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HomeMy WebLinkAboutAmend 10 Consolidated ContractKITTITAS COUNTY PUBLIC HEALTH DEPARTMENT 2015 -2017 CONSOLIDATED CONTRACT CONTRACT NUMBER: C17114 AMENDMENT NUMBER: 10 PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as "DOH", and KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT hereinafter referred to as "LHJ", pursuant to the Modifications/Waivers clause, and to make necessary changes within the scope of this contract and any subsequent amendments thereto. IT IS MUTUALLY AGREED: That the contract is hereby amended as follows: 1. Exhibit A Statements of Work, attached and incorporated by this reference, are amended as follows: ~ Adds Statements of Work for the following programs: • Office of Drinking Water Group B Program -Effective January 1,2017 • Office of Immunization & Child Profile -Effective January 1, 2017 ~ Amends Statements of Work for the following programs: • Maternal & Child Health Block Grant -Effective January 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-1 0 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-9 Allocations as follows: ~ Increase of $25,514 for a revised maximum consideration of $358,697. 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-8 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces Exhibit C-7. 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. KITTIT AS COUNTY PUBLIC HEALTH DEPARTMENT Page 1 of21 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 #10 DOH Program Name or Title: Maternal & Child Health Block Grant -Effective January 1, 2015 .................... -............ : ................................................................... 3 DOH Program Name or Title: Office of Drinking Water Group A Program -Effective January 1,2015 ................................................................................... , ....... 8 DOH Program Name or Title: Office of Drinking Water Group B Program -Effective January 1, 2017 ..................... , .................................................................. 13 DOH Program Name or Title: Office ofImmunization & Child Profile -Effective January 1, 2017 .............. ; ................................................................ : .............. 15 Exhibit A, Statements of Work Revised as of November 15,2016 Page 2 of21 Contract Number C 17114-1 0 DOH Program Name or Title: Maternal & Child Health Block Grant - Effective January l. 2015 SOW Type: Revision Revision # (for this SOW) 3 Period of Performance: January l. 2015 through September 30, 2017 Exhibit A Statement of Work Contract Term: 2015-2017 AMENDMENT #10 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 o State ~ FF A T A (Transparency Act) o Fixed Price o Other o Research & Development Statement of Work Purpose: The purpose of this statement of work is to support local interventions that impact the target population of the Maternal and Child Health Block Grant. Revision Purpose: The purpose of this revision is to add new billing language to the "Special Billing Requirements" section. Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Revenue Index (LHJ Use Only) Code Code Start Date End Date FFY15 MCHBG CBP CONCON 93.994 333.93.99 78734250 01101 /15 09/30115 FFY16 MCHBG LHJ & OTHER CONTRACTS 93.994 333 .93.99 78730260 10/01115 09/30116 FFY 17 MCHBG LHJ & OTHER CONTRACTS 93 .994 333 .93.99 78730270 10/01116 09/30117 TOTALS Task *May Support PHAB Number Task! Activity lDescri ption StandardslMeasures Deliverables/Outcomes Maternal and Child Health Block Grant (MCHBG) Administration la Participate in calls, at a minimum of every other Designated LHJ staff will month, with DOH contract manager. Dates and participate in contract time for calls are mutually agreed upon between management calls. DOH and LHJ. Ib Participate in DOH sponsored MCHBG-related Designated LHJ staff will quarterly conference calls and/or webinars, participate in calls, webinars, and including up to two (2) in-person meetings. meetings. lc Complete 2015-2016 MCHBG Budget Workbook Submit completed MCHBG for October 1,2015 through September 30,2016 Budget Workbook to DOH using DOH provided template. contract manager. Id Report actual expenditures for October 1,2014-Submit actual expenditures using December 31,2014. the MCHBG Budget Workbook Exhibit A, Statements of Work Revised as of November 15,2016 Page 3 of21 Current Change Total Consideration None Consideration 34 ,870 0 34,870 44,196 0 44,196 44,196 ° 44,196 123.262 -0 1 123,262 Payment Due DatelTime Frame Information and/or Amount September 30, 2017 Reimbursement for actual costs, not to exceed total funding consideration. Action September 30,2017 Plan and Progress Reports must only reflect activities paid September 4, 2015 for with funds provided in this statement of work for February 18,2015 the specified funding period. Contract Number C 17114-1 0 Task Number Task! Activity/Description Ie Report actual expenditures for January 1, 2015 through September 30,2015. If Complete 2016-2017 MCHBG Budget Workbook for October 1,2016 through September 30, 2017 using DOH-provided template. Ig Report actual expenditures for October 1, 2015 through September 30,2016. Ih Report actual expenditures for OctoberI, 2016 through March 31, 2017. Ii Complete 2017-2018 MCHBG Budget Workbook for October 1,2017 through September 30, 2018 using DOH-provided template MCHBG Assessment and Evaluation 2a Participate in statewide capacity and needs assessment activities in preparation for next statewide 5 year plan, as requested. 2b Participate in project evaluation activities developed and coordinated by DOH, as requested. 2c Report program level strategy measure data MCHBG Implementation 3a Develop 2015-2016 MCHBG Action Plan for October 1,2015 through September 30, 2016 using DOH provided template. 