HomeMy WebLinkAboutAmendment No.7KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2018 -2020 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH18249 AMENDMENT NUMBER: 7
PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEAL TH 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:
~ Amends Statements of Work for the following programs:
• Office of Drinking Water Group A Program -Effective January 1, 2018
D Deletes Statements of Work for the following programs:
2. Exhibit B-7 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-6 Allocations as
follows:
~ Increase of$7,600 for a revised maximum consideration of $277,154.
• 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.
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 1 of7
STATE OF WASHINGTON
D •PARTMENTOF HEA
APPROVED AS TO FORM ONLY
Assistant Attorney General
2018-2020 CONSOLIDATED CONTRACT
EXHIBIT A
STATEMENTS OF WORK
TABLE OF CONTENTS
DOH Program Name or Title: Office of Drinking Water Group A Program -Effective January 1, 2018 ...................................... .
Exhibit A, Statements of Work
Revised as of January 15, 2019
Page 2 of7
AMENDMENT #7
3
Contract Number CLHl 8249-7
Exhibit A
Statement of Work
Contract Term: 2018-2020
AMENDMENT #7
DOH Program Name or Title: Office of Drinking Water Group A Program -
Effective January 1, 2018
Local Health Jurisdiction Name: Kittitas County Public Health Department
Contract Number: CLH18249
SOW Type: Revision Revision # (for this SOW) 2 Funding Source Federal Compliance Type of Payment
~ Federal Contractor (check if applicable) D Reimbursement
Period of Performance: January 1, 2018 through December 31, 2020 ~ State D FFATA (Transparency Act) ~ Fixed Price
D Other 0_ Research & Development
Statement of Work Purpose: The purpose of thi s statement of work is to provide funding to the LHJ for conducting sanitary surveys and providing technical assistance to small
community and non-community Group A water systems .
Revision Purpose: The purpose of this revision is to change end date in Funding Period from 12/31/18 to 12/31/19, increase Total Consideration, and revise Special Billing
Requirements and Special Instructions.
Chart of Accounts Program Name or Title
Yr 20 SRF -Local Asst (15 %) (FS) ss
Sanitary Survey Fees (FO-E) SS-State
Yr 20 SRF -Local Asst (15%) (FS) TA
Yr 21 SRF -Local Asst (15%) (FS) ss
Yr 21 SRF -Local Asst (15%) (FS) TA
TOTALS
Task Task/Activity/Description Number
1 Trained LHJ staff will conduct
sanitary surveys of small community
and non-community Group A water
systems identified by the DOH Office
of Drinking Water (ODW) Regional
Office.
See Special Instructions for task
activity .
DOH will provide a tablet and GPS
Exhibit A, Statements of Work
Revised as of January 15 , 2019
CFDA#
NIA
NIA
NIA
NIA
NIA
*May Support PHAB
Standards/Measures
I
1.
BARS Master Funding Period Current Change Total
Revenue Index (LHJ Use Only) Consideration Increase(+) Consideration
Code Code Start Date End Date
346 .26 .64 24139220 01/01/18 12/31/18 0 0 0
346.26.65 24242522 01/01/18 12/31/19 2 ,400 2,800 5,200
346.26.66 24139220 01/01 /18 12/3 1/18 0 0 0
346 .26.64 24139221 0 1/01/18 12/31/19 2 ,400 2,800 5,200
346 .26 .66 24139221 01 /0 1/18 12/3 1/19 2 ,000 2 ,000 4,000
6,800 7,600 14 ,400
Deliverables/Outcomes Due Date/Time Payment Information and/or Amount Frame
Provide Final* Sanitary Final Sanitary Survey Upon ODW acceptance of the Final
Survey Reports to ODW Reports must be Sanitary Survey Report, the LHJ shall
Regional Office . Complete received by the ODW be paid $400 for each sanitary survey of
Sanitary Survey Reports shall Regional Office a non-community system with three or
include: within 30 calendar fewer connections.
1. Cover letter identifying days of conducting
significant deficiencies, the sanitary survey. Upon ODW acceptance of the Final
significant findings, Sanitary Survey Report, the LHJ shall
observations, be paid $800 for each sanitary survey of
recommendations, and a non-community system with four or
referrals for further more connections and each community
ODW follow-up . system.
2 . Completed Small Water
System checklist. Payment is inclusive of all associated
Page 3 of7 Contract Number CLH 18249-7
Task Task/ Activity/Description Number
unit for the LHJ to gather source data
during a routine sanitary survey. DOH
expects the LHJ to commit to using
the tablet and GPS for a five-year
period.
