HomeMy WebLinkAboutCLH18249 Kittitas Amend 17_encrypted_KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2018 – 2021 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH18249 AMENDMENT NUMBER: 17
PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as “DOH”, and
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT, a Local Health Jurisdiction, 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: On February 29, 2020, Governor Jay Inslee issued Proclamation 20-05 declaring a State of
Emergency due to the outbreak of COVID-19. In June 2020, DOH and LHJ agreed that to support the parties’ ongoing response to
the emergency, the parties would extend the end date of the Contract rather than beginning a new three-year contract. For ease of
reference, the Contract as amended is attached and incorporated in this amendment showing the insertions, deletions, and revi sions as
follows: Section 1 Purpose and Section 2 Statements of Work. Remove reference to repea led RCW 43.70.520 and RCW 43.70.580.
Section 33 Term. Extend the Contract term for a period of one year from December 31, 2020 through December 31, 2021. Heading
on page one and footers are updated to reflect the extended contract term.
1. Exhibit A Statements of Work, attached and incorporated by this reference, are amended as follows:
Adds Statements of Work for the following programs:
Supplemental Nutrition Assistance Program-Education - Effective October 1, 2020
Amends Statements of Work for the following programs:
Division of Emergency Preparedness & Response PHEP - Effective July 1, 2020
LSPAN-Local Strategies for Physical Activity & Nutrition - Effective February 19, 2019
Maternal & Child Health Block Grant - Effective January 1, 2018
OICP CARES Enhanced Influenza Coverage Project - Effective July 1, 2020
OICP-Promotion of Immunizations to Improve Vaccination Rates - Effective July 1, 2020
Deletes Statements of Work for the following programs:
2. Exhibit B-17 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B -16 Allocations as follows:
Increase of $155,495 for a revised maximum consideration of $2,309,403.
Decrease of for a revised maximum consideration of .
No change in the maximum consideration of .
Exhibit B Allocations are attached only for informational purposes.
3. Exhibit C-14 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces Exhibit C-13.
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
upon execution of this amendment.
IN WITNESS WHEREOF, the undersigned has affixed his/her signature in execution thereof.
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
________________________________________________
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
____________________________________________
Date Date
APPROVED AS TO FORM ONLY
Assistant Attorney General
DOH CONTRACT #: CLH18249
Page 1 of 17
2018 - 2020 2021
WASHINGTON STATE
DEPARTMENT OF HEALTH
CONSOLIDATED CONTRACT
DOH CONTRACT #: CLH18249
2018-2020 2021 Consolidated Contract Page 2 of 17
Table of Contents
1. Purpose .................................................................................................................................... 3
2. Statements of Work ................................................................................................................. 3
3. Exhibits .................................................................................................................................... 3
4. Definitions ............................................................................................................................... 3
5. Funding and Billing ................................................................................................................. 4
6. Contract Management .............................................................................................................. 5
7. Access to Records .................................................................................................................... 5
8. All Writings Contained Herein ................................................................................................ 5
9. Assignment .............................................................................................................................. 5
10. Assurances ............................................................................................................................... 5
11. Confidential Information ......................................................................................................... 6
12. Ethics ....................................................................................................................................... 6
13. Debarment Certification .......................................................................................................... 6
14. Disputes ................................................................................................................................... 6
15. Equipment Purchases ............................................................................................................... 6
16. Governing Law and Venue ...................................................................................................... 7
17. Independent Capacity .............................................................................................................. 7
18. Insurance .................................................................................................................................. 7
19. Licensing, Accreditation and Registration .............................................................................. 7
20. Maintenance of Records .......................................................................................................... 7
21. Modifications and Waivers ...................................................................................................... 7
22. No Third-Party Rights Created ................................................................................................ 7
23. Nondiscrimination ................................................................................................................... 7
24. Order of Precedence ................................................................................................................ 8
25. Ownership of Material/Rights in Data ..................................................................................... 8
26. Publications .............................................................................................................................. 8
27. Responsibility for Actions ....................................................................................................... 8
28. Loss or Reduction of Funding ................................................................................................. 8
29. Severability .............................................................................................................................. 8
30. Subcontracts ............................................................................................................................. 8
31. Subrecipient ............................................................................................................................. 9
32. Survivability ............................................................................................................................ 9
33. Term ......................................................................................................................................... 9
34. Termination for Convenience .................................................................................................. 9
35. Termination for Default ........................................................................................................... 9
36. Termination Procedure ............................................................................................................ 9
Standard Federal Certifications and Assurances ........................................................................ 11
Federal Assurances – Non-Construction Programs .................................................................... 16
DOH CONTRACT #: CLH18249
2018-2020 2021 Consolidated Contract Page 3 of 17
CONSOLIDATED CONTRACT
between
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
(Referred to as “DOH”)
and
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
(Referred to as “LHJ”)
for
THE DELIVERY OF PUBLIC HEALTH SERVICES
FOR THE PERIOD OF
January 1, 2018 through December 31, 2020 2021
1. Purpose
This Contract is entered into in accordance with RCW 43.70.520, RCW 43.70.580, the general statutory powers of the
Secretary of the Department of Health (DOH), including at RCW 43.70.040, the general statutory powers of local health
jurisdictions (LHJs), including at RCW 70.05.060, RCW 70.08.020, and RCW 70.46.060, and the authority for joint or
cooperative action provided for under chapter 39.34 RCW. The purpose of this Contract is to define the parties’ joint
and cooperative relationship. The contract and all statements of work adopted under its provisions are intended to
implement applicable objectives under the Public Health Improvement Plan and to facilitate the delivery of public health
services to the people in Washington State. This Contract is the result of cooperative planning efforts between the LHJ
and DOH.
2. Statements of Work
The individual program activities, requirements, and outcomes/deliverables to be achieved by the parties under this
Contract are described in Exhibit A, Statements of Work. Each statement of work shall comply with the performance-
based criteria under RCW 43.70.580(2)(b).
The LHJ shall furnish the necessary personnel, equipment, material and/or services and otherwise do all things necessary
for or incidental to the performance of the work as set forth in Exhibit A, Statements of Work.
3. Exhibits
This Contract incorporates by reference the following Exhibits:
Exhibit A - Statements of Work
Exhibit B - Allocations
Exhibit C - Schedule of Federal Awards
4. Definitions
As used throughout this Contract and unless amended for a particular Statement of Work, the following terms shall have
the meanings set forth below:
“Budget, Accounting, and Reporting System (BARS)”: The system designed by the State Auditor's office for
collecting, consolidating, and reporting financial budgeting and accounting information from all local governmental
units.
“Client”: An agency, firm, organization, individual or other entity applying for or receiving services provided by
the LHJ under this Contract.
“Catalog of Federal Domestic Assistance (CFDA)”: The unique identifying code assigned to a federal assistance
program which identifies the awarding agency.
“Confidential Information”: Information protected from disclosure under federal or state law.
DOH CONTRACT #: CLH18249
2018-2020 2021 Consolidated Contract Page 4 of 17
“Contract Coordinator”: Each party’s designated contact for all notices required or permitted under this Contract.
“Contracting Officer”: The DOH Contracts and Procurement Office Director and his/her delegates within that
office authorized to execute this agreement on behalf of DOH.
“Contractor”: An entity that provides goods or services to DOH and others. A contractor normally operates its
business in a competitive environment, provides its goods and/or services to many different purchasers during
normal business hours, and is not subject to the compliance requirements of the federal program.
“Equipment”: When used in this Contract is defined as an article of non-expendable, tangible property other than
land, buildings, or fixtures which is used in operations and having a useful life of more than one year and an
acquisition cost of $5,000 or more or as otherwise provided in the Exhibit A, Statements of Work.
“Federal Assistance”: Assistance provided by a federal agency in the form of grants, contracts, loans, loan
guarantees, property, cooperative agreements, interest subsidies, insurance, or direct appropriations, but does not
include direct federal cash assistance to individuals.
“Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act)”: A federal act to make
information available online so the public can see how federal funds are spent.
“Fixed Assets”: Fixed assets are property and/or equipment obtained through donation, gift, purchase, capital lease,
or construction with a service life of more than one year.
“Program Contact”: Each party’s designated contact for those purposes identified in the Exhibit A, Statements of
Work.
“Subcontractor”: Any individual or group contracted with the LHJ to perform all or part of the services included
in this Contract. This term will also apply to situations where an LHJ’s subcontractor contracts with another
individual or group to perform all or part of the services included in its agreement with the LHJ.
“Subrecipient” or “Subgrantee”: A non-federal entity that receives a subaward of federal grant money or goods
directly or indirectly from DOH and makes decisions regarding who can receive what federal assistance; has its
performance measured against the objectives contained in the DOH agreement with the federal government; makes
decisions on how to operate the program to accomplish the program goals; has the obligation to comply with federal
subrecipient requirements; and/or use federal funds to carry out a program for the public purpose specified in the
authorizing statute.
5. Funding and Billing
A. DOH shall pay the LHJ for services as set forth in the Exhibit A, Statements of Work, not to exceed funding amounts
as detailed in the Contract Allocations, Exhibit B, for those services provided herein.
The LHJ will advise the Program Contact identified in the applicable Statement of Work in writing 90 calendar
days prior to the end of the funded period, or as soon as practicable thereafter, i f the LHJ anticipates not using all
Contract funding.
B. If the Exhibit A, Statement of Work, is supported by federal funds that require compliance with FFATA (the
Transparency Act), the corresponding checkbox on the statement of work will be checked.
C. Total consideration for this Contract is $79,038, or as amended.
The LHJ will submit accurate and timely billings which, for clarity and consistency, will be prepared using the form
provided and following the instructions located on the DOH website, www.doh.wa.gov.
DOH will authorize payment only upon satisfactory completion and acceptance of deliverables and for allowable
costs as outlined in the statement of work and/or budget.
DOH CONTRACT #: CLH18249
2018-2020 2021 Consolidated Contract Page 5 of 17
D. The LHJ will submit a BARS A financial report by April 15 for the prior calendar year.
6. Contract Management
Unless otherwise specified in the Contract, the following individuals are the contacts (“Contract Coordinators”) for all
notices required or permitted under this Contract:
LHJ Contract Coordinator: DOH Contract Coordinator:
Name: Candi Blackford Name: Brenda Henrikson
Title: Contracts Specialist
Mailing Address: Mailing Address:
507 N. Nanum Street, Suite 102
Ellensburg WA 98926-2886 PO Box 47905, Olympia WA 98504-7905
Physical Address: Physical Address:
Same as above 101 Israel Rd. SE, Tumwater WA 98501-5570
Phone: 509-962-7515 Fax: 509-962-7581 Phone: 360-236-3933 Fax: 360-236-2401
Email Address: Email Address:
candi.blackford@co.kittitas.wa.us brenda.henrikson@doh.wa.gov
A party may change its Contract Coordinator or its Program Contact by providing written notice to the other party.
DOH Program Contacts can be found in the Exhibit A, Statements of Work, and on the DOH website at
www.doh.wa.gov.
7. Access to Records
To the extent authorized by applicable federal and state law, the parties shall provide access to records relevant to this
Contract to each other, the Joint Legislative Audit and Review Committee, the State Auditor, and authorized federal
officials, at no additional cost. Inspections shall occur at reasonable times and upon reasonable notice.
8. All Writings Contained Herein
This Contract contains all the terms and conditions agreed upon by the parties. No other understandings, oral or otherwise,
regarding the subject matter of this Contract shall be deemed to exist or to bind any of the parties hereto. The individuals
signing this Contract certify by their signatures that they are authorized to sign this Contract on behalf of their respective
entity.
9. Assignment
Except for subcontracting as authorized in this Contract, the LHJ shall not assign or delegate, in whole or in part, this
Contract or any of its rights, duties, obligations, or responsibilities, without the prior written consent of DOH’s
Contracting Officer, which consent shall not be unreasonably withheld.
10. Assurances
The parties agree that all activity pursuant to this Contract shall be in accordance with all applicable current federal,
state and local laws, rules, and regulations.
The LHJ acknowledges its agreement to comply with federal certifications and assurances by signing and returning the
following:
1. Standard Federal Certifications and Assurances
2. Federal Assurances for Non-Construction Programs
DOH CONTRACT #: CLH18249
2018-2020 2021 Consolidated Contract Page 6 of 17
11. Confidential Information
The parties agree to comply with all state and federal statutes and regulations relating to Confidential Information. DOH
and LHJ will limit access to the Confidential Information to the fewest number of people necessary to complete the
work. Everyone having access to Confidential Information covered by this Contract must agree to protect the
confidentiality of the information.
Either party to this Contract may designate certain Confidential Information as “Confidential Information/Notice
Requested.” The designation shall be made by clearly stamping, watermarking, or otherwise marking each page of the
Confidential Information. If a third party requestor seeks information that has been marked “Confidential
Information/Notice Requested,” notice shall be given to the marking party prior to release of the information. Such
notice shall be provided to the program contact no less than five (5) business days prior to the date of disclosure, to
allow the party objecting to disclosure to seek a protective order from the proper tribunal.
DOH and LHJ agree to establish, document and maintain security practices and safeguards consistent with state and
federal laws, regulations, standards, and guidelines to prevent unauthorized access, use, or disclosure of Confidential
Information in any form. In accordance with federal and state contracting requirements, DOH may monitor, audit, or
investigate LHJ management of Confidential Information relating to this Contract. Working together, the LHJ and
DOH may use any and all tools available to track Contract related Confidential Information.
If one of the parties becomes aware of an actual or suspected breach of confidentiality, that party will promptly notify
the Contract Coordinator for the other party of the facts. The parties will work within their respective organizations to
take any steps necessary to determine the scope of the breach and to restore reasonable security to the Confidential
Information. Both parties agree to mitigate any known harmful effects of a breach in confidentiality, including notifying
affected individuals to the extent required by law. The parties will also reasonably cooperate with law enforcement as
appropriate.
12. Ethics
Both parties and their officers shall comply with all ethics laws applicable to their activities under this Contract,
including Chapters 42.23 and 42.52 RCW. If a violation occurs and is not cured within a reasonable time after notice,
the other party shall have the right to terminate this Contract. This section is expressly subject to the Disputes section
of this Contract.
13. Debarment Certification
The LHJ, by signing this Contract, certifies that the LHJ is not presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from participating in this Contract by any federal department or agency.
The LHJ also agrees to include the above requirement in all subcontracts into which it enters. The LHJ will notify DOH
of any such events that may occur during the term of the Contract.
14. Disputes
Except as otherwise provided in this contract, when a dispute arises between the parties and it cannot be resolved by
direct negotiation, the parties agree to participate in good faith in non-binding mediation. The mediator shall be chosen
by agreement of the parties. If the parties cannot agree on a mediator, the parties shall use a mediation service located
in Washington State that selects a qualified mediator for the parties. Each party shall bear its own costs for mediation
and each party shall contribute equally to the mediator’s fee, if any. The parties agree that mediation shall precede any
action in a judicial tribunal.
Nothing in this contract shall be construed to limit the parties’ choice of a mutually acceptable alternate dispute
resolution method in addition to the dispute resolution procedure outlined above.
15. Equipment Purchases
Equipment purchased by the LHJ for use by the LHJ or its subcontractors during the term of this Contract using federal
funds, in whole or in part, shall be the property of the LHJ. The use, management and disposal of the equipment must
comply with federal requirements. These requirements are found in the Office of Management and Budget’s (OMB’s)
DOH CONTRACT #: CLH18249
2018-2020 2021 Consolidated Contract Page 7 of 17
Uniform Guidance, Title 2 Code of Federal Regulations Part 200 (2 CFR 200) - Uniform Administrative Requirements,
Cost Principles, and Audit Requirements for Federal Awards, or are included in the federal funding agency’s
regulations.
16. Governing Law and Venue
The laws of the state of Washington govern this Contract. In the event of a lawsuit by the LHJ against DOH arising
under this Contract, venue shall be proper only in Thurston County, Washington. In the event of a lawsuit by DOH
against the LHJ arising under this Contract, venue shall be proper only in the county in which the LHJ is located or in
either of the two nearest judicial districts within the meaning of RCW 36.01.050.
17. Independent Capacity
The employees or agents of each party who are engaged in the performance of this Contract shall continue to be
employees or agents of that party and shall not be considered for any purpose to be employees or agents of the other
party.
18. Insurance
The LHJ certifies that it is self-insured, is a member of a risk pool, or maintains insurance coverage as required by this
Contract. Each party shall pay for losses for which it is found liable. The LHJ agrees to require all subcontractors to
maintain insurance in types and with limits as may be determined by the LHJ and/or its risk manager, unless the LHJ and
DOH agree otherwise.
19. Licensing, Accreditation and Registration
The LHJ shall comply with all applicable local, state, and federal licensing, accreditation and registration requirements
and standards, necessary for the performance of this Contract.
20. Maintenance of Records
Each party to this Contract shall maintain books, records, documents and other evidence that sufficiently and properly
reflect all direct and indirect costs expended by it. All books, records, documents, and other material relevant to this
Contract will be retained for six (6) years after expiration. If any litigation, claim or audit is started before the expiration
of the six-year period, the records shall be retained until all litigation, claims, or audit findings involving the records
have been resolved.
Each party will use reasonable security procedures and protections to assure that records and documents provided by
the other party are not erroneously disclosed to third parties. Both parties agree to continue protecting records until
such time as the information is destroyed in accordance with applicable state and federal records retention laws.
21. Modifications and Waivers
This Contract, or any term or condition, may be modified only by a written amendment signed by the DOH Contracting
Officer and the authorized representative for the LHJ. Either party may propose an amendment.
Failure or delay on the part of either party to exercise any right, power, privilege or remedy provided under this Contract
shall not constitute a waiver. No provision of this Contract may be waived by either party except in a writing signed by the
DOH Contracting Officer or the authorized representative of the LHJ.
22. No Third-Party Rights Created
This Contract, or any program hereunder, is entered into solely for the benefit of the two parties thereto and shall not
be construed as giving rise to any right, remedy or expectancy of any kind or nature on the part of any third party.
23. Nondiscrimination
During the performance of this Contract, the LHJ and DOH shall comply with all federal and state nondiscrimination laws,
regulations and policies. In the event of the LHJ’s noncompliance or refusal to comply with any nondiscrimination law,
regulation or policy, this Contract may be rescinded, canceled or terminated in whole or in part, and the LHJ may be declared
DOH CONTRACT #: CLH18249
2018-2020 2021 Consolidated Contract Page 8 of 17
ineligible for further contracts with DOH. The LHJ shall, however, be given a reasonable time in which to cure this
noncompliance. Any dispute may be resolved in accordance with the “Disputes” procedure set forth herein.
24. Order of Precedence
In the event of an inconsistency in the terms of this Contract, or between its terms and any applicable statute or rule, the
inconsistency shall be resolved by giving precedence in the following order:
Applicable state and federal statutes, and local laws, rules and regulations.
