HomeMy WebLinkAboutConCon Amend 6KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2018 -2020 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH18249 AMENDMENT NUMBER: 6
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:
D Adds Statements of Work for the following programs:
1:8] Amends Statements of Work for the following programs:
• Maternal & Child Health Block Grant -Effective January 1, 2018
D Deletes Statements of Work for the following programs:
2. Exhibit B-6 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-5 Allocations as
follows:
•
•
Increase of
Decrease of
for a revised maximum consideration of __
for a revised maximum consideration of __
~ No change in the maximum consideration of $269,554.
Exhibit B Allocations are attached only for informational purposes.
3. Exhibit C-6 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces
Exhibit C-5.
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 HEAL TH DEPARTMENT STATE OF WASHINGTON
DEPARTMENT OF HEAL TH
~1111q
ale
Page 1 of7
APPROVED AS TO FORM ONLY
Assistant Attorney General
2018-2020 CONSOLIDATED CONTRACT
EXHIBIT A
STATEMENTS OF WORK
TABLE OF CONTENTS
AMENDMENT #6
DOH Program Name or Title: Maternal & Child Health Block Grant -Effective January 1, 2018 ................................... , ............ , ...... , .... , ............ c": •• , ................ , ••••• 3
Exhibit A, Statements of Work
Revised as of November 15, 2018
Page 2 of7 Contract Number CLH18249-6
DOH Program Name or Title: Maternal & Child Health Block Grant -
Effective January 1, 2018
SOW Type: Revision Revision# (for this SOW) 3
Period of Performance: January 1, 2018 through September 30, 2019
Exhibit A
Statement of Work
Contract Term: 2018-2020
AMENDMENT #6
Local Health Jurisdiction Name: Kittitas County Public Health Department
Contract Number: CLH18249
Funding Source Federal Compliance Type of Payment
~ Federal Subrecipient (check if applicable) ~ Reimbursement • 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 support local interventions that impact the target population of the Maternal and Child Health Block Grant and add language
related to allowable expenses in the Special Instructions section.
Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period
Revenue Index (LHJ Use Only)
Code Code Start Date End Date
FFYl 8 MCHBG LHJ CONTRACTS 93.994 333.93.99 78120281 01101118 I 09130118
FFY19 MCHBG LHJ CONTRACTS 93.994 333.93.99 78120291 10101118 I 09130119
TOTALS
Task *May Support PHAB Task/ Activity/Description Deliverables/Outcomes Number Standards/Measures
Maternal and Child Health Block Grant (MCHBG) Administration
la Participate in calls, at a minimum of every Designated LHJ staff will
quarter, with DOH contract manager. Dates and participate in contract management
time for calls are mutually agreed upon between calls.
DOHandLHJ
. lb Report actual expenditures for October 1, 2017 Submit actual expenditures using
through March 31, 2018 the MCHBG Budget Workbook to
DOH contract manager
le Develop 2018-2019 MCHBG Budget Workbook Submit MCHBG Budget
for October 1, 2018 through September 30, 2019 Workbook to DOH contract
using DOH provided template. manager
Exhibit A, Statements of Work
Revised as of November 15, 2018
Page 3 of7
Current Change Total
Consideration None Consideration
34,040 0 34 ,040
44,196 0 44,196
78,236 0 78,236
Payment
Due Date/Time Frame Information and/or
Amount
September 30, 2018 Reimbursement for
September 30, 2019 actual costs, not to
exceed total funding
consideration.
May 26, 2018 Action Plan and
Progress Reports
must only reflect
September 5, 2018 activities paid for
with funds provided
in this statement of
work for the
specified funding
Contract Number CLH18249-6
---
Task
Number Task/ Activity/Description
ld Report actual expenditures for October 1, 2018
through March 31, 2019
le Develop 2019-2020 MCHBG Budget Workbook
for October 1, 2019 through Septemb er 30 , 2020
using DOH provided template.
