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Home My WebLink AboutAmendment 12KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT 2015 -2017 CONSOLIDATED CONTRACT CONTRACT NUMBER: C17114 AMENDMENT NUMBER: 12 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 ModificationslWaivers 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 : o Adds Statements of Work for the following programs: I:8J Amends Statements of Work for the following programs: • Office ofImmunization & Child Profile -Effective January 1, 2017 D Deletes Statements of Work for the following programs: 2. Exhibit B-12 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-11 Allocations as follows: o o Increase of Decrease of for a revised maximum consideration of __ for a revised maximum consideration of __ I:8J No change in the maximum consideration of $358,397. Exhibit B Allocations are attached only for informational purposes . 3. Exhibit C-10 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces Exhibit C-9. 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 1 of 10 STATE OF WASHINGTON DEP ARTMENT OF HEALTH J]1M~lIDI I f"j Date APPROVED AS TO FORM ONLY Assistant Attorney General 2015-2017 CONSOLIDATED CONTRACT EXB1BITA STATEMENTS OF WORK TABLE OF CONTENTS DOH Program Name or Title: Office ofImmunization & Child Profile -Effective January 1, 2017 ..... Exhibit A, Statements of Work Revised as of May 15, 2017 Page 2 of 10 AMENDMENT #12 . .................................................. 3 Contract Number C 17114-12 DOH Program Name or Title: Office of Immunization & Child &ofile- Effective January 1, 2017 SOW Type : Revision Revision # (for this SOW) 2 Period of Performance: January 1. 2017 through December 31. 2017 Exhibit A Statement of Work Contract Term: 2015-2017 AMENDMENT #12 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) ~ Reimbursement o State ~ FFATA (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 modify funding. Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change !T otal Revenue Index (LHJ Use Only) Consideration None Consideration Code Code Start Date End Date FFY16 PPHF 317 Ops 93.539 333.93.53 74110267 0110111 7 03/31117 1,805 0 1,805 FFY17 VFC Ops 93.268 333.93.26 74110273 04/01117 12/31117 1,150 0 1,150 FFY17 VFC Ordering 93 .268 333.93 .26 74110274 04/01117 12/3 11 17 695 0 695 FFY17 317 Ops 93.268 333.93.2 6 74110271 04/01/17 12/31117 924 0 924 FFY17 AFIX 93.268 333.93.26 74110275 04/01117 12 /31/17 3,340 0 3,340 FFY15 PPHF lIS AFIX 93.733 333.93.73 74110257 04/011 17 04/30117 1,000 -1 ,000 0 FFY16 PPHF Adolescent AFIX 93.733 333.93.73 74110268 04/01117 04/30117 0 1,000 1,000 TOTALS 8 .914 0 8,914 Task Task! Activity /Description *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 May 15, 2017 Provider Agreements for Receipt of State Supplied Vaccine received online via the Washington Immunization Information System. - Page 3 of 10 Annually, per Annual VFC Reimbursement for Provider Agreement actual costs incurred, Update Schedule not to exceed total funding consideration amount. Contract Number C17114-12 I 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 Exhibit A , Statements of Work Revised as of May 15,2017 *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) Page 4 of 10 -----AMENDMENT #12 Payment Information Due Date/Time Frame and/or Amount Funds available for this task*: January 2017- March 2017 FFY16 PPHF 317 Ops- 74110267 April 2017 - December 2017 FFY17 AFIX- 741102 75 *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 AFlX- 74110275 *See Restrictions on Funds below Contract Number C17114-12 I I Task Task! Activity /Description Number 