Terms and conditions of this Contract.
Statements of Work.
Any other provisions of this Contract, including other materials incorporated by reference.
25. Ownership of Material/Rights in Data
Records and other documents relevant to this Contract, in any medium, furnished by one party to this Contract to the
other party, will remain the property of the furnishing party, unless otherwise agreed. Data which is delivered under
the Contract shall be transferred to DOH with a nonexclusive, royalty-free, perpetual, irrevocable license to publish,
translate, reproduce, modify, deliver, perform, dispose of, and to authorize others to do so; provided that such license
shall be limited to the extent which the LHJ has a right to grant such a license. The LHJ shall exert all reasonable effort
to advise DOH, at the time of delivery of data furnished under this Contract, of all known or potential invasions of
privacy contained therein and of any portion of such document which was not produced in the performance of this
Contract. DOH shall receive prompt written notice of each notice or claim or copyright infringement received by the
LHJ with respect to any data delivered under this Contract. DOH shall have the right to modify or remove any restrictive
markings placed upon the data by the LHJ, provided that if DOH modifies or removes such markings without the LHJ’s
approval, it assumes all liability for doing so.
26. Publications
Any program reports, articles, and publications that result from information gathered through use of state and federal
funds must acknowledge receiving support from DOH and/or the appropriate federal agencies. Correspondingly, such
documents resulting from information gathered through use of local funds must acknowledge receipt of such local
support.
27. Responsibility for Actions
Each party to this Contract shall be solely responsible for the acts and omissions of its own officers, employees, and
agents in the performance of this Contract. Neither party to this Contract will be responsible for the acts and omissions
of entities or individuals not party to this Contract. DOH and the LHJ shall cooperate in the defense of tort lawsuits,
when possible.
28. Loss or Reduction of Funding
In the event funding from state, federal, or other sources is withdrawn, reduced, or limited in any way after the effective
date of this contract and prior to normal completion, DOH may elect to suspend or terminate the contract , in whole or
in part, under the "Termination for Convenience" clause with a ten (10) business day notice to LHJ, to the extent
possible, subject to renegotiation at DOH’s discretion under those new funding limitations and conditions.
29. Severability
If any term or condition of this Contract is held invalid, such invalidity shall not affect the validity of the other terms o r
conditions of this Contract, provided, however, that the remaining terms and conditions can still fairly be given effect.
30. Subcontracts
The LHJ may subcontract any or all of the services or other obligations specified in this Contract. The LHJ will require
the subcontractor to comply with all the applicable terms and conditions of this Contract, including all terms, conditions,
certifications and assurances. The LHJ agrees it is responsible for assuring adequate performance on the part of the
subcontractor.
DOH CONTRACT #: CLH18249
2018-2020 2021 Consolidated Contract Page 9 of 17
The parties agree that all subcontractors must be responsible for any liabilities created by their actions or omissions. In
the event DOH, LHJ, and subcontractor are found by a jury or trier of fact to be jointly and severally liable for personal
injury damages arising from any act or omission, then each entity shall be responsible for its proportionate share.
31. Subrecipient
For those activities designated as “subrecipient” on Exhibit A, Statements of Work, the LHJ must comply with
applicable federal requirements, including but not limited to OMB’s Uniform Guidance at 2 CFR 200, Subparts D
(Administrative Requirements), E (Cost Principles) and F (Audit Requirements), and program specific federal
regulations. If the LHJ expends $500,000 or more in federal awards from all sources, it is responsible for obtaining
appropriate audits. If the LHJ expends $750,000 or more in federal grants or awards from all sources, it is responsible
for obtaining the required single audit.
32. Survivability
The terms and conditions contained in this Contract, which by their sense and context are intended to survive the
expiration of the Contract, shall survive. Surviving terms include, but are not limited to: Access to Records, Confidential
Information, Disputes, Responsibility for Actions, Maintenance of Records, Ownership of Material/Rights in Data,
Subcontracts, Termination for Convenience, Termination for Default, and Termination Procedure.
33. Term
This Contract will be in effect following execution by the parties from January 1, 2018 through December 31, 2020
2021, unless terminated earlier as provided herein.
34. Termination for Convenience
Except as otherwise provided in this Contract, either party may terminate or suspend this Contract, or any program
hereunder, for convenience by providing at least thirty (30) days’ advance written notice to the other party.
If DOH elects to suspend the Contract, in whole or in part, LHJ shall stop work as of the effective date of DOH’s written
notice of suspension. During suspension, each Party will reasonably notify the other of any conditions that may affect
resumption of performance. Upon DOH’s written notice to resume performance, LHJ shall resume work unless the
LHJ provides notice to DOH that services cannot be resumed. If LHJ cannot resume performance, the Contract or
affected Exhibit A, Statement of Work, will be deemed terminated upon the date the LHJ received notice to suspend
performance.
35. Termination for Default
(a) In the event of a default by either party under this Contract, the nondefaulting party may give wr itten notice to the
defaulting party that it intends to terminate this Contract, or any program hereunder, if the default is not cured within
thirty (30) days of the date of the notice, or such longer period of time as may be reasonable under the circumstances.
If the default is not cured within that time, the nondefaulting party may then notify the defaulting party in writing
that this Contract is terminated. In the event of such termination, the nondefaulting party shall have all rights and
remedies available to it under general law.
(b) A disputed termination for default is expressly subject to the Disputes section of this Contract.
36. Termination Procedure
Upon termination DOH may require the LHJ to deliver to DOH any non-LHJ-owned equipment, data, or other property
specifically produced or acquired for the performance of such part of this Contract as has been terminated.
DOH shall pay to the LHJ the agreed upon price, if separately stated, for completed work and services accepted by
DOH. In addition DOH shall pay the amount determined by DOH’s Contracting Officer for (a) completed work and
services for which no separate price is stated, (b) partially completed work and services, (c) other property or services
which are accepted by DOH, and (d) the protection and preservation of the property. Disagreement by the LHJ with
the determination of DOH’s Contracting Officer that relates to the obligations or amounts due to the LHJ shall be
considered a dispute within the meaning of the “Disputes” clause of this Contract.
DOH CONTRACT #: CLH18249
2018-2020 2021 Consolidated Contract Page 10 of 17
DOH may withhold from any amounts due the LHJ for such completed work or services such sum as DOH’s Contracting
Officer reasonably determines to be necessary to protect DOH against potential loss or liability.
The rights and remedies of DOH provided in this section shall not be exclusive and are in addition to any other rights
and remedies provided by law or under this Contract.
After receipt of a written notice of termination, the LHJ shall:
Stop work under the Contract on the date and to the extent specified in the notice;
Place no further orders or subcontracts for materials, services, or facilities, except as necessary to complete such
portion of the work not terminated;
Assign to DOH, to the extent reasonably directed by DOH’s Contracting Officer and to the extent that the LHJ
has the legal right to do so, all of the right, title, and interest of the LHJ under the orders and subcontracts in
which case DOH has the right, at its reasonable discretion, to settle or pay any or all claims ari sing out of the
termination of such orders and subcontracts.
Settle all outstanding liabilities and all claims arising out of orders or subcontracts, with the approval or
ratification of DOH’s Contracting Officer to the extent he/she may reasonably require, which approval or
ratification shall be final for all the purposes of this clause;
Transfer title to DOH and deliver, as reasonably directed by DOH’s Contracting Officer, any property which, if
the Contract had been completed, would have been required to be furnished to DOH;
Complete performance of such part of the work not terminated by DOH’s Contracting Officer; and,
Take such action as may be necessary, or as DOH’s Contracting Officer may reasonably direct, for the protection
and preservation of the property related to this Contract which is in the possession of the LHJ, or its
subcontractors, and in which DOH has or may acquire an interest.
IN WITNESS WHEREOF, the parties have executed this Contract.
KITTITAS COUNTY PUBLIC HEALTH
DEPARTMENT
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
_____________________________________________ _______________________________________________
Signature Signature
Title: ________________________________________ Title: _________________________________________
Print Name:
_____________________________________________
Print Name:
______________________________________________
Date: _________________________________ Date: __________________________________
DOH CONTRACT #: CLH18249
2018-2020 2021 Consolidated Contract Page 11 of 17
Standard Federal Certifications and Assurances
Following are the Assurances, Certifications, and Special Conditions that apply to all federally-funded (in whole or in part)
agreements administered by the Washington State Department of Health.
CERTIFICATIONS
1. CERTIFICATION REGARDING DEBARMENT AND SUSPENSION
The undersigned (authorized official signing for the contracting organization) certifies to the best of his or her
knowledge and belief, that the contractor, defined as the primary participant in accordance with 45 CFR Part 76, and
its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
covered transactions by any Federal Department or agency;
Have not within a 3-year period preceding this contract been convicted of or had a civil judgment rendered against
them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or
performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of
Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
B. Are not presently indicted or otherwise criminally or civilly charged by a governmental entity (Federal, State, or
local) with commission of any of the offenses enumerated in paragraph (b) of this certification; and
C. Have not within a 3-year period preceding this contract had one or more public transactions (Federal, State, or
local) terminated for cause or default.
Should the contractor not be able to provide this certification, an explanation as to why should be placed after the
assurances page in the contract.
The contractor agrees by signing this contract that it will include, without modification, the clause titled Certification
Regarding Debarment, Suspension, In eligibility, and Voluntary Exclusion --Lower Tier Covered Transactions in all
lower tier covered transactions (i.e., transactions with sub- grantees and/or contractors) and in all solicitations for lower
tier covered transactions in accordance with 45 CFR Part 76.
2. CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS
The undersigned (authorized official signing for the contracting organization) certifies that the contractor will, or will
continue to, provide a drug-free workplace in accordance with 45 CFR Part 76 by:
A. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession
or use of a controlled substance is prohibited in the grantee’s workplace and specifying the actions that will be
taken against employees for violation of such prohibition;
B. Establishing an ongoing drug-free awareness program to inform employees about:
1) The Dangers of drug abuse in the workplace;
2) The contractor’s policy of maintaining a drug-free workplace;
3) Any available drug counseling, rehabilitation, and employee assistance programs; and
4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;
C. Making it a requirement that each employee to be engaged in the performance of the contract be given a copy of
the statement required by paragraph 1) above;
DOH CONTRACT #: CLH18249
2018-2020 2021 Consolidated Contract Page 12 of 17
D. Notifying the employee in the statement required by paragraph 1), above, that, as a condition of employment
under the contract, the employee will:
1) Abide by the terms of the statement; and
2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring
in the workplace no later than five calendar days after such conviction;
E. Notifying the agency in writing within ten calendar days after receiving notice under paragraph D. 2) from an
employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must
provide notice, including position title, to every contract officer or other designee on whose contract activity the
convicted employee was working, unless the Federal agency has designated a central point for the receipt of such
notices. Notice shall include the identification number(s) of each affected grant;
F. Taking one of the following actions, within 30 calendar days of receiving notice under paragraph D. 2) with
respect to any employee who is so convicted:
1) Taking appropriate personnel action against such an employee, up to and including termination, consistent
with the requirements of the Rehabilitation Act of 1973, as amended; or
2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program
approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate
agency;
G. Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs
(A), (B), (C), (D), (E), and (F).
For purposes of paragraph (E) regarding agency notification of criminal drug convictions, DOH has designated
the following central point for receipt of such notices:
Compliance and Internal Control Officer
Office of Grants Management
WA State Department of Health
PO Box 47905
Olympia, WA 98504-7905
3. CERTIFICATION REGARDING LOBBYING
Title 31, United States Code, Section 1352, entitled "Limitation on use of appropriated funds to influence certain
Federal contracting and financial transactions," generally prohibits recipients of Federal grants and cooperative
agreements from using Federal (appropriated) funds for lobbying the Executive or Legislative Branches of the Federal
Government in connection with a SPECIFIC grant or cooperative agreement. Section 1352 also requires that each
person who requests or receives a Federal grant or cooperative agreement must disclose lobbying undertaken with
non-Federal (nonappropriated) funds. These requirements apply to grants and cooperative agreements EXCEEDING
$100,000 in total costs (45 CFR Part 93).
The undersigned (authorized official signing for the contracting organization) certifies, to the best of his or her
knowledge and belief, that:
A. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person
for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer
or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any
Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal
contract, grant, loan, or cooperative agreement.
B. If any funds other than Federally appropriated funds have been paid or will be paid to any person for influencing
or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee
of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or
cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying
DOH CONTRACT #: CLH18249
2018-2020 2021 Consolidated Contract Page 13 of 17
Activities," in accordance with its instructions. (If needed, Standard Form-LLL, "Disclosure of Lobbying
Activities," its instructions, and continuation sheet are included at the end of this application form.)
C. The undersigned shall require that the language of this certification be included in the award documents for all
subcontracts at all tiers (including subcontracts, subcontracts, and contracts under grants, loans and cooperative
agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made
or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed
by Section 1352, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty
of not less than $10,000 and not more than $100,000 for each such failure.
4. CERTIFICATION REGARDING PROGRAM FRAUD CIVIL REMEDIES ACT (PFCRA)
The undersigned (authorized official signing for the contracting organization) certifies that the statements herein are
true, complete, and accurate to the best of his or her knowledge, and that he or she is aware that any false, fictitious,
or fraudulent statements or claims may subject him or her to criminal, civil, or administrative penalties. The
undersigned agrees that the contracting organization will comply with the Public Health Service terms and conditions
of award if a contract is awarded.
5. CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE
Public Law 103-227, also known as the Pro-Children Act of 1994 (Act), requires that smoking not be permitted in
any portion of any indoor facility owned or leased or contracted for by an entity and used routinely or regularly for
the provision of health, day care, early childhood development services, education or library services to children under
the age of 18, if the services are funded by Federal programs either directly or through State or local governments, by
Federal grant, contract, loan, or loan guarantee. The law also applies to children’s services that are provided in indoor
facilities that are constructed, operated, or maintained with such Federal funds. The law does not apply to children’s
services provided in private residence, portions of facilities used for inpatient drug or alcohol treatment, service
providers whose sole source of applicable Federal funds is Medicare or Medicaid, or facilities where WIC coupons
are redeemed.
Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to
$1,000 for each violation and/or the imposition of an administrative compliance order on the responsible entity.
By signing the certification, the undersigned certifies that the contracting organization will comply with the
requirements of the Act and will not allow smoking within any portion of any indoor facility used for the provision
of services for children as defined by the Act.
The contracting organization agrees that it will require that the language of this certification be included in any
subcontracts which contain provisions for children’s services and that all subrecipients shall certify accordingly.
The Public Health Services strongly encourages all recipients to provide a smoke-free workplace and promote the
non-use of tobacco products. This is consistent with the PHS mission to protect and advance the physical and mental
health of the American people.
6. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY
MATTERS - INSTRUCTIONS FOR CERTIFICATION
By signing and submitting this proposal, the prospective contractor is providi ng the certification set out below.
A. The inability of a person to provide the certification required below will not necessarily result in denial of
participation in this covered transaction. The prospective contractor shall submit an explanation of why it cannot
provide the certification set out below. The certification or explanation will be considered in connection with the
department or agency's determination whether to enter into this transaction. However, failure of the prospective
contractor to furnish a certification or an explanation shall disqualify such person from participation in this
transaction.
DOH CONTRACT #: CLH18249
2018-2020 2021 Consolidated Contract Page 14 of 17
B. The certification in this clause is a material representation of fact upon which reliance was placed when the
department or agency determined to enter into this transaction. If it is later determined that the prospective
contractor knowingly rendered an erroneous certification, in addition to other remedies available to the Federal
Government, the department or agency may terminate this transaction for cause of default.
C. The prospective contractor shall provide immediate written notice to the department or agency to whom this
contract is submitted if at any time the prospective contractor learns that its certification was erroneous when
submitted or has become erroneous by reason of changed circumstances.
D. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person,
primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the
meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You
may contact the person to whom this contract is submitted for assistance in obtaining a copy of those regulations.
E. The prospective contractor agrees by submitting this contract that, should the proposed covered transaction be
entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred,
suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless
authorized by DOH.
F. The prospective contractor further agrees by submitting this contract that it will include the clause titled
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -- Lower Tier Covered
Transaction, provided by HHS, without modification, in all lower tier covered transactions and in all solicitations
for lower tier covered transactions.
G. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier
covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered
transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency
by which it determines the eligibility of its principals. Each participant may, but is not required to, check the
Nonprocurement List (of excluded parties).
H. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to
render in good faith the certification required by this clause. The knowledge and information of a participant is
not required to exceed that which is normally possessed by a prudent person in the ordinary cour se of business
dealings.
I. Except for transactions authorized under paragraph 6. of these instructions, if a participant in a covered transaction
knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or
voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal
Government, DOH may terminate this transaction for cause or default.
7. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY
MATTERS - PRIMARY COVERED TRANSACTIONS
A. The prospective contractor certifies to the best of its knowledge and belief, that it and its principals:
1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded
from covered transactions by any Federal department or agency;
2) Have not within a three-year period preceding this contract been convicted of or had a civil judgment rendered
against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain,
or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of
Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
3) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal,
State or local) with commission of any of the offenses enumerated in paragraph 1. B. of this certification; and
4) Have not within a three-year period preceding this contract had one or more public transactions (Federal,
State or local) terminated for cause or default.
DOH CONTRACT #: CLH18249
2018-2020 2021 Consolidated Contract Page 15 of 17
B. Where the prospective contractor is unable to certify to any of the statements in this certification, such prospective
contractor shall attach an explanation to this contract.
AUTHORIZED SIGNATURE REQUIRED
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE
PLEASE PRINT OR TYPE NAME:
ORGANIZATION NAME: (if applicable) DATE
DOH CONTRACT #: CLH18249
2018-2020 2021 Consolidated Contract Page 16 of 17
Federal Assurances – Non-Construction Programs
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection
of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork
Reduction Project (0348-0040), Washington, DC 20503
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND
BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact
the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional
assurances. If such is the case, you will be notified.
As the duly authorized representative of the contractor, I certify that the contractor:
1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability
(including funds sufficient to pay the non-Federal share of project cost) to ensure proper planning, management, and
completion of the project described in this application.
2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any
authorized representative, access to and the right to examine all records, books, papers, or documents related to the
award; and will establish a proper accounting system in accordance with generally accepted accounting standards or
agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the
appearance of personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728-4763) relating to prescribed
standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of
OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of
the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin;
(b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. 1681-1683, and 1685-1686), which
prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C.
794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended
(42 U.S.C. 6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment
Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive
Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended,
relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) 523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug
abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.), as amended, relating to
nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provision s in the specific
statute(s) under which application for Federal assistance is being made; and (j) the requirements of any other
nondiscrimination statute(s) which may apply to the application.
7. Will comply, or has already complied, with the requirements of Titles II and III of the uniform Relocation Assistance
and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of
persons displaced or whose property is acquired as a result of Federal or federally assisted programs. These requirements
apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases.