3b Report activities and outcomes of2014-2015 MCHBG Action Plan using DOH provided template. Exhibit A, Statements of Work Revised as of November 15, 2016 *May Support PHAB StandardsIMeasures Deliverables/Outcomes (Sections A and B only) to contract manager. Submit actual expenditures using the MCHBG Budget Workbook to DOH contract manager. Submit completed MCHBG Budget Workbook to DOH contract manager. Submit actual expenditures using the MCHBG Budget Workbook to DOH contract manager. Submit actual expenditures using the MCHBG Budget Workbook to DOH contract manager. Submit completed MCHBG Budget Workbook to DOH contract manager. Documentation using report template provided by DOH. Documentation using report template provided by DOH. Documentation using Action Plan Quarterly Report and MCHBG Budget Workbook Submit MCHBG Action Plan to DOH contract manager. Submit Action Plan quarterly reports to DOH contract manager . Page 4 of21 AMENDMENT #10 Payment Due Date/Time Frame Information and/or Amount See Program Specific Requirements and November 30,2015 Special Billing Requirements. September 2,2016 November 30,2016 May 26,2017 September 1, 2017 May 1,2015 Reimbursement for actual costs, not to exceed total funding September 30, 2017 consideration. See Program Specific Requirements and January 15,2017 Special Billing April 15, 2017 Requirements. July 15,2017 Draft -August 21, 2015 Reimbursement for Final -September 4, 2015 actual costs, not to exceed total funding January 15,2015 consideration. Action April 15,2015 Plan and Progress July 15,2015 Reports must only October 15,2015 reflect activities paid for with funds provided in this statement of work for I Contract Number C 171 14-10 Task Number Task! Activity/Description 3c Develop 2016-2017 MCHBG Action Plan for October 1, 2016 through September 30 , 2017 using DOH-provided template. 3d Report activities and outcomes of2015-2016 MCHBG Action Plan using DOH-provided template . 3e Develop 2017-2018 MCHBG Action Plan for October 1, 2017 through September 30 , 2018 usin g DOH-provided template. 3f Report activitie s and outcomes of2016-2017 MCHBG Action Plan using DOH-provided template . Children with Special Health Care Needs (CSHCN) 4a Complete Child Health Intake Form (CHIF) using the CHIF Automated System on all infants and children served by the CSHCN Program as referenced in CSHCN Program Manual. Exhibit A, Statement s of Work Revised as of November 15 ,2016 *May Support PHAB StandardslMeasures Deliverables/Outcomes Submit MCHBG Action Plan to DOH contract manager. Submit Action Plan quarterly reports to DOH contract manager, Submit MCHBG Action Plan to DOH contract manager. Submit Action Plan quarterly reports to DOH contract manager. Submit CHIF data into Secure File Transport (SFT) website: https:lfsft.Wa.20V I Page 5 of21 AMENDMENT #10 Payment Due DateITime Frame Information and/or Amount If LHJ chooses to bill on a the specified funding monthly basis , reports are period. due on or before the 15 th See Program Specific of the followin g month. Requirements and Draft-August 19 ,2016 Special Billing Final-September 2 ,2016 Requirements . January 15 ,2016 April 15 , 2016 July 15 ,2016 October 15,2016 IfLHJ chooses to bill on a monthly basis , reports are due on or before the 15 th of the followin g month. Draft-August 18 , 2017 Final-September 1,2017 January 15 ,2017 April 15 , 2017 July 15 ,2017 ~f-bI4J eheeoe!i 19 bill on (J I/i(J~I~hl}' he5'i'~, 1't1fJ9>",ftj fiFi3 dtJe (m oF-h<.1ere-tlte-J-}-III .. ,t, r _ . January 15 ,2015 Reimbursement for April 15 , 2015 actual costs , not to July 15 ,2015 exceed total funding October 15 ,2015 consideration. Action January 15 ,2016 Plan and Progress April 15, 2016 Reports must only July 15,2016 reflect activities paid October 15 ,2016 for with funds January 15 ,2017 provided in this April 15 , 2017 statement of work for July 15 ,2017 the specified fundin g Contract Number C 17114-1 0 AMENDMENT #10 Task *May Support PHAB Payment Task! Activity/Description Delivera bles/Outcomes Due Date/Time Frame Information and/or Number StandardslMeasures Amount 4b Administer requested DOH Diagnostic and Submit completed Health 30 days after forms are period. Treatment funds for infants and children per Services Authorization forms and completed. CSHCN Program Manual when funds are used. Central Treatment Fund requests See Program Specific directly to the CSHCN Program Requirements and as needed. Special Billing 4c Participate in the CSHCN Regional System and Submit Action Plan quarterly January 15 ,2015 Requirements. quarterly meetings as described in the CSHCN reports including number of April 15,2015 Program Manual. regional meetings attended to the July IS , 201S I DOH contract manager. October IS, 2015 January IS, 2016 April 15 , 2016 July 15 ,2016 October IS, 2016 January IS, 2017 April IS , 2017 July 15 ,2017 *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 mayapply can be found at: http ://www .phaboard.org/wp -conrent/'uploads/PH AB -Standards-and-Measures -Versjon-l .0.Qdf Program Specific Requirements/Narrative Special Requirements Federal Fundi ng Ac countability and Transparenc)' Act (Ji'FATA) 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 USASpendine..gov by DOH as required by P.L. 109-2.82 . Program Manual, Handbook, Policy References Children with Special Health Care Needs Manual -hrt p;//www.doh .wa.govlPortal sil/DocumentslPubs/970-209-CSHCN-Manual.pdf Health Services Authorization (HSA) Form http://www .doh . wa.