HomeMy WebLinkAboutCon Con Amend 23KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2018 _ 2021 CONSOLIDATED CONTRACT
CONTRACTNUMBERT CLIdLB249 4MENDMENTNUMBER: 23
PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as ,.DoH,,, andKITTITAS COUNTY PUBLIC HEALTH DEPARTMENT, a Local Health Jwisdiction, hereinafterrefened to as ..LHJ,,, pursuant tothe ModificationsAVaivers clause, and to make necessary changes within the scope of this contract and any subsequent amendmentsthereto.
IT IS MUTUALLY AGREED: That the conkact is hereby amended as follows:
Exhibit A Statements of Work, attached and incorporated by this reference, are amended as follows:
X Adds Statements of Work for the following programs:
r Ol-Promotion of Immunizations to Improve Vaccination Rates - Effective July 1,2021
X Amends Statements of Work for the following programs:
r Climate & Health Wildfire Smoke Indoor Air Quality Pilot Study - Effective September l,2020r COMD-l9 Coordinated Response - Effective July 1,2020r Foundational Public Health Services (FpHS) - Effective IuIy 1,2021r Supplemental Nutrition Assistance Program-Education - Effective October 1,2020
! Deletes Statements of Work for the following programs:
2' Exhibit B-23 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-22 Allocations as follows:
X Increase of $655.009 for a revised maximum consideration of $4.434.110.
n Decrease of _ for a revised maximum consideration of
! No change in the maximum consideration of
Exhibit B Alrocations are anached only for itEilitionul purposes.
3' Exhibit c-20 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces Exhibit c-19.
Unless designated otherwise herein, the effective date of this amendment is the date of execution.
ALL OTHER TERMS AND CoNDITIONS of the original contract and any subsequent amendments remain in full force and effect.
IN WITNESS WHEREOF, the undersigned has affixed his/her signature in execution thereof.
KITTITAS COT]NTY PUBLIC HEALTH DEPARTMENT STATE OF WASHINGTON
DEPARTMENT OF HEALTH
(Mf\
Breildr Iienrikson. Cotrtracls iDe€ 15.2021 08:21
Date Date
APPROVED AS TO FORM ONLY
Assistant Attorney General
Page I of39
AMENDMENT #23DOII Program Name or Title:DOH ProgramName or Title:DOH Program Name or Title:DOH Program Name or Title:DOH Program Name or Title:2OI8-202I CONSOLIDATED CONTRACTEXHIBIT ASTATEMENTS OF WORI(TABLE OF CONTENTSClimate & Health Wildfire Smoke IndoorAir Qualrty Pilot Study -COVID-l9 Coordinated Response - Effective July l, 2020.............Effective September l, 2020Foundational Public Health Se'rvices (FPHS) - Effective July 1, 202L...........OI-Promotionof Immunizafions to Improve Vaccination Rates - Effective JuIy 1,2021SupplementalNutrition Assistance Program-Education - Effective October 1,202037t92426Exhibit Ae Statements of WorkRevised as of September 15,2021Page2 of39Contract Number CLHI 8249 -23
DOH Program Name or Title: Climate & Health Wildfire Smoke Indoor Air OualityPilot Study - Effective September 1.2020SOW Type: Revision Revision # (for this SOW) 2Period of Performance: September 1. 2020 through December 3 I . 202 IAMENDMENT #23Exhibit AStatement of WorkContract Term: 2018-2021Local Health Jurisdiction Name: Kittitas countv public Health DepartnentContract Number: CLHI8249Type ofPaymentX Reimbursementn Fixed PriceFederal Compliance(check if applicable)FFATA (Transparency Act)Research & DevelopmentFunding Source[l Federal Subrecipientn stut"f]o*rerStatement of work Purpose: The purpose of this statement of work is to respond to declared wildfire disasters in washington state by identiffing the most vulnerableareas where indoor air quality needs improvement. This pilot study will be done as part of the centeiof Disease contof and irevention's grant..strengthening environmentalDOH on September 1,2020.Kittitas county Public Health Department (KCPTID) will support the DoH led wildfre Smoke Indoor Air euality pilot Study, as Kittitas county was the selected study area. Thisstatement of work provides KCPHD $90,000 to perform community outreach and implement.Revision Purpose: The purpose of tJds revision is to extend the period of performance and funding from Novemb er 30, 2021to December 31, 2021 ,change the MI code, updateactivities, decrease firndiog consideration, and extend due dates to match eitension of project timeline through 2021.Exhibit d Statements of WorkRevised as of Septemb