2 Trained LHJ staff will conduct
Special Purpose Investigations (SPI)
of small community and non-
community Group A water systems
identified by the ODW Regional
Office.
See Special Instructions for task
activity.
3 Trained LHJ staff will provide direct
technical assistance (TA) to small
community and non-community
Exhibit A, Statements of Work
Revised as of January 15, 2019
*May Support PHAB
Standards/Measures
w.
----,c,.-
AMENDMENT #7
Deliverables/Outcomes Due Date/Time
Frame Payment Information and/or Amount
3. Updated Water Facilities costs such as travel, lodging, per diem.
Inventory (WFI).
4. Photos of water system Payment is authorized upon receipt and
with text identifying acceptance of the Final Sanitary Survey
features Report within the 30-day deadline.
5. Any other supporting
documents. Late or incomplete reports may not be
accepted for payment.
*Final Reports reviewed and
accepted by the ODW
Regional Office.
The LHJ surveyor will record
at least two (2) GPS data
points, for each source, into
the preloaded Excel template
on the tablet and submit that
data file with the associated
sanitary survey.
Provide completed SPI Completed SPI Upon acceptance of the completed SPI
Report and any supporting Reports must be Report, the LHJ shall be paid $800 for
documents and photos to received by the ODW each SPI.
ODW Regional Office. Regional Office
within 2 working Payment is inclusive of all associated
days of the service costs such as travel, lodging, per diem.
request.
Payment is authorized upon receipt and
acceptance of completed SPI Report
within the 2 working day deadline.
Late or incomplete reports may not be
accepted for payment.
Provide completed TA Completed TA Upon acceptance of the completed TA
Report and any supporting Report must be Report, the LHJ shall be paid for each
documents and_photos to received by the ODW technical assistance activity as follows:
Page 4 of7 Contract Number CLH 18249-7
AMENDMENT #7
Task Task/ Activity/Description *May Support PHAB Deliverables/Outcomes Due Date/Time Payment Information and/or Amount Number Standards/Measures Frame
Group A water systems identified by ODW Regional Office. Regional Office • Up to 3 hours of work: $250
the ODW Regional Office. within 30 calendar •· 3-6 hours of work: $500
days of providing • More than 6 hours of work: $750
See Special Instructions for task technical assistance.
activity. Payment is inclusive of all associated
costs such as consulting fee, travel,
lodging, per diem.
Payment is authorized upon receipt and
acceptance of completed TA Report
within the 30-day deadline.
Late or incomplete reports may not be
accepted for payment.
4 LHJ staff performing the activities Prior to attending the Annually LHJ shall be paid mileage, per diem,
under tasks 1, 2 and 3 must have training, submit an lodging, and registration costs as
completed the mandatory Sanitary "Authorization for Travel approved on the pre-authorization form
Survey Training. (Non-Employee)" DOH in accordance with the current rates
Form 710-013 to the ODW listed on the OFM Website
See Special Instructions for task Program Contact below for htto :// www .o fm. wa.e.ov/resourcesitravel
activity. approval (to ensure that .asp
enough funds are available).
*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:
http ://www . phaboard .o re /wp-content/uploadSt"PH AB-Standards-and-Measures-Version-LO .pdf
Program Specific Requirements/Narrative
Special References (RCWs, WACs, etc)
Chapter 246-290 WAC is the set of rules that regulate Group A water systems. By this statement of work, ODW contracts with the LHJ to conduct sanitary surveys (and SPis, and
provide technical assistance) for small community and non-community water systems with groundwater sources. ODW retains responsibility for conducting sanitary surveys (and
SPis, and provide technical assistance) for small community and non-community water systems with surface water sources, large water systems, and systems with complex
treatment.
LHJ staff assigned to perform activities under tasks 1, 2, and 3 must be trained and approved by ODW prior to performing work. See special instructions under Task 4, below.
Special Billing Requirements
The LHJ shall submit quarterly invoices within 30 days following the end of the quarter in which work was completed, noting on the invoice the quarter and year being billed for.
Exhibit A, Statements of Work
Revised as of January 15, 2019
Page 5 of7 Contract Number CLH 18249-7
AMENDMENT #7
Payment cannot exceed a maximum accumulative fee of $4,8()() $10,400 for Task 1, and 14;()()() $4,000 for Task 2, Task 3 and Task 4 combined during the contracting period, to
be paid at the rates specified in the Payment M ethod/ Amount section above. When favoicing for sanitarv survevs. bill half to BARS Revenue Code 346.26.64 and half to BARS
Revenue Code 346.26 .65.
