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Home My WebLink AboutAmendment 11KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT 2015 -2017 CONSOLIDATED CONTRACT CONTRACT NUMBER: C17114 AMENDMENT NUMBER: 11 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: C8J Adds Statements of Work for the following programs: • Office of Immunization & Child Profile-Diamond Project -Effective January 1, 2017 C8J Amends Statements of Work for the following programs: • Office of Drinking Water Group A Program -Effective January 1,2015 • Office of Immunization & Child Profile -Effective January 1, 2017 o Deletes Statements of Work for the following programs: 2. Exhibit B-ll Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-1 0 Allocations as follows: o Increase of for a revised maximum consideration of __ C8J Decrease of $300 for a revised maximum consideration of $358,397. o No change in the maximum consideration of __ . Exhibit B Allocations are attached only for informational purposes. 3. Exhibit C-9 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces Exhibit C-S. 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 Page I of 17 STATE OF WASHINGTON DEPARTMENT OF HEALTH APPROVED AS TO FORM ONLY Assistant Attorney General 2015-2017 CONSOLIDATED CONTRACT EXHmITA STATEMENTS OF WORK TABLE OF CONTENTS AMENDMENT #11 DOH Program Name or Title: Office of Drinking Water Group A Program -Effective January 1,2015 ......................................................................................... ~.3 DOH Program Name or Title: Office ofImmunization & Child Profile -Effective January 1, 2017 .................................................................................. ,. ............ 8 DOH Program Name or Title: Office ofImmunization & Child Profile -Diamond Project -Effective January 1,2017 ................................................................ 16 Exhibit A, Statements of Work Revised as of March 15 ,2017 Page 2 of 17 Contract Number C 17114-11 Exhibit A Statement of Work Contract Term: 2015-2017 AMENDMENT #11 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) 5 Funding Source Federal Compliance Type of Payment IZI Federal Contractor (check if applicable) D Reimbursement IZI State D FF A T A (Transparency Act) IZI Fixed Price D Other D Research & Development Period of Performance: January 1, 2015 through December 31. 2017 Statement of Work Purpose: The purpose of this statement of work is to provide funding to the LHJ for conducting sanitary surveys and providing technical assistance to small community and non-community Group A water systems. Revision Purpose: The purpose of this revision is to decrease funding consideration and revise Special Billing Requirements and Special Instructions. Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change Total Revenue Index (LUJ Use Only) Consideration Decrease (-) Consideration Code Code Start Date End Date Drinking Water Group A -SS N/A 346.26.64 2421921C 01/01115 12/31117 9,400 0 9,400 Drinking Water Group A -SS State N/A 346.26.65 2421252C 01/01115 12/31/17 9,400 0 9~400 Drinking Water Group A -TA N/A 346.26.66 2421921D 01/01115 12/31117 I 5.400 -2 ,400 3,000 TOTALS 24,200 -2,400 21,800 - - Task *May Support PUAB Payment Information Number Tas k/ Activity /Descri ption StandardslMeasures Deliverables/Outcomes Due Date/Time Frame and/or Amount 1 Trained LHJ staff will conduct sanitary Provide Fina1* 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 identified by the DOH Office of Drinking shall include : Office within 30 calendar shall be paid $400 for Water (ODW) Regional Office. I. Cover letter identitying days of conducting the each sanitary survey of a significant deficiencies , sanitary survey . non-community system See Special Instructions for task activity. significant fmdings , with three or fewer observations, recommendations, cormections. 