er 15, 202I(-)Change-21-21CurrentConsiderationlll11l2l3U21Start Date EndFunding Period(LHJ Use Only)09/01/20MasterIndexCode25440100BARSRevenueCode333.93.07CFDA #93.070of Accounts Program Name or TitleNCEACITY-CFFY2O ENVIRHEALTH CAPTOTALSPaymentInformation and/orAmountReimbursement foractual costs not toexceed $42,000Due Date/TimeFramew@+December 31.2021Deliverables/Outcomes*LHJ presents to DOH communityhealth and disparity status andgeneral prioritiesLHJ presents to DOH selection ofpriority at-risk target populationfor pilot project and criteria forparticipant eligibility of based onneed*May Support PHABStandards/lVleasuresTask/ActivityiDescriptionCollaborate with DOH to identi$r individuals andtheir location ofresidence for residential pilotintervention within the selected target vulnerablepopulafion to include:. Identi&ing vulnerable population based onhealth risk and county needr Establishing selection criteria for participationr Identi&ing target individuals for interventionand enrolling participants in residential pilotTaskNumberIPage 3 of39Contract Numb er CLHI 8249 -23
Exhibit A" Statements of WorkRevised as of September 15,2021AMENDMENT #23PaymentInformation and/orAmountReimbursementactual costs not toexceed $46,000.for*imgursene*ferM-+oseeea-Se+fi90.Due Date/Timetr'ramelaty-+6+gXDecember 3 1, 202lDecember 31, 2021t*e+vn4er4&;eg+lDeliverableVOutcomes*recruitrnent plan forparticipation in residential pilotprojectLHJ presents a list of selectedhouseholds for residential pilotproject# of people providing infomredconsent for participation inresidential pilot prdectAforcompletionresearchofCertificationhumanA copy of the communicationA written protocol for applyinginterventions in residencesDOH and LHJ presant definitionsof roles and responsibilitiesA list of selected residences forevaluation.resourceequipment purchased(i.e. portable air cleaners)# of residences receivinginterventions from DOH and LHJIntervention*May Support PIIABStandardVMeasuresTask/Activity/Descriptionhuman subjects researchProject stafftakinghainingCollaborate with DOH totraining to create cleanerresidences include:Developing resources for communicatingguidance developed for use with thispopulation within 41" countyEstablishing protocol for applyinginterventions in residencesDefining roles and responsibilities forapplying intervention in residencesaadevelop outreach andindoor air spaces to rzo Implementing intervention stategy in ten (10residences)ofpointcleanermalnimplementationastestcreatingforservmginclude:pilotbytotostrategyDOHresidenceswithparticipantslnfor41rmterventiontheCollaborateofindoorcontacttht*"-k**t"h*Weinelade-ifttefrefrt@t@hAU z^tn^lI-L --t-.,,rLTaskNumber234Page 4 of39Contract Number CLHI 8249 -23
AMENDMENT #23*For Information Onlv:Funding is not tied to therevised Standards/Ivleasures listed here. Thisinforrnation may be helpfulin discussions ofhow programactivities might contributeto meeting aStandard/Measure.More detail on these and./or other public HealthAccreditation Board (pHAB)Standards/Measures thatmay apply can be found at:lrosram Specilic Requ eDue to the unpredictable nature of tildf''e t-oke events, KCPITD and DoH will be prepared to respond quickly to ensure timely and high quality data colrection during the event.Many tasks are jointly shared between KCPHD and Dori; specific t"[r *a ,"rpooribititi"s will be discussed on monthly calls in order to achieve deliverables.Special RequirementsThisstatementofworkissupportedby@[ancewiththeFederalFundingAcco'mtabilityandTransparencyAct(FFATAortheTransparencyAct).The purpose of the Transparency Act is to make information avaimre onti.re so the public "ur, ,"" t o* the federal funds are spent.To comply with this act and be eligible to perform the activities in this statement of work, the LHJ must have a Data universal Numbering System (DUNS@) number.Information about the LHJ and this statement of work will be made available on USASpending.gov by DoH as required by p.L. l0g-2g2.Restrictions on Funds (what funds can be used for which activities, not direct payments, etc)The fi'rnds can be used to complete the activities outlined above to conduct community "rrgug"-"ot and implement and evaluate the pilot study. Restrictions on fnds imposed bythe CDC include:r Subrecipients may not use funds for research.. Subrecipients may not use funds for clinical care except as allowed by law.r Subrecipients may use funds only for reasonable program puq)oses, including personnel, travel, supplies, and services.Exhibit A5 Statements of WorkRevisedasof Septemberll,2L2l Page5 of39 ContractNumberCLHlS24g-23PaymentInformation and/orAmountDue Date/TimeFrameNevenger+S;252++,tevem+e*S;242lDeliverables/Outcomes+@ifttefiefttiofrassessfren+*May Support PIIABStandards/l}leasuresTask/Activity/Description;rees_b-ffires+denees-inekd*theinteaentienassessffien'tMieft+e-inMe:M@TaskNumber56
