HomeMy WebLinkAboutCC Amendment 13KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2015 -2017 CONSOLIDATED CONTRACT
CONTRACT NUMBER: C17114 AMENDMENT NUMBER: 13
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:
I:8J Adds Statements of Work for the following programs:
• Emergency Preparedness & Response -Effective July 1, 2017
• FPHS Communicable Disease & Support Capabilities -Effective July 1,2017
• Supplemental Nutrition Assistance Program-Education -Effective October 1,2017
D Amends Statements of Work for the following programs:
D Deletes Statements of Work for the following programs:
2. Exhibit B-13 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-12 Allocations
as follows:
I:8J Increase of $82,051 for a revised maximum consideration of $440,448.
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-ll Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces
Exhibit C-I0.
Unless designated otherwise herein, the effective date ofthis amendment is the date of execution.
ALL OTHER TERMS AND CONDITIONS of the original contract and any subsequent amendments remain in full force
and effect.
IN WITNESS WHEREOF, the undersigned has affixed his/her signature in execution thereof.
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
Date
Page 1 of 17
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 #13
DOH Program Name or Title: Emergency Preparedness & Response -Effective July 1, 2017 ........................................................... ,; ......... : .. c ••••• ; ••••••••••••••••••••••••• 3
DOH Program Name or Title: FPHS Communicable Disease & Support Capabilities -Effective July 1, 2017 .............. < .................................................................. 8
DOH Program Name or Title: Supplemental Nutrition Assistance Program-Education Effective October 1, 2017 ........... , ............................................................. 11
Exhibit A, Statements of Work
Revised as of July 17, 2017
Page 2 of17 Contract Number C 17114-13
DOH Program Name or Title: Emergency Preparedness & Response -
Effective July 1, 2017
SOW Type: Original Revision # (for this SOW)
Period of Performance: July 1,2017 through December 31,2017
Exhibit A
Statement of Work
Contract Term: 2015-2017
AMENDMENT #13
Local Health Jurisdiction Name: Kittitas County Public Health Department
Contract Number: C17114
Funding Source Federal Compliance Type of Payment
f8l Federal Subrecipient (check if applicable) f8l Reimbursement
D State f8l FF AT A (Transparency Act) D Fixed Price
D Other D Research & Development
Statement of Work Purpose: The purpose of this statement of work is to establish the funding and tasks for the Public Health Emergency Preparedness and Response program
for the 2017 grant period.
Revision Purpose: N/ A
Chart of Accounts Program Name or Title
FFY17 EPR PHEP BPI LHJ FUNDING
TOTALS
Task Task! ActivitylDescription Number
1 Attend emergency preparedness events, (e .g .
trainings, meetings, conference calls, and
conferences) as necessary to advance LHJ
preparedness or complete the deliverables in this
statement of work.
2 Complete reporting templates as requested by
DOH to comply with program and federal grant
requirements (e.g. performance measures, gap
analysis, mid-year and end-of-year reporting
temj)lates, etc.)
3 Develop or update written procedures to activate
a comprehensive emergency response plan within
the jurisdiction. Include:
• Describe how the command structure is
utilized to manage emergency response
• Describe the relationship between the LHJ
and the county Emergency Operations
Center (EOC) during a response.
Exhibit A, Statements of Work
Revised as of July 17 ,2017
CFDA# BARS Master Funding Period Current Change rotal
Revenue Index (LHJ Use Only) Consideration Increase (+) Consideration
Code Code Start Date End Date
93.069 333 .93.06 18101380 07/01/17 I 12/31/17 0 29,749 29,749
0 29,749 29,749
*May Support PHAB Deliverables/Outcomes Due Date/Time Payment Information
StandardslMeasures Frame and/or Amount
Submit summary of progress on December 29,2017 Reimbursement for
mid-year report. actual costs not to
exceed total funding
consideration amount.
Submit completed templates to DOH December 29 ,2017
Submit deliverable/s, or a summary December 29,2017
of progress on the activity and
deliverable/s, in the mid-year report. .
Submit the most recent Emergency
Response Plan.
Page 3 of17 Contract Number C 17114-13
Task Task! ActivitylDescription Number
• Identify an EOC location from which public
health will coordinate the Emergency
Support Function #8 (ESF#8) response
• Describe the process for notifying and
mobilizing staff during an incident.
3.1) Provide training for appropriate staff who
serve in the EOC and the ESF#8 role on the
Incident Command System, ESF#8 response
plans and policies.
3.2) Train appropriate public health emergency
response staff on Web EOC or applicable
information management system utilized by local
emer.E;ency management in the county.
4 Develop a decision making protocol to support
the Local Health Officer (LHO) and the Public
Health Administrator in making policy level
decisions during an emergency.
4.1 Document that ESF#8 is identified in the
Public Health Emergency Plan (PHEP) and is
integrated with the City and County Emergency
Plans.
5 Maintain Washington Secure Electronic
Communication, Urgent Response and Exchange
System (WASECURES) program as the primary
emergency notification system within the LHJ
and include all critical LHJ positions as
registered users.
5.1) Conduct a notification drill using
WASECURES.
Notes: Registered users must log in quarterly at
a minimum. DOH will provide on-site technical
assistance to LHJs, as needed, on utilizing
WASECURES. LHJs may choose to utilize other
notification systems in addition to
W ASECURES to alert staff during incidents.
6 Update and maintain procedures for defining how
your LHJ will request assistance from the local
Exhibit A, Statements of Work
Revised as of July 17, 2017
AMENDMENT #13
*May Support PHAB Deliverables/Outcomes Due Date/Time Payment Information
StandardslMeasures Frame and/or Amount
Provide agenda and sign-in sheets of
trainings conducted.
Provide sign-in sheets of trainings
conducted, with attendee signatures
and contact information, or
registrations if training is not
conducted by the LHJ
Submit deliverable/s, or a summary December 29,2017
of progress on the activity and
deliverable/s, in the mid-year report.
Submit completed protocol to DOH
Submit written ESF#8
documentation showing inclusion in
city and county plans.
Submit deliverable/s, or a summary December 29, 2017
of progress on the activity and
deliverable/s, in the mid-year report.
Submit list of registered users to
include their title and role in the
emergency response plan.
Submit results of notification drill.
Submit deliverable/s, or a summary December 29,2017 I
of progress on the activity and I
J
Page 4 of17 Contract Number C17114-13
Task TaskiActivitylDescription Number
Emergency Operations Center (EOC),
neighboring LHJs, and DOH during disasters.
• Identify how resources are coordinated with
the local EOC.
• Identify how to coordinate the logistical
issues to receive resources from DOH and
other partners. (lfLHJs rely on local
Emergency Management (EM) or other
partners to coordinate logistical issues for
receiving resources, and the local EM plan
documents this fact, that documentation will
suffice.)