~ovJPonals/l/DocumentslPubs /91 0 -002-ApprovedHSA .docx Restrictions on Funds (what funds can be used for which activities, not dir ect payments, etc) 1. At least 30% of federal Title V funds must be used for preventive and primary care services for children and at least 30% must be used services for children with special health care needs . [Social Security Law, Sec. 505(a)(3)]. Exhibit A, Statements of Work Revised as of November IS, 2016 Page 6 of21 Contract Number C 1 71 14-10 AMENDMENT #10 2. Funds may not be used for: a. Inpatient services, other than inpatient services for children with special health care needs or high risk pregnant women and infants, and other patient services approved by Health Resources and Services Administration (HRSA). b. Cash payments to intended recipients of health services. c. The purchase or improvement of land, the purchase, construction, or pennanent improvement of any building or other facility, or the purchase of major medical equipment. d. Meeting other federal matching funds requirements. e. Providing funds for research or training to any entity other than a public or nonprofit private entity. f. payment for any services furnished by a provider or entity who has been excluded under Title XVIII (Medicare), Title XIX (Medicaid), or Title XX (social services block grant).[Social Security Law, Sec 504(b)]. 3. If any charges are imposed for the provision of health services using Title V (MCH Block Grant) funds, such charges will be pursuant to a public schedule of charges; will not be imposed with respect to services provided to low income mothers or children; and will be adjusted to reflect the income, resources, and family size of the individual provided the services. [Social Security Law, Sec. 505 (1)(0)]. Monitoring Visits (frequency, type) Telephone calls with contract manager at least one every other month. Special Billing Requirements Payment is contingent upon DOH receipt and approval of all deliverables and an acceptable A 19-1A invoice voucher. Payment to completely expend the "Total Consideration" for a specific funding period will not be processed until all deliverables are accepted and approved by DOH. Invoices must be submitted et-Iee9HjftGf'k!~ monthly on the 30th of each monthfollowing the month in which the expenditures were incurred and must be based on actual allowable program costs. Billing for services on a monthly tir qlfgFl:e • ..Jy fraction of the "Total Consideration" will not be accepted or approved.--MemhJ,. iffl'eifJC5-eR aeruel allewsbl:e PJ'9gfflHHffJ5f5-;t'ilJ...h.e....ueeepleti bllt an 1ifJtlsh=d .'fe/ien Ph11t..J2r~S Renal'l mU5! else he 61ibmifte4- Special Instructions Any materials or communication products developed regarding work related to this Statement of Work should include the following text: "Supported by the Washington State Department of Health, Office of Healthy Communities through the Maternal and Child Health Block Grant award from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration". DOH Program Contact Mary Dussol Healthy Communities Consultant Office of Healthy Communities Washington State Department of Health Street Address: 310 Israel Rd SE, Tumwater, W A 98501 Mailing Address: PO Box 47848, Olympia, WA 98504 Telephone: 360-236-37811 Fax: 360-236-3646 Email: mary.dussol@doh.wa.gov Exhibit A, Statements of Work Revised as of November 15,2016 Page 7 of21 Contract Number C 17114-1 0 Exhibit A Statement of Work Contract Term: 2015-2017 AMENDMENT #10 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) 4 Funding Source Federal Compliance Type of Payment ~ Federal Contractor (check if applicable) D Reimbursement ~ State D FF A T A (Transparency Act) ~ Fixed Price D Other D Research & Development Period of Performance: January 1, 2015 through December 31, 2017 Statement of Work Purpose: The purpose ofthis 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 funding consideration and extend funding period end dates from 12/31116 to 12/31117, revise Payment Information on Task 4, and revise Special Billing Requirements and Special Instructions. 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 Task! ActivitylDescription 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 November 15,2016 I I CFDA# BARS Master Funding Period Current Change Total Revenue Index (LHJ Use Only) Consideration Increase (+) Consideration Code Code Start Date End Date N/A 346.26.64 2421921C 01101115 12/31117 6,600 2,800 9AOO N/A 346.26.65 2421252C 01/01115 12/31117 6,600 2,800 9,400 N/A 346.26.66 2421921D 01/01115 12/31117 3,400 2,000 5,400 16,600 7,600 24,200 *May Support PHAB Delivera bles/Outcomes Due DatelTime 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 LHJ shall include: Office within 30 calendar shall be paid $400 for 1. Cover letter identifying days of conducting the each sanitary survey of a I 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 ofthe Final Sanitary checklist. Survey Report, the LHJ 3. Updated Water Facilities shall be paid $800 for Inventory (WFI). each sanitary survey of a Page 8 of21 Contract Number C 17114-10 Task Task! ActivitylDescription Number DOH will provide a tablet and GPS unit for the LHJ to gather source data during a routine sanitary 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 November IS, 2016 *May Support PHAB Standardsn\feasures Deliverables/Outcomes 4. Photos of water system with text identifying features S. 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 9 of21 AMENDMENT #10 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, 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 C 1 7114-1 0 Task T ask! ActivitylDescription Number 3 Trained LHJ staff will provide direct technical assistance (T A) to small community and non-community Group A water systems identified by the ODW Regional Office. See Special Instructions for task activity . 