o Generally' sub-recipients may not use funds to purchase fumiture or,equipment. Any such proposed spending must be clearly identified in the budget.o Reimbursement of pre-award costs generally is not allowed, unless trre cbc provides written approval to the sub-recipient.r other than for normal and recognized executive-legislative relationships, oo irnd, -uy i" used for:t t":1|1"1flJ;fi*"t** pulposes' for thelreparatio", Ji,t iu.rtio", or,r" oi7"y-..,ut".iul designed to supporr or defear the enactment of legislarion before anyo the salary or expenses ofany grant or contract sub-recipient related to any activity designed to influence the enacfinent oflegislation, appropriations, regulation,administrative action, or Executive order proposed or plnding before any legislative bodyNGos that receive funds provided through this-award, eitrrer as a prime recipient o. ,rrt ,".ipi""f *.;;til;;fiited, regardress oiit e source of funds, fromperforming abortions as a method of family pF*Tg ot "nguging in ao1 agtivitY thatpromotes abortion as a method of family plannin& or to provide financial support toany other foreign non-governmental organization thit .onoirci ,ir"t u"ii',oiti"r. -s"" eiaitional Requirement (AR) 35 for applicability(http s ://www. cdc. gov/grants/additionaliequirements/ar-3 i t;l). "Monitoring Visits (frequency, type)Project stafffrom Kittitas county Fublic Health and DoH will have at a minimum monthly phone or video carls to check-in on t]'e progress of the grant for the duration of theproject period' These may be substituted for in person meetings in the event that covlD ,"rt i"tio.r* are lifted during the project period.AMENDMENT #23DOIf Program ContactRad CunninghamClimate and Health Section ManagerPO Box 47825, Olympia WA 985b4_7S25Rad.Cunnineham@doh.wa.eov / 360-236_3359Exhibit A, Statements of WorkRevised as of September 15,2021DOH Fiscal ContactJayme HillsBudget and Fiscal ManagerPO Box 47825, Olympia WA 98504-7825Jayme.Hills@doh.wa. gov / 360-236-3Zt IPage 6 of39Contract Numb er CLHI 8249 -23
Statement of Work Purpose: The purpose of this statement of work is to provide supplemental funding for the LHJ to ensure adequate culturally and linguistically responsivetesting, investigation and contact tracing resources to limit the spread of covlD-I9NOTE: Pending execution of a new consolidated contract term or an extension to the 201 8-202 I consolidated contracts which currently end Decemb er 31, 202l,DOH plans tocontinue the task activities and funding as noted in the task(s) below in a new or revised statement of work effective January 1,2022.Revision Purpose: The purpose of this revision is to add additional funding to FFY20 ELC EDE LHJ ALLOCATION, adjust thefunding period for BITV-COVID ED LHJALLOCATION- CARES from07l0ll20-l2l3ll2l to 07101/20-06130/21, moving the remaining allocation of BITV-COVID ED LHJ ALLOCATION-CARES to FFy20 ELC EDELHJALLOCATION, andupdate task language, DCHS-Task 1 & 2DOH Program Name or Title: COVID-I9 Coordinated Response -Effective July l. 2020SOW Type: Revision Revision # (for this SOW) 5Period of Performance: July I . 2020 through December 3 I . 2021Exhibit A, Statements of WorkRevised as of September 15,2021Type of Payment[l ReimbursementI Fixed PriceFederal Compliance(check if applicable)X Ffefn (Transparency Act)n Research & DevelopmentFunding Source[l federal Subrecipientn state E ottrer[l Federal *ContractorExhibit AStatement of WorkContract Term: 2018-2021AMENDMENT #23Local Health Jurisdiction Name: Kittitas county Public Health DeparhnentContract Number: CLH|8249TotalConsiderationt31.229014.582800,968237.0770354.8031.53E.659ChangeIncrease (+)-120.80700270.8070001s0.000CurrentConsideration252-0360t4.582530.161237.0770354.8031.38E.6s9Funding Period(LHJ Use Only)Start Date End