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. I 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 May 15, 2017 *May Support PHAB StandardslMeasures Deliverables/Outcomes Electronic submission of provider vaccine orders via the Washington Immunization Information System 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 348-1 S4) complete with reason and corrective action as needed . Page 5 of 10 ----.. --AMENDMENT #12 Payment Information Due DatelTime Frame and/or Amount Based on provider order Reimbursement for schedules actual costs incurred, not to exceed total funding consideration amount. I Funds available for this task*: January 2017- March 2017 FFY16 PPHF 317 Ops- 74110267 - April 2017 - December 2017 FFY17 VFC Ordering- 74110274 FFY17 VFC Ops - 74110273 FFY17 317 Ops- 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 Contract Number C17ll4-12 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 of two (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 Exhibit A, Statements of Work Revised as of May 15, 2017 *May Support PHAB StandardslMeasures Deliverables/Outcomes d) Report all cases (or suspected cases) of .1 vaccine fraud or abuse . 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 Page 6 of 10 AMENDMENT #12 Payment Information Due Date/Time Frame and/or Amount d) Within seven (7) days April 2017 - of the incident December 2017 FFY17 AFIX- 74110275 *See Restrictions on Funds below 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- 74110267 April 2017 - December 2017 FFY17 VFC Ops- 74110273 FFY17 317 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 oftbe VFC amount. Compliance Site Visit or within five (5) Funds available for this business days of the task·: site visit. Contract Number C17114-12 Task TasklActivityillescription Number 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. 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 wiJl not be counted toward the requirements ofthis 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,t. Exhibit A, Statements of Work Revised as of May 15, 2017 *May Support PHAB StandardslMeasures Deliverables/Outcomes 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 . 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 CoCAS A reports or SMART AFIX Tool). Assessments must be completed within seven (7) days of feedback visit • Feedback visit information. Page 7 of 10 AMENDMENT #12 Payment Information Due DatelTime Frame and/or Amount January 2017 - March 2017 FFY16 PPHF 317 Ops- 74110267 April 2017 - December 2017 FFY17 AFIX- 74110275 c) Within five (5) days of the visit *See Restrictions on Funds below I 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 I 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. I Funds available for this task*: April 2017 - December 2017 FFY17 AFIX- 74110275 Contract Number C17114-12 , Task Task! ActivitylDescription Number 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. 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 ofHBsAg-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 of the 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 Information System. Exhibit A, Statements of Work Revised as of May 15, 2017 AMENDMENT #12 *May Support PHAB Deliverables/Outcomes Payment Information StandardslMeasures Due Date/Time Frame and/or Amount I b) Enter the following data in b) Within five (5) days of *See Restrictions on the Exchange tab of the AFIX visit. All follow-up Funds below Online Tool for follow-up visits must be visits: completed six (6) • Clinic progress on months after the implementing quality feedback visit. improvement strategies. • Follow-up coverage assessment results (from