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 I I Inventory (WFI). eaoh ",n;ta'y'survey of a I 4 . Photos of water system with text non-commumty system identitying features with four or more Exhibit A, Statements of Work Revised as of March 15, 2017 Page 3 of 17 Contract Number C 17114-11 Task Task! Activity/Description 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 March 15 , 2017 I. *May Support PHAB Deliverables/Outcomes StandardslMeasures 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 of 17 AMENDMENT #11 Payment Information Due DatelTime Frame and/or Amount 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 I 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 I as travel, lodging, per diem. I 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 17114-11 AMENDMENT #11 Task Task! ActivitylDescription *May Support PHAB Deliverables/Outcomes Due DatelTime Frame Payment Information Number StandardslMeasures and/or Amount 3 Trained LHJ staff will provide direct Provide completed T A Report and Completed T A Report Upon acceptance ofthe technical assistance (T A) to small any supporting documents and must be received by the completed T A Report, community and non-community Group A photos to ODW Regional Office. ODW Regional Office the LHJ shall be paid for water systems identified by the ODW within 30 calendar days of each technical assistance Regional Office . providing technical activity as follows: assistance. • Up to 3 hours of work: See Special Instructions for task activity . I $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. I 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, mandatory Sanitary Survey Training. Employee)" DOH Form 710-013 to lodging, and registration the ODW Program Contact below for costs as approved on the See Special Instructions for task activity . approval (to ensure that enough pre-authorization form in funds are available). accordance with the current rates listed on the OFM Website h!!Q:llwww.ofin.wa.gov/r esources/travel.asQ *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 StandardlMeasure. More detail on these and/or other Public Health Accreditation Board (PHAB) StandardslMeasures that may apply can be found at: http://www.phaboard.orWwR~comen tl uploadsIPHA13-SLandards-and-Measures-Version-I .O,pdf Exhibit A, Statements of Work Revised as of March 15, 2017 Page 5 of 17 Contract Number C17114-11 AMENDMENT #11 Program Specific Requirements/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 of the quarter in which work was completed, noting on the invoice the Quarter and year be in g billed for. Payment cannot exceed a maximum accumulative fee of $J9,600 $18,800 for Task 1, and U,4I)() $3,000 for Task 2, Task 3 and Task 4 combined during the contracting period, to be paid at the rates specified in the Payment Method/Amount section above. When invoicing for sanitary s urv eys. bill half to BARS Reve nue 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 A 19-1A 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 staffwill 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 ofthe 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. • 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 with four 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. Task2 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 March 15, 2017 Page 6 of 17 Contract Number C 17114-11 AMENDMENT #11 Task3 Trained LHJ staffwill 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. 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 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 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 h ttp:J/www .doh .wa.go\.{Porta.ls/l /Docu men ts/P u b sl331-486. pdf DOH Program Contact Mark 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 March 15 , 2017 DOH Fiscal Contact Karena McGovern DOH Office of Drinking Water 243 Israel Rd SE Tumwater, WA 98501 Karena.McGovern@doh.wa.gov (360) 236-3094 Page 7 of 17 Contract Number C 17114-11 DOH Program Name or Title: Office oflmmunization & Child Profile - Effective January 1, 2017 SOW Type: Revision Revision # (for this SOW) 1 Period of Performance: January 1, 2017 through December 31, 2017 Exhibit A Statement of Work Contract Term: 2015-2017 AMENDMENT # 11 Local Health Jurisdiction Name: Kittitas County Public Health Department Contract Number: C17114 Funding Source Federal Compliance Type of Payment [gI Federal Subrecipient (check if applicable) [gI Reimbursement o State [gI 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: The purpose of this revision is to add a new task and funding. Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change ifotal Revenue Index (LHJ Use Only) Consideration Increase (+) Consideration Code Code Start Date End Date FFY16 PPHF 317 Ops 93.539 333.93.53 74110267 01101117 03 /31117 1,805 0 1,805 FFY 17 VFC Op~ 93.268 333.93.26 74110273 04/01117 12/31117 U50 0 1,150 FFY 17 VFC Ordering 93.268 333.93.26 74110274 04/01117 12/31117 695 0 695 FFY17 317 Ops 93.268 333.93.26 74110271 04/01117 12/31117 924 0 924 FFY17 AFIX 93.268 333.93.26 74110275 04/01117 12/31117 3,340 0 3,340 FFY15 PPHF IIS AFIX 93.733 333.93.73 74110257 04/01117 04/30/17 0 1,000 1,000 TOTALS I 7,914 1,000 8,914 - Task Task! ActivitylDescription *May Support PHAB Deliverables/Outcomes Due Date/Time Frame Payment Information 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 emollment 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 March 15,2017 Provider Agreements for Receipt of State Supplied Vaccine received online via the Washington Immunization Information System. Page 8 of 17 Annually, per Annual VFC Reimbursement for Provider Agreement actual costs incurred, Update Schedule not to exceed total funding consideration amount. Funds available for this task*: Contract Number C17114-11 Task Task! Activity/Description 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 of the order. Exhibit A, Statements of Work Revised as of March 15 , 2017 *May Support PHAB Delivera bles/Outcomes StandardslMeasures I Provider Agreement for Receipt of State Supplied Vaccine with original I signature -DOH 348-002 (NOTE: a photocopy will not be accepted) I Electronic submission of provider vaccine orders via the Washington Immunization Information System Page 9 of 17 AMENDMENT #11 Due Date/Time Frame Payment Information and/or Amount January 2017 - March 2017 FFYl6 PPHF 317 Ops- 74110267 April 2017 - December 2017 FFYl7 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 17114-11 I I Task Task! ActivitylDescription 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 March 15, 2017 *May Support PHAB Delivera bles/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. Page 10 of 17 AMENDMENT # 11 Due Date/Time Frame Payment Information and/or Amount January 2017 - March 2017 FFY16 PPHF 317 Ops- 74110267 I I April 2017 - December 2017 FFY17 VFC Ordering- 74110274 FFY17 VFC Ops- 74110273 I FFY 17 3 1 7 Ops - I 74110271 *See Restrictions on Funds below a) By the 25th of each Reimbursement for month actual costs incurred, not to exceed total funding consideration b) Based on provider amount. order 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 AFlX-I 74110275 *See Restrictions on Funds below Contract Number C 1 7114-11 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. 6 Conduct a total oftwo (2) VFC compliance site visits at enrolled provider site(s) within your jurisdiction per the following 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 of the 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 March 15 , 2 017 *May Support PHAB Deliverables/Outcomes StandardsIMeasures Summary of LHJ Technical Assistance Form (DOH 348-257) I 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 follow -up guidance provided by VFC-PEAR for each incorrect response. Page 11 of 17 AMENDMENT # 11 Payment Information Due DatelTime Frame 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 FFY16 PPHF 317 Ops- 741lO267 I April 2017 - December 2017 FFY17 VFC Ops- 74110273 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 this business days of the task*: site visit. January 2017 - March 2017 FFY16 PPHF 317 Ops- 74110267 April 2017 - December 2017 FFY17 AFIX- 741lO275 Contract Number C17114-11 Task Task! ActivitylDescription 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 March 15 , 2017 *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 12 of 17 AMENDMENT #11 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 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. a) Within five (5) days of Reimbursement for visit. All AFIX visits actual costs incurred, must be completed not to exceed total by December 31, funding consideration 2017 amount. Funds available for this task*: April 2017 - December 2017 FFY17 AFIX- 74110275 b) Within five (5) days of *See Restrictions on visit. All follow-up Funds below visits must be completed six (6) months after the feedback visit . Contract Number C 17114-11 Task Task! ActivitylDescription Number 8 a) In coordination with hospitals , health