Date06130/2tt2130/20t2l3y2t12t31t21tzl3ll2ttzl3t/2tL2/31/21TOTALS07/0U2007/0!2007/0v200ut5/2t011011210U2ll2r07/0U20MasterIndexCode1897t29V1897129W74310209t89712081897129G934V020074310229BARSRevenueCode333.2t.01333.97.03333.93.26333.93.32333.93.32333.97.03333.93.26CFDA#21.01997.03693.26893.32393.32397.03693.268Chart of Accounts Program Name or TitleBITV-COVID ED LHJ ALLOCATION-CARESFEMA-75 COVID LHJ ALLOCATIONFFY2I COVID I 9 VACCINE SERVICES-CARESFFY2O ELC EDE LHJALLOCATIONFFYI9 ELC COVID ED LHJ ALLOCATION*MASS VACCINATION FEMA IOO%COVID 19 VACCINESPaymentInformation and/orAmountParticipate in public health emergency preparedness andresponse activities for COVID-l9. This may include surveillance, epidemiology, laboratory capacity, infection control,mitigation, communications and or other preparednessand response activities for COVID-I9.Examples of key activities include:r Incident management for the responser Testingr Caselnvestieation/ContactTracinsDue Date/Time FrameDeliverables/Outcomes*May Support PHABStandards/lVleasuresTask/Activity/DescriptionTaskNumberPage 7 of39Contract Number CLHI 8249 -23
Exhibit d Statements of WorkRevised as of September 15,2021AMENDMENT #23Paymentfnformation and/orAmountReimbursement ofactual costsincurred, not toexceed $1,169,274$1;0-19214 total.$13r,229 $2s2p36BITV-COVID EDLHJALLOCATION-CARES Funding(Mr l897t2ev)$800,968 $#eJeFFY2O ELC EDELHJALLOCATIONFunding(Mr 1897120E)Funding end date7/3U2023$237,077 FFY19ELC COVID EDLHJALLOCATIONFunding(Mr 1897129c)Funding end date10118t2022Due Date/Time FrameWithin 30 days ofreceiving any newaward for DCHSCOVID-I9 Responsetasks.Enter performancemetrics daily into DOHidentified systemsQuarterly performancereporting updatesDeliverables/OutcomesSubmit the budget planand narrative using thetemplate provided.Data collected andreported into DOHsystems daily.Enter all contact tracingdata in CREST followingguidance from-DOH.*May Support PHABStandards/lVleasuresTask/Activity/DescriptionEstablish a budget plan and narrative to be submitted to theDeparfinent of Health (DOH) Contract Manager. DOH willsend the'Budget narrative Template", "Budget Guidance"and any other applicable documents that may be identified.DOH does recognize the public health response goesbeyond December 2021 and authorizes local healthjurisdictions the ability to maximize funding streamsavailable to them by using short term funding lirst tohave longer term funding available to continue tosupport the local health jurisdiction response activitiesbeyond December 2021 ts applicable.1) LHJ Active monitoring activities. In partrership withWA DOH and neighboring Tribes, the LHJ must ensureadequate culturally and linguistically responsive testing,investigation and contact tracing resources to limit thespread disease. LHJs must conduct the followingactivities in accordance with the guidance to beprovided by DOH.a. Allocate enough funding to ensure the followingContact Tracing and Case Investigation Support:Hire a minimum of 1.0 data entry FTE to assuresystem requirements for task 2.1.a.i. Contact tracingl. Strive to maintain the capacity to surge aminimum of five (5) contact tracers forevery 100,000 people in thejurisdiction,as needed, based on disease rates. DOHcentralized investigations will counttowards this minimum.TaskNumbero Sustainable isolation and quarantine. Care coordinationr Surge managementr Data reportingtracing,9Icontact&COVID.forinvestigationsactivitiescaseandepidemiology,surveillance,healthoutcarrytootherjurisdictionshealthlocalforfundsexistingsupplementto1SagreementthisofinfectionpurposeTheNOTE:DCHS COYID-l9 Response - Tasks 1 and 2 - Unspent ELC funding can be carried forward into new contract term effective January 1,2022.I2Page 8 of39Contract Number CLHI 8249 -23
Exhibit A, Statements of WorkRevised as of September 15,2021AMENDMENT #23Paymentfnformation and/orAmountDue Date/Tine FrameDeliverables/OutcomesEnter all caseinvestigation data inWDRS-followingguidance from-DOH.