DOH CONTRACT #: CLH18249
2018-2020 2021 Consolidated Contract Page 17 of 17
8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. 1501-1508 and 7324-7328) which limit
the political activities of employees whose principal employment activities are funded in whole or in part with Federal
funds.
9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C. 276a to 276a-7), the Copeland
Act (40 U.S.C. 276c and 18 U.S.C. 874) and the Contract Work Hours and Safety Standards Act (40 U.S.C.
327-333), regarding labor standards for federally assisted construction subagreements.
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the
program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and
Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of
project consistency with the approved State management program developed under the Coastal Zone Management Act
of 1972 (16 U.S.C. 1451 et seq.); (f) conformity of Federal actions to State (Clear Air) Implementation Plans under
Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. 7401 et seq.); (g) protection of underground
sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93 -523); and (h) protection
of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205).
12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 1721 et seq.) related to protecting components
or potential components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of
1966, as amended (16 U.S.C. 470), EO 11593 (identification and protection of historic properties), and the
Archaeological and Historic Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related
activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. 2131 et seq.)
pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities
supported by this award of assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.) which prohibits the use
of lead-based paint in construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audi t Act
Amendments of 1996 and OMB Uniform Guidance at 2 CFR 200, Subpart F.
18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies
governing this program.
AUTHORIZED SIGNATURE REQUIRED
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE
PLEASE PRINT OR TYPE NAME
ORGANIZATION NAME (if applicable) DATE
AMENDMENT #17
Exhibit A, Statements of Work Page 1 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2018-2021 CONSOLIDATED CONTRACT #CLH18249
EXHIBIT A - STATEMENTS OF WORK
TABLE OF CONTENTS
DOH Program Name or Title: Division of Emergency Preparedness & Response PHEP - Effective July 1, 2020 ........................................................................... 2
DOH Program Name or Title: LSPAN-Local Strategies for Physical Activity & Nutrition - Effective February 19, 2019 ............................................................ 11
DOH Program Name or Title: Maternal & Child Health Block Grant - Effective January 1, 2018 ................................................................................................. 19
DOH Program Name or Title: OICP CARES Enhanced Influenza Coverage Project - Effective July 1, 2020 ............................................................................... 25
DOH Program Name or Title: OICP-Promotion of Immunizations to Improve Vaccination Rates - Effective July 1, 2020 .......................................................... 27
DOH Program Name or Title: Supplemental Nutrition Assistance Program-Education - Effective October 1, 2020 ...................................................................... 29
AMENDMENT #17
Exhibit A, Statements of Work Page 2 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Exhibit A
Statement of Work
Contract Term: 2018-2021
DOH Program Name or Title: Division of Emergency Preparedness & Response
PHEP - Effective July 1, 2020
Local Health Jurisdiction Name: Kittitas County Public Health Department
Contract Number: CLH18249
SOW Type: Revision Revision # (for this SOW) 1 Funding Source
Federal Subrecipient
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price Period of Performance: July 1, 2020 through June 30, 2021
Statement of Work Purpose: The purpose of this statement of work is to establish funding and tasks to support and sustain LHJ pu blic health emergency preparedness as part of
statewide public health emergency preparedness and response.
Revision Purpose: The purpose of this revision is to extend the period of performance, add the remainder of the annual allocation, ad d an end-of-year report, revise the budget
due date, add a training and exercise task, and remove activities no longer required.
Chart of Accounts Program Name or Title CFDA # BARS
Revenue
Code
Master
Index
Code
Funding
(LHJ Use
Start Date
Period
Only)
End Date
Current
Consideration
Change
Increase (+)
Total
Consideration
FFY20 PHEP BP2 LHJ Funding 93.069 333.93.06 31102280 07/01/20 06/30/21 29,480 19,653 49,133
TOTALS 29,480 19,653 49,133
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time
Frame
Payment
Information and/or
Amount
1 Across Domains and Capabilities
Complete reporting templates as requested by
DOH to comply with program and federal grant
requirements, including mid -year and end-of-year
reports.
Mid-year report on template
provided by DOH.
End-of-year report on template
provided by DOH.
Additional reporting may be
required if federal requirements
change.
December 31, 2020
June 30, 2021
Reimbursement for
actual costs not to
exceed total funding
consideration amount.
2 Across Domains and Capabilities
Participate in an evaluation of LHJ response
capabilities, upon request from DOH.
DOH will maintain documentation
of evaluation participation.
Upon request.
AMENDMENT #17
Exhibit A, Statements of Work Page 3 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time
Frame
Payment
Information and/or
Amount
3 Across Domains and Capabilities
Develop a budget demonstrating how the LHJ
plans to spend funds during this period of
performance, using a budget template provided by
DOH.
Note: 20% of the LHJ’s annual allocation will be
withheld until this requirement is met. Failure to
meet this requirement may result in DOH
redirecting funds from the LHJ.
Budget, using template provided
by DOH.
September 1, 2020
Upon request from
DOH.
4 Across Domains and Capabilities
Review and provide input to DOH on public health
emergency preparedness plans developed by DOH,
upon request from DOH.
Mid-year report on template
provided by DOH.
End-of-year report on template
provided by DOH.
Input provided to DOH upon
request from DOH.
December 31, 2020
June 30, 2021
5 Domain 1 Community Resilience
Capability 1 Community Preparedness
Participate in emergency preparedness events (for
example, trainings, meetings, conference calls, and
conferences) to advance LHJ, regional, or
statewide public health preparedness.
Mid-year report on template
provided by DOH.
End-of-year report on template
provided by DOH.
Documentation of training
available upon request.
December 31, 2020
June 30, 2021
6 Domain 2 Incident Management
Capability 3 Emergency Operations Coordination -
Training & Exercise
Based on availability of training, participate in at
least one Foundational Public Health Emergency
Preparedness Training provided by region, DOH,
DOH-contracted partner, or DOH-approved trainer
in person or via webinar.
Notes:
For some LHJs this training won’t be available
until the next Statement of Work period,
January 1 – June 30, 2021. DOH will work
Mid-year report on template
provided by DOH.
End-of-year report on template
provided by DOH.
December 31, 2020
June 30, 2021
AMENDMENT #17
Exhibit A, Statements of Work Page 4 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time
Frame
Payment
Information and/or
Amount
with regions and LHJs to customize and
schedule training(s).
This is one or more specific trainings
coordinated by DOH. DOH will work with
LHJ to implement.
Participation in an activation, exercise or real-
world event may be considered additional
training, but does not take the place of the
requirement to participate in at least one
training as described above.
7 Domain 2 Incident Management
Capability 3 Emergency Operations Coordination -
Training & Exercise
Gather and submit data for LHJ performance
measure (PM) 2: Percent of public health and
medical responders who are trained on their role
during a public health response.
Note: DOH will provide additional guidance about
submitting performance measure data.
LHJ performance measure data
(PM 2)
October 30, 2020
8 Domain 2 Incident Management
Capability 3 Emergency Operations Coordination -
Training & Exercise
8.1 Review LHJ public health preparedness and
response capabilities and identify gaps, priorities,
and training needs.
8.2 Provide input to Regional Emergency
Response Coordinators (RERCs) for Regional
Training & Exercise Plan and Training & Exercise
Planning Workshop Guide.
8.3 Participate in Integrated Preparedness
Planning Workshop unless cancelled.
Note: LHJ may opt to develop, update and
maintain a local Training & Exercise Plan. They
still need to participate in regional process
described above.
LERCs & RERCs -
Mid-year report on template
provided by DOH.
End-of-year report on template
provided by DOH.
8.2 Input into Regional Training &
Exercise Plan and Training &
Exercise Planning Workshop
Guide provided to RERCs.
December 31, 2020
June 30, 2021
8.2 As requested by
RERCs.
8.3 As requested by
DOH.
AMENDMENT #17
Exhibit A, Statements of Work Page 5 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time
Frame
Payment
Information and/or
Amount
9 Domain 2 Incident Management
Capability 3 Emergency Operations Coordination
Gather and submit data for LHJ performance
measure 3: Percent of Corrective Action Plan items
completed by due date.
Notes:
Develop corrective action plans following the
Homeland Security Exercise and Evaluation
Program (HSEEP).
DOH will provide additional guidance about
submitting performance measure data.
LHJ performance measure data
(PM 3)
October 30, 2020
10 Domain 2 Incident Management
Capability 3 Emergency Operations Coordination
Gather and submit data for LHJ performance
measure 1: Amount of time (in minutes) to
mobilize a public health and medical response.
Notes:
“Mobilize a response” is defined as the first
verbal briefing of the response team from the
initial notification to the public health
responders in the area.
The target is to mobilize a response within 45
minutes.
DOH will provide additional guidance about
submitting performance measure data.
LHJ performance measure data
(PM 1)
October 30, 2020
11 Domain 2 Incident Management
Capability 3 Emergency Operations Coordination
11.1 Provide immediate notification to DOH Duty
Officer at 360-888-0838 or hanalert@doh.wa.gov
for all response incidents involving use of
emergency response plans and/or incident
command structures.
Mid-year report on template
provided by DOH. Indicate that
this was done or that no response
incident occurred.
End-of-year report on template
provided by DOH. Indicate that
this was done or that no response
incident occurred.
December 31, 2020
June 30, 2021
AMENDMENT #17
Exhibit A, Statements of Work Page 6 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time
Frame
Payment
Information and/or
Amount
11.2 Produce and provide situation reports (sitreps)
documenting LHJ activity during all incidents.
Sitrep may be developed by the LHJ or another
jurisdiction that includes input from LHJ.
11.1 Notification to DOH Duty
Officer within 60 minutes of
activation.
11.2 Sitreps submitted to DOH
Duty Officer
12 Domain 3 Information Management
Capability 4 Emergency Public Information and
Warning - Communication
12.1 Participate in Monthly Public Health
Communicator Call/Webinar by joining
call/webinar and/or following information on
Basecamp.
12.2 Participate in at least one risk communication
drill offered by DOH between July 1, 2020 and
June 30, 2021. Drill will occur via webinar, phone
and email. DOH will offer one in July 1 –
December 31, 2020 and one drill between January
31 – June 30, 2021.
12.3 Conduct a hot wash evaluating LHJ
participation in the drill.
12.4 Identifying and implementing communication
strategies in real world incident will satisfy need to
participate in drill. Conduct a hot wash or After
Action Review (AAR) evaluating LHJ
participation in communication strategies during
the incident. If, the real world event response is
ongoing, LHJ may opt to conduct a hot wash or
AAR evaluating communication strategies to date,
OR include a summary of communication activities
in mid-year and/or end-of year reports and one
sample of communication.
Note: Participation in a real world event may meet
the requirement for 12.2, 12.2 and 12.4.
Mid-year report on template
provided by DOH.
End-of-year report on template
provided by DOH.
12.3 and 12.4 Hotwash or After
Action Review (AAR) OR
summary of communication
activities and one sample.
December 31, 2020
June 30, 2021
AMENDMENT #17
Exhibit A, Statements of Work Page 7 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time
Frame
Payment
Information and/or
Amount
13 Domain 3 Information Management
Capability 4 Emergency Public Information and
Warning
Gather and submit data for LHJ performance
measure 7: Amount of time to identify and
implement communication strategies during a
response or exercise.
Notes:
The target is within the first six hours.
DOH will provide additional guidance about
submitting performance measure data.
LHJ performance measure data
(PM 7)
October 30, 2020
14 Domain 3 Information Management
Capability 6 Information Sharing
14.1 Maintain Washington Secure Electronic
Communications, Urgent Response and Exchange
System (WASECURES) as primary notification
system.
14.2 Participate in DOH-led notification drills.
14.3 Conduct at least one LHJ drill using LHJ-
preferred staff notification system.
Notes:
Registered users must log in quarterly at a
minimum.
DOH will provide technical assistance to LHJs
on using WASECURES.
LHJ may choose to use another notification
system in addition to WASECURES to alert
staff during incidents.
14.3 doesn’t need to be completed until
June 30, 2021. LHJs may begin work in this
Statement of Work period, or may opt to do all
the work in the next Statement of Work period.
DOH tracks data for LHJ Performance
Measure 6: Percent of successful WASECURES
Mid-year report on template
provided by DOH.
End-of-year report on template
provided by DOH.
December 31, 2020
June 30, 2021
AMENDMENT #17
Exhibit A, Statements of Work Page 8 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time
Frame
Payment
Information and/or
Amount
alerts (high or medium level) confirmed within
60 minutes of receipt by LHJ staff.
15 Domain 3 Information Management
Capability 6 Information Sharing
Provide Essential Elements of Information (EEIs)
during incident response upon request from DOH.
Note: DOH will request specific data elements
from the LHJ during an incident response, as
needed to inform decision making by DOH and
state leaders, as well as federal partners when
requested.
Provide EEIs upon request.
Note in the mid-year and end-of-
year reports that EEIs were
provided or none were requested.
Upon request.
December 31, 2020
June 30, 2021
16 Domain 4 Countermeasures and Mitigation
Capability 8 Medical Countermeasures Dispensing
Capability 9 Medical Countermeasures
Management and Distribution
Update and maintain Medical Countermeasure
(MCM) Plans for LHJ and/or Region.
Notes:
MCM plans include number of local
distribution sites and number for which a
detailed point-to-point distribution plan from
RSS to distribution site has been jointly
confirmed by LHJ and DOH. (LHJ PM 4)
MCM plans include number of local points of
dispensing (PODs) and number for which a
detailed point-to-point distribution plan from
local distribution site to dispensing site has been
jointly confirmed by LHJ and POD operator
(nursing home, local agency, public POD, and
independent pharmacy). (LHJ PM 5)
LHJs are not required to maintain a hub. LHJs
may partner with other organizations to
centralize distribution. If LHJs opt to maintain a
hub, this should be included in the MCM plan.
DOH will provide technical assistance to LHJs
on core elements of an MCM plan.
Report progress and/or plans in
mid-year report on template
provided by DOH.
End-of-year report on template
provided by DOH.
If there is a regional plan, provide
input to the RERC upon request.
Updated MCM plans will be due
June 30, 2021.
December 31, 2020
June 30, 2021
AMENDMENT #17
Exhibit A, Statements of Work Page 9 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time
Frame
Payment
Information and/or
Amount
LHJ Performance Measure data will be due
October 30, 2020. DOH will gather data for
PMs 4 and 5.
17 Domain 5 Surge Management
Capability 10 Medical Surge
Engagement with regional Health Care Coalition
(HCC)
Participate in:
- At least one regional HCC meeting, in
person or virtually.
- The information sharing process during
incidents.
- At least one planning process or exercise
conducted to inform on the roles and
responsibilities of public health.
- Reviewing HCC plans for alignment with
local ESF8 plans.
Note: This task doesn’t need to be completed until
June 30, 2021. LHJs may begin work in this
Statement of Work period, or may opt to do all the
work in the next Statement of Work period.
Mid-year report on template
provided by DOH.
End-of-year report on template
provided by DOH.
December 31, 2020
June 30, 2021
18 Domain 5 Surge Management
Capability 10 Medical Surge
Gather and submit data for LHJ performance
measure 8: Percent of Critical Healthcare Facilities
whose functional status can be assessed by the
local health jurisdiction in an emergency.
Notes:
“Critical Healthcare Facilities” are hospitals,
skilled nursing facilities, blood centers, and
dialysis centers.
DOH will provide additional guidance about
submitting performance measure data.
LHJ performance measure data
(PM 8)
October 30, 2020
AMENDMENT #17
Exhibit A, Statements of Work Page 10 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
*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 contr ibute to meeting a
Standard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measure s that may apply can be found at:
http://www.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf
Program Specific Requirements/Narrative
Any subcontract/s must be approved by DOH prior to executing the contract/s.
Deliverables are to be submitted to the ConCon deliverables mailbox at concondeliverables@doh.wa.gov, unless otherwise specified.
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 Trans parency 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 s pent.
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 USASpending.gov by DOH as required by P.L. 109-282.
Restrictions on Funds (what funds can be used for which activities, not direct payments, etc)
Please reference the Code of Federal Regulations:
https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=58ffddb5363a27f26e9d12ccec462549&ty=HTML&h=L&mc=true&r=PART&n=pt2.1.200#se2.1.200_1439
DOH Program Contact
Tory Henderson, Contracts and Finance Specialist
Division of Emergency Preparedness and Response
Department of Health
P O Box 47960, Olympia, WA 98504 -7960
Desk 360-236-4596 / Mobile 360-789-7262
tory.henderson@doh.wa.gov
AMENDMENT #17
Exhibit A, Statements of Work Page 11 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Exhibit A
Statement of Work
Contract Term: 2018-2021
DOH Program Name or Title: LSPAN-Local Strategies for Physical Activity &
Nutrition - Effective February 19, 2019
Local Health Jurisdiction Name: Kittitas County Public Health Department
Contract Number: CLH18249
SOW Type: Revision Revision # (for this SOW) 3 Funding Source
Federal Subrecipient
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price Period of Performance: February 19, 2019 through September 29, 2021
Statement of Work Purpose: The purpose of this statement of work is to establish funding for Local Strategies for Physical Activity and Nutrition (LSPAN ), a project of the
State Physical Activity and Nutrition Program (SPAN).
Revision Purpose: The purpose of this revision is to extend the period of performance from September 29, 2020 to September 29, 2021 and add funding and due dates for
Year 3-FFY20 activities.
Chart of Accounts Program Name or Title CFDA # BARS
Revenue
Code
Master
Index
Code
Funding
(LHJ Use
Start Date
Period
Only)
End Date
Current
Consideration
Change
Increase (+)
Total
Consideration
FFY18 PHYS ACTVTY & NUTRITION PROG 93.439 333.93.43 77440248 02/19/19 09/29/20 60,000 0 60,000
FFY19 PHYS ACTVTY & NUTRITION PROG 93.439 333.93.43 77440239 09/30/19 09/29/20 60,000 0 60,000
FFY20 PHYS ACTVTY & NUTRITION PROG 93.439 333.93.43 77440240 09/30/20 09/29/21 0 60,000 60,000
TOTALS 120,000 60,000 180,000
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information
and/or Amount
1a PROGRAM ADMINISTRATION:
Participate in calls, at a minimum of once
every month, with DOH contract manager.
Dates and time for calls are mutually agreed
upon between DOH and Kittitas County
Public Health Department (KCPHD).
Designated KCPHD staff
will participate in contract
management calls.
February 19, 2019-September 29, 2020
2021
Reimbursement
for actual costs,
not to exceed
total contract
funding. See
Program Specific
Requirements
1b PROGRAM ADMINISTRATION:
Participate in DOH-sponsored LSPAN
related quarterly conference calls and/or
webinars, including up to one (1) in-person
meeting.
Designated KCPHD staff
will participate in calls,
webinars, and meetings.
