-up. Upon ODW acceptance
2. Completed Small Water System of the Final Sanitary
checklist. Survey Report, the LHJ
3. Updated Water Facilities shall be paid $800 for
Inventory (WFI). each sanitary survey of a
4. Photos of water system with text non-community system
identifying features with four or more
Page 3 of7 Contract Number C 17114-7
Task Task! ActivitylDescription Number
DOH will provide a cabler and GPS unir
for the LHJ to gather source data during
a routine sanitary survey. DOH expects
the LHJ to commit to using the tablet and
GPS/or afive-year period_
2 Trained LHJ staff will conduct Special
Purpose Investigations (SP I) 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 May 16, 2016
*May Support PHAB Deliverables/Outcomes StandardsIMeasures
5. Any other supporting
documents.
*Final Reports httVC heen reviewed
and accepted by the OOW Regional
Office.
The LHJ surveyor will record at leas/
Mo (2) CPS data points. jar each
source, into the pre/oaded Excel
template on the tablel and submit
thaT data file wilh the associated
sanitary survey_
Provide completed SPI Report and
an y supporting documents and
photos to OOW Regional Office .
--
Page 4 of7
AMENDMENT #7
Due DatelTime Frame Payment Information
and/or Amount
connections and each
community system .
Payment is inclusive of
all associated costs such
as travel, lodging, per
I diem.
I Payment is authorized I
upon receipt and
acceptance ofthe 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,
I OOW Regional Office the LHJ shall be paid I
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 deadJine _
Late or incomplete
reports may not be
accepted for payment.
-
Contract Number C 1 7114-7
AMENDMENT #7
Task Task! ActivityIDescription *May Support PHAB Deliverables/Outcomes Due Daterrime Frame Payment Information
Number Standards/Measures and/or Amount
3 Trained LHJ staff will provide direct Provide completed T A Report and Completed TA 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 OOW Regional Office. OOW Regional Office the LHJ shall be paid for
water systems identified by the OOW within 30 calendar days of each technical assistance
Regional Office. providing technical activity as follows :
assistance. • Up to 3 hours of work: I
See Special Instructions for task activity . $250
• 3-6 hours of work:
I
$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)" OOH Form 710-013 to lodging costs in
the OOW Program Contact below for accordance with the I
See Special Instructions for task activity. approval (to ensure that enough current rates listed on the
funds are available). OFM Website
httQ ://www .ofm. wa .gov/r
esources/travel.asl2
*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
StandardlMeasure. More detail on these andlor other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at:
hUa :'!"''''''' .phahoaru.o r2lwp -come.n lluploads ' P HA B-Standards-a nd-Measures-Version-I .O.od f
Program Specific ReguirementslNarrative
Exhibit A, Statements of Work
Revised as of May 16,2016
Page 5 of7 Contract Number C17114-7
AMENDMENT #7
Special References (RCWs, 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 SPls, and
provide technical assistance) for small community and non-community water systems with groundwater sources . ODW retains responsibility for conducting sanitary surveys (and
SPIs , 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 $1 0,000 for Task 1, and $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 se ction above . When invoicin1! for sanitarY survevs. bill ha Jfto BA RS Reven ue Code 346.16.64 and ha lf lo BARS Rewnu e Cod~
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 (TA).
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 Guide f or Sanitary Survey s, SpeciaL Purpos e Investigations and Technical Assistance (Field Guide). The sanitary survey will include an
evaluation of the following eight elements : source; treatment; distribution sy stem ; 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 I, 2016 and December 31, 2016.
• No more than 5 surveys of non-community systems with four or more connections and all community systems to be completed between January 1,2016 and
December 31,2016.
The process for ass ignment of surveys to the LH1 , notification of the water system , and ODW follow-up with unresponsive water systems ; and other roles and responsibilities of
the LHl are described in the Field Guide.
Task 2
Trained LHl staff will perform Special Purpose Investigations (SPls) as assigned by ODW. SPls are inspections to determine the cause of positive coliform samples or the cause of
other emergency conditions. SPIs may also include sanitary surveys of newly di scovered 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 LHl staff.