*May Support PHABStandards/lVleasuresTask/Activity/Descriptionprovide culturally and linguisticallycompetent and responsive services. Inaddition, or alternatively, enter into anagreement(s) with Tribal, community_based and/or culturally-specifi corganizations to provide such services.DOH cenhalized investigations will counttowards this minimum.Ensure all contact tracing staffare tainedin accordance with DOH investigativeguidelines and data entry protocols.Coordinate with Tribal parbrers inconducting contact tracing for Tribalmembers.Ensure contact tracing and caseinvestigations activities meet DOH caseand Contact Tracing Metrics. (Metrics tobe determined collaboratively by DOH,LHJs and Tribes.) Workwith DOH todevelop a corrective action plan ifunableto meet metrics.Perform daily monitoring for symptomsdwing quarantine period of contactsii. Case investigationL Strive to maintain the capacity to surge aminimum of five (5) case investigatorsand contact tracers for every 100,000people in thejurisdiction, as needed, basedon disease rates. DOH centralizedinvestigation will count toward thisminimum.2. Enter all case investigation and outbreakdata in WDRS following DOH guidance.a) Strive to enter all case investigationand outbreak data into CREST asdirected by DoH.b) Ensure all staffdesignated to utilizeWDRS have access and are trained in,,36.4.5.theTaskNumberPage 9 of39Contract Number CLHI8249 -23
Exhibit d Statements of WorkRevised as of Septemb er 15, 2021AMENDMENT#23PaymentInformation and/orAmountDue Date/Time FrameDeliverables/OutcomesMaintain a current list ofentities providingCOVID-I9 testing and arwhat volume. Providereports to DOH Conhactmanager on testinglocations and volume asrequested.Ensure all COVIDpositive test results areentered into WDRS within2 days ofreceipt*May Support PHABStandards/lVleasuresTask/Activity/Descriptionto a known existing positive case orindicate community spread.d) Conduct case investigation andmonitor outbreaks.e) Coordinate with Tribal partners inconducting case investigations fortribal members.3. Ensure contact tracing and caseinvestigation activities meet DOH Caseand Contact Tracing Mehics. (Metrics tobe determined collaboratively by DOH,LHJs, and Tribes.) Work with DOH todevelop a corrective action plan ifunableto meet metrics.b. Testingi. Work with parhers and Tribes to ensuretesting is available to every person within thejurisdiction meeting current DOH criteria fortesting and other local testing needs.ii. Work with partners and Tribes to ensuretesting is provided in a culturally andlinguistically responsive manner with anemphasis on making testing available todisproportionately impacted communities andas a part ofthejurisdiction,s contact hacingstrategy.iii. Maintain a current list of entities providingCOVID-I9 testing and at what volume.Provide reports to DOH on testing locationsand volume as requested.c. Suweillance FTE support at a minimum of .5 FTEEpidemiologist to support daily reporting needsbelow.i. Ensrue all COVID positive lab test results fromLHJ are entered in to WDRS by l) entering datadirectly in to WDRS,2) sending test results toDOH to enter, or 3) working with DOH andentities conducting tests to implement anelectronic method for test result submission.new positive cases are tiedc) Include ifTaskNumberPage l0 of39Contract Number CLHL 8249 -23
AMENDMENT #23Exhibit A5 Statements of WorkRevised as of September 15,2021PaymentInformation and/orAmountDue Date/Time FrameDeliverables/OutcomesQuarterly performanceupdates related toculturally and linguisticcompetency andresponsiveness, tribalsupport, infectionprevention and control forhigh-risk populations,community education andregional active monitoringactivities. Perfonnanceupdate should includestatus ofall projectslisted.*May Support PHABStandards/lVleasuresTask/Activity/Descriptionii. Maintain records of all COVID negative lab testresults from the LHJ and enter into WDRSwhen resources permit or send test results toDOH.iii. Collaborate with Tribes to ensure Tribal entitieswith appropriate public health authority haveread/write access to WDRS and CREST toensure that all COVID lab results from theirjurisdictions are entered in WDRS or sharedwith the LHJ or DOH for entry.d. Tribal Support. Ensure alignment of contacttracing and support for patients and family bycoordinating with local tribes if a patient identifiedas American Indian/Alaska Native and/or amember of a WA tribe.e.Support Infection Prevention and contol for high-risk populationsi. Migrant and seasonal farmworker support.Parfirer with farmers, agriculture sector andfannworker service organizations to developand execute plans for testing, quarantine andisolation, and social service needs for migrantand seasonal farmworkers.ii. Congregate care facilities: In collaborationwith the state licensing agency (DSHS),support infection prevention assessments,testing. Infection control and isolation andquarantine protocols in congregate carefacilities.iii. High risk businesses or community-basedoperations. In collaboration with statelicensing agencies and Labor and Industries,parbrer with food processing andmanufacturing businesses to ensure adequatepractices to prevent COVID-I9 exposure,conduct testing and respond to outbreaks.iv. Healthcare: Support infection prevention andcontrol assessments, testing, cohorting, andisolation procedwes. Provide educationalresources to a varietv ofhealthcare settinsTaskNumberPage 1l of39Contract Number CLHI 8249 -23