February 19, 2019-September 29, 2020
2021
Reimbursement
for actual costs,
not to exceed
total contract
funding. See
AMENDMENT #17
Exhibit A, Statements of Work Page 12 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information
and/or Amount
Program Specific
Requirements
1c PROGRAM ADMINISTRATION:
Perform administrative duties related to
LSPAN.
Quarterly progress reports to
DOH via SharePoint site or
email
Year 1-FFY18:
April 15, 2019 (covering
February 19, 2019-March 30, 2019)
July 15, 2019 (covering
March 31, 2019-June 29, 2019)
October 15, 2019 (covering
June 30, 2019-September 29, 2019)
Year 2-FFY19:
January 15, 2020 (covering
September 30, 2019-December 30,
2019)
April 15, 2020 (covering
December 31, 2019-March 30, 2020)
July 15, 2020 (covering
March 31, 2020-June 29, 2020)
October 15, 2020 (covering
June 30, 2020- September 29, 2020)
Year 3-FFY20:
January 15, 2021 (covering
September 30, 2020-December 30,
2020)
April 15, 2021 (covering
December 31, 2020-March 30, 2021)
July 15, 2021 (covering
March 31, 2021-June 29, 2021)
October 15, 2021 (covering
June 30, 2021- September 29, 2021)
Reimbursement
for actual costs,
not to exceed
total contract
funding. See
Program Specific
Requirements
AMENDMENT #17
Exhibit A, Statements of Work Page 13 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information
and/or Amount
2a PROGRAM IMPLEMENTATION:
Finalize Work Plan and Budget Workbook
using DOH-provided templates.
Submit Work Plan to DOH
contract manager via email
Draft due:
Year 1-FFY18: March 15, 2019
Year 2-FFY19: July 3, 2020
Year 3-FFY20: March 26,2021
Final due:
Year 1-FFY18: March 29, 2019
Year 2-FFY19: July 10, 2020
Year 3 – FFY20: July 9, 2021
Reimbursement
for actual costs,
not to exceed
total contract
funding. See
Program Specific
Requirements
2b PROGRAM IMPLEMENTATION:
Implement finalized community work plan
focused on LSPAN that include:
- Addressing at least two (2) state
strategies required by this grant funding.
- Achieving policy, systems, or
environmental changes consistent with
the strategies.
- Identifying and reaching populations with
health disparities.
Quarterly progress reports to
DOH via SharePoint site or
email
Year 1-FFY18:
April 15, 2019 (covering
February 19, 2019-March 30, 2019)
October 15, 2019 (covering
June 30, 2019-September 29, 2019)
Year 2-FFY19:
January 15, 2020 (covering
September 30, 2019-December 30,
2019)
April 15, 2020 (covering
December 31, 2019-March 30, 2020)
July 15, 2020 (covering
March 31, 2020-June 29, 2020)
October 15, 2020 (covering
June 30, 2020- September 29, 2020)
Year 3-FFY20:
January 15, 2021 (covering
September 30, 2020-December 30,
2020)
April 15, 2021 (covering
December 31, 2020-March 30, 2021)
July 15, 2021 (covering
March 31, 2021-June 29, 2021)
Reimbursement
for actual costs,
not to exceed
total contract
funding. See
Program Specific
Requirements
AMENDMENT #17
Exhibit A, Statements of Work Page 14 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information
and/or Amount
October 15, 2021 (covering
June 30, 2021- September 29, 2021)
2c PROGRAM IMPLEMENTATION:
Report quarterly expenditures using
DOH-provided template.
Report quarterly expenditures
using DOH-provided
template.
Year 1-FFY18:
April 15, 2019 (covering
February 19, 2019-March 30, 2019)
July 15, 2019 (covering
March 31, 2019-June 29, 2019)
October 15, 2019 (covering
June 30, 2019-September 29, 2019)
Year 2-FFY19:
January 15, 2020 (covering
September 30, 2019-December 30,
2019)
April 15, 2020 (covering
December 31, 2019-March 30, 2020)
July 15, 2020 (covering
March 31, 2020-June 29, 2020)
October 15, 2020 (covering
June 30, 2020- September 29, 2020)
Year 3-FFY20:
January 15, 2021 (covering
September 30, 2020-December 30,
2020)
April 15, 2021 (covering
December 31, 2020-March 30, 2021)
July 15, 2021 (covering
March 31, 2021-June 29, 2021)
October 15, 2021 (covering
June 30, 2021- September 29, 2021)
Reimbursement
for actual costs,
not to exceed
total contract
funding. See
Program Specific
Requirements
AMENDMENT #17
Exhibit A, Statements of Work Page 15 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information
and/or Amount
3 PROGRAM EVALUATION:
Participate in performance measure data
collection and program evaluation activities
in collaboration with DOH.
Quarterly progress reports to
DOH via SharePoint site or
email
Year 1-FFY18:
April 15, 2019 (covering
February 19, 2019-March 30, 2019)
July 15, 2019 (covering
March 31, 2019-June 29, 2019)
October 15, 2019 (covering
June 30, 2019-September 29, 2019)
Year 2-FFY19:
January 15, 2020 (covering
September 30, 2019-December 30,
2019)
April 15, 2020 (covering
December 31, 2019-March 30, 2020)
July 15, 2020 (covering
March 31, 2020-June 29, 2020)
October 15, 2020 (covering
June 30, 2020- September 29, 2020)
Year 3-FFY20:
January 15, 2021 (covering
September 30, 2020-December 30,
2020)
April 15, 2021 (covering
December 31, 2020-March 30, 2021)
July 15, 2021 (covering
March 31, 2021-June 29, 2021)
October 15, 2021 (covering
June 30, 2021- September 29, 2021)
Reimbursement
for actual costs,
not to exceed
total contract
funding.
AMENDMENT #17
Exhibit A, Statements of Work Page 16 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information
and/or Amount
4 PROGRAM COMMUNICATION:
Inform partners and public about program
successes and related best practices,
including social media posts and publication.
Write a success story related to LSPAN
projects.
Provide copies of any
relevant communication
products with quarterly
progress reports to DOH via
SharePoint site or email
One success story using
DOH-provided template
Year 2-FFY19:
January 15, 2020 (covering
September 30, 2019-December 30,
2019)
April 15, 2020 (covering
December 31, 2019-March 30, 2020)
July 15, 2020 (covering
March 31, 2020-June 29, 2020)
October 15, 2020 (covering
June 30, 2020- September 29, 2020)
Year 3-FFY20:
January 15, 2021 (covering
September 30, 2020-December 30,
2020)
April 15, 2021 (covering
December 31, 2020-March 30, 2021)
July 15, 2021 (covering
March 31, 2021-June 29, 2021)
October 15, 2021 (covering
June 30, 2021- September 29, 2021)
Year 2-FFY19:
Draft due by August 30, 2020
Final due by October 15, 2020
Year 3-FFY20:
Draft due: June 30, 2021
Final due: July 30, 2021
Reimbursement
for actual costs,
not to exceed
total contract
funding.
AMENDMENT #17
Exhibit A, Statements of Work Page 17 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
*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 app ly can be found at:
http://www.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf
Program Specific Requirements/Narrative
The Local Strategies for Physical Activity and Nutrition (LSPAN) project is providing funds to Kittitas County Public Health Department to implemen t policy, systems and
environmental changes at the community level to enact healthy nutrition guidelines and support breastfeeding -friendly environments. These changes must support the health of
priority populations who experience health disparities. LSPAN is part of DOH’s State Physical Activity and Nutrition -Washington (SPANWA) Program. Funding for SPANWA
is through a cooperative agreement awarded to DOH from the Centers for Disease Control and Prevention’s (CDC) DP18-1807: State Physical Activity and Nutrition Program
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 Trans parency 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 Univers al Numbering System (DUNS®) number.
Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. 109-282.
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 Dise ase Control and Prevention (CDC), with a copy to the
Health and Human Services (HHS) Office of Inspector General (OIG), all information related to violations of federal criminal law involving fraud, bribery, or gratuity violations
potentially affecting the federal award. Subrecipients must disclose, in a timely manner in writing to the prime recipi ent (pass through entity) and the HHS OIG, all information
related to violations of federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the fede ral award. Disclosures must be sent in writing to the CDC
and to the HHS OIG at the following addresses:
CDC, Office of Grants Services, Romero Stokes, Grants Management Officer/Specialist, Centers for Disease Control and Preventi on Chronic Disease and Birth Defects Services
Branch, 2920 Brandywine Road, Mailstop E-09, Atlanta, Georgia 30341, Email: lnj0@cdc.gov (Include “Mandatory Grant Disclosures” in subject line)
AND
U.S. Department of Health and Human Services, Office of the Inspector General, ATTN: Mandatory Grant Disclosures, Intake Coordinator, 330 Independence Avenue SW, Cohen
Building, Room 5527, Washington, DC 20201, Fax: (202) 205 -0604 (Include “Mandatory Grant Disclosures” in subject line) or
Email: MandatoryGranteeDisclosures@oig.hhs.gov
Restrictions on Funds (what funds can be used for which activities, not direct payments, etc)
Only DOH-approved budget expenditures will be reimbursed.
Subrecipients may not use funds to purchase furniture or equipment.
Funds cannot be spent on capital projects to support built environment changes.
Reimbursement of pre-award costs generally is not allowed, unless DOH provides written approval to the subrecipient.
The direct and primary recipient in a cooperative agreement program mu st perform a substantial role in carrying out project outcomes and not merely serve as a conduit for an
award to another party or provider who is ineligible.
AMENDMENT #17
Exhibit A, Statements of Work Page 18 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Monitoring Visits (frequency, type)
In-person site visits at least once a year
Special Billing Requirements
Must use the budget workbook supplied by the program
DOH Program Contact
Chris Zipperer, Physical Activity Coordinator
Washington State Department of Health
PO Box 47848
Olympia, WA 98504
360-236-3614 (desk) / chris.zipperer@doh.wa.gov
AMENDMENT #17
Exhibit A, Statements of Work Page 19 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Exhibit A
Statement of Work
Contract Term: 2018-2021
DOH Program Name or Title: Maternal & Child Health Block Grant -
Effective January 1, 2018
Local Health Jurisdiction Name: Kittitas County Public Health Department
Contract Number: CLH18249
SOW Type: Revision Revision # (for this SOW) 5 Funding Source
Federal Subrecipient
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price Period of Performance: January 1, 2018 through September 30, 2021
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 provide additional funding, add activities and deliverable due dates, and extend the perio d of performance and funding from
September 30, 2020 to September 30, 2021 for continuation of MCHBG -related activities.
Chart of Accounts Program Name or Title CFDA # BARS
Revenue
Code
Master
Index
Code
Funding
(LHJ Use
Start Date
Period
Only)
End Date
Current
Consideration
Change
Increase (+)
Total
Consideration
FFY18 MCHBG LHJ CONTRACTS 93.994 333.93.99 78120281 01/01/18 09/30/18 34,040 0 34,040
FFY19 MCHBG LHJ CONTRACTS 93.994 333.93.99 78120291 10/01/18 09/30/19 44,196 0 44,196
FFY20 MCHBG LHJ CONTRACTS 93.994 333.93.99 78120292 10/01/19 09/30/20 44,196 0 44,196
FFY21 MCHBG LHJ CONTRACTS 93.994 333.93.99 78120293 10/01/20 09/30/21 0 44,196 44,196
TOTALS 122,432 44,196 166,628
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
Maternal and Child Health Block Grant (MCHBG) Administration
1a Participate in calls, at a minimum of every
quarter, with DOH contract manager. Dates and
time for calls are mutually agreed upon between
DOH and LHJ
Designated LHJ staff will participate
in contract management calls.
September 30, 2018
September 30, 2019
September 30, 2020
Reimbursement for
actual costs, not to
exceed total funding
consideration.
Action Plan and
Progress Reports
must only reflect
1b Report actual expenditures for October 1, 2017
through March 31, 2018
Submit actual expenditures using the
MCHBG Budget Workbook to DOH
contract manager
May 26, 2018
AMENDMENT #17
Exhibit A, Statements of Work Page 20 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
1c Develop 2018-2019 MCHBG Budget Workbook
for October 1, 2018 through September 30, 2019
using DOH provided template.
Submit MCHBG Budget Workbook
to DOH contract manager
September 5, 2018 activities paid for
with funds provided
in this statement of
work for the
specified funding
period.
See Program
Specific
Requirements and
Special Billing
Requirements.
1d Report actual expenditures for October 1, 2018
through March 31, 2019
Submit actual expenditures using the
MCHBG Budget Workbook to DOH
contract manager.
May 24, 2019
1e Develop 2019-2020 MCHBG Budget Workbook
for October 1, 2019 through September 30, 2020
using DOH provided template.
Submit MCHBG Budget Workbook
to DOH contract manager
September 5, 2019
1f Report actual expenditures for October 1, 2017
through September 30, 2018
Submit actual expenditures using the
MCHBG Budget Workbook to DOH
contract manager.
November 30, 2018
1g Participate in DOH sponsored MCHBG fall
regional meeting.
Designated LHJ staff will attend
regional meeting.
September 30, 2020
1h Report actual expenditures for October 1, 2018
through September 30, 2019
Submit actual expenditures using the
MCHBG Budget Workbook to DOH
contract manager.
December 6, 2019
1i Develop 2020-2021 MCHBG Budget Workbook
for October 1, 2020 through September 30, 2021
using DOH provided template.
Submit MCHBG Budget Workbook
to DOH contract manager
September 6, 2020
1j Report actual expenditures for the six month
period from October 1, 2019 through March 31,
2020
Submit actual expenditures using the
MCHBG Budget Workbook to DOH
contract manager.
May 22, 2020
AMENDMENT #17
Exhibit A, Statements of Work Page 21 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
1k Report actual expenditures for October 1, 2019
through September 30, 2020
Submit actual expenditures using the
MCHBG Budget Workbook to DOH
contract manager
December 4, 2020
1l Report actual expenditures for the six month
period from October 1, 2020 through March 31,
2021.
Submit actual expenditures using the
MCHBG Budget Workbook to DOH
contract manager.
May 21, 2021
1m Develop 2021-2022 MCHBG Budget Workbook
for October 1, 2021 through September 30, 2022
using DOH provided template.
Submit MCHBG Budget Workbook
to DOH contract manager
September 10, 2021
MCHBG Assessment and Evaluation
2a Participate in project evaluation activities
developed and coordinated by DOH, as
requested.
Documentation using report
template provided by DOH
September 30, 2018
September 30, 2019
September 30, 2020
September 30, 2021
Reimbursement for
actual costs, not to
exceed total funding
consideration.
See Program
Specific
Requirements and
Special Billing
Requirements.
2b Report program level strategy measure data
(CSHCN, UDS, ACEs).
Documentation using report
template provided by DOH
January 15, 2018
April 15, 2018
July 15, 2018
October 15, 2018
2c Conduct a Maternal and Child Health (MCH)
Needs Assessment.
Submit Needs Assessment
documentation to DOH contract
manager using templates provided
by DOH
May 24, 2019
2d Explore health equity approaches to maternal and
child health and develop implementation plan
Include health equity plan in 2020-
2021 MCHBG Action Plan using
DOH- provided template.
Draft August 16, 2020
Final September 6, 2020
MCHBG Implementation
3a Develop 2018-2019 MCHBG Action Plan for
October 1, 2018 through September 30, 2019
using DOH-provided template.
Submit MCHBG Action Plan to
DOH contract manager
Draft August 17, 2018
Final- September 5,
2018
Reimbursement for
actual costs, not to
exceed total funding
consideration.
Action Plan and
Progress Reports
3b Report activities and outcomes of 2017-2018
MCHBG Action Plan using DOH- provided
template.
Submit Action Plan monthly reports
to DOH contract manager
Monthly, on or before
the 15th of the following
month
AMENDMENT #17
Exhibit A, Statements of Work Page 22 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
3c Develop 2019-2020 MCHBG Action Plan for
October 1, 2019 through September 30, 2020
using DOH-provided template.
Submit MCHBG Action Plan to
DOH contract manager
Draft August 17, 2019
Final- September 5,
2019
must only reflect
activities paid for
with funds provided
in this statement of
work for the
specified funding
period.
See Program
Specific
Requirements and
Special Billing
Requirements.
3d Report activities and outcomes of 2018-2019
MCHBG Action Plan using DOH- provided
template.
Submit Action Plan monthly reports
to DOH contract manager
Monthly, on or before
the 15th of the following
month
3e Develop 2020-2021 MCHBG Action Plan for
October 1, 2020 through September 30, 2021
using DOH-provided template.
Submit MCHBG Action Plan to
DOH contract manager
Draft August 16, 2020
Final September 6, 2020
3f Report activities and outcomes of 2019-2020
MCHBG Action Plan using DOH- provided
template.
Submit Action Plan monthly reports
to DOH contract manager
Monthly, on or before
the 15th of the following
month
3g Report activities and outcomes of 2020-21
MCHBG Action Plan using DOH-Provided
template.
Submit Action Plan reports to DOH
contract manager
October 15, 2020
January 15, 2021
April 15, 2021
July 15, 2021
3h Develop 2021-2022 MCHBG Action Plan for
October 1, 2021 through September 30, 2022
using DOH-Provided template.
Submit MCHBG Action Plan to
DOH contract manager
Draft August 20, 2021
Final September 10,
2021
Children and Youth with Special Health Care Needs (CYSHCN)
4a Complete Child Health Intake Form (CHIF)
using the CHIF Automated System on all infants
and children served by the CYSHCN Program as
referenced in CYSHCN Program Manual
guidance.
Ensure client data is collected on all children
served by CYSHCN contractors, including
neurodevelopmental centers, regional
maxillofacial coordinators, and the DOH
Newborn Screening Program.
Submit CHIF data into Secure File
Transport (SFT) Access Washington
website: https://sft.wa.gov
https://secureaccess.wa.gov
January 15, 2018
April 15, 2018
July 15, 2018
October 15, 2018
January 15, 2019
April 15, 2019
July 15, 2019
October 15, 2019
January 15, 2020
April 15, 2020
July 15, 2020
October 15, 2020
January 15, 2021
April 15, 2021
July 15, 2021
Reimbursement for
actual costs, not to
exceed total funding
consideration.
Action Plan and
Progress Reports
must only reflect
activities paid for
with funds provided
in this statement of
work for the
specified funding
period.
See Program
Specific
Requirements and
Special Billing
Requirements.
4b Administer requested DOH Diagnostic and
Treatment funds for infants and children per
CYSHCN Program Manual when funds are used.
Identify unmet needs for CYSHCN on Medicaid,
and refer to DOH CYSHCN Program for
Submit completed Health Services
Authorization forms and Central
Treatment Fund requests directly to
the CYSHCN Program as needed.
30 days after forms are
completed.
AMENDMENT #17
Exhibit A, Statements of Work Page 23 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
approval to access Diagnostic and Treatment
funds to meet the need.