If Report actual expenditures for October 1, 2017
through September 30, 2018
MCHBG Assessment and Evaluation
2a Participate in project evaluation activities
developed and coordinated by DOH, as
requested.
2b Report program level strategy measure data
(CSHCN, UDS, ACEs).
2c Conduct a Maternal and Child Health (MCH)
Needs Assessment.
MCHBG Implementation
3a Develop 2018-2019 MCHBG Action Plan for
October 1, 2018 through September 30 , 2019
using DOH-provided template.
3b Report activities and outcomes of 2017-2018
MCHBG Action Plan using DOH-provided
template .
Exhibit A, Statements of Work
Revised as of November 15, 2018
*May Support PHAB
Standards/Measures Deliverables/Outcomes
Submit actual expenditures using
the MCHBG Budget Workbook to
DOH contract manager.
Submit 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
Submit Needs Assessment
documentation to DOH contract
manager using templates provided
by DOH
Submit MCHBG Action Plan to
DOH contract manager
Submit Action Plan monthly
reports to DOH contract manager
Page 4 of7
AMENDMENT #6
Payment
Due Dateffime Frame Information and/or
Amount
May 24 , 2019 period.
See Program
Specific
Requirements and
September 5, 2019 Special Billing
Requirements .
November 30 , 2018
September 30 , 2018 Reimbursement for
September 30, 2019 actual costs, not to
exceed total funding
January 15 , 2018 consideration.
April 15 , 2018
July 15 , 2018 See Program
October 15, 2018 Specific
Je;;H~.· .I J , J{)U) Requirements and
April !5, 2019 Special Billing
,_ ,_ 1,: ""'" Requirements . ---, -..... -
May 24, 2019
Draft August 17, 2018 Reimbursement for
Final September 5, 2018 actual costs, not to
exceed total funding
Monthly, on or before consideration.
the 15 th of the following Action Plan and
month Progress Reports
Contract Number CLH18249-6
Task
Number
3c
Task/ Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes
AMENDMENT #6
Payment
Due Date/Time Frame I Information and/or
Amount
Develop 2019-2020 MCHBG Action Plan for Submit MCHBG Action Plan to Draft August 17 , 2019 must only reflect
October 1, 2019 through September 30 , 2020 DOH contract manager Final-September 5, activities paid for
using DOH-_provided template. 2019 with funds provided
3d I Report activities and outcomes of 2018-2019 Submit Action Plan monthly Monthly, on or before in this statement of
MCHBG Action Plan using DOH-provided reports to DOH contract manager the 15 th of the following work for the
template. month specified funding
period.
See Program
Specific
Requirements and
Special Billing
Requirements .
Children with Special Health Care Needs (CSHCN)
4a Complete Child Health Intake Form (CHIF) Submit CHIF data into Secure File January 15, 2018 Reimbursement for
using the CHIF Automated System on all infants Transport (SFT) website : April 15, 2018 actual costs, not to
and children served by the CSHCN Program as https://sfl.wa .gov July 15, 2018 exceed total funding
referenced in CSHCN Program Manual. October 15, 2018 consideration.
Ensure client data is collected on all children January 15 , 2019 Action Plan and
served by CSHCN contractors , including April 15, 2019 Progress Reports
neurodevelopmental centers , regional July 15 , 2019 must only reflect
maxillofacial coordinators, and the DOH activities paid for
Newborn Screening Program. with funds provided
4b I Administer requested DOH Diagnostic and Submit completed Health Services 30 days after forms are in this statement of
Treatment funds for infants and children per Authorization forms and Central completed. work for the
CSHCN Program Manual when funds are used. Treatment Fund requests directly specified funding
to the CSHCN Program as needed. period.