4 LHJ staff performing the activities under tasks 1, 2 and 3 must have completed the mandatory Sanitary Survey Training. See Special Instructions for task activity . Exhibit A, Statements of Work Revised as of November 15,2016 *May Support PHAB Deliverables/Outcomes StandardslMeasures Provide completed T A Report and any supporting documents and photos to ODW Regional Office. . I Prior to attending the training, submit an "Authorization for Travel (Non- Employee)" DOH Form 710-013 to the ODW Program Contact below for approval (to ensure that enough funds are available). I Page 10 of21 AMENDMENT #10 Due Date/Time Frame Payment Information and/or Amount Completed T A Report Upon acceptance of the must be received by the completed T A Report, ODW Regional Office the LHJ shall be paid for within 30 calendar days of each technical assistance providing technical activity as follows: assistance. • Up to 3 hours of work: $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. Annually LHJ shall be paid mileage, per diem, lodging, and eIhff misceUcmee'bts travel expenses registration costs as approved on the pre-authorization form in accordance with the current rates listed on the OFM Website hrm:/fwww.ofm . wa.gov/r esources/travel.ast! Contract Number C 1 7114-1 0 AMENDMENT #10 *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-conrontiuploadstpHAB-Standards-and-Measures-V tlrsion-I .O .pd f Program Specific Reguirements/Narrative Special References (RCWs, WACs, etc) Chapter 246-290 WAC is the set ofmles 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 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 $13,2()() $19,600 for Task 1, and $J,4OO $5,400 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. Whe n invoicing for sanitary surveys. bill half to 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 ODW Program Contact below and a signed A19-1A 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 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 910 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. • No more than 2 surveys of non-community systems with three or fewer connections to be completed between January 1, 2017 and December 31,2017. • No more than 6 surveys of non-community systems withfour or more connections and all community systems to be completed between January 1, 2017 and December 31,2017. 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. Exhibit A, Statements of Work Revised as of November 15,2016 Page 11 of2I Contract Number C 1 7114-1 0 AMENDMENT #10 Task 2 Trained LHJ staffwill perfonn Special Purpose Investigations (SPIs) as assigned by ODW. SPIs are inspections to detennine the cause of positive colifonn 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 SPIs 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 systempersonnel in completing work or verifying work has been addressed as required, requested, or advised by the OOW to meet applicable drinking water regulations . Examples of technical assistance activities are described in the Field Guide. The OOW Regional Office must authorize in advance any technical assistance provided by the LHJ to a water system. Task 4 LHJ staff assigned to perfonn activities under tasks 1, 2, and 3 must be trained and approved by OOW prior to perfonning work. LHJ staff perfonning the activities under tasks I, 2 and 3 must have completed, with a passing score, the OOW Online Sanitary Survey Training and the OOW Sanitary Survey Field Training. LHJ staffperfonning 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. Ifrequired trainings, workshops or meetings are not available, 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 ODW approval, substitute other training activities to be detennined by ~OW. 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 ~OW. LHJ staff may not perfonn the activities under tasks 1,2, and 3 without completing the training that has been arranged and approved by ~OW. Program Manual, Handbook, Policy References bttp:llwww.doh.wa.govI Portals/llDocumentslPubs1331-486 .pdI DOH Program Contact Mark Steward DOH Office of Orin king Water 16201 E. Indiana Ave, Suite 1500 Spokane Valley, WA 99216 Mark.S[eward @doh .wa .goy (509) 329-2136 Exhibit A, Statements of Work Revised as of November 15,2016 DOH Fiscal Contact Karena McGovern OOH Office of Orin king Water 243 Israel Rd SE Tumwater, WA 98501 Karena. McGovern @doh.wa.goy (360) 236-3094 Page 12 of21 Contract Number C 17114-10 Exhibit A Statement of Work Contract Term: 2015-2017 AMENDMENT #10 DOH Program Name or Title: Office of Drinking Water Group B Program- Effective January I, 2017 Local Health Jurisdiction Name: Kittitas County Public Health Department Contract Number: CI7114 SOW Type: Original Revision # (for this SOW) Funding Source Federal Compliance Type of Payment o Federal <Select One> (check if applicable) o Reimbursement I:8l State o FF A T A (Transparency Act) I:8l Fixed Price o Other o Research_ & Development Period of Performance: January I, 2017 through December 31, 2017 Statement of Work Purpose: The purpose of this statement of work is to provide financial support to LHJs implementing local Group B water system programs. Revision Purpose: N/A Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change Irotal Revenue Index (LUJ Use Only) Consideration Increase (+) Consideration Code Code Start Date End Date Drinking Water Group_ B N/A 334.04.90 24240103 01/01117 I 06/30117 0 5,000 5,000 Drinking Water Group B N/A 334.04.90 24240103 07 /01117 I 12/31117 0 5,000 5_,000 TOTALS 0 10,000 lO~OOO Task Task! Activity/Description *May Support PHAB Deliverables/Outcomes Joint Plan of Payment Information Number StandardslMeasures Responsibility Number and/or Amount I Implement a full Group B water system program An executed joint plan of Reference DOH JPR Semi-annual lump sum responsibility (JPR) with DOH #NI9411 payments (See Special identifying responsibilities of a Billing Requirements) full Grou~ B program. *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://w ww .p haboard.orglwp-comentiupioads /P H AB_Sta ndard s-and-M easures -VeTS ion -I .O.p df Program Specific Reg uirements/N arrative Special Billing Requirements The LHJ shall submit semi-annual invoices as follows: $5,000 in the first half of the calendar year and $5,000 in the second half of the calendar year. Payment cannot exceed a maximum accumulative fee of $1 0,000 per year. Exhibit A, Statements of Work Revised as of November 15,2016 Page 13 of21 Contract Number C 17114-10 DOH Program Contact DOH