CoCASA reports). a) Enter information for a) By the last day of each Reimbursement 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. Information System Funds available for this b) Annual Perinatal Hepatitis b) December 15th task*: B Outreach Summary (DOH 348 268) January 2017 - I March 2017 FFY16 PPHF 317 Ops- 74110267 April 2017 - December 2017 FFY17 317 Ops- 74110271 *See Restrictions on Funds below Page 8 of 10 Contract Number C 17114-12 AMENDMENT #12 -- Task Task! ActivityIDescription *May Support PHAB DeliverablesJOu tcomes Due DatelTime Frame Payment Information Number StandardslMeasures and/or Amount 9 Attend in-person Enhanced AFIX training in a) Submit evaluation form at Within three (3) business Reimbursement for April 2017 . the conclusion of in-person days after training actual costs incurred, training not to exceed total NOTE: This funding is only provided to offset I funding consideration salary costs for one (1) staff attending this amount required training . All travel, accommodations, and per-diem costs will be paid for separately by Funding available for the Department of Health. this task: FFY15 PPHF lIS AFIX MI -74110257 -~ *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) StandardslMeasures that may apply can be found at: http://WW\v.pbaboard.org/wo-conlenfl uploadslPHAB -Slalldards-and-Measures-Version-1 .0 .pdf Program Specific ReguirementsfN arrative • 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. • 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 F ederal F unding Accounta b ilitv and Transparencv Act (FF ATA) This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FFATA 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. 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 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). Exhibit A, Statements of Work Revised as of May 15,2017 Page 9 of 10 Contract Number C17114-12 AMENDMENT #12 Staffing Requirements Provide notification via email to oicpcontract S@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 F unds (what funds can be used for which activi tie s, nOl direct payments, etc.) Allowa ble expenses with 3 17 and we FA Operations Funds (da ted September 7, 20 J 1) docu ment is posted on the DOH Consolidated Contract website at this link. In addition to th e fund ing listed in Lil e Pay ment Lnfotma li oD andlor AmbUDl column fol' each ta sk. 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 fe d eral :funds m ay n0t 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 Immun ization and Child Profile. DOH Program Contact Tawney Harper, MP A 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 May 15, 2017 Deliverables may be sent electronically via email at ,oicpcontracts@doh .wa.eov, by fax to 360-236-3590, or by mail to PO Box 47843, Olympia WA 98504-7843 Page 10 of10 Contract Number C 1 7114-12 EXHIBIT 8-12 Kittitas County Public Health Department ALLOCATIONS Contract Number: C17114 Contract Term: 2015-2017 Date: May 15,2017 Indirect Rate as of January 2015: 40.25% Indirect Rate as of January 2017: 11.25% County Central Svcs & 29.5% Public Health Dept BARS Statement of Work Chart of Accounts Funding Chart of Federal Award Revenue Funding Period FUBding Period Period Accounts Chart of Accounts ProS!!m Title IJienlificalion # Amend # CFDA* Code** Start Dal~ End Dale S .. rt Date EDdDllle AmouDI Sub -Total Total FFYl7 DSHS SNAP-Ed IAR 17l7WAWA5Q390 Amend 8 10 .561 333.10.56 10/01116 09/30117 10/0 1/16 09/30/17 $14,996 $14,996 $14,996 FFY14 EPR LHJ Funding U90TPOO0559 Amend 2 93 .069 333 .93.06 01101115 06/30/15 07/01/14 06/30/15 $528 $23,574 $23,574 FFYI4 EPR LHJ Funding U90TPOO0559 N/A 93 .069 333 .93.06 01 /01 /15 06/30/15 07 /01 /14 06/30/15 $23,046 FFY16 EPR PHEP BPS LHJ Funding U90TPOOO559 Amend 8 93 .069 333.93.06 07/01116 06/30/17 07/0 II 16 06/30117 $50,000 $50,000 $105,000 FFYI5 EPR PHEP BP4 LHJ Funding U90TPOOO559 Amend 4 93 .069 333 .93.06 07/01 /15 06/30 /16 07/01 /15 06130 /16 $5,000 $55,000 FFY 15 EPR PHEP BP4 LHJ Funding U90TPOO0559 Amend 3 93.069 333 .93.06 07/01/15 06/30/16 07/01115 06/30/16 $50,000 FFY15 EPR PHEP BP4 Oper Readiness U90TPOO0559 Amend 6 93.069 333 .93 .06 07/01 /15 06/30/16 07/01/15 06/30/16 $7,704 $7,704 $7,704 FFY14 EPR Planning & Exercises U90TPOO0559 Amend I 93.069 333.93.06 01101/15 06/30/15 07/01114 06/30/15 $24,078 $24,078 $24,078 FFY17 317 Ops 5NH23IPOO0762-05-00 Amend 10 93.268 333.93.26 04/01 /17 12/31117 04/01/17 06/30/18 $924 $924 $3,609 FFY16 317 Ops H23IPOO0762 Amend 5 93.268 333.93.26 01/01116 12/31116 01/01116 12/31/16 $1,232 $1,232 FFY15 317 Ops H23IPOO0762 Amend I 93.268 333 .93 .26 01101 /15 12/31115 01/01115 12 /31 /15 $193 $1,453 FFY15 317 Ops H231P000762 N/A 93.268 333.93.26 01101115 12 /31115 01 /01 /15 12 /31 /15 $1,260 FFYI7 AFIX 5NH231P000762-05-00 Amend 10 93 .268 333 .93.26 04 /01 /17 12/31117 04/01 /17 06 /30 /18 $3,340 $3,340 $13 ,746 FFYI6 AFIX H23IPOO0762 Amend II 93 .268 333.93.26 01101 /17 03 /31117 01 /01116 03 /31117 $1,100 $1,100 FFY16 AFIX H23IPOO0762 AmendS 93.268 333 .93.26 01101/16 12/31/16 01101/16 12/31116 $4,293 $4,293 FFYI5 AFIX H231POO0762 N/A 93.268 333 .93.26 01101115 12131115 01 /01/15 12 /31115 $5,013 $5,013 FFYI7 YFC Ops 5NH23IPOO0762-05-00 Amend 10 93 .268 333.93.26 04/01117 12/31/17 04101117 06130/18 $1,150 $1,150 $3,487 FFYI6 YFC Ops H23IPOO0762 Amend 5 93 .268 333 .93.26 01101116 12/31116 01/01116 12/31116 $828 $828 FFYI5 YFC Ops H23IPOO0762 Amend I 93.268 333 .93.26 01101115 12 /31115 01/01115 12 /31115 $380 $1,509 FFY15 YFC Ops H23IPOO0762 N/A 93.268 333.93.26 01101115 12/3111 5 01101115 12/31115 $1,129 FFYl7 YFC Ordering 5NH23lPOOO762-05-00 Amend 10 93 .268 333 .93.26 04/01117 12/31 /17 (WOI/17 06 /30 /18 $695 $695 $3,249 FFY 16 YFC Ordering H23IPOO0762 Amend 5 93 .268 333.93.26 01101/16 12/31116 01/01/16 12131116 $1,400 $1,400 FFY 15 YFC Ordering H231POO0762 N/A 93.268 333.93.26 01101115 12/31/15 01101115 12/31115 $1,154 $1,154 FFYI6 PPHF 317 Ops NH23IPOO0762-04-05 Amend 10 93.539 333 .93.53 01101117 03/31117 01/01116 03/31117 $1,805 $1,805 $1,805 FFY 14 Enhance llS and YTrckS H23IPOO0922 Amend 5 93.733 333.93.73 12 /01115 08 /31 /16 09 /30/14 09129116 $1,087 $1,087 $1,087 Page I of3 EXHIBIT B-12 Kittitas County Public Health Department ALLOCATIONS Contract Number: C17114 Contract Term: 2015-2017 Date: May 15, 2017 Indirect Rate as of January 2015 : 40.25% Indirect Rate as of January 2017: 11.25% County Central Svcs & 29.5% Public Health Dept BARS Statement of Work Chart of Accounts Funding Chart of Federal Award Revenue Funding Period Funding Period Period Accounts C luirt of A "counts Proem Title Jd.enti ~tion # A m end II-CFDA* Code** Start Date End Date Start Date End Date Amount Sub Total Total FFY16 PPHF Adolescent AFIX INH23IP922562-01-00 Amend 12 93.733 333.93.73 04 /01117 04 130 /17 09 /30 /15 09 /29 /17 $1,000 $1,000 $1,000 FFY15 PPHF liS AFIX NH23IPOOI032-01-O 1 Amend 12 93.733 333.93.73 04/01117 04/30 /17 09 /30 /15 09 /29 /17 ($1,000) $0 $0 FFYI5 PPHF liS AFIX NH23IPOOI032-01-01 Amend 11 93 .733 333.93.73 04 /01 /17 04 /30 /17 09 /30 /15 09 /29 /17 $1,000 FFYI5 MCHBG CBP ConCon B04MC28134 Amend 3 93.994 333 .93.99 01/01115 09/30/15 10/01 /14 09 /30/15 $1,723 $34,870 $34,870 FFYI5 MCHBG CBP ConCon B04MC28134 N/A 93 .994 33 3.93 .99 01101 /15 09 /30 /15 10101 /14 09/30/15 $33,147 FFYI7 MCHBG