Exhibit A, Statements of WorkRevised as of September 15,2021AMENDMENT #23PaymentInformation and/orAmountDue Date/Time FrameDeliverables/OutcomesQuarterly performanceupdates to include name,address and capacity ofidentifi ed location thatcan support isolation andquarantine, andconfrrmation ofappropriate planning andcoordination as required.*May Support PHABStandardsilVleasuresTask/Activity/Descriptiontypes (e.g., nursing homes, hospitals, dental,dialysis).v. Non-healthcare settings that house vulnerablepopulations: In collaboration with statecorrections agency (DOC) and other stateparflers, support testing, infection control,isolation and quarantine and social servicesand wraparound supports for individualsliving or temporarily residing in congregateliving settings, including detention centers,prisons, jails, tansition housing, homelessshelters, and other vulnerable populations.vi. Schools: In collaboration with OSPI and localhealth jurisdictions, support infectionprevention and control and outbreak responsein K-12 and university school settings.f. Ensure adequate resources are directed towardsH2A housing facilities within communities, fishingindustries and long-term care facilities to preventand control disease transmission. Funds can beused to hire support staff provide incentives orfacility-based funding for onsite infectionprevention efforts, etc.g. Community education. Work with Tribes andparhers to provide culturally and linguisticallyresponsive community ouheach and educationrelated to COVID-l9.h. Establish sustainable isolation and quarantinemeasures.i. Have at least one (l) location identifred andconfrrmed through contract/formal agreementthat can support isolation and quarantineadequate to the population for yourjurisdiction with the ability to expand;alternatively, establish with an adjacentjurisdiction a formal agreement to provide theisolation and quarantine capacity adequate tothe population for your jurisdiction with thetoTaskNumberPage 12 of39Contract Number CLHI 8249 -23
Exhibit A" Statements of WorkRevised as of September 15,2021AMENDMENT #23PaymentInformation and/orAmountCOVID-l9 Vaccine Services - Task 3forward.- will be extended through June 30, 2022 in new contract term effective January 1,2022. Any unspent funds may be carriedReimbursement ofactual costsincurred, not toexceed:s14,582 FFY2lCOVIDI9VACCINESERVICES-CARESFunding(Mr74310209)$354,803 COVIDIgVACCINES tunding(Mr74310229)Due Date/Time FrameJanuary 31, AnnuallyJune 30, AnnuallyDecember 31, AnnuallyDeliverables/OutcomesReport census numbers toinclude historic total bymonth and monthly totalfor current quarter to date.Summary of theengagement strategies tobe used with health careproviders and otherpartners, and the locallyidentified population to bereached.Mid-term written reportdescribingactivity/activities andprogress made to-date andstrategies used (templateto be provided)Final written reportshowing the strategiesused and the final*May Support PIIABStandards/lVleasuresTask/Activity/Descriptionii. Maintain ongoing census data for isolationand quarantine for your population.iii. Planning must incorporate transfer or receiptof isolation and quarantine patients to fromadjacent jurisdictions or state facilities in theevent oflocalized increased need.iv. Planning must incorporate triggers andcoordination to request state isolation andquarantine support either through mobileteams or the state facility to include siteand accessIdentify activity/activities to support COVID vaccinerespons€ in your community, using the examples below as aguideline.Example 1: Develop and implement communicationstrategies with health care providers, community, and/orother partners to help build vaccine confidence broadly andamong groups anticipated to receive early vaccination, aswell