Note: DOH will provide technical assistance to
LHJs, as requested, on updating plans to address
resource requests.
7 Update or develop procedures and tools to inform
the public of threats to health and safety by
various means. Include a list of the various
mechanisms used by your LHJ for releasing
information to the public during drills, exercises
or incident response.
7.1) Create and maintain templates for news
releases for categories of public health hazards.
8 Participate in evaluation of response capabilities
based on a standard evaluation tool created by
DOH.
9 Develop and maintain procedures and forms to
gain and maintain situational awareness during an
incident to include the following key data
elements:
• The functionality of critical public health
operations
• The functionality of critical healthcare
facilities and the services they provide
(hospitals, skilled nursing facilities, blood
centers, dialysis centers)
• The functionality of critical infrastructure
Exhibit A, Statements of Work
Revised as of July 17, 2017
AMENDMENT #13
*May Support PHAB Deliverables/Outcomes Due Date/Time Payment Information
StandardslMeasures Frame and/or Amount
deliverable/s, in the mid-year report.
Submit the most current procedures
for requesting assistance during
disasters to DOH.
Submit deliverable/s, or a summary December 29,2017
of progress on the activity and
deliverable/s, in the mid-year report.
Submit the most current procedures
used to inform the public during
drills, exercise or incident response.
Include a summary of how
communication tools were used.
Submit sample templates.
Document participation in the December 29,2017
evaluation on mid-year progress
re port.
Submit deliverable/s, or a summary December 29,2017
of progress on the activity and
deliverable/s, in the mid-year report.
Submit procedures and situational
awareness form templates that
include the data elements listed.
Page 5 of17 Contract Number C 1 7114-13
Task TaskiActivitylDescription Number
serving public health and healthcare
facilities (roads, water, sewer, power,
communications)
• Number of disease cases
• Number of fatalities attributed to an incident
• If key elements are collected by others, such
as local EM or Health Care Coalition
(HCC), describe how the LHJ gains access
to that information.
9.1) Create an ESF#8 situation report form based
on an established planning cycle to include, at a
minimum, the data elements listed above
9.2) Develop procedures for disseminating
situation reports to ESF#8 response partners
9.3) Train staff on all procedures established to
maintain situational awareness during an
incident.
10 Update or develop procedures to request, receive
and dispense medical countermeasures.
11 Develop or update a continuity of operations plan
(COOP) plan for your jurisdiction.
Plan shall include:
• Definition and identification of essential
services to sustain LHJ mission and
operations
• Line of succession and written delegation of
authority for select critical positions in the
LHJ, including LHO.
• Plans for temporarily discontinuing select
LHJ functions to sustain critical services
12 Provide notification to DOH for all instances
involving a public health response by the LHJ to
an emergency utilizing emergency response plans
and structures.
Exhibit A, Statements of Work
Revised as of July 17, 2017
AMENDMENT #13
*May Support PHAB Deliverables/Outcomes Due Date/Time Payment Information
StandardslMeasures Frame and/or Amount
Submit an ESF#8 situation report
template.
Submit procedures for disseminating
a situation report.
Submit agendas and sign-in sheets
that include attendee signatures and
contact information for trainings
conducted.
Submit deliverable/s, or a summary December 29,2017
of progress on the activity and
deliverable/s, in the mid-year report.
Submit up to date procedure to
request, receive and dispense medical
countermeasures.
Submit deliverable/s, or a summary December 29, 2017
of progress on the task and
deliverable/s, in the mid-year report.
Submit the most current COOP plan
which includes elements listed.
Submit deliverable/s, or a summary December 29,2017
of progress on the activity and
deliverable/s, in the mid-year report.
Page 6 of 17 Contract Number C 17114-13
AMENDMENT #13
Task Task! Activityillescription *May Support PHAB Deliverables/Outcomes Due Date/Time Payment Information
Number StandardsIMeasures Frame and/or Amount
Submit Incident Action Plans,
Situation Reports and After Action
Reports
13 Provide LHJ situation reports to DOH during all Submit deliverable/s, or a summary December 29, 2017
incidents involving an emergency response by the of progress on the activity and
LHJ. deliverable/s, in the mid-year report.
Submit Situation Reports.
14 Submit essential elements of information (EEls) Submit deliverable/s, or a summary December 29, 2017
during incident response upon request by DOH. of progress on the task and
deliverable/s, in the mid-year report.
Provide information upon request.
15 Participate in the regional healthcare coalition Submit deliverable/s, or a summary December 29,2017
and attend coalition meetings as necessary of progress on the activity and
deliverable/s, in the mid-year report.
Provide a summary of participation
in coalition activities.
*For Information Only:
Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a
StandardlMeasure. More detail on these andlor other Public Health Accreditation Board (PHAB) StandardslMeasures that may apply can be found at:
htto:lI www .phaboard.omlv.'P"oonten tluoloadsIPHAB-Standards-and-Measures -Version-I .O.pdf
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 (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.
DOH Program Contact:
Jennifer Albertson, Contract and Finance Specialist
Department of Health
POBox 47960, Olympia, W A 98504-7960
jennifer.albertson@doh.wa.gov
PHEPIHPP Deliverable Submission email address: c oncondeliverables@doh.wa.!!ov
Exhibit A, Statements of Work
Revised as ofJuly 17, 2017
Page 7 of17 Contract Number C 17114-13
AMENDMENT #13
Exhibit A
Statement of Work
Contract Term: 2015-2017
DOH Program Name or Title: FPHS Communicable Disease & Support Capabilities-
Effective July 1, 2017
Local Health Jurisdiction Name: Kittitas County Public Health Department
Contract Number: C17114
SOW Type: Original Revision # (for this SOW) Funding Source Federal Compliance Type of Payment
D Federal <Select One> (check if applicable) [gI Reimbursement
[gI State D FF AT A (Transparency Act) D Fixed Price
D Other D Research & Development
Period of Performance: July 1, 2017 through December 31, 2017
Statement of Work Purpose: The purpose of this statement of work is to specify how Foundational Public Health Services (FPHS) state funds will be used during this interim
period of July 1,2017 -June 30, 2018 .
Note: The total funding consideration is for the period of July 1, 2017 through June 30, 2018. Deliverable due dates after December 31, 2017 are included in this
statement of work for informational purposes only. Unspent funds, tasks and deliverables with due dates after December 31, 2017 will be included in a new statement of
work under the new 2018-2020 consolidated contract term beginning January 1, 2018.