care providers , and health plans (if applicable), conduct activities to prevent perinatal hepatitis B infection in accordance with the Perinatal Hepatitis B Prevention Program Guidelines, including the following: 1) Identification ofHBsAg-positive pregnant women, and pregnant women with unknown HBsAg status 2) Reporting of HBsAg-positive women and their infants 3) Case management for infants born to HBsAg-positive women to ensure administration of hepatitis B immune globulin (HBIG) and hepatitis B vaccine within twelve (12) hours of birth , the completion of the 3-dose hepatitis B vaccine series , and post-vaccination serologic testing . b) Provide technical assistance to birthing hospitals to encourage administration ofthe 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 Hepatitis B Module of the Washington State Immunization Infonnation Sy stem. 9 Attend in-person Enhanced A FlX training in April 2017. NOTE: This funding is only provided to offset salary costs for one (1) staff attending this required training. All travel. accommodations. and per-diem costs will be paid for separately by the Department of Health. Exhibit A, Statements of Work Revised as of March 15 , 2017 AMENDMENT #11 *May Support PHAB Deliverables/Outcomes Due Date/Time Frame Payment Information StandardslMeasures and/or Amount a) Enter infonnation for a) By the last day of each Reimbursem ent for each case identified into month actual costs incurred, the Perinatal Hepatitis B not to exceed total module of the W A funding consideration Immunization amount. Infonnation System Funds available for this b) Annual Perinatal Hepatitis b) December 15th task*: B Outreach Summary (DOH 348 268) January 2017 - March 2017 FFYI6 PPHF 317 Ops- 74110267 April 2017- December 2017 FFY I 7 3 1 7 Ops - 74110271 *See Restrictions on I Funds below a) Submit evaluation form at Within three (3) business Reimbursement for the conclusion of in -person days after training actual costs incurred, training not to exceed total funding consideration amount Funding available for this task: FFYl5 PPHF llSAFIX I MI-74110257 Page 13 of 17 Contract Number C 17114-11 AMENDMENT # 11 *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: ht!p ;llwww.phaboard.orglwp~onteml upl oadS/PH A B-Standards-and-Measures-Version-I. 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 of Immunization 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. • All LHJ staff who conducts VFC Compliance Site Visits must participate in at least one (I) 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 Accountabilih' and Transparencv Act (FFATA) This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FF A T A or the Transparency Act). The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent. To comply with this act and be eligible to perform the activities in this statement of work, the LHJ must have a Data Universal Numbering System (DUNS®) number. Information about the LHJ and this statement of work will be made available on USASpending.goY 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 8 activities can be found at this link to our website. VFC Operations Guide - A copy will be provided by the Office ofImmunization and Child Profile. (Note: All site visit reviewers are required to have access to the most current CDC VFC Operations Guide at every VFC compliance site visit). Staffing Requirements Provide notification via email to oicpcontracts@doh.wa.gov within fifteen (15) days of any changes to staffing for those who conduct work outlined in this statement of work. Restrictions on Funds (what funds can be used for which activities, not direct payments, etc.) Allowable expenses with 317 and VFC FA Operations Funds (dated September 7,2011) document is posted on the DOH Consolidated Contract website at this link . In addition to the funding listed in the Payment Information and/or Amount column for each task, FFY 17 317 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. Exhibit A, Statements of Work Revised as of March 15 , 2017 Page 14 of 17 Contract Number C17114-11 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 lawnev.harper@dbh.