HomeMy WebLinkAboutCC Amend 14KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2015 -2017 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CI7114 AMENDMENT NUMBER: 14
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:
D Adds Statements of Work for the following programs:
~ Amends Statements of Work for the following programs:
• FPHS Communicable Disease & Support Capabilities -Effective July 1,2017
• Maternal & Child Health Block Grant -Effective January 1, 2015
D Deletes Statements of Work for the following programs:
2. Exhibit B-14 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-13 Allocations
as follows:
~ Increase of$II,049 for a revised maximum consideration of $451,497.
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-12 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces
Exhibit C-ll.
Unless designated otherwise herein, the effective date of this amendment is the date of execution.
ALL OTHER TERMS AND CONDITIONS of the original contract and any subsequent amendments remain in full force
and effect.
IN WITNESS WHEREOF , the undersigned has affixed his/her signature in execution thereof.
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
Date
Page 10flO
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
APPROVED AS TO FORM ONLY
Assistant Attorney General
2015-2017 CONSOLIDATED CONTRACT
EXHmITA
STATEMENTS OF WORK
TABLE OF CONTENTS
AMENDMENT #14
DOH Program Name or Title.: FPHS Communicable Disease & Support Capabilities -Effective July 1, 2017 ................................................................................ 3
DOH Program Name or Title: Maternal & Child Health Block Grant -Effective January 1, 2015 ................................................................. ~ ................................... 6
Exhibit A , Statements of Work
Revised as of September 15, 2017
Page 2 of 10 Contract Number C17114-14
Exhibit A
Statement of Work
Contract Term: 2015-2017
AMENDMENT #14
DOH Program Name or Title: FPHS Communic able D isease & S upport
Capabilities -Effective July 1, 2017
Local Health Jurisdiction Name: Ki ttitas County P ublic Health De partment
Contract Number: C17114
SOW Type: Revision Revision # (for this SOW) 1 Funding Source Federal Compliance Type of Payment
D Federal <Select One> (check if applicable) D Reimbursement
~ State D FFATA (Transparency Act) ~ One-Time Distribution
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 lump sum payment 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. 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: The purpose of this revision is to change the Type of Payment and Payment Information and/or Amount from reimbursement to one-time lump-sum
distribution and remove Special Billing Requirements.
Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change frotal
Revenue Index (LHJ Use Only) Consideration None Consideration
Code Code Start Date End Date
FPHS FUNDING FOR LHJS DIR N/A 336 .04 .25 91106102 07/01117 I 12 /31117 42 ,000 0 42,000
TOTALS 42 ,000 0 42,000
Note : New BARS Revenue Code listed above. See Special Instructions below for more information.
Task *May Support PHAB Payment
Number Task! Activity illescription StandardslMeasures Deliverables/Outcomes Due DatelTime Frame Information and/or
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 F£lIS Definitions -VCJ's ion 1.2 <Mnrch 2016}
G, Control of Communicable Disease and Other Notifiable Conditions
l. Provide timely, statewide, locally relevant and
accurate information statewide and to
communities on communicable disease and
other notifiable conditions and their control.
Exhibit A, Statements of Work
Revised as of September 15 ; 2017
Brief report on how funding will
be used to support the FPHS
communicable disease services
listed in tasks 1-6 or FPHS
capabilities in support of
communicable disease services
Page 3 of 10
October 1, 2017 R-eimiJlH'!>t!meRlj9 F
eeRi~
Lump sum payment as
follows:
July 2017: $42,000
Contract Number C 17114-14
AMENDMENT #14
Task *May Support PHAB Payment
Number Task! ActivitylDescription StandardslMeasures Deliverables/Outcomes Due Date/Time Frame Information and/or
Amount
2 , Promote immunization through evidence based Report on metrics (TBD) January 30,2018
strategies and collaboration with schools, health
care providers and other community partners to Baseline data July 30,2018
increase immunization rates. January 30,2019
Updated data every six (6) July 30,2019
months
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, arid 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
t() 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:
http://www.phaboard.o:rg/wp-conienrl uploadsiPHAB-S tandards--artd-Measures-VerSion-I . o. pdf
And the document Aligning Accreditation and the Foundational Public Health Capabilities, Public Health National Center for Innovations (PHNCn, Summer 2016
http://phnci.orelresourceslaligning-accreditauon-and-th e-fouodalional-public-ll1:alth-cspabiliLies
Exhibit A, Statements of Work
Revised as of September 15,2017
Page 4 of 10 Contract Number C 17114-14
AMENDMENT #14
Program Specific Reguir:ements/Narrative
Special References (RCWs, WACs, etc)
• Immunizations -hltp:/lwww.doh."vagovt YouandYourFamilvfImmunization
• Notifiable Conditions -bttp :l/www.doh.wa.govl ForPublicHealthandl-lealdlc-areProviciersrNotifiahleCondition:;
• Sexually Transmitted Diseases (STD) -http://www.doh.wa .gov/YouandYourFamilyllLlnessaodDisease/Sexual1 yTransm itteclDisease
• HUfllan Immunodeficiency Virus (HIV) -hup:fl www.dob..wa.govlYouandYourFamily/lJ.b;J.essaudDiseaselI-nYAIDS
• Tuberculosis (TB) -bnp:llwww .doh,wa.govl'touandYourFamilvJlUnessandDisea."ef[uberculosis
Definitions
• FPHS Definitions. Version 1..2 (March 2016)
~e! Billing ReqllireltHffll!j
Bi!!tng5 .re" :liisfimdiFlg HillS! be indmied-ifHhe Cel1stJiilfflWd C(mmu!! A ! 91RW)~111tJ DOH Gnm!54.Dice. PIDuJing 'i d/.5f!=;/)"ited besed fin ri!iflllmr::emcm at eXf!£,R~
This ;5 fi,iffero,i( IRon [Jiese fflmls LHJs rec€fi .'c 11'811/ Ihe "C6Iiiflj' -"-uhlic rJe(~!l1i Assi1i1tfff~mk;.fp.H1i the SEe:e.