4e · --&bmit Acti0n Plan m0Rthly l,WR f.Wj·, 0,'l er befeFI! D 1 · • · I ~ .«F~ieipaw ui uef-lCNRegiem:1 1 Sys .tem--(H-H/
quar1erly mee~inr:s RS de.ser.ilied i11 .•.l.ze CSHC:V
FeeusefW0rk
ns iRl!htding ,'lwl'lher ef lhe---JJ.flt 0fthe _,"0U0wiRg See Program
regienal R1ee1h1gs auCRded te ~he memh Specific
1 DOH C.(N!lf'8 e t ,"Hfm&ge,:_. Requirements and
4d I Del•elep and a'fJrle:e CYSHCN UJ!-mty J?.e5el{.ree -I l &bmit c0m-pkted 1'8601,wce list Sepff!me<w 30. 20.79 Speci~l Billing
lisl e11d she re wit,', µrm~cseribed l,1 :./.ie I ek~fffle~ Requirements.
CSHC.VF0cus 0(Work.
*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
Standard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at:
hnp://www.pbaboard .org/v.'P:cgntent/uploads/PHAB-Standards-and-Measures-Version-1 .0.pdf
Program Specific Requirements/Narrative
Exhibit A, Statements of Work
Revised as of November 15, 2018
Page 5 of7 Contract Number CLH18249-6
AMENDMENT #6
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 USASpe.oding.eov by DOH as required by P .L. 109-282.
Program Manual, Handbook, Policy References
Children with Special Health Care Needs Manual -http ://www.dob.wa.gov/Ponals/l /Documetits/Pubs/970-209-CSHCN-Maoual.pdf
ub s/910-002-Aim.rovedHSA.docx.
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 quarter, and annual site visit.
Special Billing Requirements
Payment is contingent upon DOH receipt and approval of all deliverables and an acceptable Al 9-lA 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 by 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.
Exhibit A, Statements of Work
Revised as of November 15, 2018
Page 6 of7 Contract Number CLH18249-6
Special Instructions
Contact DOH contract manager below for approval of expenses not reflected in approved budget workbook.
DOH Program Contact
Mary Dussol, Community Consultant
Office of Family and Community Health Improvement
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 November 15, 2018
Page 7 of7
AMENDMENT #6
Contract Number CLH18249-6
EXHIBITB-6
Kittitas County Public Health Department ALLOCATIONS Contract Number: CLH18249
Contract Term: 2018-2020 Date: November 15, 2018
Indirect Rate as of January 2018: 29.50% Public Health Dept & 12.50% County Central Svcs
BARS Statement of Work ~.of A'tcotm t\ Funding Chart of
Federal Award Revenue Funding Period F.-liimii; J>j~ Period Accounts
Chart of Accounts !:!!s,ram Title Identification # Amend# CFDA* Code** Start Date End ,Date SIUL.lratL..ulill Diitt..... Amou:nt Sub Total Toltl
FFYl 9 CSS IAR SNAP Ed Program Mgnt 197WA W A5Q3903 Amd4 10.561 333.10.56 10101/18 09130119 lOJfU/H\ l1'913UIT9 $19,745 $19,745 $44,930
FFYl 8 CSS IAR SNAP Ed Program Mgnt CF 187WAWA5Q3903 Amd4 10.561 333.10.56 10101/18 09130/19 16/llt~l 8 1)9.®fl!} $858 $858
FFY18 CSS IAR SNAP Ed Program Mgnt 187WAWA5Q3903 Amd4 10.561 333.10.56 01101/18 09130118 I OIO,lfl7 ,0~11:'!01 18 $3,000 $22,855