Fiscal Contact Dorothy Tibbetts, MS MPH Karena McGovern Eastern Regional Manager DOH Office of Drinking Water DOH Office of Drinking Water 243 Israel Rd SE 16201 E Indiana Ave, Suite 1500 Tumwater, W A 98501 Spokane Valley, WA 99216 Karena.Mcgovern@doh.wa.gov Doro[l1y.Tjbbetts@doh.wa~o\l (360) 236-3094 (509) 329-2105 Exhibit A, Statements of Work Revised as of November 15,2016 AMENDMENT #10 Page 14 of21 Contract Number C 17114-1 0 DOH Program Name or Title: Office ofImmunization & Child Profile - Effective January I. 2017 SOW Type: Original Revision # (for this SOW) Period of Performance: January 1, 2017 through December 31, 2017 Exhibit A Statement of Work Contract Term: 2015-2017 AMENDMENT #10 Local Health Jurisdiction Name: Kittitas County Public Health Department Contract Number: C17114 Funding Source Federal Compliance Type of Payment [8] Federal Subrecipient (check if applicable) [8] Reimbursement o State [8] FF A T A (Transparency Act) o Fixed Price o Other o Research & Development Statement of Work Purpose: The purpose of this statement of work is to define required immunization tasks, deliverables, and funding. The period of performance for this statement of work is divided into two funding allocation periods, January through March 2017 and April through December 2017. Tasks and deliverables will be divided proportionately between the two funding periods. 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 FFYI6 PPHF 317 Ops 93.539 333 .93 .53 74110267 01101117 03 /31117 0 1,805 1,805 FFY 17 VFC Ops 93.268 333 .93.26 74110273 04/0111 7 12/31117 0 1,150 1,150 FFY 17 VFC Ordering 93.268 333.93.26 74110274 04 /01117 12/31117 0 695 695 FFY 17 317 Ops 93.268 333.93.26 74110271 04/01117 12/31117 0 924 924 FFY17 AFIX 93.268 333.93.26 74110275 04 /01117 12/31117 0 3,340 3,340 TOTALS 0 7,914 7,914 - Task Task! Activity/Description *May Support PHAB Deliverables/Outcomes Due Date/Time Frame Payment Information I Number StandardslMeasures and/or 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 15,2016 Ii Provider Agreements for Receipt of State Supplied Vaccine received online via the Washington Immunization Information System. - Page 15 of21 Annually, per Annual VFC Reimbursement for Provider Agreement Update actual costs incurred, Schedule not to exceed total funding consideration amount. Funds available for this task*: Contract Number C 17114-10 ! Task Task! ActivitylDescription Number 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 Washington Immunization Information System 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 ofthe order. Exhibit A, Statements of Work Revised as of November 15,2016 *May Support PHAB Deliverables/Outcomes StandardslMeasures I Provider Agreement for Receipt of State Supplied Vaccine with original signature -DOH 348-002 (NOTE: a photocopy will not be accepted) I I Electronic submission of provider vaccine orders via the Washington Immunization Information System Page 16 of21 AMENDMENT #10 Due DatelTime Frame Payment Information and/or Amount January 2017 - March 2017 FFY16 PPHF 317 Ops -74110267 . April 2017 - December 2017 FFY17 AFIX- 74110275 *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*: January 2017 - March 2017 FFY16 PPHF 317 Ops -74110267 April 2017 - December 2017 FFY17 AFIX- 74110275 *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*: Contract Number C 17114-10 Task Task! Activity /Description Number 4 Monitor and assure electronic or paper submission of vaccine accountability reports for compliance with Provider Agreement related to vaccine management (ordering, inventory management, reconciliation, compliance with storage and handling, and reporting of all vaccine incidents and returns). Exhibit A, Statements of Work Revised as of November 15 ,2016 *May Support PHAB Deliverables/Outcomes StandardslMeasures a) Monthly Vaccine Accountability Report (DOH 348-006) b) Inclusion in the online ordering system of doses used in the last month and inventory on hand. c) 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 . I Page 17 of21 AMENDMENT #10 Due DatelTime Frame Payment Information and/or Amount January 2017 - March 2017 FFYI6 PPHF 317 Op s -74110267 April 2017 - December 2017 FFY 17 VFC Ordering -74110274 FFY17 VFC Ops- 74110273 FFY 1 7 3 17 Ops - 74110271 *See Restrictions on Funds below a) By the 25th of each Reimb4rsement for month actual costs incurred, not to exceed total funding consideration b) Based on provider order amount. schedules Funds available for this task*: c) Within seven (7) days January 2017- of the incident March 2017 FFY16 PPHF 317 Ops -74110267 d) Within seven (7) days April 2017 - of the incident December 2017 FFY17 AFIX- 74110275 *See Restrictions on Funds below Contract Number C I 71 14-10 Task Task! Activity/Description Number 5 Provide communication, technical assistance, consultation, and education to providers about vaccine quality assurance, accountability, program participation and vaccine management. c 6 Conduct a total of two (2) VFC compliance site visits at enrolled provider site(s) within your jurisdiction per the foIlowing schedule: January 1,2017 -September 30,2017: two (2) 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 ofthe VFC 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 mail that corrective actions were completed. Exhibit A, Statements of Work Revised as of November 15,2016 *May Support PHAB Deliverables/Outcomes StandardslMeasures 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) on-line system for each provider site visit. Follow all corrective action and foIlow-up guidance provided by VFC-PEAR for each incorrect response. Page 18 of21 AMENDMENT #10 Due Date/Time Frame Payment Information and/or Amount December 31 st Reimbursement for actual costs incurred, not to exceed total funding consideration amount. Funds available for this task*: January 2017- March 2017 I FFYI6 PPHF 317 Ops -741lO267 I April 2017 - December 