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 ofFPHS Definitions -Version 1.2 (March 2016)
SAO's BARS Manual-http ://www.sao.wa.gov/local/pages/BARSManuaLaspx
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 I Mobile 360-951-7566
Fax 360.236.4024 I marie.flake@doh.wa.gov
Exhibit A, Statements of Work
Revised as of September 15, 2017
Page 5 of 10 Contract Number C17114-14
DOH Program Name or Title: Maternal & Child Health Block Grant-
Effective January 1, 2015
SOW Type: Revision Revision # (for this SOW) 4
Period of Performance: January 1, 2015 through December 31, 2017
Exhibit A
Statement of Work
Contract Term: 2015-2017
AMENDMENT #14
Local Health Jurisdiction Name: Kittitas County Public Health Department
Contract Number: C 17114
Funding Source Federal Compliance Type of Payment
~ Federal Subrecipient (check if applicable) ~ Reimbursement
D State ~ FFATA (Transparency Act) D Fixed Price
D Other D Research & Development
Statement of Work Purpose: The purpose of this statement of work is to support local interventions that impact the target population of the Maternal and Child Health Block
Grant.
Revision Purpose: The purpose of this revision is to extend the period of performance from September 30, 2017 to December 31, 2017 , provide additional funding and add and
revise tasks and deliverable due dates for continuation of MCHBG related activities.
Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period
Revenue Index (LHJ Use Only)
Code Code Start Date End Date
FFY15 MCHBG CBP CONCON 93 .994 333 .93 .99 78734250 01101115 09 /30115
FFY16 MCHBG LHJ & OTHER CONTRACTS 93.994 333 .93 .99 78730260 10/01115 09/30/16
FFY17 MCHBG LHJ & OTHER CONTRACTS 93.994 333 .93.99 78730270 10/01116 09/30/17
FFY18 MCHBG LHJ CONTRACTS 93 .994 333 .93 .99 78120281 10/01117 12 /31117
TOTALS
-----
Task *May Support PHAB
Number Task! ActivitylDescription StandardslMeasures Deliverables/Outcomes
Maternal and Child Health Block Grant (MCHBG) Administration
la Participate in calls, at a minimum of every eIheF Designated LHJ staff will
menth quarter, with DOH contract manager. participate in contract
Dates and time for calls are mutually agreed upon management calls.
between DOH and LHJ.
Ib Participate in DOH sponsored MCHBG-related Designated LHJ staff will
quarterly conference calls and/or webinars, participate in calls, webinars, and
including up to two (2) in-person meetings. meetings.
lc Complete 2015-2016 MCHBG Budget Workbook Submit completed MCHBG
for October 1,2015 through September 30 ,2016 Budget Workbook to DOH
using DOH provided template . contract manager.
-----
Exhibit A, Statements of Work
Revised as of September 15 , 2017
Page 6 of 10
Current Change Total
Consideration Increase (+) Consideration
34,870 0 34 ,870
44,196 0 44 ,196
44 ,196 0 44 ,196
0 11 ,049 11,049
123 ,262 11,049 134,311
Payment
Due DatelTime Frame Information and/or
Amount
S~t}HtJ Reimbursement for
December 31 , 20 17 actual costs , not to
exceed total funding
consideration. Action
&pwmhe."30 Plan and Progress
December 31 , 2017 Reports must only
reflect activities paid
September 4,2015 for with funds
provided in this
statement of work for
Contract Number C17114-14
Task
Number Task! ActivitylDescription
ld Report actual expenditures for October 1, 2014-
December 31, 2014.
Ie Report actual expenditures for January 1, 2015
through September 30 , 2015 .
If Complete 2016-2017 MCHBG Budget Workbook
for October 1, 2016 through September 30 ,2017
usmg DO H -provi ded template .
19 Report actual expenditures for October 1,2015
through September 30,2016.
Ih Report actual expenditures for Octoberl, 2016
through March 31 , 2017.
Ii Complete 2017-2018 MCHBG Budget Workbook
for October 1,2017 through September 30,2018
using DOH-provided template
ij Report actual expenditures for October i, 2016-
September 30,2017.