Revision Purpose: N/ A
Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change rrotal
Revenue Index (LHJ Use Only) Consideration Increase (+) Consideration
Code Code Start Date End Date
FPHS FUNDING FOR LHJS DIR N/A 336 .04.25 91106102 07/01/17 I 12/31j17 0 42,000 42,000
TOTALS 0 42 ,000 42 ,000
Note: New BARS Revenue Code listed above. See Special Instructions below for mo re information.
Task *May Support PHAB Payment
Task! Activityillescription Deliverables/Outcomes Due Date/Time Frame Information and/or Number StandardslMeasures Amount
These funds are for delivering ANY or all of the FPHS communicable disease service (listed below) and can also be used for the FPHS capabilities that support FPHS
communicable disease services as defined in the most current version of FPHS Defmitions -Version 1.2 (March 20J6)
G. Control of Communicable Disease and Other Notifiable Condit ions
1. Provide timely, statewide, locally relevant and Brief report on how funding will October 1,2017 Reimbursement for
accurate information statewide and to be used to support the FPHS actual expenditures.
communities on communicable disease and communicable disease services
other notifiable conditions and their control. listed in tasks 1-6 or FPHS
capabilities in support of
communicable di sease services
2 . Promote immunization through evidence based Report on metrics (TBD)
strategies and collaboration with schools , health
I
I
I
Exhibit A, Statements of Work
Revised as ofJuly 17 , 2017
Page 8 of17 Contract Number CI7114-13
AMENDMENT #13
Task *May Support PHAB Payment
Task! ActivitylDescription Deliverables/Outcomes Due Daterrime Frame Information and/or Number StandardslMeasures Amount
care providers and other community partners to Baseline data January 30,2018
increase immunization rates.
Updated data every six (6) July 30,2018
months January 30,2019
July 30,2019
3. Identify statewide and local community assets
for the control of communicable diseases and
other notifiable conditions, develop and
implement a prioritized control plan addressing
important communicable diseases and other
notifiable conditions such as influenza and
hepatitis, seek resources for and advocate for
high priority policy and other control initiatives
regarding communicable diseases and other
notifiable condition.
4. Ability to receive laboratory reports and other
identifiable data~ conduct disease investigations,
including contact notification~ and recognize,
identify, and respond to cases and
outbreaks/clusters of communicable diseases
and other notifiable conditions in accordance ,
with national, state, and local mandates and
guidelines .
5. Assure the availability of partner notification
services for newly diagnosed cases of syphilis,
gonorrhea, and HIV according to Centers for
Disease Control and Prevention (CDC)
guidelines.
6. Assure the appropriate treatment of individuals
who have active tuberculosis, including the
provision of directly-observed therapy according
to CDC guidelines.
*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 andlor other Public Health Accreditation Board (PHAB) StandardslMeasures that may apply can be found at:
hltp:lI\Vww.pbaboard.oT gI\liJ)-conien tlupIQad sIPHAB-Standards-and-M~sures -Versi o n-I .O.pdf
And the document Aligning Accreditation and the Foundational Public Health Capabilities, Public Health National Center for Innovations (PHNCI), Summer 2016
hltp :!}phnci.orgfres oureeslaligning-3ccrectitation -and-the-foundalional-public -health-caoabilities
Exhibit A, Statements of Work
Revised as ofJuly 17,2017
Page 9 of17 Contract Number C17114-13
AMENDMENT #13
Program Specific Reguirements/Narrative
Special References (RCWs, WACs, etc)
• Immunizations -http://www.dah.wa .govNQuandYourFamilviImmunization
• Notifiable Conditions -http://W\liw .doh.wa.govlForPublicHealth"andHealulcareProviderslNotifiableConditions
• Sexually Transmitted Diseases (STD) -hltp :ll www.doh.wa.govlYouandYoi.trPamilv/lllnes::;andDisease/SexuaJlyTransm,i nedDisease
• Human Immunodeficiency Virus (HIV) -hLlp;/lwww.doh.wa .e.ovlYouandYourFami lv/L1lnessandDisease /HIV AIDS
• Tuberculosis (TB) -huo:J/W'\vw .doh. wa.f!.ov/Y ouandYow:Familv!illnessandDiseaselTub erculosis
Definitions
• FPHS Definitions. Ve,rsion 1.2 (March 2016)
Special Billing Requirements
Billings for this funding must be included in the Consolidated Contract A19 Invoice sent to DOH Grants Office . Funding is distributed based on reimbursement of expenditures.
This is different than those funds LHJs receive from the "County Public Health Assistance" funds from the state .
Special Instructions
There are two different BARS Revenue Codes for "state flexible funds" to be tracked separately and reported separately on your annual BARS report. These two BARS Revenue
Codes and definitions from the State Auditor's Office (SAO's) are listed below along with a link to the BARS Manual. 336.04.25 is the new BARS Revenue Code to use for the
Foundational Public Health Services (FPHS) funds included in this statement of work.
336.04.24 -County Public Health Assistance
Use this account for the state distribution authorized by the 2013 2ESSB 5034 , section 710. The local health jurisdictions are required to provide reports regarding expenditures
to the legislature from this revenue source.
336.04.25 -Foundational Public Health Services
Use this account for the funding designated for the local health jurisdictions to provide a set of core services that government is responsible for in all communities in the W A
state. This set of core services provides the foundation to support the work of the broader public health system and community partners. At this time the funding from this
account is for delivering ANY or all of the FPHS communicable disease services (listed above) and can also be used for the FPHS capabilities that support FPHS communicable
disease services as defined in the most current version of FPHS Definitions -Version 1.2 (March 2016)
SAO 's BARS Manual-http://www.sao.wa.gov/local/pagesIBARSManual.aspx
DOH Program Contact
Marie Flake, Special Projects, Foundational Public Health Services
Washington State Department of Health
PO Box 47890, Olympia, WA 98504-7890
Phone 360-236-4063 / Mobile 360-951-7566
Fax 360.236.4024 I marie.flake@doh.wa.gov
Exhibit A, Statements of Work
Revised as of July 17, 2017
Page 10 of 17 Contract Number C 17114-13
AMENDMENT #l3
Exhibit A
Statement of Work
Contract Term: 2015-2017
DOH Program Name or Title: Supplemental Nutrition Assistance Program-Education
Effective October I. 2017
SOW Type: Original Revision # (for this SOW)
Period of Performance: October 1, 2017 through December 31, 2017
Local Health Jurisdiction Name: Kittitas County Public Health Department
Contract Number: CI7114
Funding Source Federal Compliance Type of Payment
[8l Federal Subrecipient (check if applicable) [8l Reimbursement o State [8J FFATA (Transparency Act) D Fixed Price o Other o Research & Development
Statement of Work Purpose: The purpose of this statement of work is to provide Supplemental Nutrition Assistance Program-Education (SNAP-Ed) to improve the likelihood
that persons eligible for SNAP (Food Stamps) will make healthy food choices within a limited budget and choose active lifestyles consistent with the current USDA dietary
guidance system.