LHJ & Other Contracts 17B04MC30649 Amend 8 93 .994 333 .93.99 10/01116 09/30/17 10/01/16 09/30 /17 $44,196 $44,196 $88 ,392 FFYI6 MCHBG LHJ & Other Contracts B04MC29364 Amend 3 93 .994 333 .93 .99 10101 /15 09/30 /16 10/01" 5 09 /30 /16 $44,196 $44,196 Drinking Water Group B Amend 10 N/A 334.04.90 07/01117 12/31117 07/01/17 12/31117 $5,000 $5,000 $10,000 Drinking Water Group B Amend 10 N/A 334 .04.90 01 /01 /17 06 /30 /17 01 /01117 06 /30 /17 $5,000 $5 ,000 Drinking Water Group A -SS Amend 10 N/A 346 .26.64 01101115 12/31/17 01101115 12/31/17 $2,800 $9,400 $9,400 Drinking Water Group A -SS Amend 9,10 N/A 346.26.64 01101 /15 12/31 /17 01 /01115 12/31 /17 51,600 Drinking Water Group A -SS Amend 6, 10 N/A 346.26.64 01101 /15 12 /31/17 01 /01 /15 12 /31 /17 52,200 Drinking Water Group A -SS N/A, Amd 6, 10 N/A 346.26.64 01101115 12/31/17 01101115 12/31 /17 $2,800 Drinking Water Group A -SS State Amend 10 N/A 346.26.65 01101115 12 /31117 01 /01/15 12 /31 /17 52,800 59,400 $9,400 Drinking Water Group A -SS State Amend 9,10 N/A 346.26.65 OllOll15 12/31117 01/01115 12/31117 $1,600 Drinking Water Group A -SS State Amend 6 , 10 N/A 346 .26.65 01101/15 12 /31117 01 /01115 12 /31 /17 52,200 Drinking Water Group A -SS State NI A , Amd 6, 10 N/A 346 .26.65 01101115 12 /31117 01101115 12/31117 52,800 Drinking Water Group A -T A Amend II N/A 346.26 .66 01 /01115 12/31117 01101 /15 12/31 /17 ($2,400) $3,000 $3 ,000 Drinking Water Group A -T A Amend \0 N/A 346.26.66 01101115 12/31117 01101 /15 12/31117 $2,000 Drinking Water Group A -TA Amend 9,10 N/A 346.26.66 01101/15 12/31/17 01101115 12/31117 ($1,600) Drinking Water Group A -T A Amend 6, 10 N/A 346 .26.66 01/01115 12/31 /17 01 /01115 12/31 /17 $1,000 Drinking Water Group A -TA N/A , Amd 6 , 10 N/A 346.26.66 01101115 12 /31117 01 /01 /15 12 /31117 $4,000 TOTAL $358,397 $358,397 Total consideration: $358,397 GRAND TOTAL $358,397 $0 GRAND TOTAL $358,397 Total Fed $326,597 Total State $31,800 Page 2 of3 Kittitas County Public Health Department Indirect Rate as of January 2015: 40.25% EXHIBIT B-12 ALLOCATIONS Contract Term: 2015-2017 Indirect Rate as of January 2017: 11.25% County Central Svcs & 29.5% Public Health Dept Chan of Accounts Prowam Title *Catalog of Federal Domestic Assistance Federal Award Identificalioll# **Federal revenue codes begin with "333". State revenue codes begin with "334". Amend # BARS Revenue CFDA* Code"'* Page 3 of3 Statement of Work Chart ef Aceellnts Funding Period FIHldiDg Peried Start Dllte End Dale S lari·Diitt Elld ·Date. Amount Contract Number: Date: Funding Period Sub Total C17114 May 15,2017 Chart of Accounts Total Exhibit C-10 Schedule of Federal Awards AMENDMENT #12 Date: May 15. 2017 KITTITAS COUNTY HEALTH DEPT-SWVOO10475-07 CONTRACT C17114-Kittit ... 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 Award A _d Oal e Awenl D.t" Dato Federal Agency Name Identification N umber Federal Grant Award Name State Administrative Matching Department of Agriculture Food and Supplemental Nutrition Assistance FFY17 DSHS SNAP-ED IAR 3 33 .1056 09/30/16 $5 ,739,856 10/01/16 09/30 /17 $14,996 10_561 Grants for the Supplemental 1717WAWA50390 Nutrition Assistance Program Nutrition Service Program Education (SNAP-Ed) Public Heattl1 Emergency Department crt Health and Human TP12-1201 HPP AND PHEP FFY16 EPR PHEP Bl'5 LHJ FUMOING 33393--06 06123/16 $10,222,879 07101116 06130/17 $50,000 93069 Services Centers for D~ease Control U90TPOOO559 Preparedoess and Prevention COOPERATIVE AGREEMENTS Public Health Emergency Department of Health and Human TP12-1201 HPP AND PHEP FFY15 EPR PHEP BP4 OPER READINESS 3339306 06/30114 $11 ,064,407 07/01/15 06/30/16 $7,704 93069 