MCHBG Assessment and Evaluation
2a Participate in statewide capacity and needs
assessment activities in preparation for next
statewide 5 year plan, as requested .
2b Participate in project evaluation activities
developed and coordinated by DOH, as
requested .
2c Report program level strategy measure data
MCHBG Implementation
3a Develop 2015-2016 MCHBG Action Plan for
October 1, 2015 through September 30 ,2016
using DOH provided template .
3b Report activities and outcomes of2014-2015
MCHBG Action Plan using DOH provided
template .
Exhibit A, Statements of Work
Revised as of September 15 , 2017
*May Support PHAB
Standardsnvleasures Deliverables/Outcomes
Submit actual expenditures using
the MCHBG Budget Workbook
(Sections A and B only) to
contract manager.
Submit actual expenditures using
the MCHBG Budget Workbook
to DOH contract manager.
Submit completed MCHBG
Budget Workbook to DOH
contract manag er.
Submit actual expenditures using
the MCHBG Budget Workbook
to DOH contract manager.
Submit actual 'expenditures using
the MCHBG Budget Workbook
to DOH contract manager.
Submit completed MCHBG
Budget Workbook to DOH
contract manager.
Submit actual expenditures using
the MCHBG Budget Workbook to
DOH contract manager.
Documentation using report
template provided by DOH .
Documentation using report
template provided by DOH.
Documentation using Action Plan
Quarterly Report and MCHBG
Budget Workbook
Submit MCHBG Action Plan to
DOH contract manager.
,
Submit Action Plan quarterly
reports to DOH contract manager .
Page 7 of 10
AMENDMENT #14
Payment
Due Date/Time Frame Information and/or
Amount
February 18, 2015 the specified funding
period.
See Program Specific
Requirements and
November 30 ,2015 Special Billing
Requirements . I
September 2,2016
November 30 ,2016
May 26,2017
September 1, 2017
November 15 , 2017
May 1, 2015 Reimbursement for
actual costs , not to
exceed total funding
September #) consideration.
December 31, 2017 See Program Specific
Requirements and
January 15, 2017 Special Billing
April 15, 2017 Requirements.
July 15 ,2017
Draft -August 21 , 2015 Reimbursement for
Final-September 4,2015 actual costs, not to
exceed total funding
January 15, 2015 consideration. Action
April 15 ,2015 Plan and Progress
July 15,2015 Reports must only
Contract Number C 1 7114-14
,-
Task
Number Task! ActivitylDescription
3c Develop 2016-2017 MCHBG Action Plan for
October 1,2016 through September 30,2017
using DOH-provided template.
3d Report activities and outcomes of2015-2016
MCHBG Action Plan using DOH-provided
template.
3e Develop 2017-2018 MCHBG Action Plan for
October 1,2017 through September 30, 2018
using DOH~provided template .
3f Report activities and outcomes of2016-2017
MCHBG Action Plan using DOH-provided
template.
3g Report activities and outcomes of2017-18
MCHBG Action Plan for October 1,2017
through December 31,2017
Children with Special Health Care Needs (CSHCN)
4a Complete Child Health Intake Form (CHIF) using
the CHIF Automated System on all infants and
children served by the CSHCN Program as
referenced in CSHCN Program Manual.
Exhibit A, Statements of Work
Revised as of September 15, 2017
*May Support PHAB
StandardslMeasures Deliverables/Outcomes
Submit MCHBG Action Plan to
DOH contract manager.
Submit Action Plan quarterly
reports to DOH contract manager.
Submit MCHBG Action Plan to
DOH contract manager.
Submit Action Plan quarterly
reports to DOH contract manager.
Submit Action Plan monthly
reports to DOH contract
manager.
Submit CHIF data into Secure
File Transport (SFT) website:
https :llsft.wa.go v
Page 8 of 10
AMENDMENT #14
Payment
Due Date/Time Frame Information and/or
Amount
October 15 ,2015 reflect activities paid
for with funds
If LHJ chooses to bill on a provided in this
monthly basis, reports are statement of work for
due on or before the 15 th the specified funding
of the following month. period.
Draft-August 19, 2016 See Program Specific
Final-September 2,2016 Requirements and
Special Billing
January 15,2016 Requirements.
Apri115,2016
July 15 ,2016
October 15,2016
IfLHJ chooses to bill on a
monthly basis, reports are
due on or before the 15 th
of the following month.
Draft-August 18,2017
Final-September 1, 2017
January 15 , 2017 I
April 15, 2017
July 15, 2017
Monthly, on or before the
15th of the following
month .
January 15, 2015 Reimbursement for
April 15 ,2015 actual costs, not to
July 15 , 2015 exceed total funding
October 15, 2015 consideration. Action
January 15, 2016 Plan and Progress
April 15,2016 Reports must only
July 15 , 2016 reflect activities paid
October 15 ,2016 for with funds
January 15,2017 provided in this
April 15, 2017 statement of work for
July 15 , 2017 the specified funding
Octob er 15, 2017 period.
