HomeMy WebLinkAboutAmendment 15KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2OI8 _ 2O2O CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLHl824e AIVTENDMENT NUIVIBER: 15
PURPOSE OF CHANGE: To amend tltis conlract betrveen the DEPARTMENT OF HEALTH hereinafter referrecl to as
"DOH", and KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT hereinafter rcferred to as "LHJ", pursuant to the
Modihcations/Waivers clause , and to ntake necessary changes within the scope of this contract and any subsequent
arnendnrents thercto.
lr IS MUTUALLY AGREED: That the contract is hereby arneuded as follorvs;
l - Exhibit A Statetnents of Work, attached and incorporatcd by tlris reference, are amencled ns follorvs:
A Adds Statemeuts of Work for.the follou,ing prograns:
r ELC-COVID-19 - Effective June l, 2020r OlCP-Promolion of Immunizations to Improve Vaccinatiorr Rates - Effective July I ,2A20
tr Amends Statements of Work for the follorving programs:
o LSPAN-Local Strategies for Physical Activity & Nutrition - Effective February 19,2Ol9. Supplentental Nutlitiott Assistance Progarn-Education - Effective October I , 201 8
U Deletes Staterneuts of Work for the follorving prograrns:
2. Exhibit B-15 Allocations, attaclrcd and incorporated by this reference, amends ancl rcplaces Exhibit B-14 Allocations
as follorvs:
X Iucrease of $63.977 for a revisecl maxirnum consideration of $844.192.
tr Decrease of
-
for a revised mRximuur consideration of
tr No change in the uraxiururn consideration of _.
Exhibit B Allocations are attached only for infonnational purposes.
3. Exhibit C-12 Schedule of Federal Alards, attached and incorporated by this refemce, amends and rcplaces
Exhibit C-l I.
Unless designatecl otherrvise ltercin, the effeCIive date of this amendrneut is the date of execution.
ALL OTHER TERMS AND CONDITIONS of the original contract atrd any subsequent arnenclments rernain in frrll force
and effect.
IN WITNESS WHEREOF, the unclersigned has a{fixed his/her signature in execution thereof.
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT STATE OF WASHINGTON
DEPARTMENT OF HEALTH
Brm)a,09t16t20
APPROVED AS TO FORM ONLY
Assistant Attorney General
Date
Pagc I oi2l
Date
AMENDMENT #152018-2020 CONSOLIDATED C ONTRACTEXHIBIT ASTATEMENTS OF WORKTABLE OF CONTENTSDOH Program Name or Title: ELC COVID-I9 - Effective June 1,2020DOH Program Name or Title: LSPAN-Local Strategies for Physical Activity & Nutrition - Effective February Ig,2}lg .DOH Program Name or Title: OlCP-Promotion of Immunizations to Improve Vaccination Rates - Effective luly 1,2020DOH Program Name or Title: Supplemental Nutrition Assistance Program-Education - Effective October 1, 2018.Exhibit A, Statements of WorkRevised as of May 15,2020.3.5l113Page 2 of21Contract Number CLHI 8249 - I 5
AMENDMENT #I5Exhibit AStatement of WorkContract Term: 2018-2020Statement of Work Purpose: The purpose of this statement of work is to build and strengthen epidemiology, laboratory and health information systems capacity in local healthjurisdictions.Note: Pending execution of an extension to the 2018-2020 consolidated contracts which cunently end December 31, 2020,DoHplans to extend the period of performance andfunding in this statement of work through December 31 , 2021 . Unspent funds through December 3l , 2020 will be carried forward into the ne* "onsoiiduted contract periodbeginning January 1 ,2021 and will allow for work to continue through December 31, 2021 .Revision Purpose: N/ADOH Program Name or Title: ELC COVID-I9 - Effective June l. 2020SOW Type: Orieinal Revision # (for this SOW)Period ofPerformance: June 1.2020 through December 31.2020Exhibit A, Statements of WorkRevised as of May 15,2020Local Health Jurisdiction Name: Kittitas countv Public Health DepartmentContractNumber: CLHI8249Type of PaymentX ReimbursementI Fixed PriceFederal Compliance(check if applicable)X Pfnfe (Transparency Act)n Research & DevelopmentFunding SourceI Federal SubrecipientflstateflotherIotalConsideration61.t776r.r77ChangeIncrease (+)6t,17761,177CurrentConsideration00Funding Period(LHJ Use Only)Start Date End Date1213U20TOTALS06101t20MasterIndexCode1 891 0294BARSRevenueCode333.93.32CFDA#93323Chart of Accounts Program Name or TitleFFY19 COVID CARESPaymentInformation and/orAmount$61,177 - MI1891029A -COVID CARES($6l,l77fortheperiod 06/01/20-t2l3u21)Due Date/Time FrameAugust 15,2020September 30,2020Deliverables/OutcomesSubmit spending plan and staffingproposal summary to the DOHContract Manager.Staff summary and training plan*May Support PHABStandards/lleasuresTask/Activity/DescriptionEstablish a spending plan and staffing proposal tosupport the work of COVID-19 case investigationand contact tracing. The spending plan and staffingproposal should include proposed positions anddefine roles.Hire, orient and/or train staffbased on the negotiatedstaffing proposal. Develop a training plan inconsultation with DOH that is consistent with theDOH COVID-19 guideline. Training plan will beflexible depending on staffexperience and based onfor onboarding into new systems.TaskNumberI2Page 3 of2lContract Number CLHI 8249 - 1 5
AMENDMENT #15*For Information Onlv: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 aStandard/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.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-l.0.pdfSpecial RequirementsFederal Funding Accountability and Transparencv 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 firnds 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 (DLfNS@) number.Information about the LHJ and this statement of work will be made available on USASpendine.sov by DOH as required by p.L. l0g-282.Program Specifi c Requirements/NlarrativeAll work will be performed in accordance with the revised and approved project plans to be submitted to DOH by July 15,2020.Special Billing Requirementsthe budget will not be accepted or approved.Submission of Invoice Vouchers: The LHJ shall submit correct monthly A l9-1A invoice vouchers for amounts billable under this statement of work to DOH bv the 25th of thefollowing month or on a frequency no less often than quarterly.DOH Program ContactMike BoysunDOH, Communicable Disease EPI1610 NE l50th SL Shoreline, WA 98155Ph: 206-41 8-55 18 / Mike.Bo),sun@doh.wa.govExhibit A, Statements of WorkRevised as of May 75,2020DOH Fiscal ContactSummer WurstDOH, Oflice of Program Financial ManagementPO Box 47840, Olympia, WA 98504-7841Ph: 360-236-34861F ax: 360-664-221 6 / Summer.Wurst@,doh.wa. govPaymentInformation and/orAmountDue Date/Time FrameDailvDeliverables/OutcomesData collected and reported intoDOH systems*May Support PHABStandards/MeasuresTask/Activity/DescriptionConduct case investigations, contact tracing andmonitoring in accordance with DOH COVID-19lnfection Reporting and Surveillance Guidelines(DOH 420-107), Appendix 1: Case and ContactInvestigation, pages I 6-2 I :https:/iwww.doh.wa. gov/Portals/ I /Documents/5 I 00/420- I 07-Guideline-COVI D- I 9.pdfTaskNumber3Page 4 of 21Contract Number CLHI 8249-1 5