2017 FFY17 VFC Ops - 741lO273 FFY 1 7 3 17 Ops - 74110271 *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 VFC amount. Compliance Site Visit or within five (5) Funds available for business days of the site this task*: I visit. January 2017 - March 2017 FFY16 PPHF 317 Ops -74110267 April 2017 - December 2017 FFY17 AFIX- 741lO275 Contract Number C 17114-1 0 Task Task! Activity/Description Number 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 conducted in the January -March time period must be completed by March 31st. All VFC compliance site visits and the required site visit follow-ups conducted in the April-September time period must be completed by September 30th. 7 NOTE: The period of performance for this task is April 1, 2017 through December 31, 2017. Any AFIX visits conducted prior to April 1, 2017 will not be counted toward the requirements of this task. a) Conduct AFIX (Assessment, Feedback, Incentive, and Exchange) visits with two (2) provider sites in your jurisdiction between April 1,2017 and December 31, 2017. Visits can be conducted in-person, by telephone, or by webinar. All initial AFIX visits must be completed by December 31 st• b) Conduct 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 completed six (6) months after the feedback visit. Continue following up with provider sites until they fully implement their selected quality improvement activities. Exhibit A, Statements of Work Revised as of November 15, 2016 *May Support PHAB Deliverables/Outcomes StandardslMeasures c) Submit copy of signed Acknowledgement of Receipt a) Enter the following data in the AFIX Online Tool: • General Site Visit Information. • Questionnaire responses. • Coverage assessment results (from CoCASA reports or SMART AFIX Tool). Assessments must be completed within seven (7) days of feedback visit • 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). '======--- Page 19 of21 AMENDMENT #10 Due Date/Time Frame Payment Information and/or Amount c) Within five (5) days of *See Restrictions on the visit Funds below NOTE: All VFC compliance site visits and the required site visit follow-ups conducted in the January -March time period must be completed by March 31s~. All VFC compliance site visits and the required site visit follow-ups conducted in the April-September time period must be completed by September 30th. a) Within five (5) days of Reimbursement for visit. All AFIX visits actual costs incurred, must be completed by not to exceed total December 31,2017 funding consideration amount. Funds available for this task*: April 2017 - December 2017 FFY17 AFIX- 74110275 b) Within five (5) days of visit. All follow-up *See Restrictions on visits must be Funds below completed six (6) months after the feedback visit. Contract Number C 17114-1 0 AMENDMENT #10 Task Task! ActivitylDescription *May Support PHAB Deliverables/Outcomes Due Date/Time Frame Payment Information Number StandardslMeasures and/or Amount 8 a) In coordination with hospitals, health care a) Enter information for a) By the last day of each Reimbursement for providers, and health plans (if app licab Ie), each case identified into month actual costs incurred, conduct activities to prevent perinatal hepatitis B the Perinatal Hepatitis B not to exceed total infection in accordance with the Perinatal module of the WA funding consideration Hepatitis B Prevention Program Guidelines, Immunization amount. including the following: Information System 1) Identification of HBsAg-positive pregnant Funds available for women, and pregnant women with unknown b) Annual Perinatal Hepatitis b) December 15th this task*: HBsAg status B Outreach Summary 2) Reporting ofHBsAg-positive women and (DOH 348 268) January 2017 - their infants March 2017 3) Case management for infants born to FFY16 PPHF 317 Ops HBsAg-positive women to ensure administration -74110267 of hepatitis B immune globulin (HBIG) and hepatitis B vaccine within twelve (12) hours of April 2017 - birth, the completion of the 3-dose hepatitis B December 2017 vaccine series, and post-vaccination serologic FFY 1 7 3 17 Ops - testing. 74110271 b) Provide technical assistance to birthing *See Restrictions on hospitals to encourage administration of the Funds below hepatitis B birth dose to all newborns within twelve (12) hours of birth, in accordance with Advisory Committee on Immunization Practices (ACIP) recommendations. c). Report all perinatal hepatitis B investigations, including HBsAg-positive infants, in the Perinatal I Hepatitis B Module of the Washington State Immunization Information System. *For Information Only: Funding is not tied to the revised StandardslMeasures 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.9r elwp-conren ri u ploads /P J-IAS-Srandards-and-Measurcs-Version -]_ 0 .pd f Program Specific Reguirements/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 ofImmunization and Child Profile (OICP) 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 OICP staff (or designee) will periodically conduct observational VFC/ AFIX site visits with all other LHJ reviewers who conduct VFC Compliance Site Visits. Exhibit A, Statements of Work Revised as of November 15,2016 Page 20 of21 Contract Number C17114-10 AMENDMENT #10 • All LHJ staff who 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. 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 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 USASpendiri!!.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 of Immunization 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, FFY17 317 Ops funding may be used for any activity in this statement of work conducted between April 1, 2017 and December 1, 2017, per funding availability and period of performance. 