Contract Number C 17114-14
AMENDMENT #14
Payment ,
Task *May Support PHAB Task! Activity illescription Deliverables/Outcomes Due Date/Time Frame Information and/or I Number StandardslMeasures Amount
4b Administer requested DOH Diagnostic and Submit completed Health 30 days after forms are
See Program Specific I Treatment funds for infants and children per Services Authorization forms and completed.
CSHCN Program Manual when funds are used. Central Treatment Fund requests Requirements and
directly to the CSHCN Program Special Billing
as needed. Requirements.
4c Participate in the CSHCN Regional System and Submit Action Plan quarterly January 15,2015
quarterly meetings as described in the CSHCN reports including number of April 15,2015
Program Manual. regional meetings attended to the July 15, 2015
DOH contract manager. October 15,2015
January 15, 2016
April 15,2016
July 15,2016
October 15,2016
January 15,2017
April 15, 2017 . July 15, 2017
October 15. 2017
*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) Standards/Measures that may apply can be found at:
hltp;/lwww.phaboal.d.orglwp-contenUuploadsIPHAB -Standards-and-Measul.es-Version-t.O .p df
Program Specific Reguirements/Narrative
Special Requirements
Federal F unding Accountability and Transparenc.v Act (FFATA)
This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FF AT A or the Transparency Act).
The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent.
To comply with this act and be eligible to perform the activities in this statement of work, the LHJ must have a Data Universal Numbering System (DUNS®) number.
Information about the LHJ and this statement of work will be made available on USASpending .gov by DOH as required by P.L. 109-282.
Program Manual, Handbook, Policy References
Children with Special Health Care Needs Manual-http://\l.'\vw .doh.wa .govlPortalS!1IDocumenWPubsl970 -209·CSHCN-Manual.pdf
Exhibit A, Statements of Work
Revised as of September 15, 2017
Page 9 of 10 Contract Number C 17114-14
AMENDMENT #14
Restrictions on Funds (what funds can be used for which activities, not direct payments, etc)
1. At least 30% of federal Title V funds must be used for preventive and primary care services for children and at least 30% must be used services for children with
special health care needs. [Social Security Law, Sec. 505(a)(3)].
2. Funds may not be used for:
a. Inpatient services, other than inpatient services for children with special health care needs or high risk pregnant women and infants , and other patient services approved by
Health Resources and Services Administration (HRSA).
b. Cash payments to intended recipients of health services.
c. The purchase or improvement of land, the purchase, construction, or permanent improvement of any building or other facility, or the purchase of major medical
equipment.
d. Meeting other federal matching funds requirements.
e . Providing funds for research or training to any entity other than a public .or nonprofit private entity.
f. payment for any services furnished by a provider or entity who has been excluded under Title XVIII (Medicare), Title XIX (Medicaid), or Title XX (social services block
grant).[Social Security Law, Sec 504(b)].
3. If any charges are imposed for the provision of health services using Title V (MCH Block Grant) funds, such charges will be pursuant to a public schedule of charges ; will not
be imposed with respect to services provided to low income mothers or children; and will be adjusted to reflect the income, resources, and family size of the individual
provided the services. [Social Security Law, Sec . 505 (l)(D)].
Monitoring Visits (frequency, type)
Telephone calls with contract manager at least one every other month.
Special Billing Requirements
Payment is contingent upon DOH receipt and approval of all deliverables and an acceptable A19-1A invoice voucher. Payment to completely expend the "Total Consideration"
for a specific funding period will not be processed until all deliverables are accepted and approved by DOH. Invoices must be submitted monthly on the 30th of each month
following the month in which the expenditures were incurred and must be based on actual allowable program costs. Billing for services on a monthly fraction of the "Total
Consideration" will not be accepted or approved.
Special Instructions
Any materials or communication products developed regarding work related to this Statement of Work should include the following text: "Supported by the Washington State
Department of Health, Office of Healthy Communities through the Maternal and Child Health Block Grant award from the Maternal and Child Health Bureau (Title V, Social
Security Act), Health Resources and Services Administration".
DOH Program Contact
Mary Dussol
Healthy Communities Consultant
Office of Healthy Communities
Washington State Department of Health
Street Address: 310 Israel Rd SE, Tumwater, WA 98501
Mailing Address : PO Box 47848, Olympia, WA 98504
Telephone: 360-236-3781/ Fax: 360-236-3646
Email: mary.dussol @doh.wa.gov
Exhibit A, Statements of Work
Revised as of September 15,2017
Page 10 of 10 Contract Number C 17114-14
EXHIBIT B-14
Kittitas County Public Health Department ALLOCATIONS Contract Number: C17114
Contract Term: 2015-2017 Date: September 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
Chart of Accounts Pro~ram Title Identification # Amend # CFDA* Code** Start Date End Date Start Date End Date Amount Sub Total Total
FFYI8 CSS IAR SNAP Ed Prog Mgnt NGA Not Received Amend 13 10 .561 333.10 .56 10101117 12 /311 17 10101117 09 /30 /18 $9,902 $9,902 $9,902
FFY 17 DSHS SNAP-Ed IAR Carry-in NGA Not Received Amend 13 10.561 333 .10 .56 10 /0 II I 7 12/31117 10/01117 12 /31 /17 $400 $400 S15 ,396
FFY 17 DSHS SNAP-Ed IAR 1717WAWA5Q390 Amend 8 10.561 333.10 .56 10 /01116 09 /30 /17 10 /01116 09 /30 /17 $14,996 $14,996 .