DOH Program Name or Title: LSPAN-Local Strategies for physical Activitv &Nutrition - Effective February 19. 2019SOW Type: Revision Revision # (for this SOW) 2Period ofPerformance: February 19. 2019 through September 29. 2020Exhibit A, Statements of WorkRevised as of May 15,2020Type of Paymentn Reimbursement! Fixed PriceFederal Compliance(check if applicable)[l nfefe (Transparency Act)I Research & DevelopmentFunding SourceI Federal Subrecipientn staten otherAMENDMENT #15Local Health Jurisdiction Name: Kittitas CounW Public Health DepartmentContract Number: CLH18249Exhibit AStatement of WorkContract Term: 2018-2020Statement of Work Purpose: The purpose of this statement of work is to establish funding for Local Strategies for Physical Activify and Nutrition (LSpAN), a project of theState Physical Activity and Nutrition Program (SPAN).Revision Purpose: The purpose of this revision is to extend funding period for FFY18 funds from September 29,2019 to September 29,2020.IotalConsideration60,00060,000120,000ChangeNone000CurrentConsideration60.00060,000120,000Funding Period(LHJ Use Only)Start Date End Date09129t2009/29t20TOTALS02/19t1909/30t19MasterIndexCode7744024877440239BARSRevenueCode333.93.43333.93.43CFDA #93.43993.439Chart of Accounts Program Name or TitleFFYI8 PHYS ACTVTY & NUTRITION PROGFFY19 PHYS ACTVTY & NUTRITION PROGPaymentInformationand/or AmountReimbursementfor actual costs,not to exceedtotal contractfunding. SeeProgram SpecificRequirementsReimbursementfor actual costs,not to exceedtotal contractfunding. SeeProgram SpecificRequirementsDue Date/Time FrameFebruary 1 9, 2019-September 29,2020February 19, 20 l9-September 29,2020Deliverables/OutcomesDesignated KCPHD staffwill participate in contractmanagement calls.Designated KCPHD staffwill participate in calls,webinars, and meetings.*May Support PHABStandards/-lVleasuresTas k/Activity/DescriptionPROGRAM ADMINISTRATION :Participate in calls, at a minimum of onceevery month, with DOH contract manager.Dates and time for calls are mutually agreedupon between DOH and Kittitas CountyPublic Health Department (KCPHD).PROGRAM ADMINISTRATION:Participate in DOH-sponsored LSPANrelated quarterly conference calls and/orwebinars, including up to one (1) in-personmeeting.TaskNumber1albPage 5 of21Contract Number CLHI8249 -1 5
AMENDMENT #15Exhibit A, Statements of WorkRevised as of May 75,2020PaymentInformationand/or AmountReimbursementfor actual costs,not to exceedtotal contractfunding. SeeProgram SpecificRequirementsReimbursementfor actual costs,not to exceedtotal contractfunding. SeeProgram SpecificRequirementsReimbursementfor actual costs,not to exceedtotal contractfunding. SeeProgram SpecificRequirementsDue Date/Time FrameYear l-FFYI8:April 15, 2019 (coveringFebruary 19, 2019-March 30, 2019)July 15,2019 (coveringMarch 3 1, 201 9-June 29, 2019)October 15, 2019 (coveringJune 30, 2019-September 29,2019)Year 2-FFY19:January 15, 2020 (coveringSeptember 30, 2019-December 30,201e)April 15, 2020 (coveringDecember 31, 2019 -March 30, 2020)July 15,2020 (coveringMarch 3 1, 2020-June 29, 2020)October 15, 2020 (coveringJune 30, 2020- September 29,2020)Draft due:Year I-FFYI8: March 15,2019Year 2-FFY19: July 3,2020Final due:Year 1-FFYI8: March 29,2019Year 2-FFYl9: July 10, 2020Year l-FFYI8:April 15, 2019 (coveringFebruary 19, 2019-March 30, 20 I 9)October 15, 2019 (coveringJune 30, 2019-September 29,2019)Year 2-FFY19:January 1 5, 2020 (coveringSeptember 30, 2019-December 30,2019)Deliverables/OutcomesQuarterly progress reports toDOH via SharePoint site oremailSubmit Work Plan to DOHcontract manager via emailQuarterly progress reports toDOH via SharePoint site oremail*May Support PHABStandards/IVIeasuresTask/Activity/DescriptionPROGRAM ADMINISTRATION:Perform administrative duties related toLSPAN.PROGRAM IMPLEMENTATION:Finalize Work Plan and Budget Workbookusing DOH-provided templates.PROGRAM IMPLEMENTATION:Implement finalized community work planfocused on LSPAN that include:- Addressing at least two (2) statestrategies required by this grant funding.- Achieving policy, systems, orenvironmental changes consistent withthe strategies.- Identifuing and reaching populations withhealth disparities.TaskNumberlc2a2bPage 6 of21Contract Number CLH I 8249- I 5
AMENDMENT #I5Exhibit A, Statements of WorkRevised as of May 15,2020PaymentInformationand/or AmountReimbursementfor actual costs,not to exceedtotal contractfunding. SeeProgram SpecificRequirementsDue DatelTime FrameApril 15, 2020 (coveringDecember 3 7, 201 9 -March 30, 2020)July 15,2020 (coveringMarch 3 1, 2020-June 29, 2020)October 1 5, 2020 (coveringJune 30, 2020- September 29,2020)Year l-FFYI8:April I 5, 2019 (coveringFebruary 19, 2019-March 30, 2019)July 15,2019 (coveringMarch 3 1, 2019-June 29, 2019)October 15, 2019 (coveringJune 30, 2019-September 29,2019)Year 2-FFYl9:January I 5, 2020 (coveringSeptember 30, 2019-December 30,201e)April 15, 2020 (coveringDecember 3 1, 2019-March 30, 2020)July 15,2020 (coveringMarch 3 l, 2020-June 29, 2020)October 15, 2020 (coveringJune 30, 2020- September 29,2020)Deliverables/OutcomesReport quarterly expendituresusing DOH-providedtemplate.*May Support PHABStandards/MeasuresTas k/Activity/DescriptionPROGRAM IMPLEMENTATION:Report quarterly expenditures usingDOH-provided template.TaskNumber2cPageT of21Contract Number CLHI 8249 - 1 5
AMENDMENT #I5Exhibit A, Statements of WorkRevised as of May 15,2020PaymentInformationand/or AmountReimbursementfor actual costs,not to exceedtotal contractfunding.Reimbursementfor actual costs,not to exceedtotal contractfunding.Due Date/Time FrameYear 1-FFYI8:April 15, 2019 (coveringFebruary 19, 2019-March 30, 20 19)July 15,2019 (coveringMarch 3 I , 201 9-June 29, 2019)October 15, 2019 (coveringJune 30, 2019-September 29,2019)Year 2-FFY19:January 1 5, 2020 (coveringSeptember 30, 2019-December 30,2019)April 15, 2020 (coveringDecember 3 l, 2019-March 30, 2020)July 15,2020 (coveringMarch 3 l, 2020-June 29, 2020)October 1 5, 2020 (coveringJune 30, 2020- September 29,2020)January 15, 2020 (coveringSeptember 30, 201 9 -December 30,2019)April 15, 2020 (coveringDecember 3 l, 20 1 9 -March 30, 2020)July 15,2020 (coveringMarch 3 l, 2020- June 29, 2020)October 1 5, 2020 (coveringJune 30, 2020- September 29,2020)Draft due by August 30,2020Final due by October 15,2020Deliverables/OutcomesQuarterly progress reports toDOH via SharePoint site oremailProvide copies ofanyrelevant communicationproducts with quarterlyprogress reports to DOH viaSharePoint site or emailOne success story usingDOH-provided template*May Support PHABStandards/NleasuresTa sk/Activity/DescriptionPROGRAM EVALUATION:Participate in performance measure datacollection and program evaluation activitiesin collaboration with DOH.PROGRAM COMMUNICATION:Inform partners and public about programsuccesses and related best practices,including social media posts and publicationWrite a success story related to LSPANprojects.TaskNumberJ4Page 8 of21Contract Number CLHI 8249 - 1 5