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 March 15, 2017 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 15 of 17 AMENDMENT #11 Contract Number C 17114-11 Exhibit A Statement of Work Contract Term: 2015-2017 AMENDMENT #11 DOH Program Name or Title: Office ofImmunization & Child Profile -Diamond Project -Effec ti ve-January I, 2017 Local Health Jurisdiction Name: Kittitas County Public Health Department Contract Number: Cl7114 SOW Type: Original Revision # (for this SOW) Funding Source Federal Compliance Type of Payment ~ Federal Subrecipient (check if applicable) ~ Reimbursement o State ,l8] FF A T A (Transparency Act) o Fixed Price o Other Period of Performance: January 1, 2017 through March 31, 2017 o Research & Development Statement of Work Purpose: The purpose of this statement of work is to identifY tasks, deliverables, and funding related to the DOH/LHJ Engagement Process (Diamond Project). 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 FFY16 AFIX 93.268 333.93.26 74110265 01101117 I 03 /31/17 0 1,100 1,100 JOTALS 0 1,100 1,100 ------- Task Task! ActivitylDescription *May Support PHAB Deliverables/Outcomes Due DatelTime Frame Payment Information Number Standards/Measures and/or Amount I Participate in conference calls, webinars, and Submit evaluation form at the Within three (3) business Reimbursement for actual in-person meeting(s) conducted by OICP conclusion of March in-person days after the training costs incurred, not to exceed related to the DOHILHJ Engagement Process training total funding consideration (Diamond Project). amount. Funds available for this task: FFYl6 AFIX MI74110265 *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 and/or other Public Health Accreditation Board (PHAB) StandardslMeasures that may apply can be found at: http ://www .phaboard ,orglwp-comen tiuploadsfP H A B-Standards-and-Measures-Ver'si on-I . a .pdf Exhibit A, Statements of Work Revised as of March 15, 2017 Page 16 of 17 Contract Number C17114-11 AMENDMENT #11 Program Specific RequirementsfNariative 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 USASpending.gov by DOH as required by P.L. 109-282. Restrictions on Funds (what funds can be used for which activities, not direct payments, etc) Funds may be spent only for the activities and personnel costs that are directly related to the Diamond Project. Funding requests not directly related to this project are outside of this agreement and will not be funded. These federal funds may not be used for the purchase of food. These federal funds may not be used for expenses related to travel or attendance at any Centers for Disease Control and Prevention (CDC)-sponsored conference, training, or event without prior written approval from the DOH Office ofImmunization and Child Profile (OICP). Other Deliverables may be sent electronically via email to oicpcontracts@doh.wa.gov, by fax to 360-236-3590, or by mail to PO Box 47843, Olympia WA 98504-7843 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 360-236-3525/ Tawney.Harper@doh.wa.gov Exhibit A, Statements of Work Revised as of March 15,2017 DOH Fiscal Contact Vanessa Mojica Special Projects Coordinator Office of Immunization and Child Profile Department of Health PO Box 47843, Olympia WA 98504-7843 360-236-3802/ Vanessa.Mojica@doh .wa.gov Page 17 of 17 Contract Number C I 7114-11 EXHIBIT B-ll Kittitas County Public Health Department ALLOCATIONS Contract Number: C17114 Contract Term: 2015-2017 Date: March 15,2017 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 IdentifieJItion # Amend II CFDA* Code** Start Date End Date Start Date End Date Amount Sub Total Total FFYI7 DSHS SNAP-Ed IAR 1717WAWAsQ390 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 0 11011 15 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 01101115 06/30 /15 07/01114 06/30/15 $23 ,046 FFYI6 EPR PHEP BPS LHJ Funding U90TPOO0559 Amend 8 93.069 333.93 .06 07 /01116 06 /30117 07/01116 06/30/17 $50,000 $50,000 $105 ,000 FFYI5 EPR PH EP BP4 LHJ Funding U90TPOO0559 Amend 4 93.069 333 .93 .06 07 /0 11 15 06 /30 /16 07/01115 06/30/16 $5,000 $55 ,000 FFYI5 EPR PHEP BP4 LHJ Funding U90TPOO0559 Amend 3 93.069 333.93 .06 07 /01 /15 06/30116 07/01/15 06/30/16 $50 ,000 FFYI5 EPR PHEP BP4 Oper Readiness U90TPOO0559 Amend 6 93.069 333.93.06 07 /01115 06 /30 /16 07/01/15 06/30/16 $7 ,704 $7,704 $7 ,704 FFYI4 EPR Planning & Exercises U90TPOO0559 Amend I 93.069 333.93 .06 01101115 06 /30 11 5 07/01114 06/30/15 $24 ,078 $24,078 $24,078 FFYI7 