*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 m ay apply can be found at:
http://www.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf
Program Specific Requirements/Narrative
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 Trans parency 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 s pent.
To comply with this act and be eligible to perform the activities in this statement of work, the LHJ must have a Data Univer sal Numbering System (DUNS®) number.
Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. 109-282.
Program Manual, Handbook, Policy References
Children and Youth with Special Health Care Needs Manual -
https://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/PublicHealthSystemResourcesandServices/LocalHealthResourcesandTo ols/MaternalandChildHealthBlockGrant/
ChildrenandYouthWithSpecialHealthCareNeeds
Health Services Authorization (HSA) Form
http://www.doh.wa.gov/Portals/1/Documents/Pubs/910-002-ApprovedHSA.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% mus t 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 (Med icaid), or Title XX (social services block
grant).[Social Security Law, Sec 504(b)].
AMENDMENT #17
Exhibit A, Statements of Work Page 24 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
3. If any charges are imposed for the provision of health services using Title V (MCH Block Grant) funds, such charges will be p ursuant 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, re sources, and family size of the individual
provided the services. [Social Security Law, Sec. 505 (1) (D)].
Monitoring Visits (frequency, type)
Telephone calls with contract manager at least one every quarter, and annual site visit. as needed.
Special Billing Requirements
Payment is contingent upon DOH receipt and approval of all deliverables and an acceptable A19 -1A 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 quarterly by the 30th of each
month following the month quarter 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.
Special Instructions
Contact DOH contract manager below for approval of expenses not reflected in approved budget workbook.
MCHBG funds may be expended on COVID-19 response activities that align with maternal and child health priorities. Examples may include:
Providing support in educating the MCH population about COVID-19 through partnerships with other local agencies, medical providers, and health care organizations.
Working closely with state and local emergency preparedness staff to assure that the needs of the MCH population are represen ted.
Funding infrastructure that supports the response to COVID -19. For example, Public Health Nurses who are routinely supported through the Title V program may be
able to be mobilized, using Title V funds or separate emergency funding, to support a call center or deliver health services.
Partnering with parent networks and health care providers to provide accurate and reliable information to all families.
Engaging community leaders, including faith-based leaders, to educate community members about strategies for preventing illness
Restrictions listed above continue to apply.
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
AMENDMENT #17
Exhibit A, Statements of Work Page 25 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Exhibit A
Statement of Work
Contract Term: 2018-2021
DOH Program Name or Titl e: OICP CARES Enhanced Influenza Coverage Project -
Effective July 1, 2020
Local Health Jurisdiction Name: Kittitas County Public Health Department
Contract Number: CLH18249
SOW Type: Revision Revision # (for this SOW) 1 Funding Source
Federal Subrecipient
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price Period of Performance: July 1, 2020 through June 30, 2021
Statement of Work Purpose: The purpose of this statement of work is to contract with local health to conduct activities to improve influenza immunization coverage rates.
Revision Purpose: The purpose of this revision is to extend the period of performance and funding from 12/31/20 to 06/30/21 and add funds.
Chart of Accounts Program Name or Title CFDA # BARS
Revenue
Code
Master
Index
Code
Funding
(LHJ Use
Start Date
Period
Only)
End Date
Current
Consideration
Change
Increase (+)
Total
Consideration
FFY21 Enhanced Influenza Coverage CARES 93.268 333.93.26 74310219 07/01/20 06/30/21 2,800 2,800 5,600
TOTALS 2,800 2,800 5,600
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time
Frame
Payment
Information and/or
Amount
1 Develop a proposal to work with partners on
activities that implement evidence-based strategies
to increase influenza immunization coverage rates
for adult population, increase immunization and
promotion activities targeted at populations at
higher risk for COVID-19 and those that support
them, uninsured and underinsured populations, and
improve collaboration with community
partners. The proposal must include a line-item,
object-based budget and must meet the goals and
objectives outlined in the Local Health Jurisdiction
Enhanced Influenza Coverage Funding
Opportunity Guidelines.
Written proposal, to include a line-
item, object-based budget
(template will be provided) and a
report that shows starting
immunization rates for the target
population
July 28, 2020 Reimbursement for
actual costs incurred,
not to exceed total
funding consideration
amount.
*See Restrictions on
Funds below.
2 Upon approval of proposal, implement the plan to
increase immunization coverage rates with the
target population identified.
Written report describing the
progress made on reaching
milestones for activities identified
in the plan (template will be
provided)
December 31, 2020
AMENDMENT #17
Exhibit A, Statements of Work Page 26 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time
Frame
Payment
Information and/or
Amount
3 Conduct an evaluation of the interventions
implemented
Final written report, including a
report showing ending influenza
immunization rates for the target
population (template will be
provided)
March 31, 2021
*For Information Only:
Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how pro gram activities might contribute to meeting a
Standard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measures that may app ly can be found at:
http://www.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf
Program Specific Requirements/Narrative
Tasks in this statement of work may not be subcontracted without prior written approval from DOH OICP.
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 Trans parency 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 Univers al Numbering System (DUNS®) number.
Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. 109-282.
Restrictions on Funds (what funds can be used for which activities, not direct payments, etc.)
Allowable Uses of Federal Operations Funds document (dated 12/20/2017) is posted on the DOH Consolidated Contract website at this link. These federal funds may not be used
for 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 and
Child Profile.
DOH Program Contacts DOH Program Contact
Tawney Harper, MPA Misty Ellis, Project Manager
Deputy Director | Operations Manager CDC Public Health Advisor
Office of Immunization and Child Profile Office of Immunization and Child Profile
Department of Health Department of Health
PO Box 47843, Olympia WA 98504-7843 PO Box 47843, Olympia WA 98504-7843
tawney.harper@doh.wa.gov, 360-236-3525 misty.ellis@doh.wa.gov, 360-236-3675
AMENDMENT #17
Exhibit A, Statements of Work Page 27 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Exhibit A
Statement of Work
Contract Term: 2018-2021
DOH Program Name or Title: OICP-Promotion of Immunizations to Improve
Vaccination Rates - Effective July 1, 2020
Local Health Jurisdiction Name: Kittitas County Public Health Department
Contract Number: CLH18249
SOW Type: Revision Revision # (for this SOW) 1 Funding Source
Federal Subrecipient
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price Period of Performance: July 1, 2020 through June 30, 2021
Statement 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: The purpose of this revision is to extend the period of performance and funding from 12/31/20 to 06/30/21, add funds, and mod ify the statement of work.
Chart of Accounts Program Name or Title CFDA # BARS
Revenue
Code
Master
Index
Code
Funding
(LHJ Use
Start Date
Period
Only)
End Date
Current
Consideration
Change
Increase (+)
Total
Consideration
FFY21 VFC Ops 93.268 333.93.26 74310202 07/01/20 06/30/21 2,800 2,800 5,600
TOTALS 2,800 2,800 5,600
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time
Frame
Payment
Information and/or
Amount
1 Develop a proposal to improve immunization
coverage rates for a target population by increasing
promotion activities and collaborating with
community partners. The proposal must meet
guidelines outlined in the Local Health Jurisdiction
Funding Opportunity, Promotion of Immunizations
to Increase Vaccination Rates announcement.
Written proposal and a report that
shows starting immunization rates
for the target population
August 1, 2020 Reimbursement for
actual costs incurred,
not to exceed total
funding consideration
amount.
*See Restrictions on
Funds below.
2 Upon approval of proposal, implement the plan to
increase immunization coverage rates with the
target population identified.
Written report describing the
progress made on reaching
milestones for activities identified
in the plan (template will be
provided)
November 30, 2020
March 31, 2021
3 Perform data collection necessary to enable a
comparison of immunization rates from the start of
the project.
Final written report, including a
report showing ending
immunization rates for the target
population (template will be
provided)
June 15, 2021
AMENDMENT #17
Exhibit A, Statements of Work Page 28 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
*For Information Only:
Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how pro gram 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.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf
Program Specific Requirements/Narrative
Tasks in this statement of work may not be subcontracted without prior written approval from DOH OICP.
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 Trans parency 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 Univers al Numbering System (DUNS®) number.
Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. 109-282.
Restrictions on Funds (what funds can be used for which activities, not direct payments, etc.)
Allowable Uses of Federal Operations Funds document (dated 12/20/2017) is posted on the DOH Consolidated Contract website at this link. These federal funds may not be used
for 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 and
Child Profile.
DOH Program Contacts DOH Program Contact
Tawney Harper, MPA Misty Ellis, Project Manager
Deputy Director | Operations Manager CDC Public Health Advisor
Office of Immunization and Child Profile Office of Immunization and Child Profile
Department of Health Department of Health
PO Box 47843, Olympia WA 98504-7843 PO Box 47843, Olympia WA 98504-7843
tawney.harper@doh.wa.gov, 360-236-3525 misty.ellis@doh.wa.gov, 360-236-3675
AMENDMENT #17
Exhibit A, Statements of Work Page 29 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Exhibit A
Statement of Work
Contract Term: 2018-2021
DOH Program Name or Title: Supplemental Nutrition Assistance Program-
Education - Effective October 1, 2020
Local Health Jurisdiction Name: Kittitas County Public Health Department
Contract Number: CLH18249
SOW Type: Original Revision # (for this SOW) Funding Source
Federal Subrecipient
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price Period of Performance: October 1, 2020 through September 30, 2021
Statement of Work Purpose: The purpose of this statement of work is to provide Supplemental Nutrition Assistance Program-Education (SNAP-Ed) to improve the likelihood
that persons eligible for SNAP (Basic Food, Food Stamps) will make healthy food choices within a limited budget and choose acti ve lifestyles consistent with the current USDA
dietary guidelines.
Revision Purpose: N/A
Chart of Accounts Program Name or Title CFDA # BARS
Revenue
Code
Master
Index
Code
Funding
(LHJ Use
Start Date
Period
Only)
End Date
Current
Consideration
Change
Increase (+)
Total
Consideration
FFY21 IAR SNAP ED PROG MGNT -REGION 2 10.561 330.10.56 76701912 10/01/20 09/30/21 0 26,046 26,046
TOTALS 0 26,046 26,046
Task
Number Task/Activity/Description Deliverables/Outcomes Measure (where
applicable)
FFY21
Due Date/Time Frame
Payment Information
and/or Amount
1.0 Project Planning, Implementation,
and Performance
For SNAP-Ed, the Subrecipient will
develop, implement, and evaluate a
SNAP-Ed project included in the
Washington SNAP-Ed State Plan
approved by Department of Social and
Health Services (DSHS) and United
States Department of Agriculture
(USDA); and, as described in the
Subrecipient’s project work plan
approved by Department of Health
(DOH).
Project provides 100% of
SNAP-Ed activities at eligible
sites and/or with eligible
audiences.
On-time delivery,
implementation, and
evaluation of Project activities
as scheduled in approved state
plan and project work plan.
Satisfactory progress towards
State SNAP-Ed project goal(s)
selected by Subrecipient is
demonstrated and reported.
Satisfactory progress towards
project objective(s) and
additional project goal(s)
Sites and audiences
included in Project by
Subrecipient documented
as approved eligible sites
or audiences.
Documented complete
reporting by Subrecipient
of the delivery,
implementation, and
evaluation of approved
Project activities in the
required PEARS online
reporting modules, where
relevant to Project
(Program Activities, PSE
For the Period:
10/01/20 to 09/30/21
Due: per the approved work
plan and per the required
due dates during the federal
fiscal year, and no later than
09/30/21.
Reimbursement upon
on-time receipt and
approval of acceptable
deliverables/ outcomes
for the funding period
will not exceed
$26,046. Kittitas
County Public Health
Department will be
paid the allowable costs
incurred based on their
approved budget and
program allowability.
See special billing
requirements section.
AMENDMENT #17
Exhibit A, Statements of Work Page 30 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description Deliverables/Outcomes Measure (where
applicable)
FFY21
Due Date/Time Frame
Payment Information
and/or Amount
determined by Subrecipient is
demonstrated and reported.
Project maintains cost-
effectiveness per current
approved cost-effective
measure provided by DOH or
DSHS.
Site Activities, Indirect
Activities, Coalitions,
Partnerships, and Success
Stories).
Documented complete
reviews of Subrecipient
Project activities through
required reporting and
project and fiscal
monitoring reviews and
reports.
Cost per reach reported by
Subrecipient in approved
form/system provided by
DOH.
**NOTE: The DOH
SNAP-Ed program will
deny payment for any
costs not submitted by
the required due dates
without prior DOH
approval in writing.
1.1 Project Progress: Monitoring and
Compliance
For SNAP-Ed, the Subrecipient will
demonstrate satisfactory progress of
the approved Project as documented in
DOH SNAP-Ed progress reports,
progress reviews, and project and
fiscal monitoring reports.
Monitoring of Subrecipient Project
progress includes but is not limited to
the following activities:
i. one-on-one progress reviews with
DOH,
ii. progress reports submitted to
DOH,
iii. project monitoring completed
with DOH or DSHS or USDA,
and
iv. project monitoring site visits
completed by SNAP-Ed statewide
initiative teams.
1. On-time delivery of proposed
list of Project site(s) or
audience(s) to DOH.
2. All sites and/or audiences are
determined to be eligible per
current SNAP-Ed eligibility
guidance before programming
begins with site(s) or
audience(s).
3. Demographic data of class
participants collected and
reported for all direct
education strategies.
4. On-time reporting of actual
participant reach to DOH in
approved method/form.
5. Intervention strategies
implemented as planned, or
using approved alternate
strategies.
6. Approved evaluation plans
and methods implemented for
the project (e.g. pre and post
surveys for direct education;
PSE assessments).
Progress reviews –
documentation of one-on-
one meeting(s) with DOH
SNAP-Ed staff person(s)
and Subrecipient
completed in person, web
conference, phone, or via
email as needed.
Documentation of progress
review notes.
Project monitoring –
documentation of one-on-
one meeting(s) with DOH
SNAP-Ed staff person(s),
Subrecipient, other SNAP-
Ed funded staff, and
community partners and/or
participants completed in
person, web conference,
phone, or via email as
needed. Completion of on-
site program observations
where applicable.
Completion of project
For the Period:
10/01/20 to 09/30/21
Due: Progress reviews.
Occur at minimum quarterly
within the fiscal year, and
no later than 30 business
days after the end of the
federal fiscal quarter, except
for the last quarter which
must be completed by
09/30/21. Progress reviews
can be scheduled more
frequently if deemed
necessary by DOH, or if
agreed upon by both parties.
Federal quarters listed
below:
Q1: Oct 1 – Dec 31
Q2: Jan 1 – Mar 31
Q3: Apr 1 – June 30
Q4: July 1 – Sep 30
Due: Project monitoring.
Occurs at minimum once
See payment
information as
referenced in task
number 1.0
AMENDMENT #17
Exhibit A, Statements of Work Page 31 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description Deliverables/Outcomes Measure (where
applicable)
FFY21
Due Date/Time Frame
Payment Information
and/or Amount
Satisfactory progress of the
Subrecipient’s Project includes
progress shown in the following areas
and documented in reporting and/or
monitoring completed:
1. Progress demonstrated in
achieving goal(s) outlined in the
project.
2. Progress demonstrated in
achieving objective(s) outlined in
the project’s interventions.
3. Progress demonstrated in creating
a sustainable project.
4. Progress demonstrated in
engaging or involving the
community in project planning,
implementation, and/or
evaluation.
5. Progress demonstrated in working
with DSHS community services
offices (CSOs).
6. Progress demonstrated in
promoting available Federal,
state, or local fruit and vegetable
incentive programs to SNAP
clients.
7. Progress demonstrated in using
strategies that are evidence-based
and delivered with fidelity, where
applicable.
8. Compliance with current SNAP-
Ed financial and cost policy
guidance and 2 CFR 200 federal
Uniform Administrative
Requirements (OMB guidance).
7. Evaluation results used to
report progress and outcomes
of project, and to adapt the
project as needed.
8. Evidence of positive change
or improvement in SNAP-Ed
eligible site(s) or audience(s)
based on project activities is
demonstrated and reported.
9. If positive change or
improvement in SNAP -Ed
eligible site(s) or audience(s)
not apparent, project must
demonstrate acceptable
implementation of approved
interventions and strategies
and use results of process
evaluation to improve project
plan so that positive change in
SNAP-Ed eligible site(s) or
audience(s) can occur.
10. Strategy for working with one
or more CSOs implemented
and demonstrated to increase
knowledge, awareness, or
participation in SNAP-Ed
eligible audience.
11. Strategy for promoting
available Federal, state, or
local fruit and vegetable
incentive program(s)
implemented and
demonstrated to increase
knowledge, awareness, or
participation of program(s) in
SNAP-Ed eligible audience.
12. Direct education strategies
only: Statewide SNAP-Ed
Curriculum team or DOH
monitoring reviews show
education delivered with
fidelity, with no major
monitoring report forms,
with monitoring results
documented and provided
to Subrecipient.
Fiscal monitoring –
documentation of
completed fiscal reviews
scheduled by SNAP-Ed
fiscal analyst or DOH
fiscal monitoring unit, with
corresponding reports
where applicable. Fiscal
monitoring completed in
person, web conference,
phone, or via email as
needed.
within the fiscal year. If
project monitoring
documents major
deficiencies or corrective
action, the Subrecipient will
be monitored again within
the fiscal year. Project
monitoring can be
scheduled more frequently
if deemed necessary by
DOH, or if agreed upon by
both parties.
Due: Fiscal monitoring.
Each Subrecipient receives
one (1) annual fiscal
monitoring visit every other
year, unless Subrecipient
monitoring results in
corrective action or finding,
in which case Subrecipient
will be monitored again the
following year. Fiscal
monitoring can be
scheduled more frequently
if deemed necessary by
DOH, or if agreed upon by
both parties.
AMENDMENT #17
Exhibit A, Statements of Work Page 32 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description Deliverables/Outcomes Measure (where
applicable)
FFY21
Due Date/Time Frame
Payment Information
and/or Amount
deficiencies. If major
deficiencies documented,
corrected properly within
timeline required.
13. Compliance maintained with
current SNAP-Ed financial
and cost policy guidance, 2
CFR 200 federal Uniform
Administrative Requirements
(OMB guidance), and related
DOH SNAP-Ed fiscal policy
and procedures.
2.0 Evaluation Data and Reports
For SNAP-Ed, the Subrecipient will
report progress of the approved
project and work plan, including
ongoing evaluation of the project and
outcomes, using an approved
form/system on a regular basis that
will at a minimum include:
1. Progress reports
2. Reporting in PEARS online
reporting system of all
SNAP-Ed activities
SNAP-Ed activities implemented and
evaluation of the project and outcomes
are reported in an online program
evaluation and reporting system
(PEARS) through the following
required modules as appropriate for
the approved project: Program
Activity (direct education), Indirect
Activity (health promotion, indirect
education channels), PSE Site
Activities, Partnerships, Coalitions,
Success Stories, and Social Marketing.