When invoicing for Task 1, submit the list ofWS Name, ID#, Amount Billed, Survey Date and Letter Date that you are requesting payment.
When invoicing for Task 2-3, submit the list ofWS Name, ID#, TA Date and description of TA work performed, and Amount Billed.
When invoicing for Task 4, submit receipts and the signed pre-authorization form for non-employee travel to the ODW Program Contact below and a signed Al9-1A Invoice
Voucher to the DOH Grants Management, billing to BARS Revenue Code 346.26.66 under Technical Assistance (TA).
Special Instructions
Task 1
Trained LHJ staff will evaluate the water system for physical and operational deficiencies and prepare a Final Sanitary Survey Report which has been accepted by ODW. Detailed
guidance is provided in the Field Guide for Sanitary Surveys, Special Purpose Investigations and Technical Assistance (Field Guide). The sanitary survey will include an
evaluation of the following eight elements: source; treatment; distribution system; fmished water storage; pumps, pump facilities and controls; monitoring, reporting and data
verification; system management and operation; and certified operator compliance. If a system is more complex than anticipated or other significant issues arise, the LHJ may
request ODW assistance.
• No more than 8 surveys of non-community systems with three or fewer connections to be completed between January 1, 2018 and December 31, 2018.
• No more than 2 surveys of non-community systems with four or more connections and all community systems to be completed between January 1, 2018 and
December 31, 2018.
• No more than 4 surveys of non-community systems with three or fewer connections to be completed between January 1, 2019 and December 31, 2019.
• No more than 5 surveys of non-community systems with four or more connections and all community systems to be completed between January 1, 2019 and
December 31, 2019.
The process for assignment of surveys to the LHJ, notification of the water system, and ODW follow-up with unresponsive water systems; and other roles and responsibilities of
the LHJ are described in the Field Guide.
Task2
Trained LHJ staff will perform Special Purpose Investigations (SPls) as assigned by ODW. SPis are inspections to determine the cause of positive coliform samples or the cause of
other emergency conditions. SPis may also include sanitary surveys of newly discovered Group A water systems. Additional detail about conducting SPis is described in the Field
Guide. The ODW Regional Office must authorize in advance any SPI conducted by LHJ staff.
Task3
Trained LHJ staff will conduct Technical assi stance as assigned by ODW. Technical Assistance includes assisting water system personnel in completing work or verifying work
has been addressed as required, requested, or advised by the ODW to meet applicable drinking water regulations. Examples of technical assistance activities are described in the
Field Guide. The ODW Regional Office must authorize in advance any technical assistance provided by the LHJ to a water system.
Task4
LHJ staff assigned to perform activities under tasks 1, 2, and 3 must be trained and approved by ODW prior to performing work. LHJ staff performing the activities under tasks 1,
2 and 3 must have completed, with a passing score, the ODW Online Sanitary Survey Training and the ODW Sanitary Survey Field Training. LHJ staff performing activities under
tasks 1, 2, and 3 must attend the Annual ODW Sanitary Survey Workshop, and are expected to attend the Regional ODW LHJ Drinking Water Meetings.
If required trainings, workshops or meetings are not available, not scheduled, or if the LHJ staff person is unable to attend these activities prior to conducting assigned tasks, the
LHJ staff person may, with ODW approval, substitute other training activities to be determined by ODW. Such substitute activities may include one-on-one training with ODW
Exhibit A, Statements of Work
Revised as of January 15, 2019
Page 6 of? Contract Number CLH 18249-7
AMENDMENT #7
staff, co-surveys with ODW staff, or other ac tivities as arranged and pre-approved by ODW. LHJ staff may not perform the activities under tasks 1, 2, and 3 without completing
the training that has been arranged and approved by ODW.