317 Ops sNH23JPOO0762-0s-00 Amend 10 93.268 333 .93.26 04 /0111 7 12 /31117 04101117 06/30/18 $924 $924 $3,609 FFY16 317 Ops H23IPOO0762 Amend 5 93.268 333.93.26 0 1101 /16 12/31116 01101116 12/31/16 $1 ,232 $1 ,232 FFY 15 317 Ops H23IPOO0762 Amend I 93.268 333.93 .26 01101115 12/3111 5 01101115 12/31115 $193 $1,453 FFYI5 317 Ops H231POO0762 N/A 93.268 333 .93.26 01/01115 12/31/15 01/01115 12/31115 $1 ,260 FFYI7 AFIX s NH23IPOO0762-0s-00 Amend 10 93 .268 333 .93 .26 04/01 /17 12 /31117 04/01117 06/30118 $3 ,340 $3 ,340 $13 ,746 FFY16 AFIX H231POO0762 Amend 11 93.268 333.93.26 01101117 03 /31117 01101116 03/31117 $1,100 $1,100 FFYI6AFIX H23IPOO0762 Amend 5 93.268 333.93.26 01101116 12/31116 01101116 12/31116 $4 ,293 $4,293 FFYI5 AFIX H23IPOO0762 N/A 93.268 333 .93.26 01101/15 12/31115 01101115 12/31115 $5 ,013 $5 ,013 FFYI7 VFC Ops s NH23IPOO0762-0S-00 Amend 10 93.268 333.93 .26 04 /0 11 17 12/31117 04/01117 06130/18 $1 ,150 $1,150 $3,487 FFYI6 VFC Ops H23IPOO0762 Amend 5 93.268 333 .93.26 01l0Ill6 12/31116 01101116 12/31116 $828 $828 FFY 15 VFC Ops H23IPOO0762 Amend I 93.268 333 .93.26 01101115 12/3 I115 01101115 12/31115 $380 $1 ,509 FFYI5 VFC Ops H23IPOO0762 N/A 93.268 333 .93.26 01 /01 11 5 12/31 /15 01101115 12/31115 $1 ,129 FFYI7 VFC Ordering sNH23IPOO0762-0S-00 Amend 10 93 .268 333.93.26 04/01117 12/31117 04/01117 06/30/18 $695 $695 $3,249 FFY 16 VFC Ordering H231POO0762 Amend 5 93 .268 333.93.26 OIlOIl16 12/3I116 01101116 12/31116 $1 ,400 $1,400 FFYI5 VFC Ordering H231POO0762 N/A 93.268 333 .93 .26 01101115 12/31115 01101115 12/31/15 $1,154 $1,154 FFYI6 PPHF 317 Ops NH23IPOO0762-04-0s Amend 10 93.539 333.93 .53 01/01117 03/31117 01101116 03/31117 $1 ,805 $1,805 $1,805 FFYI4 Enhance liS and VTrckS H231POO0922 Amend 5 93 .733 333.93.73 12/01115 08 /31116 09/30/14 09/29/16 $1 ,087 $1,087 $1,087 FFYIS PPHF liS AFiX NH231POO 1032-01-01 Amend 11 93.733 333.93.73 04/01117 04/30 /17 09/30/15 09129117 $1,000 $1,000 $1,000 Page 1 of2 EXHIBIT B-11 Kittitas County Public Health Department ALLOCA nONS Contract Number: C17114 Contract Term: 2015-2017 Date: March 15,2017 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 Identifiation # Amend # CFDA* Cod.e** Start Date End Date Start Date End Date Amount Sub Total Total FFY15 MCHBG CBP ConCon B04MC28134 Amend 3 93 .994 333.93 .99 01101115 09/30115 10/01114 09/30/15 $1,723 $34,870 $34,870 FFY 15 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 Contracts 17B04MC30649 Amend 8 93.994 333 .93 .99 10/0 11 16 09/30/17 10/01116 09130/17 $44,196 $44 ,196 $88 ,392 FFYI6 MCHBG LHJ & Other Contracts B04MC29364 Amend 3 93 .994 333 .93 .99 10/01115 09 /30/16 10/01115 09/30/16 $44,196 $44,196 Drinking Water Group B Amend 10 N/A 334.04.90 07/01117 12/31117 07/01117 12/31117 $5,000 $5,000 $10 ,000 Drinking Water Group B Amend 10 N/A 334.04.90 01/01117 06/30/17 01101117 06/30/17 $5 ,000 $5 ,000 Drinking Water Group A -SS Amend 10 N/A 346.26.64 01 /01115 12/31117 01101/15 12/31117 $2 ,800 $9,400 $9,400 Drinking Water Group A -SS Amend 9, 10 N/A 346.26.64 01101115 12/31117 01101115 12/31117 $1,600 Drinking Water Group A -SS Amend 6, 10 N/A 346.26.64 01101/15 12/31/17 01101115 12/31117 $2,200 Drinking Water Group A -SS N/A, Amd 6, 10 N/A 346.26 .64 01101115 12131117 01/01/15 12/31117 $2,800 Drinking Water Group A -SS State Amend 10 N/A 346.26.65 01 /01115 12/31 /17 01101115 12/31117 $2 ,800 $9,400 $9,400 Drinking Water Group A -SS State Amend 9,10 N/A 346.26.65 01 /01115 12/31/17 01101/15 12/31117 $1 ,600 Drinking Water Group A -SS State Amend 6, 10 N/A 346.26.65 01 /01115 12/31117 01101/15 12/31117 $2 ,200 Drinking Water Group A -SS State N/A, Amd 6,10 N/A 346.26.65 01101115 12/31117 01101115 12/31117 $2,800 Drinking Water Group A -TA Amend 11 N/A 346.26.66 01101/15 12/31117 01101/15 12/31117 ($2,400) $3 ,000 $3,000 Drinking Water Group A -TA Amend 10 N/A 346.26.66 01101 /15 12 /31117 01101115 12131117 $2 ,000 Drinking Water Group A - T A Amend 9 ,10 N/A 346.26.66 01 /01/15 12/31117 01101115 12/31117 ($1 ,600) Drinking Water Group A - T A Amend 6, 10 N/A 346 .26 .66 01101115 12 /31117 01/01/15 12/31117 $1,000 Drinking Water Group A -TA N/A, Amd 6, 10 N/A 346.26 .66 01101115 12/31117 01101115 12/31117 $4,000 TOTAL $358,397 $358,397 Total consideration: $358,697 GRAND TOTAL $358,397 ($300) GRAND TOTAL $358,397 Total Fed $326,597 Total State $31,800 *Catalog of Federal Domestic Assistance **Federal revenue codes begin with "333". State revenue codes begin with "334". Page 2 of2 Exhibit C-9 Schedule of Federal Awards AMENDMENT #11 Date: March 15, 2017 KITTITAS COUNTY HEALTH DEPT -SWV0010475-07 CONTRACT C17114-Kittitas County Public Health Department CONTRACT PERIOD 1/1/2015-12/31/2017 DOH Total Amt Allocation Period Chart of Accounts Program Title BARS F4Xla ral Federal Start End Contract Amt CFDA CFDA Program Title Federal Agency Name Federal Award F4Xleral Grant Award Name A ward Date Award Date Oatil Idontificatlon N umber State Administrative Matching Department of Agriculture Food and Supplemental Nutrition Assistance FFY17 DSHS SNAP-ED IAR 3331056 09/30/16 $5,739,856 10/01/16 09/30/17 $14,996 10561 Grants for the Supplemental 1717WAWA5Q390 Nutrition Assistance Program Nutrition Service Program Educalion (SNAP-Ed) Public Health Emergency Department of Health and Human TP12-1201 HPP AND PHEP FFY16 EPR PHEP BP5 UIJ FUNDING 333.93.06 06123116 $10,222,879 07101/16 06130/17 $50,000 93.069 Preparedness Services Centers for Disease Control U90TPOOO559 COOPERATIVE AGREEMENTS and Prevention 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 07101/15 06/30/16 $7,704 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 FFY15 EPR PHEP BP4 LHJ FUNDING 333 ,93 ,06 06126115 512,132,694 07101115 06I30J16 $55,000 93069 Services Centers for Disease Control U90TP000559 Preparedness and Prevention COOPERATIVE AGREEMENTS Public Health Emergency Department of Health and Human TP12·1201 HPP AND PHEP FFY14 EPR PLANNING & EXERCISES 33393,06 06/30/14 $12,663,227 01/01/15 06/30/15 $24,078 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 FFY14 EPR LHJ FUNDING 333.9306 06130/14 $12,663,227 01101/15 06130/15 $23,574 93069 Services Centers for Disease Control U90TPOOO559 Preparedness and Prevention COOPERATIVE AGREEMENTS Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND FFY17 VFC ORDERING 333,93,26 03/03/17 $103,974 04/01/17 12/31/17 $695 93268 Services Centers for Disease Control 5NH23IPOO0762·05-00 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND FFY17 VFC OPS 333.93 ,26 03103117 $1 ,201 ,605 04/01/17 12131/17 $1,150 93268 Services Centers for Disease Control 5NH23IPOOO762.lJ5-00 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND FFY17 AFIX 333,9326 03/03/17 $1,672,289 04/01/17 12 /31/17 $3,340 93268 Services Centers for Disease Control 5NH23IPOO0762·05·00 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND FFY17 317 OPS 3339326 03103117 $575,969 04101/17 12/31117 $924 93266 Services Centers for Disease Control 5NH231POOO762·0!HlO VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND FFY16 VFC ORDERING 3339326 01/19/16 $3,991,784 01/01/16 12 /31/16 $1,400 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 VFC OPS 333 ,93,26 01/19/16 $3,991,784 01/01/16 12131116 $828 93.266 Services Centers for Disease Control H231 P000762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND FFY16AFIX 333 ,93 ,26 01/19/16 $3,991,784 01/01/16 03/31/17 $5,393 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 01/19/16 $3,991,784 01/01/16 12131116 $1,232 93,268 Services Centers for Disease Control H231POOO762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM Immunization Cooperative 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 93268 Services Centers for Disease Control H231P000762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM Page 1 of 2 Exhibit C-9 Schedule of Federal Awards AMENDMENT #11 Date: March 15, 2017 KITTITAS COUNTY HEALTH DEPT-SWV001047S-07 CONTRACT C17114-Kittrta. County Public Hea~h Department CONTRACT PERIOD 1/112015-12131/2017 DOH TotalAmt Allocation Period Chart of Accounts Program Title BARS Federal Federal Start End Contract Amt CFDA CFDA Program Title Federal Agency Name Federal A w ard Federal Grant Award Name Award Date Award Date Date Id"n'lificallcn N umber Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND FFY15 VFC OPS 333.93.26 12117/14 $3,437,046 01/01/15 12131115 $1,509 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 FFY15 AFIX 333.93.26 12/17/14 $3,437,046 01/01/15 12/31/15 $5,013 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 FFY15 317 OPS 333-93-26 12117114 $3,437,046 01101/15 12131115 $1,453 