The following evaluation activities
and information are required based on
On-time and correct submission of
reporting, data, and materials for
all SNAP-Ed funded activities
implemented, including:
1. Progress for all intervention
strategies reported for
approved project plan.
2. All evaluation results reported
for approved project plan
(formative, process, outcome,
qualitative, PSE).
3. All qualitative evaluation
results (success stories,
pictures, etc.) reported for
approved project plan
describing progress or success
of project activities, or positive
change or improvement in
SNAP-Ed eligible site(s) or
audience(s).
4. Required release form(s) for
all photos submitted.
5. Direct education strategies
only: All required information
for scheduled direct education
lessons submitted to Statewide
SNAP-Ed Curriculum team,
using approved form/system,
by dates required.
Documentation showing
completion of progress
report and submission to
DOH on or before the
required due dates, or by
approved extension date.
Completion of required
evaluation data in progress
reports and PEARS
electronically, or using
approved reporting
method/form, on or before
the required due dates, or
by approved extension
date.
Direct education
strategies only:
1. Submission of
required SNAP-Ed
participant surveys to
DOH using approved
submission method,
on or before the
required due dates for
submission, or by
approved extension
date.
For the Period:
10/01/20 to 09/30/21
Progress Reports: Due at
minimum quarterly, and no
later than 10 calendar days
after the end of the quarter,
except for the last month of
the FFY which is due by
9/15/21. If the 10th calendar
day falls on a weekend day,
the report is due the next
business day.
1st Progress report due
01/11/21
2nd Progress report due
04/12/21
3rd Progress report due
07/12/21
Final Progress report
due 09/15/21, or follow
close-out procedures.
PEARS: Project evaluation
and reporting required
between 10/01/20 to
09/15/21.
Direct education
strategies only:
See payment
information as
referenced in task
number 1.0
AMENDMENT #17
Exhibit A, Statements of Work Page 33 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description Deliverables/Outcomes Measure (where
applicable)
FFY21
Due Date/Time Frame
Payment Information
and/or Amount
the Subrecipient’s approved project
and work plan.
Formative evaluation
Process evaluation
Outcome evaluation
Qualitative evaluation
Evaluation of PSE strategies
Please Note: the deliverables may
change based on state SNAP-Ed
Evaluation guidance, DSHS, or USDA
requirements.
Please Note: Topics included in
Progress Report subject to change
based on Department of Health
(DOH), Department of Social and
Health Services (DSHS), Washington
SNAP-Ed (WA SNAP-Ed), or United
States Department of Agriculture
(USDA) Food and Nutrition Services
(USDA) requirements.
On-time and correct submission of
required evaluation data for direct
education strategies into PEARS
electronically, or using approved
reporting method, according to
time frame provided, including:
6. Direct education strategies
only: Pre-test surveys for each
project class series received by
DOH, or data entered into
PEARS by Subrecipient, no
later than two weeks after
completion of the pre-test
survey.
7. Direct education strategies
only: Post-test surveys for
each project class series
received by DOH, or data
entered into PEARS by
Subrecipient, no later than two
weeks after completion of the
post-test survey.
8. Direct education strategies
only: Demographic cards for
each class series received by
DOH, or data entered into
PEARS by Subrecipient, no
later than two weeks after
collection of the demographic
cards.
2. When survey data is
entered by the
Subrecipient,
completion of
required evaluation
data into PEARS
electronically, or
using approved
reporting method, on
or before the required
due dates for data
entry, or by approved
extension date.
PEARS Program
Activities module
updated with completed
activities no later than
two (2) weeks after
services are provided.
Due: PEARS Indirect
Activities, PSE Site
Activities, Partnerships,
Coalitions, Success
Stories, and Social
Marketing modules
completed no later than
the last business day of
the month following
when the activity took
place, except for the
last month of the FFY
which is due by
09/15/21.
Activities completed in
Oct 2020 due in
PEARS by 11/30/20
Nov 2019 by 12/31/20
Dec 2019 by 01/29/21
Jan 2020 by 02/26/21
Feb 2020 by 03/31/21
Mar 2020 by 04/30/21
Apr 2020 by 05/31/21
May 2020 by 06/30/21
Jun 2020 by 07/30/21
Jul 2020 by 08/31/21
Aug 2020 by 09/15/21
Final data entry for all
activities not already
reported, due by
09/15/21, or follow
close-out schedule.
AMENDMENT #17
Exhibit A, Statements of Work Page 34 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description Deliverables/Outcomes Measure (where
applicable)
FFY21
Due Date/Time Frame
Payment Information
and/or Amount
SNAP-Ed Direct education
conducted between 10/1/20
and 09/15/21.
Direct education
strategies only:
Completed Pre- and
post-test surveys
received by DOH, or
data entered into
PEARS database by
Subrecipient, no later
than two weeks after
completion of the
survey. All completed
pre- and post-test
surveys must be
received, or data
entered by
Subrecipient, no later
than COB 09/15/21, or
follow close-out
schedule.
3.0 Civil Rights Training
All SNAP-Ed funded staff must
complete training each fiscal year in
civil rights.
*See special requirements section-
Civil Rights
Documentation must include:
Training and source
Who attended
Date completed
On-time completion of an
approved Civil Rights training for
all SNAP-Ed funded staff.
Submission of
documentation showing
completed Civil Rights
training for all SNAP-Ed
funded staff on or before
the required due date.
For the Period:
10/01/20 to 09/30/21
Due: 12/31/20 for all
SNAP-Ed funded staff. New
hires to complete within 30
days of hire.
See payment
information as
referenced in task
number 1.0
3.1 Other Required Training and
Meetings
The following trainings or meetings
are required for all Subrecipients
when provided by DOH or WA
On-time completion of all required
trainings by required SNAP-Ed
staff.
Documentation showing
required person(s) and
date(s) of attendance for all
web-based and in-person
required meetings.
For the Period:
10/01/20 to 09/30/21
Fiscal: Annually, and no
later than March 31, 2021.
See payment
information as
referenced in task
number 1.0.
AMENDMENT #17
Exhibit A, Statements of Work Page 35 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description Deliverables/Outcomes Measure (where
applicable)
FFY21
Due Date/Time Frame
Payment Information
and/or Amount
SNAP-Ed for the staff listed. Unless
more staff attendance is required,
minimum of one (1) staff person
required to attend to satisfy
requirements. Multiple staff may
attend if costs for attendance are
covered in Subrecipient’s annual
budget.
Fiscal training – fiscal agent or
project coordinator, whoever is
most responsible for creating and
monitoring budget, procurements,
invoices, budget decisions, or
budget amendments for the
SNAP-Ed program.
Food handler training – all staff
who will handle, prepare, cook,
assemble, and/or serve food or
drink to participants or the public.
Training on data collection and
reporting – project coordinator
or any staff person responsible for
collecting, reporting, or entering
SNAP-Ed related data.
Regional meeting(s), when
provided – project coordinator or
any qualified designated staff
person.
Annual State SNAP-Ed forum,
when provided - project
coordinator or any qualified
designated staff person.
SNAP-Ed Curriculum training
(either in person or online)
(only required for direct
education strategies) – project
Attendance of required or
appropriate staff person(s) at all
required meetings.
Demonstration of satisfactory
understanding of the information
and concepts included in required
trainings.
SNAP-Ed Curriculum: On-time
completion of required training for
specific curriculum to be used in
direct education strategy by project
coordinator or qualified designated
staff person responsible for
delivering SNAP-Ed curricula to
SNAP-Ed eligible audience.
Food handler training:
Completion of a Washington State
authorized food handler or food
worker training by all staff who
will handle and serve food to the
public.
Coordinator meetings:
Attendance of project coordinator
or qualified, designated staff
person to at least 75% of all
coordinator meetings provided.
Regional meetings: Attendance of
project coordinator or qualified,
designated staff person to at least
50% of all regional meetings
provided.
State Forum: Attendance of
project coordinator or qualified,
designated staff person to all state
forums provided.
Documentation showing
required person(s); date(s)
of attendance; and,
completion of training for
all web-based and in-
person required trainings.
Documentation of
satisfactory understanding
gained from required
trainings, and application
of applicable knowledge
and skills in progress
reviews and/or monitoring
reports.
SNAP-Ed Curriculum:
New direct education staff
trained within 30 days for
specific curriculum to be
used in direct education
strategy, or before providing
SNAP-Ed direct education
activities to SNAP-Ed
audience. Project
coordinator or qualified
designated staff person to
complete additional SNAP-
Ed Curriculum training
when new information is
provided for specific
curriculum to be used in
direct education strategy.
Data collection and
reporting: Annually, or
more often as needed. If
approved data collection
system changes, every
SNAP-Ed funded staff
member entering data will
be required to complete
training on any new
expectations or system
changes on the day of, or
within 30 days of when the
training is provided.
Annual Forum: Annually,
when provided, and no later
than 09/30/21.
Coordinator meetings:
Completed on dates
scheduled by DOH, when
provided.
AMENDMENT #17
Exhibit A, Statements of Work Page 36 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description Deliverables/Outcomes Measure (where
applicable)
FFY21
Due Date/Time Frame
Payment Information
and/or Amount
coordinator or qualified
designated staff person
responsible for delivering SNAP-
Ed curricula to SNAP-Ed eligible
audience.
SNAP-Ed Systems Approaches
for Healthy Communities
training (online, when
provided) - project coordinator
and all staff involved in planning,
implementing, and evaluating
SNAP-Ed project activities.
SNAP-Ed Systems Approaches
for Healthy Communities
training (in person, when
provided) - project coordinator or
qualified designated staff person.
Project coordinator meetings
(conference calls or in person) –
project coordinator or qualified
designated staff person.
SNAP-Ed Systems Approaches
for Healthy Communities:
Demonstrate satisfactory
understanding of the information
and concepts included in the
training. Satisfactory application of
knowledge and skill learned from
training to SNAP -Ed project, as
needed.
If required meeting or training is
not provided, Subrecipient is not
required to make up requirements
for attendance and will be in
compliance. Attendance at required
meetings and completion of
required trainings required only
when provided.
Regional meetings:
Completed on dates
scheduled by DOH, when
provided.
SNAP-Ed systems
approaches training
online: At least once within
the three year period of
performance, and no later
than the end of the first
fiscal year within the three
year period of performance.
Due: On or before
09/30/21
SNAP-Ed systems
approaches training in
person: Once annually,
when provided, on dates
scheduled by WA SNAP-
Ed.
4.0 SNAP-Ed Inventory
SNAP-Ed Subrecipients are required
by regulation to keep an up-to-date
inventory list that includes all non-
capital equipment, approved capital
equipment, purchased curriculum, and
other SNAP-Ed purchased items that
are not disposable. This list should
include items purchased in prior fiscal
years still in use and in possession of
the Subrecipient. This list should be
updated per the due dates required.
Agencies are required to follow the
DOH SNAP-Ed Inventory policy and
procedure.
On-time updates to SNAP-Ed
inventory list.
1. Inventory list updated per due
dates required.
2. Inventory list contains
complete list of all items
purchased with SNAP-Ed
funds in current fiscal year and
previous fiscal years still in
use and in possession of the
Subrecipient.
Completed documentation
showing updated SNAP-Ed
inventory using approved
form/system provided.
For the Period:
10/01/20 to 09/30/21
Due: Inventory list is
required to be updated no
later than 30 days after the
end of each quarter. Final
inventory list updated by
09/15/20.
At the time of a fiscal or
project monitoring review,
or when requested, an up-to-
date inventory list must be
made available.
See payment
information as
referenced in task
number 1.0.
AMENDMENT #17
Exhibit A, Statements of Work Page 37 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Task
Number Task/Activity/Description Deliverables/Outcomes Measure (where
applicable)
FFY21
Due Date/Time Frame
Payment Information
and/or Amount
*See special requirements section -
Monitoring
5.0 SNAP-Ed A19 Invoices
Subrecipients must use the A19
invoice form specific to the DOH
SNAP-Ed program. This document
will be sent to all Subrecipients prior
to October 31st of the current fiscal
year.
On-time delivery of correct
completion of SNAP-Ed A19
invoices, using the current form for
the fiscal year.
On-time delivery of detailed ledger
supporting the costs to be reviewed
by SNAP-Ed program via the most
current submission procedure
before approval of payment.
Complete documentation of all
actual costs incurred shall be
accompanied by the Subrecipient’s
financial system report. If
Subrecipient does not have a
financial reporting system, the
Subrecipient must check with the
DOH SNAP-Ed program for
further guidance.
SNAP-Ed invoices (A19)
with all documented costs
and any required
accompanying materials
received at DOH by due
dates required, or by
approved extension date.
For the Period:
10/01/20 to 09/30/21
Due: Monthly - Submit
invoices to DOH no later
than 30 calendar days after
the end of the preceding
month. (E.g. October A19
invoice submitted no later
than November 30)
o Oct. Invoice due:
11/30/20
o November: 12/30/20
o December: 01/30/21
o January: 02/28/21
o February: 03/30/21
o March: 04/30/21
o April: 05/30/21
o May: 06/30/21
o June: 07/30/21
o July: 08/30/21
o August: 09/30/21
Final invoice is due
October 30, 2021, or follow
close-out schedule.
Or
*If pre-approved in
writing by DOH, agencies
can submit invoices every
two months. Upon approval,
a list of submission dates
will be provided.
See payment
information as
referenced in task
number 1.0.
*For Information Only:
Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how pro gram 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:
AMENDMENT #17
Exhibit A, Statements of Work Page 38 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
http://www.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf
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 an d 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 s pent.
To comply with this act and be eligible to perform the activities in th is statement of work, the Subrecipient must have a Data Universal Numbering System (DUNS®) number.
Information about the Subrecipient and this statement of work will be made available on https://www.usaspending.gov by DOH as required by P.L. 109-282.
*Program Specific Requirements/Narrative
Contract Noncompliance and Corrective Action (see CFR § 200.338 Remedies for noncompliance)
The Subrecipient must meet the required set of acceptable deliverables/outcomes a nd adhere to contractual obligations. The contract’s acceptable deliverables/outcomes along with
specified due dates will be determined by the DOH SNAP -Ed program and provided to the Subrecipient in writing. Based on contract performance (as documented in progress
reviews, progress reports, project monitoring reports, and fiscal monitoring reports) and after implementation of other specific conditions as appropriate listed in CFR § 200.207 -
Specific conditions (see https://www.govregs.com/regulations/2/200.207), DOH reserves the right to withhold up to 10% of funds from the next applicable payment to the
Subrecipient for deliverables/outcomes that are documented as consistently incomplete; conti nually late (without approved extension by DOH in writing); found to be unacceptable
or unsatisfactory according to the standards of acceptable deliverables/outcomes outlined in the Statement of Work; or, not c arried out sufficiently or consistently and documented
as such. After DOH SNAP -Ed provides documentation of the issue(s) and outlines the appropriate corrective action in writing, and with approval from t he DOH SNAP-Ed
program manager, the first withholding of funds up to 10% would occur one time and allow 60 days for the appropriate corrective action to be completed by the Subrecipient. If
satisfactory corrective action is completed within 60 days, the funds withheld will be released to the Subrecipient. If satis factory corrective action does not take place within 60
days, up to 5% of funds will be withheld from each subsequent monthly payment until the appropriate corrective action is comp leted. If satisfactory corrective action is completed
after the 60-day window, the initial 10% of funds withheld will not be provided as reimbursement to the Subrecipient as penalty. The subsequent monthly withholdings (of up to
5% per month) will be reimbursed to the Subrecipient upon satisfactory completion of the corrective action. The Subrecipient may request reconsideration by submitting a letter to
Washington Department of Health SNAP -Education, PO Box 47886, Olympia, WA 98504 -7886, or in writing via email to snap-ed@doh.wa.gov.
All invoices must be approved by DOH prior to payment; approval will not be unreasonably withheld. DOH will authorize payment only upon satisfactory and on -time completion
of acceptance deliverables/outcomes and for allowable costs as outlined in the SNAP -Ed federal guidance, statement of work, state plan, and/or budget. DOH will return all
incorrect or incomplete invoices and will not pay for services that occur outside the period of performance or that are deeme d unallowable costs.
Additional Details Regarding Deliverables
Required deliverables for SNAP-Ed reporting will depend on approved SNAP -Ed plan activities for each Subrecipient, e.g. if direct education is not an approved plan activity for a
Subrecipient, submission of pre/post surveys is not a required deliverable for that Subrecipient. To attend required trainings during fiscal year, the Subrecipient must use the travel
funds within their current allotted budget to send the minimum number of one (1) staff person to the required training. The S ubrecipient may request additional travel funds from
DOH for required training(s) if necessary and if funds are available.
Monitoring Expectations
The Subrecipient’s premises and records will be made available upon request to DOH, DSHS, and USDA staff for the purposes of observing project activities and reviewing for
project and fiscal compliance. All non-capital equipment, capital equipment, reusable educational materials and supplies, and any non -disposable items purchased using SNAP-Ed
funds should be tracked in an inventory list and available for review upon request. Based on fiscal and project monitoring results or findings, additional monitoring during the
fiscal year may be required at the discretion of the DOH SNAP -Ed program, DOH fiscal analyst, or DOH fiscal monitoring unit. Completed project and fiscal monitoring reports
with suggestions, observations, comments, feedback, findings, and/or corrective action will be kept on file at DOH and shared with Subrecipients regularly and by request.
AMENDMENT #17
Exhibit A, Statements of Work Page 39 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Staff Requirements
Upon request by DOH, the Subrecipient 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.
Project Coordinator requirements
The Subrecipient must maintain a SNAP-Ed project coordinator. The project coordinator is the main contact between Department of Health SNAP -Ed team and the Subrecipient.
DOH SNAP-Ed expectations for the project coordinator responsibilities include:
Ensure all contract deliverables are met.
Coordinate the planning, implementation, evaluation, and reporting of all parts of the approved project plan.
Comply with and remain knowledgeable about all WA SNAP -Ed and DOH SNAP-Ed policies and procedures.
Comply with and remain knowledgeable about the National SNAP-Ed Guidance.
Ensure staff and any sub-Subrecipients funded through this contract stay informed of current and new SNAP -Ed policies, and are held accountable to policies when needed.
Ensure staff and any sub-Subrecipients meet requirements appropriate to their positions, including but not limited to: background checks, food handlers’ p ermits, and trainings
required by WA SNAP-Ed and DOH.
Attend, or designate and send qualified staff member as proxy to, required DO H and State SNAP‑Ed meetings and trainings.
Monitor or maintain knowledge of project budget status, including estimated spend out and total dollars spent to date.
Submit plan and budget amendments for approval as outlined in the current year’s policy and p rocedures.
Coordinate the on-time completion of all data entry and reporting.
Ensure photo and media release forms are obtained for persons featured in SNAP -Ed programming photographs or videos.