AMENDMENT #15*For Information Onlv: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 aStandard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at:http://wvw.nhaboard.ore/$rr-content/uploads/PHAB-Standards-and-Measures-Version-l.0.pdfProgram Specifi c Req uirementsAlarrativeThe Local Strategies for Physical Activity and Nutrition (LSPAN) project is providing funds to Kittitas County Public Health Department to implement policy, systems andpriority populations who experience health disparities. LSPAN is part of DOH's State Physical Activity and Nutrition-Washington (SPANWA) program. funaing for SpANWAis through a cooperative agreement awarded to DOH from the Centers for Disease Control and Prevention's (CDC) DPl8-1807: State physical Activiw and Nutriiion proeramSpecial RequirementsFederal Funding Accountability and Transparencv 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 ofthe 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 (DLINS@) number.Information about the LHJ and this statement of work will be made available on USASpendine.sov by DOH as required by P.L. l0g-282.Required Disclosures for Federal Awardee Performance and Integrity Information System (FAPIIS):Consistent with 45 CFR 75.113, applicants and recipients must disclose in a timely manner, in writing to the Centers for Disease Control and Prevention (CDC), with a copy to theand to the HHS OIG at the following addresses:CDC, Office of Grants Services, Romero Stokes, Grants Management Officer/Specialist, Centers for Disease Control and Prevention Chronic Disease and Birth Defects ServicesBranch, 2920 Brandywine Road, Mailstop E-09, Atlanta, Georgia 30341, Email: lnj0@cdc.gov (lnclude "Mandatory Grant Disclosures" in subject line)ANDU.S. Department of Health and Human Services, OfIice of the Inspector General, ATTN: Mandatory Grant Disclosures, Intake Coordinator, 330 Independence Avenue SW, CohenBuilding, Room 5527, Washington, DC2020l,Fax:(202)205-0604 (lnclude "Mandatory Grant Disclosures" in subject line) orEmail : MandatoryGranteeDi sclosures@o i s. hhs. sovRestrictions on Funds (what funds can be used for which activities, not direct payments, etc). Only DOH-approved budget expenditures will be reimbursed.o Subrecipients may not use funds to purchase furniture or equipment.r Funds cannot be spent on capital projects to support built environment changes.o Reimbursement of pre-award costs generally is not allowed, unless DOH provides written approval to the subrecipient.r The direct and primary recipient in a cooperative agreement program must perform a substantial role in carrying out project outcomes and not merely serve as a conduit for anaward to another party or provider who is ineligible.Exhibit A, Statements of WorkRevised as of May 15,2020Page9 of2lContract Number CLHI 8249 -1 5
Monitoring Visits (frequency, type)o In-person site visits at least once a yearSpecial Billing Requirementsr Must use the budget workbook supplied by the programDOH Program ContactChris Zipperer, Physical Activity CoordinatorWashington State Department of HealthPO Box 47848, Olympi4 WA 98504360-236-3614 (desk) / chris.zipperer@doh.wa.govExhibit A, Statements of WorkRevised as of May 15,2020AMENDMENT #15Page l0 of2lContract Number CLH1 8249- I 5
DOH Program Name or Title: OlCP-Promotion of Immunizations to ImproveVaccination Rates - Effective July l. 2020AMENDMENT #15Local Health Jurisdiction Name: Kittitas Countv Public Health DepartmentContract Number: CLH18249Exhibit AStatement of WorkContract Term: 2018-2020SOW Type: Original Revision # (for this SOW)Period of Performance: July 1 . 2020 through December 3 l. 2020Statement of Work Purpose: The purpose of this statement of work is to contract with local health to conduct activities to improve immunization coverage rates.Revision Purpose: N/A*For Information Onlv: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 aStandard/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.ors/wp-content/uploads/PHAB-standards-and-Measures-Version-l.0.pdfExhibit A, Statements of WorkRevised as of May 15,2020Type of PaymentX Reimbursement! Fixed PriceFederal Compliance(check if applicable)I f'fefe (Transparency Act)n Research & DevelopmentFunding SourceX Federal Subrecipientn staten otherTotalConsideration2,8002.800ChangeIncrease (+)2.8002.800CurrentConsideration00Funding Period(LHJ Use Only)Start Date End Datel2l3U20TOTALS07/01/20MasterIndexCode74310202BARSRevenueCode333.93.26CFDA #93.268Chart of Accounts Program Name or TitleFFY21 VFC OpsPaymentInformation and/orAmountReimbursement foractual costs incurred,not to exceed totalfunding considerationamount.*See Restrictions onFunds below.Due DatelTimeFrameAugust 1,2020November 30,2020Deliverables/OutcomesWritten proposal and a report thatshows starting immunization ratesfor the target populationWritten report describing theprogress made on reachingmilestones for activities identifi edin the plan (template will beprovided)*May Support PHABStandards/M€asuresTask/Activity/DescriptionDevelop a proposal to improve immunizationcoverage rates for a target population by increasingpromotion activities and collaborating withcommunity partners. The proposal must meetguidelines outlined in the Local Health JurisdictionFunding Opportunitv. Promotion of Immunizationsto Increase Vaccination Rates announcement.Upon approval of proposal, implement the plan toincrease immunization coverage rates with thetarget population identifi ed.TaskNumberI2Page 11 of2lContract Number CLH 1 8249- 1 5
AMENDMENT #15Program Specific Req uirements/NarrativeTasks in this statement of work may not be subcontracted without prior written approval from DOH OICPSpecial RequirementsFederal Fundine Accountabilitv and Transparencv 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 (DLINS@) number.Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. l0g-2t2.Restrictions on Funds (what funds can be used for which activities, not direct payments, etc.)Allowable Uses of Federal Operations Funds document (dated 12120/2017) is posted on the DOH Consolidated Contract website at this link. These federal funds may not be usedfor expenses related to travel or attendance at any non-DOH sponsored conference, training, or event without prior written approval from the DOH Office of Immunization andChild Profile.DOH Program ContactsTawney Harper, MPADeputy Director I Operations ManagerOffice of Immunization and Child ProfileDepartment of HealthPO Box 47843, Olympia WA 98504-7843tawney.harper@doh.wa. gov. 360-236-3525Exhibit A, Statements of WorkRevised as of May 15,2020DOH Program ContactMisty Ellis, Project ManagerCDC Public Health AdvisorOffice of Immunization and Child ProfileDepartment of HealthPO Box 47843, Olympia WA 98504-7843mistv.ellis@doh.wa. gov, 3 60 -23 6 -3 67 5Page 12 of2lContract Number CLH I 8249- I 5
AMENDMENT #15Exhibit AStatement of WorkContract Term: 2018-2020DOH Program Name or Title: Supplemental Nutrition Assistance Program-Education - Effective October 1.2018Local Health Jurisdiction Name: Kittitas CounW Public Health DepartmentContract Number: CLH18249SOW Type: Revision Revision # (for this SOW) 3Type of PaymentX Reimbursement! Fixed PriceFederal Compliance(check if applicable)XtrFFATA (Transparency Act)Research & DevelopmentFunding SourceFederal SubrecipientStaten otherPeriod ofPerformance: October 1.2018 through Seotember 30.2020Statement of Work Purpose: The purpose of this statement of work is to provide Supplemental Nutrition Assistance Program-Education (SNAP-Ed) to improve the likelihoodthat persons eligible for SNAP (Food Stamps) will make healthy food choices within a limited budget and choose active lifestyles consistent with the current USDA dietaryguidance system.RevisionPurpose: Thepurposeofthisrevisionisto(1)updatelanguageinTask2.0and,2.l .(2)AddlanguageinTask2.l.Exhibit A, Statements of WorkRevised as of May 15,2020TotalConsideration85820,'t7420,6034l,635ChangeNone0000CurrentConsideration85820,17420,60341,635Funding Period(LHJ Use Only)Start Date End Date09/30/190913011909130120TOTALS10/01/1810/01/1810/01/19MasterIndexCode762119937621199176701902BARSRevenueCode330.10.56330.10.56330.10.56CFDA #10.56110.561I 0.561Chart of Accounts Program Name or TitleFFY1S CSS IAR SNAP ED PROG MGNT CFFFYI9 CSS IAR SNAP ED PROG MGNTFFY2O CSS IAR SNAP ED PROG MGNT-REGION 2PaymentInformation and/orAmountReimbursement uponreceipt and approvalofdeliverables for thefunding period willnot exceed $41,635.Kittitas CountyPublic HealthDepartment will bepaid the allowablecosts incurred basedon their approvedFFY2ODue Date/Time FrameFor the Period:10/01119 to 09/30120Due: per the approvedwork plan and no later than09/30/20FFYI9Due Date/Time FrameFor the Period:l0/01/18 to09130119Due: per the approvedwork plan and no laterthan09l30l19Deliverables/Outcomesr Project qualified targetaudiences reachedr Project activitiescompleted (# directeducation, PSE, Etc.)noted in project plans andworkbooks.r Required demographicdata collected.r Evaluationactivitiescompleted per theimplementing agency and*MaySupportPHABStandards/MeasuresTask/Activity/DescriptionFor SNAP-Ed, the LHJ willperform work as described in theirapproved:FFYI9 SNAP-Ed projectdescription and work plansapproved by DOH,Department of Social andHealth Services (DSHS), andUnited States Department ofAgriculture (USDA) that wasaqF.1.0Page l3 of21Contract Number CLH18249-I 5
