HomeMy WebLinkAboutCon Con Amendment 3Kittitas County
Review Form
Grants & Contract Agreement
Today's Date:
July 7, 2018
f Fund/Department
116 -Public Health
Contract/Grant Information
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Agenda Date
Contract /Grant Agency: Consolidated Contract Amendment 3
Period Begin Date: January 1, 2018 7
Period End Date: 12/31/2020
Total Grant/Contract Amount: Increase of $57,600 for a revised maximum consideration of $151,121
Grant/Contract Number: CLH18249
Contract/Grant Summary:
The Consolidated Contract Amendmer+3adds Statements of Work for the FPHS Communicable Disease
and Support Capabilities and the OICP-Promotion of Immunizations to Improve Vaccination Rates. It
also amends statements of work for the Office of Drinking Water Group A and B programs. The
Consolidated Contract increases the contract amount by 57,600.00 for a new revised maximum of
$151,121.00.
Recommendation for Board of Health and Board of Health Review on
Department Head Signature:
L
Administrator Date:
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APPROVED AS TO FORM:
� U
Signature f Proo'secutor ffice Date
Sign t re 0 Auditor's Office Date
Signature of Board of Health member
Date
Financial Information
Total Amount $57,600 State Funds $52,000 Federal Funds $5,600
Percentage County Funds Matching Funds $ CFDA# 93.268 $5,600 Immz Rate
Grant/Contract Review Page 1
In -Kind $
Is Equipment being purchased? No Who owns equipment?
New Personnel being hired? No Contact HR hiring — reporting requirements
Future impacts or liability to Kittitas County:
Budget Information
Budget Amendment Needed? Yes E]attach budget form
New Division Created? No
Revenue Code 612.32.333.93.26 $ 5,600 Immz Rate Increase
612.39.17.336.04.25 $42,000 FPHS CD
615.2.3.334.04.90 $10,000 Group B Water
Pass Through Information
Agency to Pass Through
Amount to Pass Through $
Sub -Contract Approved Date:
No FX Why not
Already in budget
Prosecutor Review
Has the Prosecutor reviewed this agreement? Yes ❑ No
County Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Submitted
Signature: Date:
Department:
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Grant/Contract Review Page 2
Reviewer
Date
Grant/Contract Review Page 3
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2018 — 2020 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH18249 AMENDMENT NUMBER: 3
PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as
"DOH", and KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT hereinafter referred to as "LHJ", pursuant to the
Modifications/Waivers clause, and to make necessary changes within the scope of this contract and any subsequent
amendments thereto.
IT IS MUTUALLY AGREED: That the contract is hereby amended as follows:
1. Exhibit A Statements of Work, attached and incorporated by this reference, are amended as follows:
® Adds Statements of Work for the following programs:
FPHS Communicable Disease & Support Capabilities - Effective January 1, 2018
OICP-Promotion of Immunizations to Improve Vaccination Rates - Effective July 1, 2018
® Amends Statements of Work for the following programs:
Office of Drinking Water Group A Program - Effective January 1, 2018
Office of Drinking Water Group B Program - Effective January 1, 2018
❑ Deletes Statements of Work for the following programs:
2. Exhibit B-3 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-2 Allocations as
follows:
® Increase of $57,606 for a revised maximum consideration of $151,121.
❑ Decrease of for a revised maximum consideration of
❑ No change in the maximum consideration of
Exhibit B Allocations are attached only for informational purposes.
3. Exhibit C-3 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces
Exhibit C-2.
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 STATE OF WASHINGTON
DEPARTMENT OF HEALTH
Date
APPROVED AS TO FORM ONLY
Assistant Attorney General
Page 1 of 13
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