Program Manual, Handbook, Policy References
htrp:.//www.doh.wa.gov/Portals/l1Documents/Pubs/331-486.pdf
DOH Program Contact
Mark Steward
DOH Office of Drinking Water
16201 E. Indiana Ave, Suite 1500
Spokane Valley, WA 99216
Mark.Steward@doh. wa. gov
(509) 329-2136
Exhibit A, Statements of Work
Revised as of January 15, 2019
DOH Fiscal Contact
Karena McGovern
DOH Office of Drinking Water
243 Israel Rd SE
Tumwater, WA 98501
Karcna.McGovern@doh.wa.go v
(360) 236-3094
Page 7 of7 Contract Number CLH 18249-7
EXHIBIT 8-7
Kittitas County Public Health Department ALLOCATIONS Contract Number: CLH18249
Contract Term: 2018-2020 Date: January 15, 2019
Indirect Rate as of January 2018: 29.50% Public Health Dept & 12.50% County Central Svcs
OOH Use Only
BARS Statement of Work Chart of Accounts Funding Chart of
Federal Award Revenue Funding Period Funding Period Period Accounts
Chart of Accounts Pros_ram Title Identification # Amend# CFDA* Code** Start Date End Date Start Date End Date Amount Sub Total Total
FFYl 9 CSS lAR SNAP Ed Program Mgnt l 97WAWA5Q3903 Amd4 10.561 333.10.56 10/01/18 09/30/19 10/01/18 09/30/19 $19,745 $19,745 $44,930
FFYl 8 CSS !AR SNAP Ed Program Mgnt CF l 87WAWA5Q3903 Amd4 10 .561 333.10.56 10101/18 09130119 10/01/18 09/30119 $858 $858
FFYl 8 CSS !AR SNAP Ed Program Mgnt l 87WAWA5Q3903 Amd4 10.561 333.10.56 01101118 09130118 10/01/17 09/30118 $3,000 $22,855
FFYI 8 CSS !AR SNAP ED Program Mgnt l 87WAW A5Q3903 Amd2 10.561 333.10.56 01101/18 09130118 10/01/17 09/30/18 $11,025
FFYl 8 CSS !AR SNAP ED Program Mgnt 187W AW A5Q3903 NIA 10 .561 333.10.56 01/01/18 09/30/18 10/01/17 09/30/18 $8 ,830
FFYl 7 CSS !AR SNAP ED Program Mgnt CF 1717WAWA5Q390 NIA ~ 10 .561 333.10.56 01/01 118 09/30118 10/01/17 09/30/18 $1,472 $1,472
FFYl 7 EPR PHEP BPI LHJ Funding NU90TP921889-0l Amd2 93.069 333.93.06 01 /01/18 06130/18 07/01/17 07102118 $565 $20,398 $20,398
FFYI 7 EPR PHEP BPI LHJ Funding NU90TP921889-01 NIA 93.069 333.93.06 01 101/18 06130/18 07/01/17 07102118 $) 9,833
FFYI 8 EPR PHEP BPI Supp LHJ Funding NU90TP92l889-01 Amd5 93.069 333.93.06 07101/18 06130/19 07101/18 06130119 $885 $49,134 $49,134
FFY18 EPR PHEP BPI Supp LHJ Funding NU90TP921889-0l Amd4 93.069 333.93.06 07101/18 06130119 07101/18 06/30119 $48,249
FFYI 7 317 Ops 5NH23IP000762-05-00 NIA 93.268 333.93.26 01101/18 06/30/18 04/01/17 06/30/18 $616 $616 $616
FFY17 AFIX 5NH23IP000762-05-00 NIA 93.268 333.93.26 01101/18 06130/18 04/01/17 06130/18 $2,226 $2,226 $2,226
FFYl 7 Increasing Immunization Rates NH23IP000762 Amd3,4 93.268 333.93.26 07101/18 06/30/19 07101118 06/30119 $5,600 $5,600 $5,600
FFY17 VFC Ops 5NH23IP000762-05-00 NIA 93.268 333.93.26 01 /01 118 06130/18 04/01117 06130/18 $1,114 $1,114 $1,114
FFYI 9 MCHBG LHJ Contracts B04MC32578 Amd4 93 .994 333.93.99 10101 118 09 130119 10101/18 09130119 $44,196 $44,196 $78,236
FFYI 8 MCHBG LHJ Contracts B04MC31524 Amd2 93.994 333 .93.99 01/01/18 09130/18 10101117 09130/18 $893 $34,040
FFYl 8 MCHBG LHJ Contracts B04MC31524 NIA 93.994 333.93.99 01101/18 09130/18 10101/17 09130/18 $33,147
GFS -Group B (FO-E) NIA NIA 334.04.90 01/01/18 06130118 07101/17 06/30119 $5,000 $5,000 $5,000
FY2 Group B Programs for DW (FO-E) Amd3 NIA 334.04.90 07/01118 06130119 07101/17 06130119 $10,000 $10,000 $10,000
SFY2 Lead Environments of Children Amd4 NIA 334.04.93 07101/18 06130/19 07101118 06130119 $1,500 $1,500 $3,500
SFYI Lead Environments of Children Amd I NIA 334.04.93 01 /01 118 06130/18 07/01/17 06130/18 $2,000 $2,000
FPHS Funding for LHJs Dir Amd3 NIA 336.04.25 07/01/18 06130/19 07101117 06130/19 $42,000 $42,000 $42,000
YR 20 SRF -Local Asst (15%) (FS) SS Amd3 NIA 346.26.64 01 101/18 12131/18 07101115 12/31/18 ($2,400) $0 $0
YR 20 SRF -Local Asst (15%) (FS) SS N/A,Amd3 NIA 346.26.64 01101/18 12131/18 07101115 12/31/18 $2,400
Page I of2
Kittitas County Public Health Department
Indirect Rate as of January 2018: 29.50% Public Health Dept & 12.50°/o County Central Svcs
Chart of Acco11nu Pro.&!_am Title
YR 21 SRF -Local Asst (15%) (FS) SS
YR 21 SRF -Local Asst (15%) (FS) SS
Sanitary Survey Fees (FO-E) SS-State
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
YR 21 SRF -Local Asst (15%)(FS) TA
TOTAL
Total consideration:
GRAND TOTAL
'"Catalog of Federal Domestic Assistance
Federal Award
Identification #
$269,554
$7,600
$277,154
••Federal revenue codes begin with "333". State revenue codes begin with "334".
