HomeMy WebLinkAboutAmendment No. 9KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2015 -2017 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CI7114 AMENDMENT NUMBER: 9
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:
~ 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-9 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-8 Allocations as
follows:
~ Increase of$I,600 for a revised maximum consideration of $333,183 .
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.
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
APPROVED AS TO FORM ONLY
Assistant Attorney General
2015-2017 CONSOLIDATED CONTRACT
EXHffiITA
STATEMENTS OF WORK
TABLE OF CONTENTS
AMENDMENT #9
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 September 15,2016
Page 2 of7 Contract Number C17114-9
Exhibit A
Statement of Work
Contract Term: 2015-2017
AMENDMENT #9
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: Cl71l4
SOW Type: Revision Revision # (for this SOW) 3 Funding Source Federal Compliance Type of Payment
[gI Federal Contractor (check if applicable) o Reimbursement
[gI State o FF A TA (Transparency Act) [gI Fixed Price o Other o Research & Development
Period of Performance: January 1, 20 IS 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 increase contract Consideration, add language to the Payment Information on Task 4, revise Special Billing Requirements and
Special Instructions, and change DOH Contact Names.
Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change rrotal
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 01101115 12/31/16 5,000 1,600 6,600
Drinking Water Group A -SS State N/A 346.26.65 2421252C 01 /01115 12/31116 5,000 1,600 6,600
Drinking Water Group A -TA N /A 346.26.66 24219210 01 /01115 12 /31116 5,000 -1 ,600 3,400
TOTALS
-------
!5,OOO 1,600 16,600
Task Task! Activity/Description *May Support PHAB Delivera bles/Outcomes Due Date/Time Frame Payment Information
Number StandardsIMeasures and/or Amount
1 Trained LHJ staff will conduct sanitary Provide Final* Sanitary Survey Final Sanitary Survey Upon ODW acceptance
surveys of small community and non-Reports to ODW Regional Office. Reports must be received of the Final Sanitary
community Group A water systems Complete Sanitary Survey Reports by the ODW Regional Survey Report, the LHJ I
identified by the DOH Office of Drinking shall include: Office within 30 calendar shall be paid $400 for I
Water (ODW) Regional Office. l. Cover letter identifying days of conducting the each sanitary survey of a
See Special Instructions for task activity .
Exhibit A, Statements of Work
Revised as of September 15,2016
:
significant deficiencies,
significant findings,
observations, recommendations,
and referrals for further ODW
follow-up.
2. Completed Small Water System
checklist.
3. Updated Water Facilities
Inventory (WFl).
Page 3 of7
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 C17114-9
Task Task! Activity/Description Number
DOH will provide a tablet and GPS unit
for the LHJ to gather source data during a
routine sar:itary survey. DOH expects the
LHJ to commit to using the tablet and
GPS for a five-year period.
2 Trained LHJ staff will conduct Special
Purpose Investigations (SPI) of small
community and non-community Group A
water systems identified by the ODW
Regional Office.
See Special Instructions for task activity .
--
Exhibit A, Statements of Work
Revised as of September 15,2016
*May Support PHAB
StandardslMeasures Deliverables/Outcomes
4. Photos of water system with text
identifying features
5. Any other supporting
documents.
*Final Reports reviewed and
accepted by the ODW Regional
Office.
The LHJ surveyor will record at least
two (2) GPS data points , for each
source, into the preloaded Excel
template on the tablet and submit that
data file with the associated sanitary
survey.
Provide completed SPI Report and
any supporting documents and
photos to ODW Regional Office.
----
Page 4 of7
AMENDMENT #9
Due DatelTime Frame Payment Information
and/or Amount
non-community system
with four or more
connections and each I
community system.
Payment is inclusive of
all associated costs such
as travel, lodging, per
diem.
I
Payment is authorized
upon receipt and
acceptance of the Final
Sanitary Survey Report
I
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,
ODW 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 Number C17114-9
AMENDMENT #9
Task Task! Activity/Description *May Support PHAB Deliverables/Outcomes Due DatelTime Frame Payment Information
Number StandardslMeasures and/or Amount
3 Trained LHJ staff will provide direct Provide completed TA Report and Completed TA Report Upon acceptance of the
technical assistance (TA) to small any supporting documents and must be received by the completed TA 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 Specia l 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
TA 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 I, 2 and 3 must have completed the an "Authorization for Travel (Non-mileage, per diem, and
mandatory Sanitary Survey Training. Employee)" DOH Form 710-013 to lodging eosIS, and other
the ODW Program Contact below for miscellaneous travel
See Special Instructions for task activity. approval (to ensure that enough expenses as approved on
funds are available). the pre-authorization
form in accordance with
the current rates listed on
the OFM Web site
httQ://www .ofm.wa.gov/r
esouIcesltrave!.aso
-
*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:
tlp:ll w,,","\v .phaboaJ'd.oralwQ-conlen tJ uploads /PHAB-Sland ard s-and -Measures -Version-I ;O.gdf
Exhibit A, Statements of Work
Revised as of September 15,2016
Page 5 of7 Contract Number C17114-9
AMENDMENT #9
Program Specific Reguirements/Narrative
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 SPIs, 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 1,2, 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 ofthe 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 $,ro,()()() $13,200 for Task 1, and $5-;OOfJ $3,400 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 invoiciM fOLsanirarvsurveys. biJJ haJito BARS Revenue Code 346.26.64 and half to 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 OD W 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 for 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 § 9 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 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. SPIs may also include sanitary surveys of newly discovered Group A water systems. Additional detail about conducting SPIs is described in the Field
Guide. The ODW Regional Office must authorize in advance any SPI conducted by LHJ staff.