AMENDMENT # 15Exhibit A, Statements of WorkRevised as of May 15,2020PaymentInformation and/orAmountbudget and programallowability. Seespecial billingrequirements section.**NOTE: TheSNAP-Ed programwill deny paymentfor any costs notsubmitted by the duedate and withoutprior DOH approvalin writing.See paymentinformation asreferenced in tasknumber l 0FFY2ODue Date/Time FrameFFY20 Quarterly ProgressReports due:a1 st quarter report forthe work completedduring 10/01/19 to1213U19.Final Due: COB0'Ut0l202nd quarter report forthe work completedduring 01/01/20 to0313v20.Final Due: COB04,/l l,/20 04/13/20a3rd quarter report forthe work completedduring 04/01/20 to06130t20.Final Due: COBg7,q l,/29 07/13/20FFYl9Due Date/Time FrameFFYI 9 Quarterly ProgressRepofts due:a1't quarter report forthe work completedduring l0/01/18 to12131118.Final Due: COB0vl0l19a2nd quarter report forthe work completedduring 0l/01/19 to03131119.Final Due: COB04111119a3rd quarter report forthe work completedduring 04/01/19 to06130119.Final Due: COB0711yt9Deliverables/Outcomesstate evaluation team (preand post surveys, PSEtracking, success storiesetc.).Submit Quarterly ProgressReport for all SNAP-Edprojects within the DOHapproved form/system.*MaySupportPHABStandards/MeasuresTask/Activity/Descriptionsubmitted to them via DOHemail.aFFY20 SNAP-Ed projectdescription and work plansapproved by DOH,Department of Social andHealth Services (DSHS), andUnited States Department ofAgriculture (USDA) that wassubmitted to them via DOHemail.Quarterly Progress ReportsThe following data is collectedand submitted within DOHprovided form /system:l. Project major achievements.2. Project major challenges.3. If projects are running on timewith original timeline? If notwhy, and how will you correctthe timeline?4. Any PSE progress.5. Any success stories to date.Topics included in quarterlyprogress report subject to changebased on Department of Health(DOH), Department of Social andHealth Services (DSHS),Washington SNAP-Ed (WASNAP-Ed), or United StatesDepartment of Agriculture (USDA)Food and Nutrition Services (FNS)requirements.:+hF,2.0Page 14 of27Contract Number CLHI 8249 -1 5
AMENDMENT # I5Exhibit A, Statements of WorkRevised as of May 15,2020PaymentInformation and/orAmountSee paymentinformation asreferenced in tasknumber 1.0FFY2ODue Date/Time FrameFinal report for allwork not alreadyreported.Final Due: COB09t18t20aaPEARS data reportingsubmitted l0/01/19 togg4Am 09/t8/20.Due: PEARSProgram Activities(direct education)module completed inreal time and no laterthan two (2) weeksafter services areprovided.o Due: PEARS IndirectActivities, PSE SiteActivities,Partnerships,Coalitions, SuccessStories, and SocialMarketing modulescompleted no laterthan the last businessday of the monthfollowing when theactivity took place,except for the lastmonth of the FFYwhich is due by09130120.r Activities completedin Oct 2019 due inPEARS by 11130119r Nov 2019 by l2l3ll19o Dec 2019 by 01131120r Jan 2020 by 02129120FFYl9Due Date/Time FrameFinal report for allwork not alreadyreported.Final Due: COB09/21t19l-4. Due: At minimumquarterly.. lst quarterreport due by011r0t19. 2nd quarter dueby 04/11119o 3rd quarter dueby 07111119r Final report forall other workdue 091211195-6. Due: MonthlyNo later than 30 daysafter the end oftheprevious month. (E.g.October pre and postsurveys submitted no laterthan November 30 and soon...).Deliverables/OutcomesCollect and submit reportingand evaluation data intoPEARS electronicallyaccording to time frameprovided, or using approvedreporting method.Collect and report anyformative and process datacompleted based onapproved project plan.2. Submit PSE progress andoutcomes based onapproved project plan.3. Capture and submitqualitative (success stories,pictures, etc.) informationin PEARS per yourapproved work plan.4. Submit a required releasefor all photos submitted.5. Conduct and submit/mailpretest surveys for eachproject class series.6. Conduct and submit/mailposttest surveys for eachproject class series.*MaySupportPHABStandardslMeasuresTask/Activity/DescriptionEducation and AdministrativeReporting Systems (EARS),Evaluation Data and ReportsThe following evaluation activitiesand information is required for allprojects based on your approvedproject/planr Formativeo Processo PSEo Outcomer QualitativePlease Note: the deliverables maychange based on state evaluationteam requirements.Education and AdministrativeReporting Systems (EARS) data isrequired for each SNAP-Edproject. This information iscollected through the followingrequired modules in PEARS:Program Activity (directeducation), Indirect Activity(indirect intervention channels),PSE Site Activities, Partnerships,Coalitions, Success Stories, andSocial Marketing.Required deliverables for SNAP-Ed reporting will depend onapproved SNAP-Ed plan activitiesfor each sub-recipient, e.g. Ifdirect:tti(qF2.1Page 15 of21Contract Number CLHI 8249 - | 5
AMENDMENT #I5Exhibit A, Statements of WorkRevised as of May 15,2020PaymentInformation and/orAmountSee paymentinformation asreferenced in tasknumber 1.0FFY2ODue Date/Time Frame. Feb 2020by 03131/20o Mar 2020 by 04130120. Apr 2020by 05/31120. May 2020 by 06130120. Jun 2020 by 07/31/20r Jul2020by 08131120. Aug 2020by Og3ADg09/ I 8/20. Sep 2020by g9BO2409/ r 8/20SNAP-Ed Direct educationconducted between10/01/18 and09/30120.o Due: Pre- and post-test surveys submittedto DOH in real timeand no later than twoweeks aftercompletion of thesurvey. All pre- andpost-test surveys mustbe received no laterthan COB S9B02A09/18/20Due: l2l3lll9 New hiresneed to complete within 30days.FFYI9Due Date/Time FrameDue:. 12131119Deliverables/OutcomesSubmit documentation showingCivil Rights training wascompleted for all SNAP-Edpaid staff. Documentation mustinclude:r Training and source' Who attendedr Date completed*MaySupportPHABStandards/MeasuresTask/Activity/Descriptioneducation is not an approved planactivity for a sub-recipient,submission of pre/posl surveys isnot a required deliverable for thatsub-recipient.Civil RightsAll staff must be trained each fiscalyear in civil rights.*See special requirements section-civil rightsF3.0Page l6 of21Contract Number CLHl 8249-1 5