Revision Purpose: NI 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
FFY18 CSS IAR SNAP ED PROG MGNT 10.561 333 .10.56 76211981 10/01/17 I 12/31/17 0 9 ,902 9,902
FFY17 CARRY-IN DSHS SNAP-ED IAR 10.561 333 .10.56 TBD 10/01/17 I 12/31/17 0 400 400
TOTALS 0 10 ,302 1~ -
Task *May Support PHAB Payment
Task! Activity /Description Deliverables/Outcomes Due Date/Time Frame Information and/or Number StandardslMeasures Amount
1.0 For SNAP-Ed, the LHJ will perform work as • Project qualified target For the Period: Reimbursement upon
described in their approved FFY18 SNAP-audiences reached 10/01117-12 /31117 receipt and approval
Ed project description and work plans • Project activities completed (# Due: Per the approved work of deliverables for the
approved by DOH, Department of Social direct education, PSE, Etc .) plan and no later than funding period will
and Health Services (DSHS), and United noted in project plans and 12/31117 not exceed $10,302 .
States Department of Agriculture (USDA) workbook
that was submitted to them via DOH email. • Required demographic data The LHJ will be paid
collected the allowable costs
• Evaluation activities completed incurred based on
per the state evaluation team their approved budget
(pre and post surveys , PSE and program
tracking, success stories etc .) allowability. See
Special Billing
Requirements
section.
---I
Exhibit A, Statements of Work
Revised as of July 17 , 2017
Page 11 of 17 Contract Number C 17114-13
Task
Number Task! Activityillescription
2.0 Quarterly Progress Reports
The following data is collected and
submitted within DOH provided form
/system:
1. Project major achievements
2. Project major challenges
3. If projects are running on time with
original timeline? If not why, and how
will you correct the timeline?
4. Any PSE progress
5. Any success stories to date
2.1 Education and Administrative Reporting
System (EARS) Data and Reports
The following EARS data is required for
each project and in order to count clients
toward unduplicated direct reach. Required
entry for the PEARS Database includes but
is not limited to:
• Unduplicated number of clients
served per project.
• # unduplicated clients served per
project based on the following:
0 Race/ethnicity
0 Gender
0 Age
• % SNAP eligible per site
• Setting type -school, church etc.
• Top Key Messages delivered per
project
LHJ is required to submit data electronically
or within the template provided by DOH.
Exhibit A, Statements of Work
Revised as of July 17, 2017
*May Support PHAB
StandardslMeasures
AMENDMENT #13
Payment
Deliverables/Outcomes Due Date/Time Frame Information and/or
Amount
**NOTE: The
SNAP-Ed program
will deny payment
for any costs not
submitted by the due
date without prior
DOH approval in
writing.
Submit Quarterly Progress Report Quarterly Progress Reports See payment
for all SNAP-Ed projects within the due: information as
DOH approved fonnlsystem referenced in task
• 1 sl quarter report for the number 1.0
work completed during
10/1/17 to 12/31/17.
Final Due: COB
12/31/17
Submit EARS data for all project(s). Data should be collected in See payment
real time and submitted to information as
LHJ is required to collect and DOH by the following referenced in task
submit EARS data electronically or dates: number 1.0
within a template provided by DOH. • EARS data collected
10/1/17 to 12/31/17.
This must be done in real time. Real Due: In real time and
time = As you provide services and no later than one (1)
no later than one week after data is week after services are
collected. provided.
Page 12 of17 Contract Number C 17114-13
Task
Number Task! ActivitylDescription
2 .2 Evaluation Data and Reports
The following evaluation activities* and
information is required for all projects based
on your approved project/plan
• Formative
• Process
• PSE
• Outcome
• Qualitative
*Please Note : the deliverables may change
based on state evaluation team requirements
3.0 Civil Rights Training
All staff must be trained each fiscal year in
civil rights.
3.1 Other Agency Training
The following trainings are required for all
agencies:
• Fisca1-fiscal lead and coordinator
• Data collection and reporting -
coordinator and program staff who
are reporting data
--
Exhibit A, Statements of Work
Revised as of July 17, 2017
*May Support PHAB
StandardslMeasures Deliverables/Outcomes
l. Collect and report any
formative and process data
completed based on approved
project plan
2 . Submit PSE progress and
outcomes based on approved
project plan.
3. Conduct and submit/mail
pretest surveys for each project
class series
4. Conduct and submit/mail
posttest surveys for each project
class series
s. Capture and submit qualitative
(success stories, pictures)
information per your approved
work plan
Submit documentation showing
Civil Rights training was completed
for all SNAP-Ed paid staff.
Documentation must include:
• Training and source
• Who attended
• Date completed
Fiscal and Data reporting training
completed.
Page 13 of 17
AMENDMENT #13
Payment
Due Date/Time Frame Information and/or
Amount
1. Due: Submit within See payment ,
Quarterly reporting information as
listed above in task 2.1 referenced in task
number l.0
2. Due: Quarterly
1 st quarter report due
12/31117
3. Due: Within 30 days
after completed.
Submit all pretests
surveys/data when
they are completed for
a specific project.
4. Due: Within 30 days
after completed.
Submit all posttest
surveys/data when
they are completed for
a specific project.
s. Due: Submit within
Quarterly reporting
listed above in task 2 .0
along with photo
releases
Due: 12 /31117 See payment
information as
referenced in task
number l.0
Due: New staff trained See payment
within 30 days of starting information as
SNAP-Ed activities and referenced in task
again at least once every number 1.0
five (S) years.
Contract Number C 17114-13
AMENDMENT #13
Task *May Support PHAB Payment
Number Task! ActivitylDescription StandardslMeasures Deliverables/Outcomes Due DatelTime Frame Information and/or
Amount
*It is required that all staff making any If the data collection system
SNAP-Ed purchases or reporting data be changes in FFY18 every
trained. staff member entering data
into the electronic system
will be required to take
training on the new system.
4.0 SNAP-Ed Inventory List SNAP-Ed inventory list Due: Yearly, at the time of See payment
Keep an up -to-date inventory list that a fiscal monitoring and/or information as
includes all non-capital equipment, site visit. referenced in task
purchased curriculum, and other SNAP-Ed number 1.0
paid items that are not disposable . This list
should include items purchased in prior
fiscal years and be updated yearly.