FFY14 EPR LHJ Funding V90TPOO0559 Amend 2 93 .069 333.93.06 01101115 06/30/15 07/01114 06/30/15 $528 $23,574 $23,574
FFYI4 EPR LH1Funding V90TPOO0559 N/A 93.069 333 .93.06 OIlOIlIS 06/30/lS 07 /01/14 06 /30/1S $23,046
FFYI7 EPR PHEP BPI LHJ Funding NV90TP921889-01 Amend 13 93.069 333.93.06 07 /01117 12/31117 07101117 07 /02 /18 $29,749 $29,749 $134,749
FFY16 EPR PHEP BPS LHJ Funding V90TPOOOSS9 Amend 8 93.069 333.93.06 07 /01 /16 06/30117 07 /01116 06 /30117 $SO,OOO $SO,OOO
FFYlS EPR PHEP BP4 LHJ Funding V90TPOO0559 Amend 4 93.069 333.93 .06 07/01115 06/30116 07 /01115 06/30116 $5,000 $55,000
FFY15 EPR PHEP BP4 LHJ Funding U90TPOO0559 Amend 3 93.069 333.93.06 07/01115 06/30/16 07/01llS 06/30/16 $SO,OOO
FFY15 EPR PHEP BP4 Oper Readiness V90TPOO0559 Amend 6 93 .069 333 .93 .06 07 /01llS 06 /30 /16 07 /01115 06/30/16 $7,704 $7,704 $7,704
FFY14 EPR Planning & Exercises V90TPOO0559 Amend I 93.069 333.93 .06 01 /0 11 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 04/01117 12 /31117 04/01117 06/30/18 $924 $924 $3,609
FFYI6 317 Ops H23IPOO0762 AmendS 93.268 333.93 .2 6 01101116 12/311 16 01101116 12 /31116 $1,232 $1,232
FFY153170ps H23IPOO0762 Amend I 93.268 333 .93.26 OIlOI /IS 12 /31115 01/01115 12 /31/15 $193 $1,453
FFYI5 317 Ops H23IPOO0762 N/A 93 .268 333.93.26 01 10 I l lS 12 /31 /15 01 /01 /15 12/31 /15 $1,260
FFYI7 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
FFYI6AFIX H23IPOO0762 Amend II 93.268 333.93.26 01101117 03/31117 01101/16 03/31/17 $1,100 $1,100
FFY16 AFIX H23IPOO0762 AmendS 93 .268 333.93.26 01101116 12 /311 16 01101116 12 /31/16 $4,293 $4,293
FFYI5 AFIX H23IPOO0762 N/A 93.268 333 .93.26 OIlOII1S 12 /31 /15 01/01115 12 /31 /15 $5 ,013 $5,013
FFYI7 VFC Ops 5NH23IPOO0762-0S-00 Amend 10 93.268 333.93.26 04 /01 117 12 /31117 04101117 06 /30 /18 $1,150 $1,150 $3,487
FFY 16 VFC Ops H23IPOO0762 AmendS 93 .268 333 .93.26 01101116 12 /31116 01101116 12/31116 $828 $828
FFY15 VFC Ops H23IPOO0762 Amend I 93.268 333.93.26 01101115 12 /31/1S 01101115 12/31/15 $380 $1,509
FFY 15 VFC Ops H23IPOO0762 N/A 93.268 333 .93.26 0110111S 12 /311 1S 01101115 12/31/1S $1,129
Page I of3
EXHIBIT B-14
Kittitas County Public Health Department ALLOCATIONS Contract Number: CI7114
Contract Term: 2015-2017 Date: September IS, 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 hari o f Acroun15 Pr oeam Tille Identification #. Amend # CFDA* Code** Start Date End Date Start Date End Date Amount Sub Total Total
FFYI7 VFC Ordering 5NH23IPOO0762-05-00 Amend 10 93 .268 333.93 .26 04 /01117 12 /31117 04/01117 06/30/18 $695 $695 $3,249
FFYI6 VFC Ordering H23IPOO0762 Amend 5 93 .268 333.93 .26 01101116 12 /31116 01101116 12/31116 $1 ,400 $1 ,400
FFY 15 VFC Ordering H23IPOO0762 N/A 93 .268 333 .93 .26 01 /01 /15 12/3111S 01 /01 /lS 12 /3111S $1,IS4 $1,154
FFYI6 PPHF 317 Ops NH23IPOO0762-04-05 Amend 10 93.S39 333.93.S3 01101117 03 /31117 01101116 03/31/17 $1,805 $1,80S $1,80S
FFYI4 Enhance IlS and VTrckS H23IPOOO922 AmendS 93 .733 333.93 .73 12 /01 /15 08 /31116 09/30/14 09 /29/16 $1,087 $1,087 $1 ,087
FFY 16 PPHF Adolescent AFIX I NH23IP922S62-01-00 Amend 12 93.733 333.93.73 04 /01 /17 04 /30 /17 09 /30 /lS 09129 /17 $1,000 $1,000 $1 ,000
FFYIS PPHF liS AFIX NH23 IPOO I 032-0 1-0 I Amend 12 93 .733 333.93 .73 04/01117 04 /30/17 09/30/1S 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/lS 09/29/17 $1,000
FFY15 MCHBG CBP ConCon B04MC28134 Amend 3 93.994 333 .93 .99 01101115 09 /30llS 10101114 09 /30 /15 $1,723 $34,870 $34,870
FFYIS MCHBG CBP ConCon B04MC28134 N/A 93 .994 333.93.99 OI /OIlIS 09 /30/15 10101114 09 /30 /15 $33,147
FFYI8 MCHBG L HJ Contracts NGA Not R eceived Amend 14 93.994 333.93.99 10/0 11 17 12 /31117 1010 11 17 09 /30/18 $11,049 $11,049 $11,049
FFY17 MCHBG LHJ & Other Contracts 17B04MC30649 Amend 8 93.994 333 .93 .99 10101/16 09 /30 /17 10101116 09/30/17 $44,196 $44,196 $88,392