AMENDMENT #15Exhibit A, Statements of WorkRevised as of May 15,2020Paymentlnformation and/orAmountSee paymentinformation asreferenced in tasknumber 1.0See paymentinformation asreferenced in tasknumber 1.0See paymentinformation asreferenced in tasknumber 1.0FFY2ODue Date/Time FrameDue: New staff trainedwithin 30 days of startingSNAP-Ed activities andagain at least once everythree years.Ifthe data collectionsystem changes in FFY20every staff memberentering data into theelectronic system will berequired to take training onany new expectations orsystem changes.Due: Inventory list isrequired to be updated at12l3lll9 and 09/1 8/20, aswell as at the time of afiscal or programmonitoring site visit. It canalso be requested whendeemed necessary.Due: Monthly - Submitinvoices to DOH no laterthan 30 days after the endof the preceding month.(E.g. October Al9 invoicesubmitted no later thanNovember 30 and so on...)o Oct. Invoice: 11130/19o November:12130119o December:01130120o January: 02/29120FFYI9Due Date/Time FrameDue: New stafftrainedwithin 30 days of startingSNAP-Ed activities andagain at least once everyfive years.Ifthe data collectionsystem changes in FFYI9every staffmemberentering data into theelectronic system will berequired to take trainingon new expectations orsystem chanqes.Due: Yearly, at the timeof a fiscal monitoringand/or site visit. It canalso be requested whendeemed necessary.Due: Monthly - Submitinvoices to DOH no laterthan 30 days after the endof the preceding month.(E.g. October Al9 invoicesubmitted no later thanNovember 30 and soon...).Final invoice is dueOctober 30,2019Deliverables/OutcomesFiscal and Data reportingtraining completed.SNAP-Ed inventory listSubmit sNAP-Ed Al9 invoicesand detailed ledger supportingthe costs to be reviewed bySNAP-Ed program via the mostcurrent submission procedurebefore approval of payment.*MaySupportPHABStandards/MeasuresTask/Activity/DescriptionOther Agency TrainingThe following trainings arerequired for all agencies:o Fiscal - fiscal lead,coordinator, and any staffwho will purchase items forthe SNAP-Ed program.aData collection andreporting - coordinator andprogram staff who arereporting data.SNAP-Ed Inventory ListKeep an up-to-date inventory listthat includes all non-capitalequipment, purchased curriculum,and other SNAP-Ed paid items thatare not disposable. This list shouldinclude items purchased in priorfiscal years and be updated yearly.Agencies are required to follow theDOH SNAP-Ed Inventory policyand procedure.*See special requirements section-monitoring.SNAP-Ed Al9InvoicesUse the Al9-1A specific to theDOH SNAP-Ed program. Thisdocument will be sent to all LHJsprior to October l6th based on thecurrent fiscal year.qF3.14.O5.0Page 17 of21Contract Number CLHI 8249 - 1 5
AMENDMENT #15*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 aStandard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at:http://wvw.phaboard.orgiwp-content/uploads/PHAB-Standards-and-Measures-Version-l .0.pdfSpecial RequirementsFederal Funding Accountability and Transparencv 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 contractor must have a Data Universal Numbering System (DLINS@) number.lnformation about the contractor and this statement of work will be made available on USASpending.gov by DOH as required by P.L. l0g-282.Exhibit A, Statements of WorkRevised as of May 15,2020PaymentInformation and/orAmountFFY2ODue Date/Time Frameo February:03130120o March:04130120o April: 05130120o May: 06130120o June:0 7130120o July: 08130120o August: 09/30120o September:10130120Final invoice is dueOctober 30th,2020Or*Ifpre-approved inwriting by contractmanager, agencies cansubmit invoices every twomonths. Upon approval, alist of submission dateswill be provided.FFYI9Due Date/Time FrameOr*Ifpre-approved inwriting by contractmanager, LHJ can submitinvoices every two (2)months. Invoices must bereceived by DOH no laterthan dates listed below:o Oct and Novdue: 12129118o Dec and Jandue:02128119o Feb and Mardue:04130119o Apr and Maydue:06129119o Jun and Juldue:08/31/19o Aug and Septdue:10/30/19Deliverables/OutcomesDocumentation of all costsincurred shall be accompaniedby an agency financial systemreport. Ifyour agency does nothave a financial reportingsystem you must check with theSNAP-Ed program for furtherguidance.*MaySupportPHABStandards/MeasuresTask/Activity/DescriptionFPage l8 of2lContract N umber CLHI 8249 - | 5
AMENDMENT #15* Program Specifi c Requirements/NarrativeContract Noncompliance and Corrective Action (see CFR I200.338 Remedies for noncompliance)The agency must meet the required set of deliverables and adhere to contractual obligations. The contract deliverables along with specified due dates will be determined by theSNAP-Ed program and provided to the LHJ in writing. Based on contract performance (i.e. program and fiscal monitoringiesults ;nd findings) and after implementationtf otherl0% of funds from the LHJ for deliverables that are not completed, not submitted by the due dates specified (without approved extension by DOH in writing), or not carried outsufficiently or consistently. After DOH SNAP-Ed provides documentation of the issue and outlines the appropriate correction action in wriiing, and with approval from the DOHSNAP-Ed program manager, the first withholding of funds up to l0%o would occur one time and allow 60 days for the appropriate corrective iction to be completed by the LHJ. Ifsatisfactory corrective action does not take place within 60 days, up to 5oh of funds will be withheld from each monthly payment until the appropriate corrective action iscompleted. The LHJ may request reconsideration by submitting a letter to Washington Department of Health, PO Box 478:S6,Olympia, We SgjO+-2S86, or email to snap-ed@.doh.wa.eov. All invoices must be approved by DOH prior to payment; approval will not be unreasonably withheld. OOU wilt authorize payment only upon satisfa$rycompletion and acceptance of deliverables and for allowable costs as outlined in the statement of work, state plan, andlor budget. DOH will ieturn all incorrect or incompleteinvoices and will not pay for services that occur outside the period ofperformance.Staff RequirementsUpon request by DOH, LHJ must demonstrate that SNAP-Ed staff meet requirements appropriate to their positions including but not limited to: background checks, food handlers'permits, qualifications, and training required by DOH.SNAP-Ed Assurances: The following assurances must be followed (see program Guidancehttps://snaped.frrs.usda.goviprogram-administration/guidance-and-templates).' The LHJ is fiscally responsible for activities funded with Supplemental Nutrition Assistance Program Education funds and is I iable for repayment of unallowable costs.r Efforts are made to target SNAP-Ed to the SNAP-Ed target audience.' Only expanded or additional coverage of those activities funded under the Expanded Food and Nutrition Education Program (EFNEP) may be claimed under theSNAP-Ed grant. Approved activities are those designed to expand the State's current EFNEP coverage in order to serve additional SNAp-Ed targeted individuals. In nocase may activities funded under the EFNEP grant be included in the budget for SNAP-Ed.o Contracts are procured through competitive bid procedures governed by State procurement regulations.' Program activities are conducted in compliance with all applicable Federal laws, rules, and regulations including Civil Rights and OMB regulations governing cost issues.Program activities do not supplant existing nutrition education and obesity prevention programs, and where operating in conjunction with existing programs, enhance aswell as supplement them. This applies to all activities and costs under the Federal budget.Program activities are reasonable and necessary to accomplish SNAP-Ed objectives and goals.All materials developed with SNAP- Ed funds include the appropriate USDA non-discrimination statement and credit SNAP as a funding source in standard font that iseasily readable.AuditsThe LHJ must make State financial and program audits or reviews conducted by other entities available to the DOH, DSHS, USDA, or its designee.Monitoring ExpectationsThe LHJ's premises and records will be made available upon request to DOH, DSHS, and USDA staff for the purposes of observing program activities and reviewing for programand fiscal compliance. All non-capital equipment and reusable educational materials should be tracked in an inventory list and available for review upon request.Exhibit A, Statements of WorkRevised as of May 15,2020aaaaPage 19 of2lContract Number CLHI 8249 - 1 5