5.0 SNAP-Ed A19 Invoices Submit SNAP-Ed A19-1A invoices Due: Monthly -Submit See payment
Use the A19-lA specific to SNAP-Ed and detailed ledger supporting the invoices to DOH no later information as
program. This document will be sent to all costs to be reviewed by SNAP-Ed than 30 days after the end of referenced in task
contractors prior to October 16,2017. program before approval of the preceding month. (e .g . number 1.0
payment. October A19 invoice
submitted no later than
Documentation of all costs incurred November 30 and so on ... )
shall be accompanied by an agency
financial system report . If your
agency does not have a financial
reporting system you must check
with the SNAP-ED program for
further guidance.
*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:
hup:!/www.phaboard .orglwp -contenlluploadsiPRAB-Standards-and-Measutes-Version-I.O.pdf
Special Requirements
Federal Funding Accountability and Transparency Act (FF AT A)
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 Specific Reg uirementslN arrative
Exhibit A, Statements of Work
Revised as of July 17 , 2017
Page 14 of 17 Contract Number C17114-13
AMENDMENT #13
Staff Requirements
Upon request by DOH, contractor must demonstrate that SNAP-Ed staff meet requirements appropriate to their positions including but not limited to: background checks, food
handlers' permits, and training required by DOH.
SNAP-Ed Assurances: The following assurances must be followed (see program Guidance
btlDs :lIsnaped.fus.usda.gov/national-snao-edisnalked-plan-.e.uidance-and-templates)
• The LHJ is fiscally responsible for nutrition education activities funded with Supplemental Nutrition Assistance Program Education funds and is liable for repayment of
unallowable costs.
• Efforts are made to target SNAP-Ed to the SNAP-Ed target audience.
• Only expanded or additional coverage of those activities funded under the Expanded Food and Nutrition Education Program (EFNEP) may be claimed under the SNAP-
Ed grant. Approved activities are those designed to expand the State's current EFNEP coverage in order to serve additional SNAP-Ed targeted individuals. In no case may
activities funded under the EFNEP grant be included in the budget for SNAP-Ed.
• Contracts are procured through competitive bid procedures governed by State procurement regulations.
• Program activities are conducted in compliance with all applicable Federal laws, rules, and regulations including Civil Rights and OMB circulars governing cost issues.
• Program activities do not supplant existing nutrition education and obesity prevention programs, and where operating in conjunction with existing programs, enhance as
well as supplement them. This applies to all activities and costs under the Federal budget.
• Program activities are reasonable and necessary to accomplish SNAP-Ed objectives and goals.
• All materials developed or printed with SNAP-Ed funds include the appropriate USDA non-discrimination statement and credit SNAP as a funding source in standard
font that is easily readable.
Audits
The LHJ must make State financial and program audits or reviews conducted by other entities available to the DOH, DSHS, USDA, or its designee.
Monitoring expectations
The LHJ's premises and records will be made available upon request to DOH, DSHS, and USDA staff for the purposes of observing nutrition education activities and reviewing
for program and fiscal compliance. All non-capital equipment and reusable educational materials should be tracked in an inventory list and available for review upon request.
Curriculum Requirements
Agencies are expected to communicate with, respond to, and comply with all state curriculum team requests, sites visits, approved curriculum list, and curriculum fidelity findings.
Indirect Rate
All indirect rates must be submitted and preapproved by DOH and the DOH SNAP-Ed program. The LHJ is responsible for ensuring that indirect costs included in the LHJ's
SNAP-Ed plan are supported by an indirect cost agreement and/or cost allocation plan approved by the appropriate agency. The contractor cannot bill indirect costs that are
detennined to be unacceptable and will be disallowed.
Annual Civil Rights Training Requirement (see FNS Instruction Number 113-1 Chapter XI) -http://www.fns.usda.gov/sites/defaultlfiles/I13-l.pdf "Training is required so
that people involved in all levels of administration of programs that receive Federal financial assistance understand civil rights related laws, regulations, procedures, and directives.
The local governmental agency, Indian Tribal Organization or non-Governmental Agency are responsible for training their subrecipients, including 'frontline staff.' 'Frontline
staff who interact with program applicants or participants, and those persons who supervise 'frontline staff must be provided civil rights training an annual basis."
Records -Record Retention and Management-State Agency and All Sub-grantees 7CFR 272.2
SNAP-Ed regulations require that all records be retained for six years from fiscal closure. This requirement applies to fiscal records, reports and client infonnation. Supporting
documentation may be kept at the sub-grantee level, but shall be available for review for six years from the date of quarterly claim submittal. Any costs that cannot be
substantiated by source documents will be disallowed as charges to SNAP.
Exhibit A, Statements of Work
Revised as of July 17, 2017
Page 15 of 17 Contract Number C 17114-13
Travel
The LHJ is expected to comply with the Office of Financial Management's Travel Management Requirement and Restrictions as found in policy 10 .10.
http://www.ofm.wa.gov/policv/10.htm
Amendments
AMENDMENT #13
Agencies must submit a request to DOH to amend a project plan and/or budget for prior approval whenever they wish to change the USDA-approved scope of activities and/or
budget. All requests for amendments must be submitted no later than April 1, 2018.
*Please Note:
• No changes may be incorporated into the project plan until an amendment request is approved by DOH and/or USDA
• Any requests submitted after April 1, 2018 will NOT be approved .
Overtime
Overtime is not billable in the DOH SNAP-Ed program unless it has been reviewed and preapproved by the state DOH SNAP-Ed program in advance and was approved in writing.
Budget Revisions
All changes to the budget must be pre-approved in writing by DOH SNAP-Ed.
Special Funding Requirements
Payment for deliverables as specified herein is dependent on receipt of funding from the USDA funding sources . In the event funding is not received, DOH is under no obligation
to make payments for the deliverables as specified. If funding is reduced or limited in any way after the effective date of this contract and prior to normal completion DOH may
terminate task(s), remove funds, or reallocate funds at DOH's discretion under new funding limitations and conditions. DOH will make payments only upon the receipt of the
funding. DOH will notify the LHJ within seven (7) working days upon notice by the funding source of funding availability.
Special Billing Requirements
1. All invoices, billing and reimbursements must be in compliance with all applicable Federal laws, rules, regulations including the FFY18 SNAP-Ed Guidance and OMB
circulars governing cost issues.
2. Total costs billed will not exceed the USDA-approved budget amount listed in the box below.
a. Bills must be for only SNAP-Ed specific activities, using a DOH AI9-IA Invoice voucher
b. A SNAP-Ed specific A19-1A must be submitted to the agency's designated DOH SNAP-Ed contract manager within 30 days of the last day of the month for which the
work is being billed, OR
c. An agency may request pre-approval to bill every two (2) months instead, in which case, that agency is required to adhere to the billing due dates listed in Task 5 (see
above)
3. NOTE: In FFY18 the SNAP-Ed program will deny payment for any costs not submitted by the due date without prior approval. If for ANY reason a contractor is unable to
submit the SNAP-Ed A19-1A on the due date, the contractor is required to submit a request for an exception to the DOH no later than seven (7) days prior to due date to the
DOH SNAP-Ed program. The SNAP-Ed program reserves the right and responsibility to either approve or deny the request for an exception and will reply to the request.