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, MPA 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 WA 98504-7843 Sonja.morris@doh.wa .gov, 360-236-3545 Exhibit A, Statements of Work Revised as of November 15,2016 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 21 of21 Contract Number C 1 7114-1 0 EXHIBIT B-IO Kittitas County Public Health Department ALLOCATIONS Contract Number: C17114 Contract Term: 2015-2017 Date: November 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 Program Title ldentific;ttion # 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 10/01116 09/30/17 $14,996 $14,996 $14,996 FFYI4 EPR LHJ Funding U90TPOO0559 Amend 2 93.069 333.93.06 01101115 06/30/15 07/01114 06/30/15 $528 $23,574 $23,574 FFYI4 EPR LHJ Funding U90TPOO0559 N/A 93.069 333 .93.06 01/01115 06/30/15 07/01114 06/30/15 $23,046 FFY16 EPR PHEP BP5 LHJ Funding U90TPOO0559 Amend 8 93.069 333 .93.06 07/01116 06/30/17 07/01116 06/30/17 $50,000 $50,000 $105,000 FFY15 EPR PHEP BP4 LHJ Funding U90TPOO0559 Amend 4 93.069 333 .93.06 07/01115 06/30/16 07/01115 06/30/16 $5,000 $55,000 FFY15 EPR PHEP BP4 LHl Funding U90TPOO0559 Amend 3 93.069 333.93.06 07/01115 06/30/16 07/01115 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 $7,704 $7,704 $7,704 FFY14 EPR Planning & Exercises U90TPOO0559 Amend 1 93.069 333.93.06 01101115 06/30115 07/01114 06130/15 $24,078 $24,078 $24,078 FFYI7 317 Ops NGA Not Received Amend 10 93.268 333.93.26 04/01117 12/31117 04/01117 06/30/18 S924 S924 S3,609 FFYI6 317 Ops H23IPOO0762 Amend 5 93 .2 68 333.93.26 01101116 12/31116 01101116 12/31116 $1,232 $1,232 FFYI5 317 Ops H23IPOO0762 Amend I 93 .268 333.93.26 01101115 12/31/15 01/01115 12/31115 $193 $1,453 FFY15 317 Ops H23IPOO0762 N/A 93.268 333.93.26 01101115 12/31115 01101115 12/31115 $1,260 FFY17 AFIX NGA Not Received Amend 10 93.268 333.93.26 04/01117 12/31117 04/01117 06/30/18 S3,340 S3,340 S12,646 FFY16AFIX H23IPOO0762 Amend 5 93.268 333.93.26 01101/16 12/31116 01l01l16 12/31/16 $4,293 $4,293 FFY15 AFIX H23IPOO0762 N/A 93.268 333 .93 .26 01101115 12/31115 01101115 12/31115 $5,013 $5,013 FFY17 VFC Ops NGA Not Received Amend 10 93.268 333.93.26 04/01117 12/31117 04/01117 06/30/18 SI,150 SI,150 S3,487 FFY16 VFC Ops H23IPOO0762 Amend 5 93 .2 68 333.93.26 01101116 12/31116 01101116 12/31116 S828 $828 FFY15 VFC Ops H23IPOO0762 Amend 1 93 .268 333.93.26 01101115 12/31115 01l01l15 12/31115 $380 $1,509 FFYI5 VFC Ops H23IPOO0762 N/A 93.268 333.93.26 01101115 12/31115 01l01l15 12131115 $1,129 FFY17 VFC Ordering NGA Not Received Amend 10 93.268 333.93.26 04/01117 12/31117 04/01117 06130/18 S695 S695 S3,249 FFY16 VFC Ordering H23IPOO0762 Amend 5 93.268 333 .93.26 01101116 12/31116 01l01/16 12/31116 $1,400 $1,400 FFY15 VFC Ordering H23IPOO0762 N/A 93.268 333 .93.26 01/01115 12/31115 01l01l15 12/31115 $1,154 $1,154 FFY16 PPHF 317 Ops NGA Not Received Amend 10 93.539 333.93.53 01101117 03/31117 01l01l16 03/31117 $1,805 $1,805 $1,805 FFY14 Enhance lIS and VTrckS H23IPOO0922 Amend 5 93.733 333 .93.73 12/01115 08/31116 09/30/14 09/29/16 $1,087 $1,087 $1,087 FFYI5 MCHBG CBP ConCon B04MC28134 Amend 3 93.994 333 .93.99 01101115 09/30/15 10/01114 09/30/15 $1,723 $34,870 $34,870 FFY15 MCHBG CBP ConCon B04MC28134 N/A 93.994 333.93.99 01101115 09/30/15 10101l14 09130/15 $33,147 FFYI7 MCHBG LHJ & Other Contracts NGA Not Received Amend 8 93.994 333 .93.99 10/01116 09/30/17 10/01116 09/30/17 $44,196 $44,196 $88,392 FFYI6 MCHBG LHJ & Other Contracts B04MC29364 Amend 3 93.994 333.93.99 10/01115 09/30/16 10/01l15 09/30/16 $44,196 $44,196 Page I of2 EXHIBIT B-I0 Kittitas County Public Health Department ALLOCATIONS Contract Number: C17114 Contract Term: 2015-2017 Date: November 15,2016 Indirect Rate as of January 2015: 40.25% tron uSe (\j uly BARS Statement of Work (man of Mtoun ~ Funding Chart of Federal Award Revenue Funding Period ,FiJi!Eifug -P~riod Period Accounts C harI o f Accounrs Pr2Sram Title Identification # Amend # CFDA* Code** Start Date End Date sfln Dl fi ' Eil lJol>l 1C1 Amount S u bTota l Totul Drinking Water Group B Amend 10 N/A 334.04.90 07/01117 12/31117 OVi!'O'I II7 ~ lU3111' 55,000 55,000 510,000 Drinking Water Group B Amend 10 N/A 334.04.90 01101117 06/30/17 () J I/) U,(',7 . 06/3~1(1 55,000 55,000 Drinking Water Group A -SS Amend 10 N/A 346.26.64 01101115 12/31117 ~)10 1:l I;S 12I3W,1 52,800 59,400 59,400 Drinking Water Group A -SS Amend 9,10 N/A 346.26.64 01101115 12/31/17 O'llOl{~ I'2I3P'lJ $1,600 Drinking Water Group A -SS Amend 6, 10 N/A 346.26.64 01101115 12/31/17 6'1101115' 1.~Jiq~ $2,200 Drinking Water Group A -SS N/A, Amd 6, 10 N/A 346.26.64 01101115 12/31117 tL:Q J j~ @ 'VJ[l $2,800 Drinking Water Group A -SS State Amend 10 N/A 346.26.65 01101115 12/31117 O)/O))t5 I1J3~f.1.1 52,800 59,400 59,400 Drinking Water Group A -SS State Amend 9, 10 N/A 346.26.65 01101115 12/31/17 ({INV I ~'; 12iJ1/11 $1,600 Drinking Water Group A -SS State Amend 6,10 N/A 346.26.65 01101115 12/31117 01/01/16 IrID 111:17 $2,200 Drinking Water Group A -SS State N/A, Amd 6, 10 N/A 346.26.65 01101115 12/31117 a1Yo.J Jr~ ~1'lcli $2,800 Drinking Water Group A -TA Amend 10 N/A 346.26.66 01101115 12/31117 q)l{)Jll:S ~ pl3i>/f7 $2,000 55,400 55,400 Drinking Water Group A -TA Amend 9,10 N/A 346.26.66 01101115 12/31/17 .PI~91 !~~ ~j {l1 ($1,600) Drinking Water Group A • T A Amend 6, 10 N/A 346.26.66 01/01115 12/31/17 (H/OIIlS , t..21S I/I:i $1,000 Drinking Water Group A • T A N/A, Amd 6, 10 N/A 346.26.66 01101/15 12/31/17 _.o:!!oY.1~ I:1,t.3VL.