AMENDMENT #15SNAP-Ed Statewide InitiativesAgencies are expected to communicate with, respond to, and comply with requests, requirements, and/or on-site visits from WA SNAp-Ed statewide initiative entities.Any curriculum modifications should be developed and executed based on the most current curriculum modification guidance. Local Agencies must consult their DOH contractmanager as directed. httes://s3.wo.wsu.edu/uploads/sites/2090/2017l01/Guidance-for-Curriculum-Modification-FFY20l8-Modified-10.9.17-pDF.pdfIndirect Rate/Allocation PlanAll indirect ratelallocation plans must be submitted and preapproved by the DOH grants office and the DOH SNAP-Ed program. The LHJ is responsible for ensuring that indirectare determined to be unacceptable and will be disallowed.who supervise 'frontline staff must be provided civil rights training on an annual basis."Records - Record Retention and Management-State Agency and AII Sub-grantees 7CFR272.2claim submittal. Any costs that cannot be substantiated by source documents will be disallowed as charges to SNAP-Ed.TravelThe LHJ is expected to comply with the Office of Financial Management's Travel Management Requirement and Restrictions as found in policy 10.10.http:i/www.ofin.wa.eov/polic),/l0.htm. and with the travel requirements found in the_current year's SNAP-Ed federal guidance.AmendmentsAgencies should check the current year's federal SNAP-Ed guidance, DOH SNAP-Ed budget amendment guidance, and with the DOH contract manager to know what kinds ofchanges they can make on their own and what changes require an amendment and pre-approval in writing. Agencies must submit a written amendment request to DOH, andreceive written pre-approval from DOH, prior to making/implementing any changes within their project or budget. Any requests needing FNS approval must be submitted to DOHno later than April 1st ofeach fiscal year. Ifagencies are making smaller changes that do not require FNS approval, DOH can review those and make approvals on a case by casebasis. All of these non FNS amendments should be submitted to DOH no later than July 16th of each fiscal year.OvertimeStaff overtime is not billable in the DOH SNAP-Ed program unless it has been reviewed and preapproved by the state DOH SNAP-Ed program in advance and was approved inwntlng.Special Funding RequirementsPayment for deliverables as specified herein is dependent on receipt of funding from the USDA funding sources. In the event funding is not received, DOH is under no obligationtomakepaymentsforthedeliverablesasspecified. IffundingisreducedorlimitedinanywayaftertheeffectivedateofthiscontractandpriortonormalcompletionDOHmayterminate task(s), remove funds, or reallocate funds at DOH's discretion under new funding limitations and conditions. DOH will make payments only upon the receipt of thefunding. DOH will noti! the LHJ within seven (7) working days upon notice by the funding source of funding availability.Exhibit A, Statements of WorkRevised as of May 75,2020Page 20 of 21Contract Number CLHI 8249 -1 5
2AMENDMENT #15Special Billing Requirementsl. All invoices, billing, and reimbursements must be in compliance with all applicable Federal laws, rules, regulations including the current year SNAp-Ed Guidance and OMBcirculars governing cost issues.Total costs billed will not exceed the UsDA-approved budget amount listed in the box below.. Bills must be for only SNAP-Ed specific activities, using a DOH A19-lA Invoice Voucher.' A SNAP-Ed specific A19-1A must be submitted to the agency's designated DOH SNAP-Ed staffmember within 30 days of the last day of the month for whichthe work is being billed, OR' An agency may request pre-approval to bill every two (2) months instead, in which case, that agency is required to adhere to the billing due dates provided byDOH.In FFYl9 and FFY20 the SNAP-Ed program will deny payment for any costs not submitted by the due date without prior approval. If for ANy reason the LHJ is unable tosubmit the SNAP-Ed ,{19-1A on the due date, the LHJ is required to submit a request for an exception to the DOH no laterlhan seven (7) days prior to due date to the DOHSNAP-Ed program. The SNAP-Ed program reserves the right and responsibility to either approve or deny the request for an exception and will reply to the request.Supporting documentation for each month must be submitted with each SNAP-Ed A19-1A.r At the very least this means a copy ofan agency's financial expanded/detailed general ledger level report.r Additionally, all receipts, timecards and other supporting documentation, as noted by USDA, must be available upon request.lf an agency meets one of the criteria below, they will need to submit all SNAP-Ed backup documentation with each bill and this requirement will continue until further noticeby DOH SNAP-Ed program.. All new SNAP-Ed contractors within their I't fiscal year.r LHJs with cunent fiscal findings.r LHJs who have not submitted adequate or accurate backup documentation within the last year.BUDGETAmount$4r,63 5SourceUSDA345DOH Program ContactJamie Wells, SNAP-Ed Contract ManagerDepartment of HealthPO Box 47886, Olympia, WA 98504-7886Jamie.Wells@doh.wa. eov I 360-236-3 668Exhibit A, Statements of WorkRevised as of May 15,2020DOH Fiscal ContactKim Henderson, Fiscal AnalystDepartment of HealthPO Box 47886, Olympia, WA 98504-7886Kim.Henderson@.doh.wa.gov / 360-236-3491Page 21 of21Contract Number CLHI 8249 - 1 5
Kittitas County Public Health DepartmentlndirectRateasofJanuary20l8:29.50ToPublicHealthDept&l2.50TocountyCentralSvcslndirect Rate as ofJanuary 2019: 28.25% Public Health Dept & 12.75o/o county central SvcsChart ofAccounts Program TitleFederal AwardIdentification #Amend #DOH Use OnlyBARS Statement of Work Chart of Acco[ntsRevenue Funding Period Funding PeriodCode*" Start Date End Date Start Dat€ Etrd Datel97WAWAsQ3903l97WAWAsQ3903187WAWA5Q3903187WAWA5Q3903l87WAWA5Q3903l87WAWA5Q3903l7r7wAwA5Q390NU90TP921 889-01NU90TP921 889-01NU90TP92l 889-01NU90TP92 1 889-0 lNGA Not ReceivedNH23IP9226195NH23tP000762-05-00NU58DP006504NU58DP006504B04MC32578B04MC32s78804MC31524804MC3152410.5611 0.56 110.s611 0.56 110.56110 56110.561333.1 0.56333. l 0.s6333.10 56333.10.s6333. I 0.56333 10 56333. l0 s6Contract Number:Date:FundingPeriodSub Total$20,t'74$8s8$22,855$1,472$20,603$20,398$49. l 34$49, l 33$616$2,226$s,600$2,800$s,600$l.l l4$60,000$60,000$44,196$44,196$34,040cLHt8249May 15,2020Chart ofAccountsTotal$4s,359$20,603$20,398$49, l 34$49, l 33$616$2,226$s,600$9,514$6t,177978,s22$ r 20,000$t22,432EXHIBIT B-I5ALLOCATIONSContract Term: 2018-2020CFDA*l'-FY20 CSS IAR SNAP Ed Prog MgntRegion 2 207WAWA5Q3903FFYl9 CSS IAR SNAP Ed Program MgntF-FYI9 CSS IAR SNAP Ed Program MgntFFYI8 CSS IAR SNAP Ed Program Mgnt CFFFY l8 CSS IAR SNAP Ed Program MgntFFYI8 CSS IAR SNAP ED Program MgntFFYI8 CSS IAR SNAP ED Program MgntFI'-Y17 CSS IAR SNAP ED Program Mgnt CFFF-Yl7 EPR PHEP BP1 LHJ FundingFI"Yl7 EPR PHEP BPI LHJ FundingFF-Yl8 EPR PHEP BPI Supp LHJ FundingFFYI8 EPR PHEP BPI Supp LHJ FundingFFYI9 PHEP BPI LHJ FundingFFYIT 317 OpsFFYIT AFIXFFYI 7 lncreasing Immunization