FFY18 CSS IAR SNAP ED Program Mgnt 187W AW A5Q3903 Amd2 10.561 333.10.56 01/01/18 09130/18 1tiJ0:1h1 09)3(11,18 $11,025
FFYl 8 CSS IAR SNAP ED Program Mgnt 187W AW A5Q3903 NIA 10.561 333.10.56 01/01118 09130118 J¥9,ltl 7 0¥.,!~1'1! $8,830
FFYl 7 CSS IAR SNAP ED Program Mgnt CF 1717WAWA5Q390 NIA 10.561 333.10.56 01/01/18 09/30118 "ilO(Q~/11" 09.!SOIJB $1,472 $1,472
FFYl 7 EPR PHEP BPl LHJ Funding NU90TP92l889-01 Amd2 93.069 333.93.06 01101/18 06130118 ®/Olrt7 1)7/()~J.8 $565 $20,398 $20,398
FFYl 7 EPR PHEP BPl LHJ Funding NU90TP92l889-01 NIA 93.069 333.93.06 01/01/18 06130118 lJ1tnl"7 0'1l~-,!tS $19,833
FFYl 8 EPR PHEP BPl Supp LHJ Funding NU90TP921889-0l Amd5 93.069 333.93.06 07101/18 06130119 0llfnlfl$, ®,!SOil~ $885 $49,134 $49,134
FFY18 EPR PHEP BPl Supp LHJ Funding NU90TP921889-0l Amd4 93.069 333.93.06 07101/18 06130119 ·07/0IJl&:-06'30H9 .. $48,249
FFYl 7 317 Ops 5NH23IP000762-05-00 NIA 93.268 333.93.26 01/01/18 06130118 r0.VOU 17 OMO/IS $616 $616 $616
FFY17 Afl){ 5NH23IP000762-05-00 NIA 93.268 333.93.26 01/01/18 06130118 04/0l "17 b61::1011.S $2,226 $2,226 $2,226
FFYl 7 Increasing hnmunization Rates NH23IP000762 Amd3,4 93.268 333.93.26 07101/18 06130119 0171tl 1'/Lll O&':IOf l~ $5,600 $5,600 $5,600
FFY17 VFC Ops 5NH23IP000762-05-00 NIA 93.268 333.93.26 01101/18 06130118 ,04/0 1117 06'30/,_~& $1,114 $1,114 $1,114
FFYl 9 MCHBG LHJ Contracts 804MC32578 Amd4 93.994 333.93.99 10101/18 09130/19 10/0 111,s" 09ts:(i'f19 $44,196 $44,196 $78,236
FFYl 8 MCHBG LHJ Contracts B04MC31524 Amd2 93.994 333.93.99 01/01/18 09130/18 ~,111.0111,,, ow.aur~ $893 $34,040
FFYl 8 MCHBG LHJ Contracts B04MC31524 NIA 93.994 333.93.99 01/01/18 09130118 IO/fl l/17 @no, t ~ $33,147
GFS -Group B (FO-E) NIA NIA 334.04.90 01/01/18 06130118 Jj7/0 IVH .fif,;/,3 llfl9 $5,000 $5,000 $5,000
FY2 Group B Programs for OW (FO-E) Amd3 NIA 334.04.90 07101/18 06/30119 ,07/UIM? 'rf6,l\;011ri•1 $10,000 $10,000 $10,000
SFY2 Lead Environments of Children Amd4 NIA 334.04.93 07101118 06130119 ,a7Ju II hit' '0,/;/aor t 9 $1,500 $1,500 $3,500
SFYl Lead Environments of Children Amd I NIA 334.04.93 01/01/18 06130/18 1)7/011 }'1 1)§-'~ffli $2,000 $2,000
FPHS Funding for LHJs Dir Amd3 NIA 336.04.25 07101/18 06130119 07'0 1117' ~0l-i9 $42,000 $42,000 $42,000
YR 20 SRF -Local Asst (15%) (FS) SS Amd3 NIA 346.26.64 01/01/18 12131118 1)7'9 11\j _ ~f.Ul:ft.' ($2,400) $0 $0
YR20 SRF-Local Asst (15%) (FS) SS NIA, Amd 3 NIA 346.26.64 01/01/18 12131118 01101 115 ("11!ii II&, $2,400
Pagel of2
Kittitas County Public Health Department
Indirect Rate as of January 2018: 29.50% Public Health Dept & 12.50% County Central Svcs
Chart of Accounts l'!!!S,nnt Title
YR21 SRF-Local Asst (15%) (FS) SS
Sanitary Survey Fees (FO-E) SS-State
YR 20 SRF-Local Asst (15%) (FS) TA
YR 20 SRF -Local Asst (15%) (FS) TA
YR 21 SRF-Local Asst (15%) (FS) TA
TOTAL
Total consideration:
GRAND TOTAL
"Catalog of Federal Domestic Assistance
Federal Award
Identification #
$269,554
so
$269,554
••Federal revenue codes begin with "333". State revenue codes begin with "334".
