HomeMy WebLinkAbout19-33 Amend 2 Kittitas YMPEP#19-33 Amend 2 GT&C Kittitas County Public Health Yr 4 YMPEP 1 of 1
Service Agreement # 19-33 Amendment # 2
Between
WALLA WALLA COUNTY DEPARTMENT OF COMMUNITY HEALTH
And
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
Agreement 19-33 by and between Walla Walla County Department of Community Health,
hereinafter “County,” and Kittitas County Public Health Department hereinafter “Contractor,” is
amended as follows and in the attached Exhibit E (Expenditure and Budget Workbook):
Amendment 2: Add funding for July 2020 to June 2021 and extend Performance Period.
Attachments: Exhibit A – Statement of Work
Exhibit B - Budget
Exhibit E – Budget and Expenditure Workbook
All other conditions of Service agreement #19-33 remain in full force and effect.
By their signatures below, the parties agree to the terms and conditions of this Agreement and all
documents incorporated by reference. The parties signing below certify that they are authorized
to sign this Agreement.
IN WITNESS WHEREOF, the parties hereto have signed this Agreement.
COUNTY: CONTRACTOR:
Chairman/Vice-Chairman Date
Walla Walla County Board of Commissioners
c/o Department of Community Health
314 W Main Street
Authorized By Date
Walla Walla, WA 99362
Phone: (509) 524-2650 Fax: (509) 524-2642
Print Name & Title of Person Signing
Telephone Number / Email Address:
Mailing Address (Street address required in addition to PO Box.):
Social Security or Business Tax ID#:
CFDA# (if applicable): UBI#:
State Industrial Account ID # (if applicable):
Grantee Name:
Agreement Number:
Exhibit A
STATEMENT OF WORK
Kittitas County Public Health Department
19-33 Amend 2 Contract Period: 07/01/2019-06/30/2021
19-33 Amend 2 EXHIBIT A SOW Kittitas County Public Health Dept Yr 4 YMPEP Page 1 of 1
Payment
Task
Task/Activity/
Deliverables/Outcomes
Due
Date/Time
Informatio
Number
Description
Frame
nand/or
Amount
1
Monthly Report
Complete monthly report form
10t" of the
N/A
and email to YMPEP Program
month for the
Coordinator
previous
month in the
contract
2
Attend YMPEP
Attend monthly YMPEP
June 30, 2021
Invoiced
regional meetings
conference call meeting and
and trainings
attend quarterly YMPEP regional
trainin s
3
Support YMPEP
Attend planning and evaluation
June 30, 2021
Invoiced
(optional)
planning and
meetings and provide data and
evaluation
as time allows.
4
..input
Adult Influencer
Deliver Hidden In Plain Sight
June 30, 2021
Invoiced
Awareness/Educat
presentations to communities
ion
5
Policy Advocacy
Advocate for policy change to
June 30, 2021
Invoiced
support the prevention of youth
marijuana use in your community
6
Promote
Purchase materials or publish
June 30, 2021
Invoiced
Recovery Hotline
media to promote recovery
hotline
7
Media Campaigns
Under the Influence of You,
June 30, 2021
Invoiced
Social Norms, other DOH
marijuana reduction campaigns
19-33 Amend 2 EXHIBIT A SOW Kittitas County Public Health Dept Yr 4 YMPEP Page 1 of 1
19-33 Amend 2 EXHIBIT B Budget Kittitas County Public Health Department Yr 4 YMPEP Page 1 of 1
Exhibit B
BUDGET
Agency Name: Kittitas County Public Health Department
Agreement Number: 19-33 Amend 2 Contract Period: 07/01/2019-06/30/2021
Line Item/Description Award
Program Operations – Year 3 (7/1/19 – 6/30/20) $10,000
Program Operations – Year 4 (7/1/20 – 6/30/21) $12,500
TOTAL: $22,500
Funded By:
WA State Department of Health Youth Marijuana Prevention and Education Program