Exhibit A, Statements of Work
Revised as of September 15,2016
Page 6 of7 Contract Number C17114-9
AMENDMENT #9
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
has been addressed as ::-equired, requested, or advised by the ODW to meet applicable drinking water regulations. Examples oftechnical 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.
Task 4
LHJ staff assigned to perform activities under tasks 1, 2, and 3 must be trained and approved by ODW prior to performing work. LHJ staff performing the activities under tasks 1,
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, H a ndbook, Policy References
http://www.doh.wa.gov/Portals/I /Documenrs /Pubs1331-486.pdf
DOH Program Conta ct
Dcmiel.f.e RMsseU Mar k Steward
DOH Office of Drinking Water
16201 E. Indiana Ave, Suite 1500
Spokane Valley, WA 99216
Mark. Steward@doh.wa.gov
(509) 329-2136
Exhibit A, Statements of Work
Revised as of September 15,2016
DOH Fiscal Contact
Karena M~ McGovern
DOH Office of Drinking Water
243 Israel Rd SE
Tumwater, WA 98501
Karena.McGovem@doh.wa.gov
(360) 236-3094
Page 7 of7 Contract Number C 17114-9
EXHIBIT B-9
Kittitas County Public Health Department ALLOCATIONS Contract Number: C17114
Contract Term: 2015-2017 Date: September 15,2016
Indirect Rate as of January 2015: 40.25%
DOH Use Only
BARS Statement of Work Chart of Accounts Funding Chart of
Federal Award Revenue Funding Period Funding Period Period Accounts
Chart of Accounts Prollram Title Identification # Amend # CFDA* Code** Start Date End Date Start Date End Date Amount Sub Total Total
FFYI7 DSHS SNAP-Ed IAR NGA Not Received Amend 8 10 .561 333.10.56 10101116 09 /30 /17 10101116 09/30117 $14,996 $14,996 $14,996
FFYI4 EPR LHJ Funding U90TPOO0559 Amend 2 93 .069 333,93 .06 01101115 06/30115 07/01114 06/30/15 $528 $23,574 $23 ,574
FFY14 EPR LHJ Funding U90TPOO0559 N/A 93 .069 333 .93 .06 01101115 06/30115 07/01114 06/30115 $23 ,046
FFYI6 EPR PHEP BP5 LHJ Funding U90TPOO0559 Amend 8 93 .069 333.93 .06 07 /01116 06 /30 /17 07/01116 06130/17 $50,000 $50,000 $105 ,000
FFYI5 EPR PHEP BP4 LHJ Funding U90TPOO0559 Amend 4 93.069 333.93.06 07 /01115 06 /30 /16 07/01/15 06/30/16 $5 ,000 $55 ,000
FFYI5 EPR PHEP BP4 LHJ Funding U90TPOO0559 Amend 3 93.069 333 .93 .06 07 /01115 06 /30 /16 07/01115 06/30/16 $50,000
FFYI5 EPR PHEP BP4 Oper Readiness U90TPOO0559 Amend 6 93 .069 333 .93.06 07/01115 06/30/16 07/01115 06/30/16 $7 ,704 $7,704 $7,704
FFYI4 EPR Planning & Exercises U90TPOO0559 Amend I 93 .069 333.93 .06 01/01/15 06 /30 /15 07/01114 06/30115 $24,078 $24,078 $24,078
FFYI63170ps H23IPOO0762 Amend 5 93.268 333 .93 .26 01/01116 12/31116 01101116 12/31116 $1 ,232 $1,232 $2 ,685
FFYI5 317 Ops H23IPOO0762 Amend I 93.268 333.93.26 01101115 12/31115 01101115 12/31115 $193 $1,453
FFYI5 317 Ops H23IPOO0762 N/A 93.268 333 .93.26 01/01115 12/31115 01101115 12/31115 $1 ,260
FFYI6 AFIX H23IPOO0762 Amend 5 93 .268 333 .93 .26 01101116 12/31116 01/01116 12131/16 $4 ,293 $4,293 $9 ,306