FFYI6 MCHBG LHJ & Other Contracts B04MC29364 Amend 3 93.994 333 .93 .99 10 /01115 09 /30 /16 10 /01115 09 /30 /16 $44,196 $44,196
Drinking Water Group B Amend 10 N/A 334 .04 .90 07 /01/17 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 01/01117 06/30/17 $5,000 $5,000
FPHS Funding for LHls Dir Amend 13 N/A 336.04.25 07/01117 12 /31117 07/01117 06/30/19 $42,000 $42,000 $42,000
Drinking Water Group A -SS Amend 10 N/A 346.26.64 01101115 12/31 /17 01101 115 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 OI /OIlIS 12 /31 /17 $1,600
Drinking Water Group A -SS Amend 6, 10 N/A 346.26.64 01101115 12 /311 17 OIlOIlIS 12/31117 $2,200
Drinking Water Group A -SS NI A, Amd 6, 10 N/A 346.26.64 01101115 12/31117 01101/15 12/31117 $2,800
Drinking Water Group A -SS State Amend 10 N/A 346.26 .65 01101115 12 /31117 01101/15 12 /31117 $2,800 $9,400 $9,400
Drinking Water Group A -SS State Amend 9 , 10 N/A 346.26.65 01101115 12 /31 /17 01/01115 12 /31 /17 $1 ,600
Drinking Water Group A -SS State Amend 6,10 N/A 346.26.6S 01101 11 5 12 /31117 01l01llS 12/31117 $2,200
Drinking Water Group A -SS State N/A, Amd 6, 10 N/A 346.26.65 01101/15 12 /31117 01l01l1S 12/31117 $2,800
Page 2 00
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
EXHIBIT B-14
ALLOCATIONS
Contract Term: 2015-2017
BARS Statement of Work
Revenue Funding Period
Chart of Accounts
Funding Period
Chart of Accounts Pro2ram Title
Federal Award
Identification # Amend # CFDA* Code** Start Date End Date Start Date End Date
Drinking Water Group A -T A
Drinking Water Group A -T A
Drinking Water Group A -T A
Drinking Water Group A -T A
Drinking Water Group A -T A
TOTAL
Total consideration:
GRAND TOTAL
*Catalog of Federal Domestic Assistance
$440,448
511,049
$451,497
Amend 11
Amend 10
Amend 9, 10
Amend 6,10
N/A, Amd 6,10
**FederaI revenue codes begin with "333 ". State revenue codes begin with "334",
N/A 346.26 .66 01 /01 /15 12 /31/17 01101115 12 /31117
N/A 346.26 .66 01101115 12 /31 /17 01/01115 12 /31117
N/A 346.26.66 01101115 12/31117 01101115 12/31117
N/A 346.26.66 01101115 12/31117 01101/15 12/31/17
N/A 346 .26 .66 01 /01115 12 /31/17 01101115 12/31117
Page 3 of3
Amount
($2,400)
$2,000
($1,600)
$1,000
$4,000
$451,497
Contract Number:
Date:
Funding
Period
Sub Total
$3 ,000
$451,497
GRAND TOTAL
Total Fed
Total State
C17114
September 15, 2017
Chart of
Accounts
Total
"3 ,000
5451,497
$377,697
573,800
Exhibit C-12 Schedule of Federal Awards
KmlT AS COUNTY HEALTH DEPT ·SWV001 0475-07
CONTRACT C17114-Kilti1as County Public Health Department
CONTRACT PERIOD 11112015·1213112017
Chart of Accounts Program Title BARS
FFY18 CSS IAR SNAP·ED PROG MGNT 333 to.56
FFY17 DSHS SNAP·ED IAR CARRY-IN 33310.56
FFY17 DSHS SNAP-ED IAR 333_10,56
FFY17 EPR PHEP BPl LHJ FUNDING 3339306
FFY16 EPR PHEP BP5 LHJ FUNDING 333,9306
FFY15 EPR PHEP BP4 OPER READINESS 3339306
FFY15 EPR PHEP BP4 LHJ FUNDING 333,93,06
FFY14 EPR PLANNING & EXERCISES 333,93.06
FFY14 EPR LHJ FUNDING 33393,06
FFY17 VFC ORDERING 333,9326
FFY17 VFC OPS 333.93.26
FFY17 MIX 333.9326
FFY17 317 OPS 333,93,26
FFY16 VFC ORDERING 3339326
FFY16 VFC OPS 333.9326
FFY16 MIX 333,93,26
DOH
Federal
Award Date
NGA Not
Received
NGA Not
Received
09/30/16
07/18/17
06/23/16
06/30/14
06/26/15
06/30/14
06/30/14
03/03117
03/03/17
03/03/17
03/03/17
01/19/16
01/19/16
01119/16
TotalAmt Allocation Period
Federal Start End
Award Date Date
NGANot tOIOtl17
Received 12/31/17
NGANot 10/01 /17
Received 12/31/17
$5,739,856 10/01/16 09130117
$11,062,782 07/01/17 12/31/17
$10,222,879 07/01/16 06/30/17
$11,064,407 07101115 06130 /16
$12,132,694 07/01 /15 06/30/16
$12,663,227 01101/15 06/30/15
$12,663,227 01/01/15 06 /30 /15
$103,974 04/01/17 12/31/17
$1,201,605 04/01/17 12/31/17
$1,672,289 04101/17 12/31/17
$575,969 04/01117 12131 /17
$3,991,764 01/01/16 12/31/16
$3,991,784 01/01/16 12/31/16
$3,991,784 01/01/16 03/31117
AMENDMENT #14
Date: September 15, 2017
