HomeMy WebLinkAboutConsolidated Contract Amendment 4Kittitas County
Review Form
Grants & Contract Agreement
Today's Date
09/06/2018
Fund/Department
116 -Public Health
Contract/Grant Information
Agenda Date
iru nEs. 'a n„
�rsrr.�y t•� n > i r
Contract /Grant Agency: Consolidated Contract Amendment 4
Period Begin Date: January 1, 2018 Period End Date: December 31, 2020
Total Grant/Contract Amount: Increase of $117,548.00 for a new revised maximum consideration of
$281,644.00
Grant/Contract Number:
Contract/Grant Summary:
The Consolidated Contract Amendment 4:
Adds Statements of Work for the following programs:
Office of Emergency Preparedness and Response
Supplemental Nutrition Assistance Program and Education
Amends Statements of Work for the following programs:
Childhood Lead Poisoning Prevention Program
Maternal and Child Health Block Grant
OICP-Promotion of Immunization to Improve Vaccination Rates
Supplemental Nutrition Assistance Program
Recommendation for Board of Health and Board of Health Review on
Department Head Signature:
Administrator Date:
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APPROVED AS TO FORM:
Signature of Prosecutor's Office Date
Signature of Auditor's Office
Date
Signature of Board of Health member Date
Grant/Contract Review Page 1
Financial Information
Total Amount $ 117,548 State Funds $ 1,500 Federal Funds $ 116,048
Percentage County Funds Matching Funds $ CFDA# 10.561 SnapEd;
In -Kind $ 93.069 EPR PHEP; 93.268 Immz Rate
Explain 93.994 MCHGB
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 ❑ attach budget form No ] why not—already in budget
New Division Created?
Revenue Code 612.94.333.10.56
612.88.3.333.93.06
612.22.333.93.99
612.334.04.93
Pass Through Information
Agency to Pass Through
Amount to Pass Through $
Sub -Contract Approved Date:
SNAP ED
EPR PHEP
MCHBG LHJ
LEAD ENVIRONMT
$23,603 ($19,745+$858+$3,000)
$48,249
$44,196
$ 1,500
Prosecutor Review
Has the Prosecutor reviewed this agreement? Yes ❑ No ❑
County Departments I
Auditor
Information Services
Prosecutor
Submitted
Signature:
Department:
ed
Assignment of Tracking Intormation
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Facilities Maintenance
Human Resource
Treasurer
Date:
Reviewer Date
Grant/Contract Review Page 2
Grant/Contract Review Page 3
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2018 - 2020 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH18249 AMENDMENT NUMBER: 4
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:
Office of Emergency Preparedness & Response - Effective July 1, 2018
Supplemental Nutrition Assistance Program -Education - Effective October 1, 2018
® Amends Statements of Work for the following programs:
• Childhood Lead Poisoning Prevention Program - Effective January 1, 2018
r Maternal & Child Health Block Grant - Effective January 1, 2018
• OICP-Promotion of Immunizations to Improve Vaccination Rates - Effective July 1, 2018
r Supplemental Nutrition Assistance Program -Education - Effective January 1, 2018
❑ Deletes Statements of Work for the following programs:
2. Exhibit B-4 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-3 Allocations as follows:
® Increase of $117,548 for a revised maximum consideration of28$ 1.644.
❑ 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-4 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces Exhibit C-3.
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
Pagel of 32
Date
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