~ $4,000 TOTAL 5358,697 5358,697 Total consideration: 5333,183 GRAND TOTAL 5358,697 525,514 GRAND TOTAL 5358,697 Total Fed 5324,497 Total State 534,200 *Catalog of Federal Domestic Assistance **Federal revenue codes begin with "333". State revenue codes begin with "334", Page 2 of2 Exhibit C-8 Schedule of Federal Awards AMENDMENT #10 Date: November 15,2016 KITTITAS COUNTY HEALTH DEPT-SWVOO10475-07 CONTRACT C17114-Kittitas County Public Health Department CONTRACT PERIOD 1/1/2015-12/31/2017 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 NGA Not NGANot 10/01/16 State Administrative Matching Department of Agriculture Food and FFY17 DSHS SNAP-ED IAR 333 ,10,56 09/30/17 $14,996 10"561 Grants for the Supplemental NGA Not Received NGA Not Received Received Received Nutrition Assistance Program Nutrition Service Public Health Emergency Department of Health and Human TP12-1201 HPP AND PHEP FFY16 EPR PHEP BP5 LHJ FUNDING 33393,06 06/23/16 $10,222,879 07/01/16 06130/17 $50,000 93069 Services Centers for Disease Control U90TPOO0559 Preparedness and Prevention COOPERATIVE AGREEMENTS Public Health Emergency Department of Health and Human TP12-1201 HPP AND PHEP FFY15 EPR PHEP BP4 OPER READINESS 33393,06 06/30/14 $11,064,407 07/01/15 06/30/16 $7 ,704 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 FFY15 EPR PHEP BP4 L.HJ FUNDING 3339306 06126115 $12,132,694 07/01/15 06130116 $55,000 93069 Preparedness Services Centers for Disease Control U90TPOO0559 COOPERATIVE AGREEMENTS and Prevention Public Health Emergency Department of Health and Human TP12-1201 HPP AND PHEP FFY14 EPR PLANNING & EXERCISES 3339306 06/30/14 $12,663,227 01/01/15 06/30/15 $24,078 93069 Preparedness Services Centers for Disease Control U90TPOO0559 COOPERATIVE AGREEMENTS and Prevention Public Health Emergency Department of Health and Human TP12-1201 HPP AND PHEP FFY14 EPR L.HJ FUNDING 333.9306 06/30/14 $12,663,227 01/01/15 06130/15 $23,574 93069 Services Centers for Disease Control U90TPOO0559 Preparedness and Prevention COOPERATIVE AGREEMENTS NGA Not 1oIG,<l.Not 04/01/17 Immunization Cooperative Department of Health and Human FFY17 VFC ORDERING 3339326 12/31/17 $695 93268 Services Centers for Disease Control NGA Not Received NGA Not Received Received R«twed Agreements and Prevention NGA Not Jo(~Not 04/01/17 Immunization Cooperative Department of Health and Human FFY17 VFC OPS 3339326 12131117 $1,150 93268 Services Centers for Disease Control NGA Not Received NGA Not Received Received ReceNed Agreements and Prevention NGA Not NGA Not 04/01/17 Immunization Cooperative Department of Health and Human FFY17 AFIX 333.9326 12/31/17 $3,340 93268 Services Centers for Disease Control NGA Not Received NGA Not Received Received Received Agreements and Prevention NGA Not NGA Not 04/01/17 Immunization Cooperative Department of Health and Human FFY17 317 OPS 333,93,26 12131/17 $924 93268 Services Centers for Disease Control NGA Not Received NGA Not Received Received Received Agreements and Prevention Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND FFY16 VFC ORDERING 333,93,26 $3,991,764 01/01/16 01/01/16 12/31/16 $1,400 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 fFY16 VFC OPS 333.93.26 $3,991,784 01/01/16 01/01/16 12131116 $828 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 FFY16 AFIX 333 ,93 ,26 $3,991,764 01/01/16 01/01/16 12/31/16 $4,293 93268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND FFY16 317 OPS 333_93.26 $3,991,784 01/01/16 01/01/16 12131116 $1,232 93268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM Department of Health and Human IMMUNIZATION GRANT AND FFY15 VFC ORDERING 3339326 12/17/14 $3,437,046 01/01/15 12/31/15 $1,154 93_268 Immunization Cooperative Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM Page 1 of 2 Exhibit C-8 Schedule of Federal Awards KITTITAS COUNTY HEALTH DEPT -SWV0010475-07 CONTRACT C17114-Kittitas County Public Health Department CONTRACT PERIOD 111/2015-12131/2017 Chart of Accounts Program Title BARS FFY15 VFC OPS 3339326 FFY15AFIX 333"9326 fFY15 317 OPS 3339326 FFY16 PPHF 317 OPS 3339353 FFY14 ENHANCE liS AND VTRCKS 333,9373 FFY17 MCHBG LHJ & OTHER CONTRACTS 333"93"99 FFY16 MCHBG LHJ & OlliER CONlRACTS 33393.99 FFY15 MCHBG CBP CONCON 3339399 DOH Federal Award Date 12117/14 12/17/14 12117/14 NGA Not Received 09/16/14 NGA Not Received 10122115 10/21/14 TotalAmt Allocation Period Federal Start End Award Date Date $3,437,046 01101/15 12131/15 $3,437,046 01/01/15 12/31/15 $3,437,046 01/01/15 12131/15 NGANot 01/01/17 Received 03/31/17 $700,000 12101/15 08/31/16 NGA Not 10101/16 Received 09/30/17 $1,739,609 10/01/15 09130/16 $8,646,149 01/01/15 09/30/15 TOTAL Contract Amt CFDA CFDA Program Title $1,509 93268 Immunization Cooperative Agreements $5,013 93268 Immunization Cooperative Agreements $1,453 93.268 Immunization Cooperative Agreements Assistance to Strengthen Public $1,805 93539 Health Immunization Infrastructure and Performance financed in part by Prevention Capacity Building ASSistance to $1,087 93733 Strengthen Public Health Immunization Infrastructure & Performance -Financed in part Matemal and Child Health $44,196 93_994 Services Block Grant to the States Maternal and Child HeaHh $44,196 93994 Services Block Grant to the States Maternal and Child Health $34,870 93994 Services Block Grant to the States $324,497 Page 2 of 2 Federal Agency Name Department of Health and Human Services Centers for Disease Control and Prevention Department of Health and Human Services Centers for Disease Control and Prevention Department of Health and HUman Services Centers for Disease Control and Prevention Department of Health and Human Services Centers for Disease Control and Prevention Department of Health and Human Federal Award Identification Number H231PO00762 H231P000762 H231P000762 NGA Not Received Services Center.;; for Disease Control H231P000922 and Prevention Department of Health and Human Services Health Resources and NGA Not Received Services Administration Department of Health and Human Services Health Resources and Services Administration Department of Health and Human Services Health Resources and Services Administration B04MC29364 B04MC28134 AMENDMENT #10 Date: November 15, 2016 Federal Grant Award Name IMMUNIZATION GRANT AND VACCINES FOR CHILDREN'S PROGRAM IMMUNIZATION GRANT AND VACCINES FOR CHILDREN'S PROGRAM IMMUNIZATION GRANT AND VACCINES FOR CHILDREN'S PROGRAM NGA Not Received PPHF 2014: IMMUNIZATION ENHANCE AN IMMUNIZATION INFORMATION SYSTEM OIS) TO INTERFACE WITH CDC'S VTRCKS VACCINE ORDERING NGA Not Received MATERNAL AND CHILD HEAL lli SERVICES MATERNAL AND CHILD HEALTH SERVICES