93268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM PPHF Capacity Building PPHF 2017: IMMUNIZATION GRANTS- Assistance to Strengthen Public Department af Health and Human IMMUNIZATION & VACCINES FOR FFY16 PPHF 317 OPS 33393.53 09/08/16 $4,009,643 01/01/17 03/31/17 $1,805 93539 Health Immunization Services Centers for Disease Control NH23IPOO0762-04-05 CHILDREN PROGRAM-FINANCED IN Infrastructure and Performance and Prevention PART BY 2017 PREVENTION & PUBLIC Capacity Building Assistance to Department of Health and Human Strengthen Public Health PPHF 2015: UTILIZATION OF liS FOR FFY15 PPHF liS AFIX 3339373 09130/15 $362,768 04/01/17 04/30/17 $1,000 93733 Immunization Infrastructure & Services Centers for Disease Control NH23IP001032-01-01 AFIX ASSESSMENTS Performance -Financed in part and Prevention Capacity Building Assistance to PPHF 2014: IMMUNIZATION ENHANCE Strengthen Public Health Department of Health and Human AN IMMUNIZATION INFORMATION FFY14 ENHANCE liS AND VTRCKS 3339373 09/16/14 $700,000 12/01/15 08/31/16 $1,087 93J33 Immunization Infrastructure & Services Centers for Disease Control H231POO0922 SYSTEM (liS) TO INTERFACE WITH Performance -Financed in part and Prevention CDC'S VTRCKS VACCINE ORDERING Maternal and Child Health Department of Health and Human FFY17 MATERNAL AND CHILD HEALTH FFY17 MCHBG LHJ & DTHER CONTRACTS 333.93.99 10/31/16 $1 ,697,083 10101116 09/30117 $44,196 93_994 SelVice. Block Gr.'"t to the Services Health Resources and 17B04MC30649 SERVICES States Servtces Administration Matemal and Child Health Department of Health and Human MATERNAL AND CHILD HEALTH FFY16 MCHBG LHJ & OTHER CONTRACTS 333.93.99 10/22/15 $1,739,609 10101/15 09/30116 $44,196 93994 Services Block Grant to the Services Health Resources and B04MC29364 SERVICES States Services Administration Matemal and Child Health Department of Health and Human MATERNAL AND CHILD HEALTH FFY15 MCHBG CBP CONCON 333 ,93.99 10/21/14 $8,846,149 01/01/15 09130115 $34,870 93994 SelVices Block Grant to the Services Health Resources and B04MC28134 States Services Administration SERVICES TOTAL $326,597 Page 2 of2 Kittitas County Review Form Grants & Contract Agreement tt:3B55_~ Today's Date Agenda Date lJjVf /!Vrt May 9,2017 Fund/Department 116-Public Health Contract/Grant Information Contract /Grant Agency: Consolidated Contract Amendment 11 Period Begin Date : tTaJ1IAMMA "I, d-D15 I I Period End Date: DeCem hW 31,.1b1± Total Gra nt/Co ntract Amount: D~re ase of $300.00 for a revised maximum consideration of $358,397.00 Grant/Contract Number: C17114 Contract/Grant Summary: The Consolidated Contract Amendment 11 is Amended to add a statement of work for the Office of Immunization and Child Profile Diamond Project. It also amends statements of work for the Office of Drinking Water Group A Program and Office of Immunization Child Profile. The Amendment Exhibit B-11 Allocations is decreased by $300.00 for a new maximum consideration of $358,397.00. Recommendation for Board of Health and Board of Health Review on Department Head Signature: ________ ---', Administrator Date : __ _ Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: ·APPROVED AS TO FORM : ice Date 5 1!;, (, Date Signature of Board of Health member Date Financial Information Total Amount $2100.00 (inc) State Funds $ Federal Funds $2100.00 (inc) Percentage County Funds Matching Funds $ CFDA#93.733,93 .268 Grant/Contract Review Page 1 In-Kind $ Expl ain Is Equi pm ent being purchased? Who owns equipment? New Personnel being hired? Contact HR hiring -reporting requirements Future impacts or liability to Kittitas County: Budget Information Budget Amendment Needed? Yes 0 attach budget form No [K] Why not New Division Created? No increase in expenditures, offset Revenue Code 116-612.32.15.333.93.733 -$1000 116-612.32.11.333.93.268 -$1100 Pass Through Information Agency to Pass Through Amount to Pass Through $ Sub-Contract Approved Date : Prosecutor Review I Has the Prosecutor reviewed this agreement? I Yes 0 No D County Departments Impacted Auditor Facilities Maintenance Information Services Human Resource Prosecutor Treasurer Submitted I Signature: Department: I Date : Assignment of Tracking Information Auditor's Office Human Resource Prosecutor's Office Who Signed the grant application I Reviewer I Date Grant/Contract Review Page 2