Contract Amt CFDA CFDA Program Title Federal Agency Name Federal Award Federal Grant Award Name
Identification Humber
State Administrative Matching Department of Agriculture Food and $9,902 10561 Grants for the Supplemental NGA Not Received NGA Not Received
Nutrition Assistance Program Nutrition Service
State Administrative Matching Department of Agriculture Food and $400 10.561 Grants for the Supplemental NGA Not Received NGA Not Received
Nutrition Assistance Program Nutrition Service
State Administrative Matching Department of Agriculture Food and Supplemental Nutrition Assistance S14 ,996 10561 Grants for the Supplemental 1717WAWA5Q390
Nutrition Assistance Program Nutrition Service Pro9ram Education (SNAP-Ed)
Public Health Emergency Department of Health and Human HPP AND PHEP COOPERATIVE $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 $50,000 93069 Services Centers for Disease Control U90TPOO0559 Preparedness and Prevention COOPERATIVE AGREEMENTS
Public Hea~h Emergency Department of Health and Human TP12-1201 HPP AND PHEP $7,704 93069 Services Centers for Disease Control U90TPOO0559 Preparedness and Prevention COOPERATIVE AGREEMENTS
Public Health Emergency Department of Health and Human TP12-1201 HPP AND PHEP
$55 ,000 93069 Services Centers for Disease Control U90TPOO0559 Preparedness and Prevention COOPERATIVE AGREEMENTS
Public Health Emergency Department of Health and Human TP12-1201 HPP AND PHEP
$24,078 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
$23,574 93069 Services Centers for Disease Control U90TPOO0559 Preparedness and Prevention
COOPERATIVE AGREEMENTS
Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
$695 93268 Services Centers for Disease Control 5NH231POO0762-05-00 VACCINES FOR CHILDREN'S
Agreements and Prevention PROGRAM
Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
$1,150 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
$3,340 93.268 Services Centers for Disease Control 5NH231POO0762-05-00 VACCINES FOR CHILDREN'S
Agreements and Prevention PROGRAM
Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
$924 93268 Services Centers for Disease Control 5NH231POO0762-05-00 VACCINES FOR CHILDREN'S
Agreements and Prevention PROGRAM
Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
$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
$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
$5,393 93268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM
Page 1 of 2
Exhibit C-12 Schedule of Federal Awards AMENDMENT #14
Date: September 15, 2017
KITIITAS COUNTY HEALTH DEPT·SWV0010475-07
CONTRACT C17114-KittJlas County Public Health Department
CONTRACT PERIOD 111/2015-12/3112017
DOH TotalAmt Allocation Period
Chart of Accounts Program Title BARS Federal Federal Start End Contract Amt CFDA CFDA Program Title Federal Agency Name Federal Award Federal Grant Award Name Award Date Award Date Date Identif i cation N llmbftt
Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
FFY16 317 OPS 333 .93 .26 01/19/16 $3,991,784 01/01/16 12/31/16 $1,232 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
FFY15 VFC ORDERING 33393 ,26 12/17/14 $3,437,046 01101115 12/31/15 $1,154 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
FFY15 VFC OPS 33393,26 12/17/14 $3,437,046 01101115 12/31/15 $1 ,509 93268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM
Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
FFY15AFIX 333.93.26 12/17/14 $3,437,046 01101/15 12/31/15 $5,013 93268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM
Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND
FFY15 317 OPS 3339326 12/17/14 $3,437,046 01/01/15 12/31/15 $1,453 93 .268 Services Centers for Disease Control H231POO0762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM
PPHF Capacity Building Department of Health and Human
PPHF 2017: IMMUNIZATION GRANTS·
Assistance to Strengthen Public IMMUNIZATION & VACCINES FOR