as dispel vaccine misinformation. Document andprovide a plan that shows the communication strategiesused with health care providers and other partrers and thelocally identified population anticipated to reach.Example 2:Engage in other vaccination planning activitiessuch as parhrership development, provider education,vaccination point of dispensing (POD) planning, tabletopexercises, engagement with communities, leaders, non-traditional provider, or vulnerable populations to developstrategies to ensure equitable access to vaccination servicesImplement the communication strategies or other activities,working with health care providers and other partners toreach the locally identified population, support providers invaccination plans, and support equitable access tovaccination services.Catalog activities and conduct an evaluation ofthestrakgies usedTaskNumber3.A3.B3.CPage l3 of39Contract Numb er CLHI 8249 -23
Exhibit A" Statements of WorkRevised as of September 15,2021AMENDMENT #23PaymentInformation and/orAmount*Reimbursement ofeligible costs.MASSVACCINATIONFEMA 1OO%Funding(Mr 934V0200)(See ProgramSpecificRequirements forMass VaccinationTask 4 below)Due Date/Time FrameWithin 30 days ofcontract amendmentexecution.Deliverables/Outcomesprogress oftle reach(template to be provided)Submit to DOH a massvaccination planincluding:. type of site,. site locations,r tbroughput,o considerationsmade to ensureequity tohistoricallymarginalizedpopulations,. andtotheextentpossible a*May Support PHABStandardslUleasuresTask/Activity/DescriptionSUBRECIPIENT but are as a CONTRACTORof DOH.DOH reimbursement provided for local massvaccination clinic (see definition below) planning,implementation and operations in coordination betweenUnified Command and the Regionat IMT to administerthe vaccine as elficienfly, quicklS equitably, and safelyin all regions of Washington State. State Supported,Regionally Coordinated" Locally Implemented.Definition: Mass vaccination clinics defined as thoseoutside of the usual healthcare delivery. method such aspop-up clinics, mobile clinics, non- clinical facility(fairgrounds, arenas, etc.).Leaders Intent about this work from DOH is included as anattachment.Guidance on vaccination protocols must be followed asprovided by DOH and CDC.for Mass Vaccination ClinicsareNOT CONSIDERED*N(IE: Task 4 activitiesin this statement of workprovided within the county(s) with a regional incidentmanagement team/organization as approved by DOH.Request for regional IMT should be submitted through thenormal process through WebEOC.Local healthjurisdiction is the coordinating agency for themass vaccination plan within the county.Regional IMT will be under the delegation authority ofDOH and they are to provide support and coordination forplanningclinicVsitescoordinatewillvaccination(LHr)massofjurisdictionhealthimplementationLocalandandtosupportorderlnresourceplanning,informationvacclneandaroundeffortsallTaskNumberRegional Incident Managenent ream (IMT) Mass vaccination clinics - Task 44.4Page 14 of39Contract Number CLHL8249 -23
AMENDMENT #23Exhibit A, Statements of WorkRevised as of September 15,2021PaymentInformation and/orAmountDue Date/Time FrameWithin 30 days ofcontract amendmentexecution.MonthlyDailyMonthlyDeliverables/Outcomesregional map ofsites/locations.Submit estimated budgetfor the mass vaccinationplan.Monthly Cost SummarySpreadsheet to theIMT/IMO by the fifth ofthe following month.Submission of vaccineuse into WA IIS databasewithin 24hrs of use.Jurisdiction/Regions willensure a fair and equitableprocess for registration ofeligible Washingtoniansacross all availablemodalities.Provide monthly situationreport to IMT/IMO onstatus of implementationof mass vaccination plan,or more frequently if thatis the LHJ procedure.Sites operating for thetime period, vaccinesadministered bv site for*May Support PHABStandards/lVleasuresTask/Activity/Descriptionregionally coordinate efforts. Local jurisdictions willmaintain all decisional authority around vaccinationplanning and execution within their jurisdictior/district.Provide any infonnation as requested by the regional IMTFunding for eligible Mass Vaccination activities arereimbursed on actual costs as outlined in the DOH guidanceto provide the services and to carry out the mission.Funding will be dependent on full participation in the LHJand IMT processes and all documentation