Services Centers for Disease Control U90TPOO0559 Preparedness and Prevention COOPERATIVE AGREEMENTS Public Healtl1 Emergency Department crt Health and Human TPI2·1201 HPP AND PHEP FFYIS EPA PHEP Bl'4 LHJ FUNDING 333,9306 0612 6/1 5 $12,1 32 ,694 07/0 1115 06130116 $55,000 93~069 Services Centers for Disease Control U90TPOO0559 Preparedness and Prevention COOPERATIVE AGREEMENTS Public Health Emergency Department of Health and Human TP12-1201 HPPAND PHEP FFY14 EPR PLANNING & EXERCISES 333.9306 06/30/14 $12,663,227 01/01115 06/30/15 $24,078 93~069 Preparedness Services Centers for Disease Control U90TPOO0559 COOPERATIVE AGREEMENTS and Prevention Public HeattI1 Emergency Department of Hearth and Human TPI2-1201 HPP AND PHEP FFY14 EPR LHJ FUNDIHG 3 33,9306 06130/14 $1 2 ,663,227 01/0 1/15 06130115 $23,574 93069 Preparedness Services Cen~ for Disease Control U90TPOOO559 COOPERATIVE AGREEMENTS and Prevention Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND FFY17 VFC ORDERING 333,9326 03/03/17 $103,974 04/01/17 12/31117 $695 93.268 Services Centers for Disease Control 5NH23IPOOQ762-05-00 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM Immunization Cooperative Department of Heatth aoo Human IMMUNIZATION GRANT AND FFY17 VFC CPS 3339326 03103117 $1,201,605 ()4101I17 12 /31117 $1,150 93.268 Services Centers for Disease Control 5NH231P000762-<J5-00 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND FFY17 AFIX 333.93,26 03/03/17 $1,672,289 04/01/17 12/31/17 $3,340 93,268 Services Centers for Disease Control 5NH23IPOO0762-05-00 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM Immunization Cooperative Department crt Health and Human IMMJNIZATlON GRANT AND FFY17 317 OPS 333 93,26 03103 /17 $575,969 04J01I17 1213 1117 $924 93268 SeMces Center.; for Disease Control 5NH23IPOO0762-<J5-00 VACCINES FOR CHILDREN'S Agreements and Prevent:ior1 PROGRAM Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND FFY16 VFC ORDERING 333.93.26 01119116 $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 I~NlZATION GRANT AND FFYt6 VFC CPS 333,9326 01/19/16 $3,991,784 0 1/01/18 12/3 1116 $628 93268 Services Center.! for Disease Control H231POOO762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND FFY16AFIX 333.93.26 01119/16 $3,991,784 01/01/16 03/31/17 $5,393 93.268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM ImmunizatJon Cooperafrve Department of Health and Human Iw..4UNIZA TION GRANT AND FFY16 317 0P5 33393,26 0111 91 16 5 3 ,991 ,784 0 110 1116 12131 /16 $1,232 93.268 Services Centers for Disease Control H231POOO762 VACCINES FOR CHILDREN'S A9'eemem. and Prevention PROGRAM Department of Health and Human IMMUNIZATION GRANT AND FFY15 VFC ORDERING 333.93.26 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-10 Schedule of Federal Awards KITTITAS COUNTY HEALTH OEPT-SWV0010475-07 CONTRACT C17114-Kitlitas County Public Health Department CONTRACT PERIOD 1/11201!;-12131/2017 Chart of Accounts Program Title BARS FFYl! YfC CPS 333 932e FFY15 MIX 333.93.26 FFY15 317 OPS 333.93 .26 FFY16 PPHF 317 OPS 333.9353 FFY18 PPHF ADOLESCENT MIX 33 39373 FFY14 ENHANCE liS AND VTRCKS 333,93.73 FFY17 IICH8G LHJ & OTHER CONTRACTS 333,9399 FFY16 MCHBG LHJ & OTHER CONTRACTS 333,93.99 FFY15 MCHBG CBP CONCON 333 93.99 DOH Federal Award Date 12/17/1~ 12/17114 12117/14 09108/16 08129116 09/16114 10/31/16 10/22115 10/21/14 TotalAmt Allocation Period Federal Start End Award Date _Date $3,437,~6 01/01115 12131/15 $3 ,437,046 01/01/15 12/31115 $3 ,437,~6 01101/15 12131115 $4,009,643 01/01117 03131117 $500,000 04101117 04130117 $700,000 12101/15 08131116 $1,697,083 10101116 09130/17 $1,739,609 10/01/15 09130116 $8,846,149 01101/15 09l30I15 TOTAL Contract Am! 51,509 $5,013 51,453 $1,805 $1,000 $1,087 $44,196 $44,196 $~,870 $326,597 AMENDMENT #12 Date: May 15. 