4. Supporting documentation for each month must be submitted with each SNAP-Ed AI9-1A.
a. At the very least this means a copy of an agency's financial expanded/detailed general ledger level report.
b. Additionally, all receipts, timecards and other supporting documentation, as noted by USDA, must be available upon request.
Exhibit A, Statements of Work
Revised as of July 17,2017
Page 16 of 17 Contract Number C 17114-13
AMENDMENT #13
5. PLEASE NOTE: If an agency is a new SNAP-Ed contractor or has had a fiscal finding, or does not submit adequate and/or accurate backup documentation within the last
year, all SNAP-Ed backup documentation must be submitted with each bill and this requirement will continue until further notice by DOH SNAP-Ed program.
BUDGET
Source I Amount
USDA $10,302
DOH Program Contact
Jamie Wells, SNAP-Ed Contract Manager
Department of Health
PO Box 47886, Olympia W A 98504-7886
Jamie . W ells@doh.wa.gov
360-236-3668
Exhibit A, Statements of Work
Revised as ofJuly 17,2017
DOH Fiscal Contact
Kim Henderson, Fiscal Analyst
Department of Health
PO Box 47886, Olympia, W A 98504-7886
Kim.Henderson@doh.wa.gov
360-236-3491
Page 17 of 17 Contract Number C 17114-13
EXHIBIT 8-13
Kittitas County Public Health Department ALLOCATIONS Contract Number: C17114
Contract Term: 2015-2017 Date: July 17, 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
8ARS Statement of Work Chart of Accounts Funding Chart of
Federal Award Revenue Funding Period Funding Period Period Accounts
Chart of Accounts Pro~ram Title Identification # Amend # CFDA* Code** Start Date End Date Start Date End Date Amount Sub Total Total
FFYI8 CSS fAR SNAP Ed Prog Mgnt NGA Not Received Amend 13 10.561 333.10.56 10101117 12/31/17 10101117 09/30/18 $9,902 $9,902 $9,902
FFY17 DSHS SNAP-Ed fAR Carry-in NGA Not Received Amend 13 10.561 333.10.56 10101117 12/31117 10101/17 12/31117 $400 $400 $15,396
FFY17 DSHS SNAP-Ed IAR 1717WAWA5Q390 Amend 8 10.561 333.10.56 10101116 09/30/17 10101116 09/30/17 $14,996 $14,996
FFY14 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
FFY14 EPR LHJ Funding U90TPOO0559 N/A 93.069 333.93.06 01101115 06/30/15 07/01114 06/30/15 $23,046
FFY17 EPR PHEP 8Pl LHJ Funding NU90TP921889-01 Amend 13 93.069 333.93.06 07/01117 12/31117 07/01117 07/02/18 $29,749 $29,749 $134,749
FFY16 EPR PHEP BP5 LHJ Funding U90TPOO0559 Amend 8 93.069 333.93.06 07/01116 06/30117 07/01/16 06/30/17 $50,000 $50,000
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 LHJ Funding U90TPOO0559 Amend 3 93.069 333.93.06 07/01115 06/30/16 07/01/15 06/30/16 $50,000
FFY15 EPR PHEP BP4 Oper Readiness U90TPOO0559 Amend 6 93.069 333.93.06 07/01115 06/30/16 07/01/15 06/30/16 $7,704 $7,704 $7,704
FFY14 EPR Planning & Exercises U90TPOO0559 Amend I 93.069 333.93.06 01101115 06/30115 07/01114 06/30/15 $24,078 $24,078 $24,078
FFY17 317 Ops 5NH23IPOO0762-05-00 Amend 10 93.268 33H3.26 04/01117 12/31117 04/01117 06/30/18 $924 $924 $3,609
FFY163170ps H23IPOO0762 Amend 5 93.268 333.93.26 01101116 12/31116 01101116 12/31116 $1,232 $1,232
FFY153170ps H23IPOO0762 Amend 1 93 .268 333.93.26 01101115 12/31115 01101115 12/31115 $193 $1,453
FFY15 317 Ops H23IPOO0762 N/A 93.268 333 .93.26 01101115 12/31115 01/01115 12/31/15 $1,260
FFY17 AFIX 5NH23IPOO0762-05-00 Amend 10 93.268 333 ,93.26 04/01117 12/31117 04/01117 06/30/18 $3,340 $3,340 $13,746
FFY16AFIX H23IPOO0762 Amend 11 93.268 333.93.26 01101117 03/31117 01101116 03/31117 $1,100 $1,100
FFY16AFIX H23IPOO0762 Amend 5 93.268 333.93.26 01101116 12/31116 01/01116 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 5NH23IPOO0762-05-00 Amend 10 93.268 333.93.26 04/01117 12/31117 04/01117 06/30/18 $1,150 $1,150 $3,487
FFY16 VFC Ops H23IPOO0762 Amend 5 93.268 333.93.26 01101116 12/31116 01/01116 12/31116 $828 $828
FFY15 VFC Ops H23IPOO0762 Amend 1 93.268 333.93.26 01101115 12/31115 01/01115 12/31115 $380 $1,509
FFY15 VFC Ops H23IPOO0762 N/A 93.268 333.93.26 01101115 12/31115 01/01115 12/31115 $1,129
Page 1 of3
EXHIBIT B-13
Kittitas County Public Health Department ALLOCATIONS Contract Number: C17114
Contract Term: 2015-2017 Date: July 17,2017
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
Chart of Accounts Prosram Title Identification # Amend # CFDA* Code** Start Date End Date Start Date End Date Amount Sub Total Total
FFY17 VFC Ordering 5NH23IPOO0762-05-00 Amend 10 93.26 8 333 .93.26 04/01117 12/31/17 04/01117 06/30/18 $695 $695 $3,249
FFY16 VFC Ordering H23IPOO0762 Amend 5 93.268 333.93 .26 01101116 12/31116 01101116 12/31116 $1,400 $1,400
FFY15 VFC Ordering H23IPOO0762 N/A 93.268 333 .93 .2 6 01 /01115 12 /31115 01/01115 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 03/3\/17 $1 ,805 $1,805 $\,805
FFY14 Enhance lIS and VTrckS H23IPOOO922 Amend 5 93.733 333.93.73 12 /01115 08 /31116 09/30/14 09/29/16 $1,087 $1,087 $1,087
FFYI6 PPHF Adolescent AFIX 1 NH23IP922562-0 1-00 Amend 12 93.733 333.93.73 04/01117 04/30/17 09/30/15 09/29/17 $1,000 $1,000 $1,000
FFY15 PPHF lIS AFIX NH23IPOO 1 032-0 1-0 I Amend 12 93 .733 333 .93.73 04/01117 04/30/17 09/30/15 09/29/17 ($1,000) $0 $0
FFY15 PPHF lIS AFIX NH23IPOOI032-01-01 Amend 11 93.733 333 .93.73 04/01117 04/30/17 09/30/15 09129/17 $1,000
FFY15 MCHBG CBP ConCon B04MC28134 Amend 3 93 .994 333 .93.99 01101115 09 /30 /15 10101/14 09/30/15 $1,723 $34,870 $34,870