Communication Requirements
The Subrecipient must maintain communication with DOH SNAP-Ed. Communication required between DOH SNAP-Ed and the Subrecipient will not be unreasonable or
excessive. DOH SNAP-Ed expectations for communication include:
Submit updates to DOH following any change in contact information for the project coordinator, fiscal agent, contract signatory, or any SNAP ‑Ed funded staff within 10
business days of the change.
Be available for regular and intermittent meetings, both in person and phone, with DOH SNAP ‑Ed as agreed upon or as needed.
Respond to all DOH and SNAP‑Ed Statewide initiative requests within the timeline requested.
Maintain or obtain an internet connection for communication with DOH, for access to DOH SharePoint webpages, to view updates and messages from Washington SNAP‑Ed
through the WA SNAP‑Ed Providers website, and for reliable reporting of SNAP ‑Ed activities. If reliable internet connection cannot be secured, the Subrecipient and DOH
SNAP-Ed will agree on a plan for necessary communication, data entry, and reporting.
Obtain a Secure Access Washington (SAW) account to access DOH SNAP ‑Ed SharePoint webpages.
SNAP-Ed Assurances:
The following assurances must be followed (see program Guidance https://snaped.fns.usda.gov/program-administration/guidance-and-templates)
The Subrecipient is fiscally responsible for activities funded with Supplemental Nutrition Assistance Program Education funds and is liable for repayment of unallowable
costs.
Programming is provided to approved SNAP -Ed eligible audiences.
Only expanded or additional coverage of those activities funded under the Expanded Food and Nutrition Education Program (EFNE P) may be claimed under the SNAP-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 no case may
activities funded under the EFNEP grant be included in the budget for SNAP -Ed.
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 Right s and OMB regulations governing cost issues.
AMENDMENT #17
Exhibit A, Statements of Work Page 40 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
Program activities do not supplant existing nutrition education and obesity prevention programs, and where operating in conjunction with existing programs , enhance as well
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 is easily
readable.
SNAP-Ed Statewide Initiatives
Subrecipients are expected to communicate with, respond to, and comply with requests, guidance, requirements, and/or on -site visits from all contracted SNAP-Ed statewide
initiative entities.
Any SNAP-Ed curriculum modifications should be developed and executed based on the most current Guidance for Curriculum Modification, found under “Guidance and
Process” on WA SNAP-Ed Providers website. Subrecipients must consult DOH SNAP-Ed as directed.
After notification to the DOH SNAP-Ed implementing agency, the Subrecipient may adjust or deny requests, requirements, and/or site visits from any contracted SN AP-Ed
statewide initiative entities if said request, requirement, and/or site visit is deemed unreasonable, burdensome, unnecessarily costly, or inequitable after appropriate considerati on
and deliberation between the Subrecipient, DOH SNAP -Ed, and the contracted SNAP-Ed statewide initiative entity/entities; and, when necessary, DSHS. After appropriate
consideration and deliberation, the resulting decision about whether or not the Subrecipient must comply or can adjust or den y a specific will be provided in writing to the
Subrecipient from DOH SNAP-Ed and/or DSHS.
Health and Safety
Subrecipients are not required to work under conditions that could endanger their health, safety, or well -being. Additionally, Subrecipients should ensure they are not putting any
SNAP-Ed audience or community members in situations that could endanger their health, safety, or well-being. Participation in SNAP-Ed by the SNAP-Ed audience is voluntary.
If an activity is deemed unsafe, Subrecipients must adapt activities as needed to allowable and safe alternatives. For a give n situation, all Subrecipients and SNAP-Ed activities
should follow current health and safety laws, regulation and guidance from the designated authorities in the applicable city/town, county, state, and/or the related federal authority,
e.g. CDC, USDA. If Subrecipient is unable to adapt activities as needed to safe, allowable alternatives within their allocation, funding for the current fiscal year may change after
sufficient and acceptable technical assistance between Subrecipient and DOH SNAP -Ed and after prior written notification to the Subrecipient. Any change in annual funding due
to inability to adapt project activities as needed to safe, allowable alternatives will not be a permanent change in annual f unding, unless accompanied by actions outlined under the
‘Contract Noncompliance and Corrective Action’ section.
Audits
The Subrecipient must make State financial and program audits or reviews conducted by other entities available to the DOH, DS HS, USDA, or its designee.
Indirect Rate/Allocation Plan
All indirect rate/allocation plans must be submitted and preapproved by the DOH grants office and the DOH SNAP -Ed program. The Subrecipient is responsible for ensuring that
indirect costs included in the Subrecipient’s SNAP -Ed plan and budget are supported by an indirect rate and/or cost allocation plan approved by the appropriate agency. The
Subrecipient cannot bill indirect costs that are determined to be unacceptable and will be disallowed.
Annual Civil Rights Training Requirement (see USDA Instruction Number 113-1 Chapter XI) http://www.fns.usda.gov/sites/default/files/113-1.pdf “Training is required so
that people involved in all levels of administration of programs that receive Federal financial assistance understand civil rights related laws, regulations, procedures, and directives.
Local agencies are responsible for training their sub recipients, including ‘frontline staff.’ ‘Frontline staff’ who interac t with program applicants or participants, and those persons
who supervise ‘frontline staff’ must be provided civil rights training an annual basis.”
Records Maintenance - Record Retention and Management - State Agency and All Subrecipients 7CFR 272.2
DOH SNAP-Ed regulations require that all records related to the SNAP-Ed program be retained for six (6) years from fiscal closure. This requirement applies to fiscal
documentation and procurement records, contract related documents and emails, progress reports, monitoring reports, and SNAP -Ed client information (pre/post surveys,
AMENDMENT #17
Exhibit A, Statements of Work Page 41 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
demographic cards, etc.). Supporting documentation may be kept at the Subrecipient level, but shall be available for review within six years from the date of the last quarterly
claim submittal. Any costs that cannot be substantiated by source documents will be disallowed as charges to SNAP -Ed.
Travel
The Subrecipient is expected to comply with the Office of Financial Management’s Travel Management Requirement and Restrictio ns as found in policy 10.10
(http://www.ofm.wa.gov/policy/10.htm), with the travel requirements found in the current year’s SNAP -Ed federal guidance, and with any travel related DOH SNAP-Ed policy
and procedures. If the Subrecipient organization’s travel related policy and procedures are in conflict with any of the aforementioned travel related federal or state policies a nd
procedures, the Subrecipient organization will follow the stricter of the travel related policy and procedures unless otherwi se approved and allowable by DOH or higher authority.
Amendments
Subrecipients should check the current year’s federal SNAP -Ed guidance, the current year’s DOH SNAP-Ed budget amendment guidance, and/or with a DOH SNAP -Ed program
consultant to know what changes they can make on their own and what changes require an amendment and pre -approval in writing. Notify DOH staff prior to implementing
amendments that significantly change the scope or direction of the approved project plan, including creating new or c ompletely ending interventions, or adding different
recruitment or delivery sites for reaching SNAP eligible population. Following the current year’s guidance when required, sub recipients must submit a written plan amendment or
written budget amendment request to DOH, and receive written approval from DOH, prior to making any changes within their project or budget and prior to m aking any purchases
included within the amendment. Any requests needing USDA approval must be submitted to DOH no later than April 1st of each fiscal year, or no later than date specified by
USDA, DSHS, or DOH. Following the current year’s guidance when required, if Subrecipients submit plan or budget no cost amend ments that do not require DSHS or USDA
approval, DOH can review those and make approvals on a case by case basis during the federal fiscal year following the current year’s guidance when required. All cost
amendments that do not require DSHS or USDA approval should be submitted to DOH no later than July 16 th of each fiscal year.
Overtime
Staff overtime is not billable in the DOH SNAP-Ed program unless it has been reviewed by the DOH SNAP-Ed program in advance and approved in writing.
Special Funding Requirements
Payment 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 obligation
to make payments for the deliverables as specified. If funding is reduced or limited in any way after the effective date of this contract and prior to normal completion, DOH may
terminate task(s), remove funds, or reallocate funds at DOH’s discretion under new funding limitations and conditions. DOH wi ll make payments only upon the receipt of the
funding. DOH will notify the Subrecipient within 10 working days upon notice by the funding source of funding availability.
Special Billing Requirements
1. All invoices, billing, and reimbursements must be in compliance with all applicable Federal laws, rules, regulations includin g the current year SNAP-Ed Guidance and OMB
circulars governing cost issues.
2. 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 A19-1A Invoice voucher.
A SNAP-Ed specific A19-1A must be submitted to the subrecipient’s designated DOH SNAP-Ed staff member within 30 days of the last day of the month for which the
work is being billed, OR
An Subrecipient may request pre-approval to bill every 2 months instead, in which case, that Subrecipient is required to adhere to the billing due dates provided by DOH.
3. The SNAP-Ed program will deny payment for any costs not submitted by the due date without prior approval. If for ANY reason a Subrecip ient is unable to submit the SNAP-
Ed A-19-1A on the due date, the Subrecipient is required to submit a request for an exception to the DOH no later than 7 days prior t o due date to the DOH SNAP-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.
AMENDMENT #17
Exhibit A, Statements of Work Page 42 of 42 Contract Number CLH18249-17
Revised as of September 15, 2020
4. Supporting documentation for each month must be submitted with each SNAP -Ed A19-1A.
At the very least this means a copy of a Subrecipient’s financial expanded/detailed general ledger level report.
Additionally, all receipts, timecards and other supporting documentation, as noted by USDA, must be available upon request.
5. If a Subrecipient 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
notice by DOH.
All new SNAP-Ed Subrecipients within their 1st fiscal year.
Subrecipients with current fiscal findings.
Subrecipients who have not submitted adequate or accurate backup documentation within the last year.
Subrecipients who receive a rating of “High” from the DOH Federal Subrecipient Risk Assessment Tool.
BUDGET
Source Amount
USDA $26,046
DOH Program Contact DOH Fiscal Contact
Jamie Wells, SNAP-Ed Contract Manager Kim Henderson, Fiscal Analyst
Department of Health Department of Health
PO Box 47886, Olympia, WA 98504-7886 PO Box 47886, Olympia, WA 98504-7886
Jamie.Wells@doh.wa.gov / 360-236-3668 Kim.Henderson@doh.wa.gov / 360-236-3491
EXHIBIT B-17
Kittitas County Public Health Department ALLOCATIONS Contract Number:CLH18249
Contract Term: 2018-2021 Date:September 15, 2020
Indirect Rate as of January 2018: 29.50% Public Health Dept & 12.50% County Central Svcs
Indirect Rate as of January 2019: 28.25% Public Health Dept & 12.75% County Central Svcs
BARS Funding Chart of
Federal Award Revenue Period Accounts
Chart of Accounts Program Title Identification #Amend #CFDA*Code**Start Date End Date Start Date End Date Amount Sub Total Total
FFY19 CSS IAR SNAP Ed Program Mgnt 197WAWA5Q3903 Amd 9 10.561 333.10.56 10/01/18 09/30/19 10/01/18 09/30/19 $429 $20,174 $45,359
FFY19 CSS IAR SNAP Ed Program Mgnt 197WAWA5Q3903 Amd 4 10.561 333.10.56 10/01/18 09/30/19 10/01/18 09/30/19 $19,745
FFY18 CSS IAR SNAP Ed Program Mgnt CF 187WAWA5Q3903 Amd 4 10.561 333.10.56 10/01/18 09/30/19 10/01/18 09/30/19 $858 $858
FFY18 CSS IAR SNAP Ed Program Mgnt 187WAWA5Q3903 Amd 4 10.561 333.10.56 01/01/18 09/30/18 10/01/17 09/30/18 $3,000 $22,855
FFY18 CSS IAR SNAP ED Program Mgnt 187WAWA5Q3903 Amd 2 10.561 333.10.56 01/01/18 09/30/18 10/01/17 09/30/18 $11,025
FFY18 CSS IAR SNAP ED Program Mgnt 187WAWA5Q3903 N/A 10.561 333.10.56 01/01/18 09/30/18 10/01/17 09/30/18 $8,830
FFY17 CSS IAR SNAP ED Program Mgnt CF 1717WAWA5Q390 N/A 10.561 333.10.56 01/01/18 09/30/18 10/01/17 09/30/18 $1,472 $1,472
FFY21 IAR SNAP Ed Prog Mgnt-Region 2 NGA Not Received Amd 17 10.561 333.10.56 10/01/20 09/30/21 10/01/20 09/30/21 $26,046 $26,046 $46,649
FFY20 IAR SNAP Ed Prog Mgnt-Region 2 207WAWA5Q3903 Amd 10 10.561 333.10.56 10/01/19 09/30/20 10/01/19 09/30/20 $20,603 $20,603
BITV-COVID Ed LHJ Allocation-CARES NGA Not Received Amd 16 21.019 333.21.01 07/01/20 12/30/20 07/01/20 12/30/20 $63,009 $63,009 $63,009
COVID LHJ OFM Allocation-CARES NGA Not Received Amd 16 21.019 333.21.01 03/01/20 12/30/20 03/01/20 12/30/20 $909,400 $909,400 $909,400
FFY17 EPR PHEP BP1 LHJ Funding NU90TP921889-01 Amd 2 93.069 333.93.06 01/01/18 06/30/18 07/01/17 07/02/18 $565 $20,398 $20,398
FFY17 EPR PHEP BP1 LHJ Funding NU90TP921889-01 N/A 93.069 333.93.06 01/01/18 06/30/18 07/01/17 07/02/18 $19,833
FFY18 EPR PHEP BP1 Supp LHJ Funding NU90TP921889-01 Amd 5 93.069 333.93.06 07/01/18 06/30/19 07/01/18 06/30/19 $885 $49,134 $49,134
FFY18 EPR PHEP BP1 Supp LHJ Funding NU90TP921889-01 Amd 4 93.069 333.93.06 07/01/18 06/30/19 07/01/18 06/30/19 $48,249
FFY20 PHEP BP2 LHJ Funding NU90TP922043 Amd 17 93.069 333.93.06 07/01/20 06/30/21 07/01/20 06/30/21 $19,653 $49,133 $98,266
FFY20 PHEP BP2 LHJ Funding NU90TP922043 Amd 16, 17 93.069 333.93.06 07/01/20 06/30/21 07/01/20 06/30/21 $29,480
FFY19 PHEP BP1 LHJ Funding NU90TP922043 Amd 10 93.069 333.93.06 07/01/19 06/30/20 07/01/19 06/30/20 $49,133 $49,133
FFY17 317 Ops 5NH23IP000762-05-00 N/A 93.268 333.93.26 01/01/18 06/30/18 04/01/17 06/30/18 $616 $616 $616
FFY17 AFIX 5NH23IP000762-05-00 N/A 93.268 333.93.26 01/01/18 06/30/18 04/01/17 06/30/18 $2,226 $2,226 $2,226
FFY21 Enhanced Influenza Coverage CARES NH23IP922619 Amd 17 93.268 333.93.26 07/01/20 06/30/21 06/05/20 06/30/21 $2,800 $5,600 $5,600
FFY21 Enhanced Influenza Coverage CARES NH23IP922619 Amd 16, 17 93.069 333.93.06 07/01/20 06/30/21 06/05/20 06/30/21 $2,800
FFY17 Increasing Immunization Rates NH23IP000762 Amd 3, 4 93.268 333.93.26 07/01/18 06/30/19 07/01/18 06/30/19 $5,600 $5,600 $5,600
FFY21 VFC Ops NH23IP922619 Amd 17 93.268 333.93.26 07/01/20 06/30/21 07/01/20 06/30/21 $2,800 $5,600 $12,314
FFY21 VFC Ops NH23IP922619 Amd 15, 17 93.268 333.93.26 07/01/20 06/30/21 07/01/20 06/30/21 $2,800
FFY20 VFC Ops NH23IP922619 Amd 9 93.268 333.93.26 07/01/19 06/30/20 07/01/19 06/30/20 $5,600 $5,600