FFY16 PPHF 317 OPS 3339353 09/08/16 $4,009,643 01/01117 03/31/17 $1,805 93.539 ~hn '''''''''lriIz:a~ Services Centers for Disease Control NH23IPOO0762-Q4-Q5 CHILDREN PROGRAM-FINANCED IN
Infrastructure and Performance and Prevention PART BY 2017 PREVENTION & PUBLIC
Capacity Building Assistance to PPHF 2016: INCREASING HPV
Strengthen Public Health Department of Health and Human VACCINE COVERAGE BY
FFY16 PPHF ADOLESCENT AFIX 3339373 08129/16 $500,000 04/01/17 04/30/17 $1 ,000 93733 Immunization Infrastructure & Services Centers for Disease Control 1 N H231 P922562·0 1·00 STRENGTHENING ADOLESCENT AFIX
Performance • Financed in part and Prevention ACTIVITIES, FUNOEO IN PART BY 2016
Capacity Building Assistance to Department of Health and Human
PPHF 2014: IMMUNIZATION ENHANCE
Strengthen PuDlic Health AN IMMUNIZATION INFORMATION
FFY14 ENHANCE 115 AND VTRCKS 33393.73 09/16/14 $700,000 12/01/15 08/31/16 $1,087 93733 Immunization Infrastructure & Services Centers for Disease Control H231POO0922 SYSTEM (liS) TO INTERFACE WITH
Performance • Financed in part and Prevention COC'S VTRCKS VACCINE ORDERING &
NGA Not NGA Not 10101/17
Maternal and Child Health Department of Health and Human
FFY18 MCHBG LHJ CONTRACTS 3339399 Received 12/31/17 $11,049 93994 Services Block Grant to the Services Health Resources and NGA Not Received NGA Not Received Received States Services Administration
Maternal and Child Health Department of Health and Human FFY17 MATERNAL AND CHILD HEALTH
FFY17 MCHBG LHJ & OTHER CONTRACTS 3339399 10131116 $1,697,083 10/01116 09/30/17 $44,196 93.994 Servk:es 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
FFY16 MCHBG LHJ & OTHER CONTRACTS 333.9399 10/22/15 $1,739,609 10101/15 09/30/16 $44,196 93994 Services Block Grant to the Services Health Resources and B04MC29364 SERVICES
States Services Administration
Matemal and Child Health Department of Health and Human MATERNAL AND CHILD HEALTH
FFY15 MCHBG CBP CONCON 33393,99 10/21/14 $8,946,149 01/01/15 09/30/15 $34,870 93994 Services Block Grant to the Services Health Resources and B04MC28134 SERVICES
States Services Administration
TOTAL $377 ,697
Page 2of2
Kittitas County
Review Form
Grants & Contract Agreement it WO'Ol4l-
loday's Date Agenda Date J:;J t) 11+ November 2,2017
Fund/Department ~
116-Public Health
Contract/Grant Information
Contract /Grant Agency: Consolidated Contract Amendment 14
Period Begin Date: January 1, 2015 I I Period End Date: December 31, 20l'l-
Total Grant/Contract Amount: Increase of $11,049 for a revised maximum consideration of $451,497
Grant /Contract Number: C17114
Contract/Grant Summary:
The Consolidated Contract Amendment 14
Amends Statements of Work for the following programs:
• FPHS Communicable Disease and Support Capabilities-Effective July 1, 2017
• Maternal and Child Health Block Grant-Effective January 1, 2015
Exhibit B-14 Allocations amends and replaces Exhibit B-13 Allocations:
• Increase of $11,049 for a revised maximum consideration of $451,497
Recommendation for Board of Health and Board of Health Review on
~L>----ZO" I
Date : tl 2111 l Department Head Signature ~\~ , Administrator
0--I
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APPROV ED 5 T O. FORM: :;
Date
Signature of Board of Health member Date
Financial Information
Grant/Contract Review Page 1
Total Amount $11,049 (increase) State Funds $ Federal Funds $11,049 (increase)
Percentage County Funds Matching Funds $ CFDA#93.994
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 No IK] Why not
New Division Created? Already budgeted for
Revenue Code
116.612.022.1x.333.93.994-$11,049
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 D No D
County Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Submitted I Signature:
Department:
I Date:
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
I Reviewer I Date
Grant/Contract Review Page 2