Amend#
Amd3
NIA, Amd 3
Amd3
NIA, Amd 3
Amd3
EXHIBITB-{;
ALLOCATIONS
Contract Term: 2018-2020
BARS Statement of Work
Revenue Funding Period
0~ c,f s\t~~llli!lt
Fu111Jifig filobia
CFDA* Cod~ Start Dare £11d Date ,Stan Dam.-End. l•.ue
NIA 346.26.64 01101/18 12131/18 ()7/0lm 06faf}r19
NIA 346.26.65 01/01/18 12/31/18 ()-7/01117 ~QfW .
NIA 346.26.66 01/01/18 12/31/18 07,'\l l l ~ ·Mlti&
NIA 346.26.66 01/01118 12/31/18 u1101 ,1s l2131'18,
NIA 346.26.66 01/01 118 12131/18 j)1J CJ Ul1 Q_~Q/19
Page 2 of2
Contract Number:
Date:
Funding
Period
Amount SubTol1\I
$2,400 $2,400
$2,400 $2,400
($2,000) $0
$2,000
$2,000 $2,000
$269,554 $269,554
GRAND TOTAL
Total Fed
Total State
CLH18249
November 15, 2018
Chart of
Accounts
Total
$2,400
$2,400
$0
$2,000
$269,554
$202,254
$67,300
Exhibit C-6 Schedule of Federal Awards AMENDMENT t#6
Date: November 15, 2018
KJTTITAS COUNTY HEALTH DEPT-SWV0010475-07
CONTRACT CLH18249-Kittitas County Public Health Department
CONTRACT PERIOD: 01/01/2018-12/31/2020
OO H T ota l Amt AII OO>llio n 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 Identification Number
State Administrative Matching Department of Agriculture Food and FFY19 CSS IAR SNAP-ED PROG MGNT 333.10.56 09/28/18 $5,386,268 10/01/18 09/30/19 $19,745 10,561 Grants for the Supplemental 197WAWA503903 SNAP 2YR NUTRITION ED OBESITY
Nutrition Assistance Program Nutrition Service
---
State Administrative Matching Department of Agriculture Food and 2018 SUPPLEMEIIITAL NUTRITION
FFY18 CSS IAR SNAP-cD PROGRAM MGNT CF 333.10.56 09/28/17 $5,300,000 10/01/18 09/30/19 $858 10.561 Grants for the Supplemental 187WAWA503903 ASSISTANCE PROGRAM EDUCATION
Nutrition Assistance Program Nutrition Service (SNAP-ED} ---
Slate Administrative Matching Department of Agriculture Food and 2018 SUPPLEMENTAL NUTRITION
FFY18 CSS IAR SNAP-cD PROGRAM MGNT 333.10.56 09/28/17 $5,300,000 01/01/18 09/30/18 $22,855 10.561 Grants for the Supplemenlal 187WAWA503903 ASSISTANCE PROGRAM EDUCATION
Nutrition Assislance Program Nutrition Service (SNAP-cD}
State Administrative Matching Department of Agriculture Food and 2018 SUPPLEMEIIITAL NUTRITION
FFY17 CSS IAR SNAP-ED PROGRAM MGNT CF 333.10.56 09/10/16 $5,739,856 01/01/18 09/30/18 $1,472 10.561 Grants for the Supplemental 1717WAWA5O390 ASSISTANCE PROGRAM EDUCATION
Nutrition Assistance Program Nutrition Service (SNAP-ED}
Department of Health and Human HOSPITAL PREPAREDNESS
Public Health Emergency PROGRAM AND PUBLIC HEAL TH FFY18 EPR PHEP BP1 SUPP LHJ FUNDING 333.93.06 08/01/18 $11,062,782 07/01/18 06/30/19 $49,134 93.069 Preparedness Services Centers for Disease Contrnl NU90TP921889-01 EMERGENCY PREPAREDNESS and Prevention ff>QP~RATIVE AGREEMENT
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 01/01/18 06/30/18 $20,398 93.069 Preparedness Services Centers for Disease Control NU90TP921889-01 AGREEMENT and Prevention
Immunization Cooperative Department of Health and Human IMMUNIZATION GRAIIIT AND
FFY17 VFC OPS 33393.26 03/03117 $1,201,605 01/01/18 06/30/18 $1,114 93268 Services Centers for Disease Contrnl 5NH231P000762--05-00 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM
Immunization Cooperative Department of Health and Human IMMUNIZATION GRAIIIT AND
FFY17 INCREASING IMMUNIZATION RATES 333,93.26 06/29/18 $1,722,443 07/01/18 06/30/19 $5,600 93.268 Services Centers for Disease Control NH231P000762 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM
Immunization Cooperative Department of Health and Human IMMUNIZATION GRAIIIT AND
FFY17 AFIX 333.93,26 03103117 $1,672,289 01/01/18 06/30/18 $2,226 93.268 Services Centers for Disease Contrnl 5NH231P000762--05-00 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM ---
Immunization Cooperative Department of Health and Human IMMUNIZATION GRAIIIT AND
FFY17 317 OPS 333.93.26 03/03/17 $575,969 01/01/18 06/30/18 $616 93.268 Services Centers for Disease Control 5NH231P000762--05-00 VACCINES FOR CHILDREN'S Agreements and Prevention PROGRAM ---
Maternal and Child Health Oepartmeot of Health and Human MATERNAL AND CHILD HEALTH FFY19 MCHBG LHJ CONTRACTS 333.93.99 11/14/18 $2,225,977 10/01/18 09/30/19 $44,196 93994 Services Block Grant to the Services Health Resources and B04MC32578 SERVICES BLOCK GRANT
Slates Services Administration
Maternal and Child Health Department of Health and Human MATERNAL AND CHILD HEAL TH
FFY18 MCHBG LHJ CONTRACTS 333.93.99 10/20/17 $1,650,528 01/01/18 09/30/18 $34,040 93.994 Services Block Grant to the SeN\0<!$ Heal/Ill Resources •nd B04MC31524 SERVICES States Services Administration
TOTAL $202,254
Page 1 of 1
Kittitas County
Review Form
Grants & Contract Agreement
Today's Date Agenda Date P-/Jq j JO, 01/14/2018
Fund/Department I
116-Public Health
Contract/Grant Information
Contract /Grant Agency: Consolidated Contract Amendment 6
Period Begin Date: 01/01/2018 I I Period End Date: 12/31/2020
Total Grant/Contract Amount: $269,544.00
Grant/Contract Number:
Contract/Grant Summary:
The Consolidated Contract amends Statements of Work for the following program :
• Maternal and Child Health Block Grant-Effective January 1, 2018
There is no change in the maximum consideration of $269,554.00
Recommendation for Board of Health and Board of Health Review on
Kittitas County Prosec utor, Auditor, and Board of Health Review and Comment:
APPRO AS TO FORM :
Date
Signature of Board of Health member Date
Financial Information -NO CHANGE
Total Amount$ 269,554.00 State Funds$ 67,300.00 Federal Funds $ 202,254.00
Percentage County Funds Matching Funds $ CFDA# No Changes
Grant/Contract Review Page 1
In-Kind$
Explain
Is Equipment being purchased? Who owns equi p ment?
New Personnel being hired? Contact HR hi r in g -r e porting requirements
Future impacts or liability to Kittitas County:
Budget Information -NO CHANGE
Budget Amendment Needed? Yes D attach budget form No D Why not
New Division Created?
Revenue Code -No Changes
I
Pass Through Information
Agency to Pass Through
Amount to Pass Through $
Sub-Contract Approved Date :
Prosecutor Review
J Has the Prosecutor reviewed this agreement? I Yes • 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