FFY17 VFC Ops 5NH23IP000762-05-00 N/A 93.268 333.93.26 01/01/18 06/30/18 04/01/17 06/30/18 $1,114 $1,114
Chart of Accounts
Funding Period
Statement of Work
Funding Period
DOH Use Only
Page 1 of 3
EXHIBIT B-17
Kittitas County Public Health Department ALLOCATIONS Contract Number:CLH18249
Contract Term: 2018-2021 Date:September 15, 2020
Indirect Rate as of January 2018: 29.50% Public Health Dept & 12.50% County Central Svcs
Indirect Rate as of January 2019: 28.25% Public Health Dept & 12.75% County Central Svcs
BARS Funding Chart of
Federal Award Revenue Period Accounts
Chart of Accounts Program Title Identification #Amend #CFDA*Code**Start Date End Date Start Date End Date Amount Sub Total Total
Chart of Accounts
Funding Period
Statement of Work
Funding Period
DOH Use Only
FFY19 COVID CARES NU50CK000515 Amd 15 93.323 333.93.32 06/01/20 12/31/20 06/01/20 06/30/21 $61,177 $61,177 $61,177
FFY20 CDC COVID-19 Crisis Resp LHJ-Tribe NU90TP922069 Amd 13 93.354 333.93.35 01/20/20 12/31/20 01/01/20 06/30/21 $78,522 $78,522 $78,522
FFY20 Phys Actvty & Nutrition Prog NGA Not Received Amd 17 93.439 333.93.43 09/30/20 09/29/21 09/30/20 09/29/21 $60,000 $60,000 $180,000
FFY19 Phys Actvty & Nutrition Prog NU58DP006504 Amd 10 93.439 333.93.43 09/30/19 09/29/20 09/30/19 09/29/20 $60,000 $60,000
FFY18 Phys Actvty & Nutrition Prog NU58DP006504 Amd 8, 15 93.439 333.93.43 02/19/19 09/29/20 09/28/18 09/29/20 $60,000 $60,000
FFY21 MCHBG LHJ Contracts NGA Not Received Amd 17 93.994 333.93.99 10/01/20 09/30/21 10/01/20 09/30/21 $44,196 $44,196 $166,628
FFY20 MCHBG LHJ Contracts B04MC32578 Amd 10 93.994 333.93.99 10/01/19 09/30/20 10/01/19 09/30/20 $44,196 $44,196
FFY19 MCHBG LHJ Contracts B04MC32578 Amd 4 93.994 333.93.99 10/01/18 09/30/19 10/01/18 09/30/19 $44,196 $44,196
FFY18 MCHBG LHJ Contracts B04MC31524 Amd 2 93.994 333.93.99 01/01/18 09/30/18 10/01/17 09/30/18 $893 $34,040
FFY18 MCHBG LHJ Contracts B04MC31524 N/A 93.994 333.93.99 01/01/18 09/30/18 10/01/17 09/30/18 $33,147
FEMA-75 COVID LHJ Allocation NGA Not Received Amd 16 97.036 333.97.03 07/01/20 12/30/20 07/01/20 12/30/20 $189,027 $189,027 $189,027
GFS-Group B (FO-E)Amd 10 N/A 334.04.90 07/01/20 12/31/20 07/01/19 06/30/21 $20,000 $20,000 $25,000
GFS - Group B (FO-E)N/A N/A 334.04.90 01/01/18 06/30/18 07/01/17 06/30/19 $5,000 $5,000
FY2 Group B Programs for DW (FO-E)Amd 3 N/A 334.04.90 07/01/18 06/30/19 07/01/17 06/30/19 $10,000 $10,000 $10,000
Zoonotics-GFS Amd 9 N/A 334.04.91 07/01/19 06/30/20 07/01/19 06/30/21 $4,029 $4,029 $5,000
Zoonotics-GFS Amd 9 N/A 334.04.91 06/01/19 06/30/19 07/01/17 06/30/19 $971 $971
FY20/21 COVID-19 Disaster Response Acct Amd 13 N/A 334.04.92 01/20/20 12/31/20 01/01/20 06/30/21 $71,478 $71,478 $71,478
SFY2 Lead Environments of Children Amd 8 N/A 334.04.93 07/01/18 06/30/19 07/01/18 06/30/19 ($1,500)$0 $2,000
SFY2 Lead Environments of Children Amd 4 N/A 334.04.93 07/01/18 06/30/19 07/01/18 06/30/19 $1,500
SFY1 Lead Environments of Children Amd 1 N/A 334.04.93 01/01/18 06/30/18 07/01/17 06/30/18 $2,000 $2,000
FPHS Funding for LHJs Amd 16 N/A 336.04.25 07/01/20 12/31/20 07/01/19 06/30/21 $58,000 $100,000 $242,000
FPHS Funding for LHJs Amd 10 N/A 336.04.25 07/01/20 12/31/20 07/01/19 06/30/21 $42,000
FPHS Funding for LHJs Amd 16 N/A 336.04.25 07/01/19 06/30/20 07/01/19 06/30/21 $58,000 $100,000
FPHS Funding for LHJs Amd 10 N/A 336.04.25 07/01/19 06/30/20 07/01/19 06/30/21 $42,000
FPHS Funding for LHJs Dir Amd 3 N/A 336.04.25 07/01/18 06/30/19 07/01/17 06/30/19 $42,000 $42,000
YR 20 SRF - Local Asst (15%) (FS) SS Amd 3 N/A 346.26.64 01/01/18 12/31/18 07/01/15 12/31/18 ($2,400)$0 $0
YR 20 SRF - Local Asst (15%) (FS) SS N/A, Amd 3 N/A 346.26.64 01/01/18 12/31/18 07/01/15 12/31/18 $2,400
Page 2 of 3
EXHIBIT B-17
Kittitas County Public Health Department ALLOCATIONS Contract Number:CLH18249
Contract Term: 2018-2021 Date:September 15, 2020
Indirect Rate as of January 2018: 29.50% Public Health Dept & 12.50% County Central Svcs
Indirect Rate as of January 2019: 28.25% Public Health Dept & 12.75% County Central Svcs
BARS Funding Chart of
Federal Award Revenue Period Accounts
Chart of Accounts Program Title Identification #Amend #CFDA*Code**Start Date End Date Start Date End Date Amount Sub Total Total
Chart of Accounts
Funding Period
Statement of Work
Funding Period
DOH Use Only
YR 21 SRF - Local Asst (15%) (FS) SS Amd 10 N/A 346.26.64 01/01/18 06/30/19 07/01/17 06/30/19 ($3,200)$2,400 $2,400
YR 21 SRF - Local Asst (15%) (FS) SS Amd 9, 10 N/A 346.26.64 01/01/18 06/30/19 07/01/17 06/30/19 $400
YR 21 SRF - Local Asst (15%) (FS) SS Amd 7, 10 N/A 346.26.64 01/01/18 06/30/19 07/01/17 06/30/19 $2,800
YR 21 SRF - Local Asst (15%) (FS) SS Amd 3, 7, 10 N/A 346.26.64 01/01/18 06/30/19 07/01/17 06/30/19 $2,400
YR 22 SRF - Local Asst (15%) (FO-E) SS Amd 14 N/A 346.26.64 01/01/19 12/31/20 01/01/19 06/30/21 ($400)$6,600 $6,600
YR 22 SRF - Local Asst (15%) (FO-E) SS Amd 12 N/A 346.26.64 01/01/19 12/31/20 01/01/19 06/30/21 $3,800
YR 22 SRF - Local Asst (15%) (FO-E) SS Amd 10, 12 N/A 346.26.64 01/01/19 12/31/20 01/01/19 06/30/21 $3,200
Sanitary Survey Fees (FO-E) SS-State Amd 14 N/A 346.26.65 01/01/18 12/31/20 07/01/17 06/30/21 ($400)$9,000 $9,000
Sanitary Survey Fees (FO-E) SS-State Amd 12 N/A 346.26.65 01/01/18 12/31/20 07/01/17 06/30/21 $3,800
Sanitary Survey Fees (FO-E) SS-State Amd 9, 12 N/A 346.26.65 01/01/18 12/31/20 07/01/17 06/30/21 $400
Sanitary Survey Fees (FO-E) SS-State Amd 7, 12 N/A 346.26.65 01/01/18 12/31/20 07/01/17 06/30/21 $2,800
Sanitary Survey Fees (FO-E) SS-State N/A, Amd 3, 7, 12 N/A 346.26.65 01/01/18 12/31/20 07/01/17 06/30/21 $2,400
YR 20 SRF - Local Asst (15%) (FS) TA Amd 3 N/A 346.26.66 01/01/18 12/31/18 07/01/15 12/31/18 ($2,000)$0 $0
YR 20 SRF - Local Asst (15%) (FS) TA N/A, Amd 3 N/A 346.26.66 01/01/18 12/31/18 07/01/15 12/31/18 $2,000
YR 21 SRF - Local Asst (15%) (FS) TA Amd 10 N/A 346.26.66 01/01/18 06/30/19 07/01/17 06/30/19 ($4,000)$0 $0
YR 21 SRF - Local Asst (15%) (FS) TA Amd 7, 10 N/A 346.26.66 01/01/18 06/30/19 07/01/17 06/30/19 $2,000
YR 21 SRF - Local Asst (15%) (FS) TA Amd 3, 7, 10 N/A 346.26.66 01/01/18 06/30/19 07/01/17 06/30/19 $2,000
YR 22 SRF - Local Asst (15%) (FO-E) TA Amd 14 N/A 346.26.66 01/01/19 12/31/20 01/01/19 06/30/21 ($2,000)$2,000 $2,000
YR 22 SRF - Local Asst (15%) (FO-E) TA Amd 12 N/A 346.26.66 01/01/19 12/31/20 01/01/19 06/30/21 $2,000
YR 22 SRF - Local Asst (15%) (FO-E) TA Amd 10, 12 N/A 346.26.66 01/01/19 12/31/20 01/01/19 06/30/21 $2,000
TOTAL $2,309,403 $2,309,403
Total consideration:$2,153,908 GRAND TOTAL $2,309,403
$155,495
GRAND TOTAL $2,309,403 Total Fed $1,933,925
Total State $375,478
*Catalog of Federal Domestic Assistance
**Federal revenue codes begin with "333". State revenue codes begin with "334".
Page 3 of 3
Exhibit C-14 Schedule of Federal Awards AMENDMENT #17
Date: September 15, 2020
DOH Total Amt
Chart of Accounts Program Title BARS Federal
Award Date
Federal
Award
Start
Date
End
Date Contract Amt CFDA CFDA Program Title Federal Agency Name Federal Award
Identification Number Federal Grant Award Name
FFY20 IAR SNAP ED PROG MGNT-REGION 2 333.10.56 09/30/19 $5,300,000 10/01/19 09/30/20 $20,603 10.561
State Administrative Matching
Grants for the Supplemental
Nutrition Assistance Program
Department of Agriculture Food and
Nutrition Service 207WAWA5Q3903
2019 SUPPLEMENTAL NUTRITION
ASSISTANCE PROGRAM-EDUCATION
(SNAP-ED)
FFY20 IAR SNAP ED PROG MGNT-REGION 2 333.10.56 NGA Not
Received
NGA Not
Received 10/01/20 09/30/21 $26,046 10.561
State Administrative Matching
Grants for the Supplemental
Nutrition Assistance Program
Department of Agriculture Food and
Nutrition Service NGA Not Received NGA Not Received
FFY19 CSS IAR SNAP-ED PROG MGNT 333.10.56 09/28/18 $5,386,268 10/01/18 09/30/19 $20,174 10.561
State Administrative Matching
Grants for the Supplemental
Nutrition Assistance Program
Department of Agriculture Food and
Nutrition Service 197WAWA5Q3903 SNAP 2YR NUTRITION ED OBESITY
FFY18 CSS IAR SNAP-ED PROGRAM MGNT CF 333.10.56 09/30/19 $5,300,000 10/01/18 09/30/19 $858 10.561
State Administrative Matching
Grants for the Supplemental
Nutrition Assistance Program
Department of Agriculture Food and
Nutrition Service 187WAWA5Q3903
2018 SUPPLEMENTAL NUTRITION
ASSISTANCE PROGRAM EDUCATION
(SNAP-ED)
FFY18 CSS IAR SNAP-ED PROGRAM MGNT 333.10.56 09/28/17 $5,300,000 01/01/18 09/30/18 $22,855 10.561
State Administrative Matching
Grants for the Supplemental
Nutrition Assistance Program
Department of Agriculture Food and
Nutrition Service 187WAWA5Q3903
2018 SUPPLEMENTAL NUTRITION
ASSISTANCE PROGRAM EDUCATION
(SNAP-ED)
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
State Administrative Matching
Grants for the Supplemental
Nutrition Assistance Program
Department of Agriculture Food and
Nutrition Service 1717WAWA5Q390
2018 SUPPLEMENTAL NUTRITION
ASSISTANCE PROGRAM EDUCATION
(SNAP-ED)
COVID LHJ OFM ALLOCATION-CARES 333.21.01 NGA Not
Received
NGA Not
Received 03/01/20 12/30/20 $909,400 21.019 Coronavirus Relief Fund Department of the Treasury NGA Not Received NGA Not Received
BITV-COVID ED LHJ ALLOCATION-CARES 333.21.01 NGA Not
Received
NGA Not
Received 07/01/20 12/30/20 $63,009 21.019 Coronavirus Relief Fund Department of the Treasury NGA Not Received NGA Not Received
FFY20 PHEP BP2 LHJ FUNDING 333.93.06 06/12/20 $11,365,797 07/01/20 06/30/21 $49,133 93.069 Public Health Emergency
Preparedness
Department of Health and Human
Services Centers for Disease Control
and Prevention
NU90TP922043
PUBLIC HEALTH EMERGENCY
PREPAREDNESS (PHEP)
COOPERATIVE AGREEMENT
FFY19 PHEP BP1 LHJ FUNDING 333.93.06 06/29/19 $11,307,904 07/01/19 06/30/20 $49,133 93.069 Public Health Emergency
Preparedness
Department of Health and Human
Services Centers for Disease Control
and Prevention
NU90TP922043
PUBLIC HEALTH EMERGENCY
PREPAREDNESS (PHEP)
COOPERATIVE AGREEMENT
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 Public Health Emergency
Preparedness
Department of Health and Human
Services Centers for Disease Control
and Prevention
NU90TP921889-01
HOSPITAL PREPAREDNESS
PROGRAM AND PUBLIC HEALTH
EMERGENCY PREPAREDNESS
COOPERATIVE AGREEMENT
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 Public Health Emergency
Preparedness
Department of Health and Human
Services Centers for Disease Control
and Prevention
NU90TP921889-01 HPP AND PHEP COOPERATIVE
AGREEMENT
FFY21 VFC OPS 333.93.26 07/01/19 $9,234,835 07/01/20 06/30/21 $5,600 93.268 Immunization Cooperative
Agreements
Department of Health and Human
Services Centers for Disease Control
and Prevention
NH23IP922619 IMMUNIZATION GRANT AND
VACCINES FOR CHILDREN PROGRAM
FFY21 ENHANCED INFLUENZA COVERAGE CARES 333.93.26 08/13/20 $12,548,955 07/01/20 06/30/21 $5,600 93.268 Immunization Cooperative
Agreements
Department of Health and Human
Services Centers for Disease Control
and Prevention
NH23IP922619 IMMUNIZATION GRANT AND
VACCINES FOR CHILDREN PROGRAM
FFY20 VFC OPS 333.93.26 07/01/19 $9,234,835 07/01/19 06/30/20 $5,600 93.268 Immunization Cooperative
Agreements
Department of Health and Human
Services Centers for Disease Control
and Prevention
NH23IP922619 IMMUNIZATION GRANT AND
VACCINES FOR CHILDREN PROGRAM
FFY17 VFC OPS 333.93.26 03/03/17 $1,201,605 01/01/18 06/30/18 $1,114 93.268 Immunization Cooperative
Agreements
Department of Health and Human
Services Centers for Disease Control
and Prevention
5NH23IP000762-05-00
IMMUNIZATION GRANT AND
VACCINES FOR CHILDREN'S
PROGRAM
Allocation Period
KITTITAS COUNTY HEALTH DEPT-SWV0010475-07
CONTRACT CLH18249-Kittitas County Public Health Department
CONTRACT PERIOD: 01/01/2018-12/31/2021
Page 1 of 2
Exhibit C-14 Schedule of Federal Awards AMENDMENT #17
Date: September 15, 2020
DOH Total Amt
Chart of Accounts Program Title BARS Federal
Award Date
Federal
Award
Start
Date
End
Date Contract Amt CFDA CFDA Program Title Federal Agency Name Federal Award
Identification Number Federal Grant Award Name
Allocation Period
KITTITAS COUNTY HEALTH DEPT-SWV0010475-07
CONTRACT CLH18249-Kittitas County Public Health Department
CONTRACT PERIOD: 01/01/2018-12/31/2021
FFY17 INCREASING IMMUNIZATION RATES 333.93.26 06/29/18 $1,722,443 07/01/18 06/30/19 $5,600 93.268 Immunization Cooperative
Agreements
Department of Health and Human
Services Centers for Disease Control
and Prevention
NH23IP000762
IMMUNIZATION GRANT AND
VACCINES FOR CHILDREN'S
PROGRAM
FFY17 AFIX 333.93.26 03/03/17 $1,672,289 01/01/18 06/30/18 $2,226 93.268 Immunization Cooperative
Agreements
Department of Health and Human
Services Centers for Disease Control
and Prevention
5NH23IP000762-05-00
IMMUNIZATION GRANT AND
VACCINES FOR CHILDREN'S
PROGRAM
FFY17 317 OPS 333.93.26 03/03/17 $575,969 01/01/18 06/30/18 $616 93.268 Immunization Cooperative
Agreements
Department of Health and Human
Services Centers for Disease Control
and Prevention
5NH23IP000762-05-00
IMMUNIZATION GRANT AND
VACCINES FOR CHILDREN'S
PROGRAM
FFY19 COVID CARES 333.93.32 04/23/20 $22,581,799 06/01/20 12/31/20 $61,177 93.323
Epidemiology and Laboratory
Capacity for Infectious Diseases
(ELC)-Building and
Strengthening Epidemiology,
Laboratory and Health
Department of Health and Human
Services Centers for Disease Control
and Prevention
NU50CK000515
EPIDEMIOLOGY & LABORATORY
CAPACITY FOR INFECTIOUS
DISEASES (ELC)-BUILDING &
STRENGTHENING EPIDEMIOLOGY,
LABORATORY & HEALTH
FFY20 CDC COVID-19 CRISIS RESP LHJ-TRIBE 333.93.35 03/16/20 $13,230,799 01/20/20 12/31/20 $78,522 93.354
Public Health Emergency
Response: Cooperative
Agreement for Emergency
Response: Public Health Crisis
Response
Department of Health and Human
Services Centers for Disease Control
and Prevention
NU90TP922069
CDC COOPERATIVE AGREEMENT FOR
EMERGENCY RESPONSE: PUBLIC
HEALTH CRISIS RESPONSE CDC-RFA-
TP18-1802
FFY20 PHYS ACTVTY & NUTRITION PROG 333.93.43 NGA Not
Received
NGA Not
Received 9/30./20 09/29/21 $60,000 93.439 State Physical Activity and
Nutrition (SPAN)
Department of Health and Human
Services NGA Not Received NGA Not Received
FFY19 PHYS ACTVTY & NUTRITION PROG 333.93.43 07/24/19 $1,846,000 09/30/19 09/29/20 $60,000 93.439 State Physical Activity and
Nutrition (SPAN)
Department of Health and Human
Services NU58DP006504 STATE PHYSICAL ACTIVITY AND
NUTRITION-WASHINGTON (SPANWA)
FFY18 PHYS ACTVTY & NUTRITION PROG 333.93.43 09/01/18 $923,000 02/19/19 09/29/20 $60,000 93.439 State Physical Activity and
Nutrition (SPAN)
Department of Health and Human
Services NU58DP006504 STATE PHYSICAL ACTIVITY AND
NUTRITION-WASHINGTON (SPANWA)
FFY21 MCHBG LHJ CONTRACTS 333.93.99 NGA Not
Received
NGA Not
Received 10/01/20 09/30/21 $44,196 93.994
Maternal and Child Health
Services Block Grant to the
States
Department of Health and Human
Services Health Resources and
Services Administration
NGA Not Received NGA Not Received
FFY20 MCHBG LHJ CONTRACTS 333.93.99 11/14/18 $2,225,977 10/01/19 09/30/20 $44,196 93.994
Maternal and Child Health
Services Block Grant to the
States
Department of Health and Human
Services Health Resources and
Services Administration
B04MC32578 MATERNAL AND CHILD HEALTH
SERVICES BLOCK GRANT
FFY19 MCHBG LHJ CONTRACTS 333.93.99 11/14/18 $2,225,977 10/01/18 09/30/19 $44,196 93.994
Maternal and Child Health
Services Block Grant to the
States
Department of Health and Human
Services Health Resources and
Services Administration
B04MC32578 MATERNAL AND CHILD HEALTH
SERVICES BLOCK GRANT
FFY18 MCHBG LHJ CONTRACTS 333.93.99 10/20/17 $1,650,528 01/01/18 09/30/18 $34,040 93.994
Maternal and Child Health
Services Block Grant to the
States
Department of Health and Human
Services Health Resources and
Services Administration
B04MC31524 MATERNAL AND CHILD HEALTH
SERVICES
FEMA-75 COVID LHJ ALLOCATION 333.97.03 NGA Not
Received
NGA Not
Received 07/01/20 12/30/20 $189,027 97.036
Disaster Grants-Public
Assistance (Presidentially
Declared Disasters)
Department of Homeland Security NGA Not Received NGA Not Received
TOTAL $1,933,925
Page 2 of 2