2017 CFDA CFDA Program Title Federal Agency Name Federal Award Federal Grant Award Name Identification Number Immunization CooperatiwI Department of Health and HlJman IMllJNIZATION GRANT AND 93.268 Services Centers for Disease Control H231POOO762 VACCINES FOR CHILDREN'S ~emenIS and Prevention PROGRAM Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND 93,268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM Immunization COOj)eI'8Iive Department of Health and HlJman IMMUNIZATION GRANT ANa 83_268 Se<vlces Cen\e(S for Disease Conlro4 H231POO0762 VACCINES FOR CHILDREN'S Agreements and~ PROGRAM PPHF Capacity Building PPHF 2017: IMMUNIZATION GRANTS- Assistance to Strengthen Public Department of Health and Human IMMUNIZATION & VACCINES FOR 93539 Health Immunization Services Centers for Disease Control NH23IPOO0762-04-Q5 CHILDREN PROGRA!M'INANCED IN Infrastructure and Performance and Prevention PART BY 2017 PREVENTION & PUBLIC Capacity Building AssIstance to F'PHF2 016: INCREAsiNG HPV 'Slr~~'~~ Department 01 Health and HlJman VACCINE COVERAGE BY 83.733 Immunization Infrastructure & Services Cente<s for Disease Control 1 NH231P922562-{)1-QO STRENGTHENING ADOLESCENT AFIX Perfoonanca -Finaoced In part and PreYerTtion ACTlVITIES, FUNDED IN PART BY 2016 Capacity Building Assistance to PPHF 2014: IMMUNIZATION ENHANCE Strengthen Public Health Department of Health and Human AN IMMUNIZATION INFORMATION 93J33 Immunization Infrastructure & Services Centers for Disease Control H231POO0922 SYSTEM (115) TO INTERFACE WITH Perlonnance -Financed in part and Prevention CDC'S VTRCKS VACCINE ORDERING Maternal and Child Health Department 01 Health anG Human FFY17 M>.TERNAL AND CHILD HEALTH 93994 ServIces BIod< Grant to Ihe Services Health Resources and 17B0411AC30649 SERVICES Slates Services Adminisltation Maternal and Child Health Department of Health and Human MATERNAL AND CHILD HEALTH 93.994 Services Block Grant to the Services Health Resources and B04MC29364 SERVICES States Services Administration Ma\emal and Child Heatth Depar1ment 01 Health and Human MATERNAL ANa CHIlD HEALTH 93.994 ServIces Blodt Grant tD !he Services Health Resources and B04MC28134 SERVICES Slates Setvi<:es Administration Page 2 of 2 Kittitas County Review Form Grants & Contract Agreement Today's Date r Agenda Date 07/11/2017 Fund/Department 116-Public Health Contract/Grant Information Contract /Grant Agency: Consolidated Contract Amendment 12 eJ31/rt- Period Begin Date:Ja", lutvLA \,21)1S I I Period End Date: O(UWI J:iY b l f 1JJ 1':.)- Total Grant/Contract Amoun~ $ ·65e:>;?pn . CD Gran t/Contract Number: C17114 Contract/Grant Summary: The Consolidated Contract Amendment 12 is amending the Statements of Work for the Office of Immunization & Child Profile. It also amends and replaces Exhibit C-9 with Exhibit C-10 Schedule of Federal Awards. Recommendation for Board of Health and Board of Health Review on Department Head Signature : ~ , Administrator Signature of Board of Health member Date Financial Information Total Amount $ State Funds $ Federal Funds $ Percentage County Funds Matching Funds $ CFDA# In-Kind $ Explain Is Equipment being purchased? Who owns equipment? Grant/Contract Review Page 1 New Personnel being hired? I Contact HR hiring -reporting requirements Future impacts or liability to Kittitas County: Budget Information Budget Amendment Needed? YesD attach budget form No 0 Why not New Division Created? Revenue Code 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 0 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