Task 3
Trained LHl staff will conduct Technical assistance as assigned by ODW. Technical Assistance includes assisting water system personnel in completing work or verifying work
has been addressed as required, requested, or advised by the ODW to meet applicable drinking water regulations. 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 May 16,2016
Page 6 of7 Contract Number C17114-7
AMENDMENT #7
Task 4
LHJ staff assigned to perform activities under tasks I, 2, and 3 must be trained and approved by ODW prior to performing work. LHJ staff performing the activities under tasks I,
2 and 3 must have completed, with a passing score, the ODW Online Sanitary Survey Training and the ODW Sanitary Survey Field Training. LHJ staff performing activities under
tasks 1,2, and 3 must attend the Annual ODW Sanitary Survey Workshop, and are expected to attend the Regional ODW LHJ Drinking Water Meetings.
If required trainings, workshops or meetings are not available, not scheduled, or ifthe LHJ staff person is unable to attend these activities prior to conducting assigned tasks, the
LHJ staff person may, with ODW approval, substitute other training activities to be determined by ODW. Such substitute activities may include one-on-one training with ODW
staff, co-surveys with ODW staff, or other activities as arranged and pre-approved by ODW. LHJ staff may not perform the activities under tasks 1,2, and 3 without completing
the training that has been arranged and approved by ODW.
Program Manual, Handbook, Policy References
http://www.doh.wa.gov/Portals/llDocuments/PubsJ331-486.pdf
DOH Program Contact
Danielle Russell
DOH Office of Drinking Water
16201 E. Indiana Ave, Suite 1500
Spokane Valley, WA 99216
Danielle.Russell@doh.wa.gov
(509) 329-2136
Exhibit A, Statements of Work
Revised as of May 16,2016
DOH Fiscal Contact
Karena Myers
DOH Office of Drinking Wafer
243 israel Rd SE
Tumwater, WA 98501
Karena.Mvers(ivdoh. wa.gov
(360) 236-3094
Page 7 of7 Contract Number C 17114-7
EXHIBIT B-7
Kittitas County Public Health Department ALLOCATIONS Contract Number: CI71l4
Contract Term: 2015-2017 Date: May 16,2016
Indirect Rate as of January 2015: 40.25%
DOHUseOuly
BARS Statement of Work Chart of Aewuuls 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 Start Date Eud Date Amount Sub Total Total
FFYI4 E PR LHJ fundin g U90TPOO0559 Amend 2 93_069 333 .93.06 01101115 06/30115 07/01114 06130/15 $528 $23,574 $23 ,574
FFYI 4 EPR LIIJ Funding U90TPOO0559 N/A 93 .069 333.93.06 01101115 06 /30 /15 07/01/14 06130115 $23 ,046
I+Y 15 EPR PHEP BP4 LHJ Funding U90TPOO0559 Amend 4 93.069 333 .93.06 07 /01115 06 /30 /16 07/01115 06130116 $5,000 $55 ,000 $55 ,000
fFYIS EPR PHEP BP4 LHJ Funding U90TPOO0559 Amend 3 93069 333 .93 .06 07/0 1115 06130116 07/01115 06130116 $50,000
FFYI5 EPR PHEP BP4 Opcr Readiness U90TPOO0559 Amend 6 93.069 333.93.06 07/0lfl5 06/30/16 07101115 06/30/16 $7,704 $7,704 $7,704