Amend.II
Amd7
Amd3, 7
Amd7
NIA, Amd 3, 7
Amd3
NIA, Amd 3
Amd7
Amd3, 7
EXHIBITB-7
ALLOCATIONS
Contract Tenn: 2018-2020
BARS Statement of Work
Revenue Funding Period
DOP ,U~01,1~,,
Ouu:trof ACCO)llll:$
F~ndu\gP~
CFDA* Code•·.-Stan D11 1c .£nd Date Start OaJe E11<LDan~
N/A 346.26.64 01/01/18 12/31/19 07JU 1/1'7 12/l]JJC/
NIA 346.26.64 01/01/18 12/31/19 (J;7/0 l/17 1.2f.Wl9
N/A 346.26.65 01/01/18 12131 119 0.7/0,1117 '11213 /M
NIA 346 .2 6.65 01101/18 12/31/19 07/0}J;l;v ~~l/11}
NIA 346 .26.66 01/01/18 1213 1118 OViOl/.lS 12131/1.S
NIA 346.26.66 01 101 118 12131/18 07/0l/lS '1-2il-l/l·S
NIA 346.26.66 01/01 118 12131/19 07io'lfl7 12131/19
NIA 346.26.66 01/01118 12131/19 ~J.{Ol/!7 ,l.g/3 j\/19
Page2 of2
Contract Number:
Date:
Funding
Period
AmounL .Su.lJ T ota!
$2,800 $5,200
$2,400
$2,800 $5,200
$2,400
($2,000) $0
$2,000
$2,000 $4,000
$2,000
$277,154 $277,154
GRAND TOTAL
Total Fed
Total State
CLH18249
January 15, 2019
Chart of
Accounts
Total
$5,200
$5,200
$0
$4,000
$277,154
$202,254
$74,900
Kittitas County
Review Form
Grants & Contract Agreement
Today's Date
03/05/2019
Agenda Date •
Fund/Department
116-Public Health
Contract/Grant Information
Contract /Grant Agency: Consolidated Contract Amendment 7
Period Begin Date: 01/01/2018 I I Period End Date: 12/31/2020
Total Grant/Contract Amount: $277 ,154.00 (Increase of $7,600.00)
Grant/Contract Number:
Contract/Grant Summary:
The Consolidated Contract amends Statements of Work for the following program:
• Office of Drinking Water Group A Program-Effective January 1, 2018
Exhibit B-7 allocations amends and replaces Exhibit B-6 Allocations as follows:
• Increase of $7,600.00 for a revised maximum consideration of $277,154.00
Recommendation for Board of Health and Board of Health Review on
Signature of Board of Health member Date
Financial Information
Total Amount$ $7,600 State Funds $2,800 Federal Funds $4,800
Percentage County Funds Matching Funds $ CFDA#346.26.64, .65, .66
Grant/Contract Review Page 1
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 D attach budget form NoO Whynot
New Division Created?
Revenue Code
116.615.2.2.346.26.64 $2,800 EH Sanitary Survey-FS SS
116.615.2.2.346.26.65 $2,800 EH Sanitary Survey-SS-State
116.615.2.2.346.26.66 $2,000 EH Sanitary Survey-FS Tech Asst
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 • 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