FFYI5 MCHBG CBP ConCon B04MC28134 N/A 93 .994 333 .93 .99 01101115 09 /30 /15 10/01114 09/30/15 $33,147
FFYI7 MCHBG LHJ & Other Contracts 17B04MC30649 Amend 8 93 .994 333 .93 .99 10/01116 09 /30 /17 10101/16 09/30117 $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 01101117 06 /30 /17 01/01/17 06/30/17 $5,000 $5,000
FPHS Funding for LHJs Dir Amend 13 N/A 336.04.25 07/01117 12/31117 07/01117 06/30119 $42,000 $42,000 $42,000
Drinking Water Group A -SS Amend 10 N/A 346 .26.64 01101115 12/31117 01101115 12/31117 $2,800 $9,400 $9,400
Drinking Water Group A -SS Amend 9,10 N/A 346 .26 .64 01101115 12 /31 /17 01/01115 12/31117 $1,600
Drinking Water Group A -SS Amend 6,10 N/A 346 .2 6 .64 01/01 /15 12 /31117 01/01/15 12/31117 $2,200
Drinking Water Group A -SS N/A, Amd 6,10 N/A 346 .2 6 .64 01101 /15 12 /31 /17 01101115 12/31117 $2,800
Drinking Water Group A -SS State Amend 10 N/A 346 .26 .65 01101115 12/31117 01/01115 12/31117 $2,800 $9,400 $9,400
Drinking Water Group A -SS State Amend 9, 10 N/A 346 .26 .65 01101115 12 /311\7 01101115 12/31117 $1,600
Drinking Water Group A -SS State Amend 6,10 N/A 346 .26 .65 01101115 12 /31117 01101115 12/31117 $2,200
Drinking Water Group A -SS State N/A, Amd 6, 10 N/A 346 .26 .65 01/01115 12 /3\/17 01/01115 12/31117 $2,800
Page 2 of3
Kittitas County Public Health Department
Indirect Rate as of January 2015: 40.25%
Indirect Rate as of January 2017: 11.25% County Central Svcs & 29.5% Public Health Dept
Federal Award
EXHIBIT 8-13
ALLOCATIONS
Contract Term: 2015-2017
BARS S tatement of Work
Revenue fi!I,nding Period
Cha rt of e\'Clro,U n(s:
,lillll~\fg P«iiiil
Chart of Accounts Program Title Identification # Amend # CFDA* Code** Start DIll e End Date ~'\i@# D.~j!. ·m I d, D!!fi:.
Drinking Water Group A -TA
Drinking Water Group A -TA
Drinking Water Group A -TA
Drinking Water Group A -TA
Drinking Water Group A -TA
TOTAL
Total consideration:
GRANDTOTAL
*Catalog of Federal Domestic Assistance
$358,397
$82,051
$440,448
Amend 11
Amend 10
Amend 9, 10
Amend 6, 10
N/A, Amd 6,10
**Federal revenue codes begin with "333". State revenue codes begin with "334".
N/A
N/A
N/A
N/A
N/A
346.26.66 OI IOIIlS 12 /31 117 (llla l "IS 1:y./j ,WW
346.26.66 OI IOI ~15 12131 /17 tH f OH I.~ 1-W:1,11·11
346.26.66 01 /0 1/15 12131117 01l0 11iS l lD$t ll'l
346.26.66 OtlOl-Il5 12/31 117 fJilO l/!';), iJllJc\i,l.'1
346.26.66 01 101 115 12 /31117 QJIOI! li;l J ;'!b1-1~ll li
Page 3 00
Amount
($2,400)
$2,000
($1,600)
$1,000
$4,000
$440,448
Contract Number:
Date:
Funding
Period
Sub Total
$3,000
$440,448
GRAND TOTAL
Total Fed
Total State
C17114
July 17, 2017
Chart of
Accounts
Total
$3,000
$440,448
$366,648
$73,800
Exhibit C-11 Schedule of Federal Awards AMENDMENT #13
Date : July 17, 2017
KITTITAS COUNTY HEALTH DEPT -SWVOO10475-07
CONTRACT C17114-Kittitas County Public Health Department
CONTRACT PERIOD 1/1/2D1~12/31/2D17
DOH TotalAmt Allocation Period
Chart of Accounts Program Title BARS F ederal Federal Si an End Contract Amt CFDA CFDA Program Title Federal Agency Name Federal Award Federal Grant Award Name Awa rd Date Award Data · Dale l ru.milic:alion N umb e r
NGA Not NGANot 10101/17
State Administrative Matching Department of Agriculture Food and FFY18 CSS IAR SNAP-ED PROG MGNT 333.10.56 Received ReceIVed 12/31/17 $9,902 10.561 Grants for the Supplemental Nutrition Service NGA NOI Received NGA Not Received
Nutrition Assistance Program
NGA Not NGANot 10101/17
State Administrative Matching Department of Agriculture Food and FFY17 DSHS SNAP-ED IAR CARRY-IN 3331056 12/31/17 $400 10561 Grants for the Supplemental NGA Not Received NGA Not Received Received Received Nutrition Assistance Program Nutrition Service
State Administrative Matching Department of Agricutture Food and Supplemental Nutrition Assistance FFY17 DSHS SNAP-ED IAR 3331056 09130/16 $5,739.856 10101/16 09130117 $14,996 10561 Grants for the Supplemental Nutlition Service 17l7WAWA5Q390 Program Education (SNAP-Ed) Nutrition Assistance Program
Public Health Emergency Department of Health and Human HPP AND PHEP COOPERATIVE FFY17 EPR PHEP BP1 LHJ FUNDING 333_93_06 07/18/17 $11,062,782 07/01117 12/31/17 $29,749 93069 Services Centers for Disease Control NU90TP921889-01 Preparedness and Prevention AGREEMENT
Public Health Emergency Department of Health and Human TP12-1201 HPP AND PHEP FFY16 EPR PHEP BP5 LHJ FUNDING 333.9306 06/23/16 $10,222,879 07/01/16 06/30/17 $50,000 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 OPER READINESS 3339306 06/30/14 $11,064,407 07/01/15 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 333,9306 06126/15 $12,132,694 07101115 06/30/16 555,000 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 333.93.06 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 HPPAND PHEP
FFY14 EPR LHJ FUNDING 3339306 06/30/14 $12,663,227 01/01/15 06/30/15 $23,574 93.069 Preparedness Services Centers for Disease Control U90TPOO0559 COOPERATIVE AGREEMENTS and Prevention
Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
FFY17 VFC ORDERING 3339326 03/03/17 $103,974 04/01117 12131117 $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 03/03/17 $1,201,605 04/01/17 12/31/17 $1,150 93268 Services Centers for Disease Control 5NH23IPOO0762-0~0 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM
Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