FFY 14 EPR Planning & Exerc ises U90TPOO0559 Amend I 93.069 333 .93_06 01101115 06 /30115 07/01/14 06/30/15 '1)24 ,078 $24,078 $24,078
FFY I 6 3 I7 Ops H231POO0762 Amend 5 9D68 333.93.26 01/01(16 12/31/16 01/01116 12/31116 SI,232 $1,232 $2,685
FFYI5 317 Ops 11231 POO0762 Amend I 93268 333 .93.26 01101115 12/31115 01101115 12/31/15 $193 $1,453
FFYI5 317 Ops 11 23 1POO0762 N/A 93.268 333.93.26 01/0 1/15 12131115 01/01115 12131115 $1,260
FFYI6 MIX H231POO0762 Amend 5 93.268 33393.26 01/01116 12 /31 116 01/01/16 12131116 $4,293 $4,293 $9_306
FFYI5 AFIX H2JIPOO0762 N/A 93.268 33393.26 01 /01/15 12 /3 1115 OIIOI/lS 12131/15 $5,013 $5 ,013
rfYl6 vrc Ops H23IPOO0762 Amend 5 93.268 333.93.26 01l0lfl6 12/31/16 01101/16 12131116 $828 $828 $2,337
FFY 15 VFC Ops H23 IPOOO762 Amend I 93.268 333.93.26 0 1101115 12/3 1115 01/01/15 12131115 $380 $1,509
FFYI5 VFC Ops H231POO0762 N/A 93.268 333 .93 .26 01/01115 12/31115 01/01/15 12131/15 $1.129
FFY 16 VFC Ordering H23IPOO0762 Amend 5 93.268 333,93 .26 01 /01116 12/31/16 01/0)/16 12131/16 $1 ,400 $1 ,400 $2 ,554
fFYIS VfC Ordering 11231POO0762 N/A 93 .268 333_93.26 0 1/0111 5 12 /31115 OI/OIIIS 12131115 $U54 $1 ,154
FFYI4 Enhance liS and VTrckS H231POO0922 Amend 5 93733 333.9373 12/01115 08/311 16 09/30/14 09/29/16 $1,087 $1,087 SI,()87
FFYI5 MCHBG CBP ConCon B04MC28134 Amend 3 93.994 -333.9B9 0 1/01115 09130/15 10101114 09/30/15 $1,723 $34,870 $34,870
FFYI5 MCHBG CBP ConCan B04MC28134 N/A 93.994 333.93,99 01101115 09 /30115 10/01114 09130/15 $33,147
FFY 16 MCHBG I.HJ & Other Contracts B04MC29 364 Amend 3 93.994 333 .93.99 10 /0 1115 09 /30116 10/01115 09130/16 $44,196 $44,196 $44,196
Drinking Water Group A -SS Amend 6 NiA 346.26.64 01/01/15 12/311 16 01101/15 06/30/17 $2,200 $5,000 $5,000
Drinking Water Group A -SS N/A, Amend 6 N/A 34626.64 01/01115 12/31116 01/01/15 06130117 $2,800
Drinking Water Group A -SS State Amend 6 N/A 346.2 6.65 OJ /Ol1l5 12131116 01/01/15 06130117 $2,200 $5,000 $5 ,000
Drinking Water Gro up A -SS State N/A, Amend 6 N/A 346.26.65 01 /01 /15 12/31/1 6 01101115 06/30/17 $2,800
Page 1 of I
Kittitas County Public HeaJtb Department
Indirect Rate as of January 2015: 40.25%
Cbart of Accounts Program T itle
Drinking Water Group A -TA
Drinking Water Group A -TA
TOTAL
Total consideration:
GRAND TOTAL
*Catalog of Federal Domestic Assistance
Federal Award
Ideo lillealio D 1/
5222,391
SO
$222,391
Amend #
Amend 6
N/A, Amend 6
"·Federal revenue codes begin with "333". State revenue codes begin with "334"
EXHIBITB-7
ALLOCATIONS
Contract Term: 2015-2017
BARS Statement of Work
Revenue Funding Period
DOH Use Oaly
l.1tart of A«~Dts
Fnldiag PeriO/J
CFDA* CO d f*" Start Date End Ollie ~bd: Iblli: flId JllI.Iil
N/A 346 .26.66 01/01115 12131116 0 11011 15 O6d0t.t 7
N/A 346.26.66 01101115 12/31116 0ifOl l f5 06130/1
Page 2 of 1
Amount
$1,000
$4,000
5222,391
Contract Number:
Date:
Funding
Period
SubTotal
$5,000
5222,391
GRAND TOTAL
Total Fed
Total State
C17114
May 16, 2016
Cbart'l)f
Accounts
TotaJ
$5,000
5222,391
5207,391
S15,000