RatesFFY2I VFC OpsFFY20 VFC OpsFFYIT VFC OpsFFYI9 Phys Actlty & Nutrition ProgFFY I 8 Phys Actrty & Nutrition ProgFFY20 MCHBC LHJ ContractsFFYI9 MCHBG LHJ ContractsFFYI8 MCHBG LHJ ContractsFFY I 8 MCHBC LHJ ContracrsAmd 10 10 561 333 10.56 t0l0tlt9 09130/20 t0/01/19 09t30/20 $20,603Amd 9Amd 4Amd 4Amd 4Amd 2N/AN/Al0/0 l/1 8l0/01/r810/01/180 l/01 /l 80l /01/1801/01/l 80 1/0 l/r 809/3011909/30t'1909/30t1909/30t1809/30/1809/30/t809130/1810/01/18t0/01/l 8l0/01/l 8t0/01n710/01/1710/01/t7t0t0l/t709/30/1909/30t1909/30/1909/30/1809/30/1809/30/t809/30/1 8Amounts429$19,745$8s8$3,000$ l 1,02s$8,830s1"472$s6s$ 1 9,833$88s$48,249$2,800$s,600$1,1 14$60,000$60,000944,196944,196$893$33,141Amd 2N/AAmd 5Amd 4Amd 15Amd 9N/AAmd l0Amd 8, 15Amd l0Amd 4Amd 2N/A93.06993.069333.93.06 01i01/18 06t30t18 07/01/t7333 93 06 01i01/18 06130t18 07/or/17w/02/1807/02/1893 06993.069333.93.06 07/0U18 06130t19 07/0v18333 93 06 01/0Ut8 06t30^9 07t01/t806t30n906/30/19NU90TP922043Amd l0 93.069 333 93.06 07/01119 06130120 0't/01/t9 06t30/20 S49.1335NH23tP000762-05-00N/A93.268 333 93.26 0l/0t/18 06/30/t8 04/01/t7 06/30/18$6165NH23IP000762-05-00N/A93.268 333.93.26 0l/01/18 06/30t18 04/01/17 06/30/18$2,226NH23rP000762Amd 3, 4 93.268 333.93 26 07101/18 06/30119 07/01/18 068A/gss,60093.26893.26893 268333.93.26 07/0v20 t2t31/20 07/0r/20333.93.26 01/01t19 06t30/20 07/oln9333.93.26 01/01/18 06t30/t8 04/0t/1706/30/2t0613012006t30/t8FFYT9 COVID CARESNUs0cK000slsFFY20 CDC COVID-19 Crisis Resp LHJ-Tribe NU90TP922069Amd 15 93.323 333.93.32 06/01120 12131120 06/0l/20 06/30/21s6t,t77$6t,177Amd 13 93 354 333.93.35 01120/20 12/31120 0l/01/20 06/30/21s78,s22$78,s2293.43993.439333.93 43 09t30/t9333.93.43 02/19/t909129t20 09/30/1909t29t20 09t28/1809n9D009D9/2093 99493 99493.99493.994333.93.99333.93.99333.93.99333.93 9910/01/t91 0/01/l 801/01/1801/01/r 809130t2009t30n909/30/l 809/30/t810/01/19l0/01/l 810/01/1710/0U1709130/2009/30/1909/30/t809/30/t8Page I of3
Kittitas County Public Health DepartmentIndirect Rate as of January 201 8: 29.507o Public Health Dept & 12.507o county Central SvcsIndirect Rate as ofJanuary 2019: 28.257o Public Health Dept & 12.75o/o cotnty Central SvcsFederal AwardIdentification #EXHIBIT B-15ALLOCATIONSContract Term: 2018-2020Contract Number:Date:FundingPeriodSub TotalCLH1E249May 15,2020Chart ofAccountsTotalBARSRevenueCFDA* 666.**Statement of WorkFunding PeriodStart Date End DateDOH Use OnlyChart ofAccountsFunding PeriodChart of AccountsTitleGFS-Group B (FO-E)GFS-GroupB(FO-E)FY2 Group B Programs for DW (FO-E)Zoonotics-GFSZoonotics-GFSFY20l21 COVID- l9 Disaster Response AcctSFY2 Lead Environments of ChildrenSFY2 Lead Environments ofChildrenSFYI Lead Environments of ChildrenIjPFIS Funding for LHJsFPIJS Funding for LHJsFPHS Funding for LHJs DirYR 20 SRF - Local Asst (15%) (FS) SSYR 20 SRF - Local Asst ( I 5%) (FS) SSYR 2l SRF - Local Asst (15%) (FS) SSYR 2l SRF - Local Asst (15%) (FS) SSYR 21 SRF - Local Asst (15%) (FS) SSYR 2l SRF - Local Asst (15%) (FS) SSYR 22 SRF - Local Asst (15%) (FO-E) SSYR 22 SRF - Local Asst (15%) (FO-E) SSYR 22 SRF - Local Asst (15%) (FO-E) SSSanitary Survey Fees (FO-E) SS-StateSanitary Survey Fees (FO-E) SS-StateSanitary Survey Fees (FO-E) SS-StateSanrtary Survey Fees (FO-E) SS-StateSanitary Survey Fees (FO-E) SS-StateYR 20 SRF - Local Asst (15%) (FS) TAYR 20 SRF - Local Asst ( I 5%) (FS) TAAmend #Amd l0N/AAmd 9Amd 9Amd 8Amd 4Amd IAmd 10Amd 10Amd 3Amd 3N/A, Amd 3Amd 10Amd 9, 10Amd 7, l0Amd 3,7, l0Amd 14Amd 12Amd 10, 12Amd 14Amd 12Amd 9, 12Amd'Z,12N/A, Amd 3,7, 12N/AN/AN/A 3340491N/A 334.04 91Date334049Q 01t01120 t2t31t20 07/Ol/19 06B0nl334.0490 0l/01/18 06130^8 07m/n 06/30/1906130t2t06/30/19Amount$20,000$s,00094"029$971($ l ,soo)$1,s00$2,000$42,000$42,000$42,000($2,400)$2,400$20,000ss,000$4,029$971$0$2,000$42,000s42,000$42,000$0$2,400s6,600$9,000$2s,000$ I 0,000$5,000s71,478$2,000$ r 26,000$2,400$6,600$9,000Amd 3N/A 334.04 90 07/01/18 06/30/t9 07/01/17 06/30/t9 $10,000$ 10,00001/0U19 06/30120 07/01/1906/01/t9 06/30/t9 07/01/17Amd l3N/A 334.0492 0v20t20 t2131/20 0l/un0 06/30/21 971,478s71,418N/A 33404.93 07/0v18 06t30/19 0'7/01/1.8N/A 3340493 0t/01Jt8 06t30,r9 07/01/18N/A 334.04.93 0l/01/18 06t30/18 U/01/1706/30/1906130/1906/30il8N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A3360425 0701/20 12t3U20 07/0!19336.04.2s 0'7t01^9 06/30t20 07/01/19336 04 25 01t01/t8 06/30t19 07/01/1706/30/2t06t30/2106t30/19346.26.64 01/01/18 t2t31n8 07/01/153462664 01i01/18 t2t31n8 07t0v1st2/31ir8l2/3t /t8$0346.26.64 01/01/19346.26.64 0v01/193462664 01t01/19t2/3t/20 0t/01/19 a6R0/21t2/31t20 0v0t/19 06/30/211213v20 0l/01fi9 06q0nr346.26 64346.26.64346.26 64346.26.640l /01/180l /01/180 l/01 /1 80l/01iI806/30/t906/30/1906/3011906/3011907/01/1,107 /01 /1701/o'r/17o7 /ot/17068A/1906/30/r906/30/1906/30/t9($3,200)$400$2,800$2,400($400)$3,800$3,200($400)$3,800$400$2,800$2,400($2,ooo)$2,000Amd 3N/AN/A346.26.66 0l/01/18 12t3U18 07t01/15346.26.66 0l/01il8 12/3vt8 07t01/15346.26.65346.26.6s346.26.6s346.26.6s346.26.6501/01/l 801/0 I /1 801/0r /1801/0 l/1 801/01/1 812/3t /20t2131/2012/31/20t2/31/2012/31n00'7/01il707101/1707101/t707/0t/1707/o1/t706/30/2t06/30/2106/30/2106/30/2106/30/2t12131/t8t2/31/18N/A, Amd 3Page 2 of 3$0$0
Kittitas County Public Health DepartmentIndirect Rate as of Jaouary 2018: 29.507o Public Health Dept & 12.507o county Central SvcsIndirect Rate as ofJanuary 2019: 28.257o Public Health Dept &lL7So/o county central SvcsEXHIBIT B.I5ALI,OCATIONSContract Term: 2OI8-2O2OContract Number:Date:cLHr8249May 15,2020Federal AwardIdentification ## CFDA* 966"** StartDateEndBARS Staten€nt of WorkRevenue FundingPeriodN/A 346.26.66 01/01/18 06/30/19N/A 346.26.66 01/01/18 06/30/19N/A 3M.26.66 0t/01/18 0680/t9FundingPeriodSub($4,000)$2,000$2"000$0($2"000)$2,000$2,000$2,ooo$E44,192 5844,192GRANDTOTATTotal FedTotal StateChart ofAccountsTotal$2,0009844,192s584,7r4$259,478Chart ofAccountsTitleYR 2l SRF - Local Asst (15%) (FS) TAYR 2l SRF - Local Asst (15%) (FS) TAYR 2l SRF - Local Asst (15%) (FS) TAYR 22 SRF - Local Asst (15%) (FO-E) TAYR 22 SRF - Local Asst (15%) (FO-E) TAYR 22 SRF - Local Asst (15%) (FO-E) TATOTALTotal consideration:GRAND TOTALAmd l0Amd ?, 10Amd 3,7, 10Amd 14Amd 12Amd 10, 12$0N/AN/AN/A346.26.66 0t/Ot/19 12t31/20346.26.66 01/AL/t9 t2/31/20346.26.66 0l/0y19 t2/t1/2As7802ls$63,977w44,t92*Catalog of Federal Domestic Assistance**Federal revenue codes begin with "333". State revenue codes begin with "334"Page 3 of3
Exhibit C-l2 Schedule of Federal AwardsKITTITAS COUNTY HEALTH DEPT-SVWOOI0475-07CONTRACT CLH1824g-Kiftitas County Public Health DepartmentCONTRACT PERIOD: 01/01/201 8-1231 l2O2OContract Amt CFDA CFDA Program TitleFederal Agency NameFederal AwardldentificationDepartment of Agricullure Food and207WAWAsQ3903Nutrition SeruiceDepartment of Agriculture Food andNutrition Seruice197WAWA503903Departmeni ofAgriculture Food andNutrition Setuice1 87WAWA5Q3903Department of Agilculture Food andNutrition Seryice'187WAWAs03903Departmeni of Agriculture Food andNulrition Seryice1717WAWA50390Department of Health and HumanSeruices Centers for Disease Control NU90TP921E89-01and PreventionAMENDMENT #15Date: May 15,2020Federal Grant Am.d Name201 9 SUPPLEI\4ENTAL NUTRITIONASSISTANCE PROGRAI\4-EDUCATION(SNAP.ED)SNAP 2YR NUTRITION EO OBESITY201 E SUPPLEIV]ENTAL NUTRITIONASSISTANCE PROGRAIII EDUCATION(SNAP-ED)201 8 SUPPLEI\4ENTAL NUTRITIONASSISTANCE PROGRAM EDUCATION(sNAP-ED)DOHFederalAward DateTotal AmtFederalAwardAllocation PeriodStart EndDate DateChart of Accounts Program TitleBARSFFY2O CSS IAR SNAP ED PROG MGNT.REGION 2 333.10.5609/30/19 $5,300,000 