FFY17 AFIX 3339326 03/03117 $1,672,289 04101117 12131/17 $3,340 93268 Services Centers for Disease Control 5NH23IPOO0762-o~0 VACCINES FOR CHILDREN'S
Agreements and Prevention PROGRAM
Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
FFY17 317 OPS 333,93.26 03/03/17 $575,969 04/01/17 12131117 $924 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
FFY16 VFC ORDERING 333,9326 01/19/16 $3,991,764 01/01116 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 01/19/16 $3,991,764 01/01/16 12/31/16 $828 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
FFY16AFIX 333.9326 01119/16 $3,991 .764 01101/16 03131/17 55,393 93.268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S
Agreements and Prevention PROGRAM
Page 1 of 2
Exhibit C-11 Schedule of Federal Awards
KmlTAS COUNTY HEALTH DEPT-SWV0010475-07
CONTRACT C17114-Kittitas County Public Health Department
CONTRACT PERIOD 1I11201!;-1213112017
Chart of Accounts Program Title BARS
FFY16 317 OPS 3339326
FFY15 VFC ORDERING 3339326
FFY15 VFC OPS 333_93-26
FFY15AFIX 333.93.26
FFY15 317 OPS 333.93.26
FFY16 PPHF 317 OPS 3339353
FFY16 PPHF ADOLESCENT AFIX 333_9373
FFY14 ENHANCE 115 AND VTRCKS 3339373
FFY17 MCHBG LHJ & OTHER CONTRACTS 333_93.99
FFY16 MCHBG LHJ & OTHER CONTRACTS 333.9399
FFY15 MCHBG CBP CONCON 33393_99
DOH
FedOral
Award Date
01119116
12117114
12117114
12117114
12117114
09108116
08129116
09116114
10131116
10122115
10121 114
TotalAmt Allocation Period
Federal S tut End
A ward D.I~ Dale
$3,991,784 01101116 12131116
$3,437,046 01101115 12131115
53,437,046 01/01/15 12131/15
$3,437,046 01101115 12131115
$3.437,046 01101115 12131115
$4,009,643 01101117 03131117
$500,000 04101117 04130117
$700,000 12101115 08131116
$1,697,083 10101116 09130117
$1,739,609 10101115 09130116
$8,646,149 0 110 1115 0913 0/15
TOTAL
Contract Amt
$1,232
$1,154
$1,509
$5 ,013
$1.453
$1,805
Sl,OOO
$1,087
$44,196
$44,196
$34,870
$366,648
AMENDMENT #13
Date : July 17, 2017
CFDA CFDA Program Title Federal Agency Name Federal Award Federal Grant Award Name Identification Number
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 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 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 Cooperative Department of Health and Human IMMUNIZATION GRANT AND
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
93268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM
PPHF Capacity Buildin9 Department of Health and Human
PPHF 2017: IMMUNIZATION GRANTS-
Assistance to Strengthen Public IMMUNIZATION & VACCINES FOR
93.539 Health Immunization Services Centers for Disease Control NH231POO0762-04-05 CHILDREN PROGRAM-FINANCED IN
Infrastructure and Performance and Prevention PART BY 2017 PREVENTION & PUBLIC
Capacity Bu ilding Ass istance to
Department of Hea lth and Human
PPHF 2016: INCREASING HPV
Strengthen Public Health VACCINE COVERAGE BY
93.733 Immunization Infrastructure & Services Centers for Disease Control 1 NH23 1P922562-01-00 STRENGTHENING ADOLESCENT AFIX
Performance -Financed in part and Prevention ACTIVITIES , FUNDED IN PART BY 2016
Capacity Building Assistance to PPHF 2014: IMMUNIZATION ENHANCE
Strengthen Public Health Department of Health and Human AN IMMUNIZATION INFORMATION
93733 lin"irj ~:lnff<lStro~u(l!'& 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
93.994 Services Block Grant to the Services Health Resources and 17B04MC30649 SERVICES
States Services Administration
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
Maternal and Child Health Department of Health and Human MATERNAL AND CHILD HEALTH 93_994 Services Block Grant to the Services Hea lth Resources and B04MC28134 SERVICES States Services Administration
Page 2 of 2
G
Kittitas County
Review Form
t &C t tA ran s on rac greemen t $-4D Cj"-:t-:.p
Today's Date Agenda Date l Dt 3/ r:r 09/19/2017
Fund/Department
116-Public Health
Contract/Grant Information
Contract /Grant Agency: Consolidated Contract Amendment #13
Period Begin Date : January 1, 2015 I I Period End Date: December 31,2017
Total Grant/Contract Amount: A new reviewed maximum consideration of $440,480.00
Grant/Contract Number: C17114
Contract/Grant Summary:
The Amendment 13
Adds Statements of Work
• Emergency Preparedness & Response-Effective July 1, 2017
• FPHS Communicable Disease & Support Capabilities-Effective July 1, 2017
• Supplemental Nutrition Assistance Program-Education-Effective October 1, 2017
Exhibit B-13 Allocations:
• Increases of $82,051 for a revised maximum consideration of $440,448.00
Recommendation for Board of Health and Board of Health Review on
Department Head Signatu ~ • Administrator Date: {O {::,{ ( 7
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APPROVED AS TO FORM :
Date
Signature of Board of Health member Date
Financial Information
Grant/Contract Review Page 1
Total Amount $82,051.00 State Funds $ Federal Funds $82,051
Percentage County Funds Matching Funds $ CFDA# various (see below)
In-Kind $
Explain
Is Equipment 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 []I Why not
New Division Created? Not an increase in bottom line
Revenue Code
116-612.88.3.333.93.069 -$29,749
116.612.32.9.336.04.25 -$42,000
116.612.94.333.10.561-$10,302
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
Grant/Contract Review Page 2
I Reviewer I Date
Grant/Contract Review Page 3