FFYI5 AFIX H231POO0762 N/A 93 .268 333 .93.26 01 /01 /15 12/31/15 01101115 12/31/15 $5 ,013 $5 ,013
FFY 16 YFC Ops H231POO0762 Amend 5 93 .268 333 .93.26 01 /01116 12/31 /16 01/01116 12/31116 $828 $828 $2 ,337
FFYI5 YFC Ops H23IPOO0762 Amend I 93 .268 333.93.26 01101115 12/31/15 01/01115 12/31/15 $380 $1,509
FFYI5 YFC Ops H23IPOO0762 N/A 93 .268 333 .93.26 01101/15 12/31115 01101115 12/31115 $1 ,129
FFYI6 YFC Ordering H23IPOO0762 Amend 5 93.268 333.93.26 01/01/16 12/31116 01101/16 12/31116 $1 ,400 $1,400 $2,554
FFYI5 YFC Ordering H23IPOO0762 N/A 93.268 333 .93.26 01101115 12/31115 01/01115 12/31115 $1 ,154 $1,154
FFYI4 Enhance lIS and YTrckS H23IPOO0922 Amend 5 93 .733 333.93.73 12/01115 08/31116 09/30/14 09129116 $1 ,087 $1,087 $1 ,087
FFY 15 MCHBG CBP Con Con B04MC28134 Amend 3 93.994 333 .93 .99 01101115 09 130 /15 10/01114 09/30/15 $1 ,723 $34,870 $34,870
FFYI5 MCHBG CBP Con Con B04MC28134 N/A 93.994 333 .93 .99 01101115 09/30 /15 10/01114 09/30/15 $33 ,147
FFY 17 MCHBG LHJ & Other C J ntracts NGA Not Received Amend 8 93.994 333.93.99 10/01116 09 /30117 10/01116 09/30/17 $44,196 $44,196 $88,392
FFY16 MCHBG LHJ & Other C)ntracts B04MC29364 Amend 3 93 .994 333m.99 10 /01115 09 /30116 10/01115 09130116 $44,196 $44,196
Drinking Water Group A -SS Amend 9 N/A 346.26.64 01101115 12 /31 /16 01101115 06/30/17 SI,600 S6,600 56,600
Drinking Water Group A -SS Amend 6 N/A 346.26.64 01101115 12/31/16 01101/15 06/30/17 $2 ,200
Drinking Water Group A -SS N/A, Amend 6 N/A 346.26,64 01101115 12/31116 01101115 06/30117 $2 ,800
Drinking Water Group A -SS State Amend 9 N/A 346.26.65 01101115 12/31116 01101/15 06tJl'l /Jr SI,600 $6 ,600 S6,600
Drinking Water Group A -SS State Amend 6 N/A 346.26.65 01101115 12131116 01101115 'Q6'~~Ol,1 7 $2 ,200
Drinking Water Group A -SS State N/A, Amend 6 N/A 346 .26.65 01/01115 12/31116 01101115 .06l3CJtl 7 $2 ,800
Page I of2
Kittitas County Public Health Department
Indirect Rate as of January 2015: 40.25%
C hart of Accounts Pr~ram TI tle
Drinking Water Group A -TA
Drinking Water Group A -TA
Drinking Water Group A -TA
TOTAL
Total consideration:
GRAND TOTAL
*Catalog of Federal Domestic Assistance
Federal Award
Idc.ntifica tion #
$331,583
51,600
5333,183
Amend #
Amend 9
Amend 6
N/A,Amend6
**Federal revenue codes begin with "333". State revenue codes begin with "334"_
EXHIBIT B-9
ALLOCATIONS
Contract Term: 2015-2017
BARS
Revenue
CFDA* Cod ~"'"
N/A 346.26.66
N/A 346.26.66
N/A 346.26.66
Page 2 of2
DO~l~Ql'J l y
Statemenl ·of Work .C hart ot A~\'Dlll1t.~
F unding Period Fundiilg PCriOfl
Sta rt Dale End D:II ~ SUfd,Da I'lLEhd..D iJ.l e
01101 /15
OIJOJ.lIS
0.1 /01/15
1213 1/16
1213 1/16
1213 ),/16
()110'V-l S
1)1/0111 ~'
OI/OUl 5
Amount
(51,600)
$1,000
$4,000
5333,183
Contract Number: C17114
Date: September 15,2016
Funding
Period
Sub Total
53,400
5333,183
GRAND TOTAL
Total Fed
Total State
Chart of
Accounts
Total
53,400
5333,183
5316,583
516,600