10/01t19 09t30t20FFY,19 CSS IAR SNAP-ED PROG MGNT333.10.5609t28t18 $5,386,26810tUt1a 09130t19FFY'I8 CSS IAR SNAP-ED PROGRAIV MGNT CF333.10.560s/30/19 s5,300,000 10/01/18 09/30/19FFY,18 CSS IAR SNAP-ED PROGRAM I\4GNT333.1 0.56o9nat17 $5,300,00001/01/18 09/30/18State Administratjve Maiching$20,603 1 0.561 crants for ihe SuppiementalNutrition Assistance PrcgramStaie Administrative lvlatching$20,174'10.561 GrantsfortheSupplementatNutrition Assistance Progmms858 1 0 561State AdministEtive l\4atchingGrants for the SupplementalNutrition Assislance Program$22,855 10.561State AdministEtive Ma{chingGrants fo. the SupplementalNutrition Assistance PrcgramState Administralive MatchingGrants for the SupplementalNutrition Assistance ProgramFFY17 CSS IAR SNAP-ED PROGRAM MGNT CF333.10.56FFY,I9 PHEP BPl LHJ FUNDING09/10/16 $5,739,85601/01/18 09i30/18sl.472 10.5612018 SUPPLEMENTAL NUTRITIONASSISTANCE PROGRAM EDUCATION(sNAP-ED)333.93.0606129119 $11,307,904 07t01t19 06t30t20$49,133 93.069Public Health EmergencyPreparednessDepartmenl of Health and HumanSeryices Centers for Disease Conlroland PreventionDepartment of Health and HumanSeNices Cente6 for Disease Contrcland PrevenlionNU90TP922043NU90TP921 889-01PUBLIC HEALTH EMERGENCYPREPAREDNESS (PHEP)COOPERATIVE AGREE[/IENTFFY18 EPR PHEP BP'I SUPP LHJ FUNDINGFFY17 EPR PHEP BP1 LHJ FUNDINGFFY21 VFC OPSFFY2O VFC OPSFFY,I7 VFC OPSFFY1 7 INCREASING IMMUNZATION RATESFFY17 AFIXFFY17 317 oPS333.93.06oatutlE 51 1,062,782 07t01t18 06t30t19333.93.06s49,134 93.069Public Health EmergencyPreparednessPublic Health EmergencyPreparednesslmmunization CoopeEtiveAgreementsHOSPITAL PREPAREDNESSPROGRAM AND PUBLIC HEALTHEIV]ERGENCY PREPAREDNESSCOOPERATIVE AGRE EI\4ENT07t14t17 $11,062,782 01/01/18 06/30/18 $20,398 93.069HPP AND PHEP COOPERATIVEAGREEI\4ENT333.93.26NGA NotReceivedNGA NolReceived07t01t20 12t31t20$2,800 93.268Department of Health and HumanSeruices Cente6 for Disease Contol NGA Noi Receivedand PreventionNGA Not ReceivedEPIDEN4IOLOGY & LABORATORYCAPACITY FOR INFECTIOUSDISEASES (ELC)-BUtLDtNG &STRENGTHENING EPIDEIV]IOLOGY07101t19 $9,234,83507101t19 06t30t20333.93.2603t03t17 $1,201,60501/01/16 06/30/18$1,1 14 93.268333.93.2606t29/14sl,722,443 07/01/18 06/30/19$5,600 93.26803t03117 $1,672.289 01/01/1E 06/30/18$2.226 33.268333.93.2603/o3t17$575,969 01/01/18 06/30/18$6'16 93.268$61,177 93.323lmmunization Coope€tiveAgreemenlsDepartment of Heallh and HumanSeryices Cente6 for Disease Control NH231P000762and PreveniionII\4MUNIZATION GRANT ANDVACCINES FOR CHILDREN'SPROGRAM55,600 93.268lmmunization CooperataveAgreementsDepartment of Health and HumanSeryices Cenlerc for Disease Control NH231P922619and PreventionDepartmeni of Health and HumanServices CenteF for Disease Control 5NH231P000762-05-00and PreventionII\,1IV]UNIZATION GRANT ANDVACCINES FOR CHILDREN PROGRAMIIVIMUNIZATION GRANT ANDVACCINES FOR CHILDREN'SPROGRAMINIMUNIZATION GRANT ANDVACCINES FOR CHILDREN'SPROGRAIVlIMIVlUNIZATION GRANT ANDVACCINES FOR CHILDREN'SPROGRAMlmmunization CooperativeAgreementslmmunization CooperaliveAgreemenlslmmunization CoopectiveAgreementsEpidemiology and LaboratoryCapacity for lnfectious Diseases(ELC)-Building andStrengthening Epidemiology,Department of Health and HumanSetuices Cente6 for Disease Control 5NH231P000762-05-00and PreveniionDepartment of Health and HumanSeNices Centers for Disease Control 5NH231P000762-05-00and PreventionDeparlment of Heallh and HumanServices Centerc for Disease Contrcl NU50CK000515and PreventonFFY19 COVID CARES04t23120 s22,581,799 06t01t20 12t31t20Page 1 of 2
Exhibit G-12 Schedule of FederalAwardsKITTITAS COUNTY HEALTH OEPT-SVINOOIO475{I7CONTRACT CLH18249-Kittitas County Public Health DepartmentCONTRACT PERIOD: 01 |O'U2O1A-12131 I2O2ODOHFederalTotal Amt Allocation PeriodFederal Start EndChart of Accounts Prcgnm TitleBARSAMENDMENT #15Date: May 15,2020Federal AmrdAmrd Date03116120 $'t3,230,799 01t20t20 12t31t20$78,s22 93.354333.93.43o7t24t19 $1,846,00009/30/19 09/29120$60,000 93.439Contract Amt CFDA CFDA Prcgnm TitleFedeal Agency NameResponse: Coope.aliveAgreement for EmergencyResponse: Public Heallh CrisisState Physi€l Aqtivity andNutrition (SPAN)Department of Health and HumanSeryices Cente6 for Disease Contrcl NU90TP922069and PrevenlionldentificationDepadment of Health and HumanSeryicesN1J58DP006504Department of Health and HumanServicsNU58DP006504Department of Health and HumanSetui@s Health Resou@s andSefri@s Adminisi€lion804MC32578CDC COOPEMTIVE AGREEI\4ENTFOR EMERGENCY RESPONSE:PUBLIC HEALTH CRISIS RESPONSECDC.RFA-TPlE-1802Federal GEnt Amrd NameIIIATERNAL AND CHILD HEALTHSERVICES ELOCK GRANTMATERNAL AND CHILD HEALTHSERVICES BLOCK GRANTIIIATERNAL AND CHILD HEALTHSERVICESFFY2O CDC COVID-1g CRISIS RESP LHJ.TRIBEFFY,I9 PHYS ACTVW & NUTRITION PROGFFY18 PHYS ACTVTY & NUTRITION PROGFFY2O ITIGHBG LI,IJ CONTRACTSFFY19 MCHBG LTU CONTRACTSFFYIS MCHBG LHJ CONTRACTS333.93.4309/01/18$923,000 02119/19 09/29120$60,000 93.439State Physi@i Activity andNutrition (SPAN)STATE PHYSICAL ACTIVITY ANDNUTRITION-WASHINGTON (SPANWA)STATE PHYSICAL ACTIVITY ANDNUTRITION-WASHINGTON (SPANWA)333.93.9911t1q1g 52,225,977 10t01119 09t30t20333.93.9911l1q1$ $2,225,97710/01/18 09/30/19333.93.9910t20t17 $1,650,52801/01/18 09/30/18Matemal and Child Health$44,196 93.994 Setuices Block Grant to theStatesMatemal and Child Health$44,196 93.994 Setui@s Block GEnt to theStatesMatemal and Child Health$34,040 93.994 Seryices Block crant to theStatesDepartment of Health and HumanSeruices Heallh Resources andDepartment of Health and HumanSeM@s AdministEtion804MC32578804MC31524TOTAL $5U,711Page 2 of 2
Kittitas County
Review Form
Grants & Contract Agreement
Contract/G ra nt I nformation
Recommendation for Board of Health and Board of Health Review on
Financial lnformation
+4ucl
Today's Date
1.1./06/2018
Agenda Date 4 ?,o
Fund/Department
116-Public Health
Contract /Grant Agency: Con Con Amendment L5
Period Begin Date : OL/OL/2O78 Period End Date: 72/31/2020
T ot a G ra nt/Co ntra ct Am ou n t n crea se o f s 63 977 fo f a re vised m axt m u m of s 844,L92 00
Grant/Contract N umber: CFH18249
Contract/G ra nt Su m ma ry:
The Amended Consolidated Contract Adds a Statement of Work for the followingo ELC-COVID 19- Effective June1,2O2
I OICP-Promotion of lmmunizations to lmprove Vaccine Rates- Effective July L,202O
Exhibit B-15 Allocations amends and replaces Exhibit B-i.4 Allocations as follows:o lncrease of 553,927 for a revised maximum of 5944.192.00
re ,QlAjllD---t
Department Head Si Administrator Date
Kittitas County Prosecutor, Auditor, and Board of Health Review and comment
APPR
Si of Prosecutor's ce Date
Y /r, /sD?-
Signat of ditor's Office Date
Signature of Board of Health member Date
TotalAmount S State Funds $Federal Funds $
Grant/Contract Review Page L
Percentage County Funds Matching Funds S CFDA#
ln-Kind S
Explain
ls Equipment being purchased?Who owns equipment?
New Personnel being hired?Contact HR hiring - reporting requirements
Future impacts or liability to Kittitas County:
Budget Amendment Needed?
New Division Created?
Yes f, attach budgetform No tr why not
Revenue Code
B lnformation
Pass Through lnformation
Agency to Pass Through
Amount to Pass Through s
Sub-Contract Approved Date
Prosecutor Review
Has the Prosecutor reviewed this agreement?Yes No
County De rtments lmpacted
Submitted
Signature:Date:
Department:
Assignment of Trackin lnformation
Auditor Facilities Maintenance
lnformation Services Human Resource
Prosecutor Treasurer
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Reviewer Date
Grant/Contract Review Page 2