will be requiredto be provided to frrlly close out funding requests by the endof the mission period of performance.Allowable costs include expenses such as facility rentals,staffto conduct planning, management, support andoperation ofthe site, medical personnel for vaccinations,site security personnel, wrap around services for staff(meals, travel, lodging), equipment (which must be pre-approved by IMT/DOH if it exceeds $5,000 each), suppliesfor vaccinations and site operation. LHJs should providenarratives to help assist IMT and DOH finance know whatexpenditures were necessary to carry out the mission.Vaccination data - will be maintained according to currentstate and federal requirements.Vaccine Registration Systems - If a local jurisdiction orregion does not have a registration system(s) the includeinternet based, phone option and other methods to ensureequitable registration, the state PrepMod system and toolswill be available for use.Regularly report on vaccinations sites and operationalactivities (number ofvaccinations, personnel to operate thesite, challenges, successes to share for learning across thepublic health system).TaskNumber4.84.C4.DPage l5 of39Contract Number CLHI 8249 -23
AMENDMENT #23aFor Information Onlv:Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting aStandard/\deasure' More detail on these and./or other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at:http:/hwvw.ohaboard.org/wp-contenVuploads/PHAB-Standards-and-Measures-Version-l.0.pdf -Special RequirementsFederal Fundins Accountabilitv and Transparencv Act (FFATA)This statement of work is supported by federal frrnds that require compliance with the Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act).The purpose of the Transparency Act is to make inforrnation available online so the public can see how the federal funds are spent.To comply with this act and be eligible to perform the activities in this statement of work, the LHJ must have a Data Universal Numbering System (DLTNS@) number.Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by p.L. l0g-2g2.Prosram Snecific ReouirementsAlarrativeBITV-COVID ED LHJ ALLOCATION-CARESFFYI9 ELC COVID ED LHJALLOCATIONFFY2O ELC EDE LHJ ALLOCATIONFFY21 COVID 19 VACCINE SERVICES-CARESCOVID 19 VACCINESMASS VACCINATION FEMA lOO%DCHS COVID-l9 Response - Tasks I and 2COVID-l9 Vaccine Seryices - Task 3RegionalIncident Management Team (IMT) Mass Vaccination Clinics - Task4DCHS COVID-l9 Resnonse - Tasks 1 and 2Restrictions on tr'unds: Indirects are NOT allowable for CARES funding from September 212020 forward - LHJ can charge administrative activities as direct costs but notincur indirects from Septemb er 2,2020 tlrougfi. June 30 Deeember#,202l for activities funded wittr CARES funds (COVID LOCAL CARES - COVID LHJ OFMALLOCATION-CARES, BITV-COVID ED LHJ ALLOCATION-CARES, FEMA-75 COVID LHJ ALLOCATION)o Since the federal guidance was not updated until Septemb er 2, 2020, DOH understands that indirects could be charged from March-August, 2020.the budget will not be accepted or approved.Exhibit A, Statements of WorkRevised as of September 15,2021PaymentInformation and/orAmountDue Date/Time FrameDeliverables/Outcomesthe time period, estimatedcosts for the time period,any challenges/successesof note, includingassistance requested.*May Support PHABStandardsllVleasuresTask/Activity/DescriptionTaskNumberPage 16 of39Contract Numb er CLHI 8249 -23
AMENDMENT #23Submission of Invoice Vouchers: The LHJ shall submit correct monthly Al9-lA invoice vouchers for amounts billable under this statement of work to DOH by the 25s of thefollowing month or on a frequency no less often than quarterly.COVID-!9 Vaccine Services - Task 3 - allowable activities https://www.doh.wa.eov/Portals/l/Documents/9240lAllowableUseFedOpsFunds.pdfMass Vaccination - Task 4Program Manualo Handbook, Policy ReferencesEmergency Response Plan (or equivalent)Medical Couutermeasure/IVlass Vaccination PlanRestrictions on Funds (what funds can be used for which activities, not direct payments, etc.):Non-mass.vaccination efforts are not allowable through this funding stream.Duplication of billing (sending request for reimbursement) to entities outside of this agreement is prohibited.Indirect rates are not applicable to these funds.Special References (RCWs, WACs, etc.)County Health Emergency Documentation if applicableMonitoring Visits (frequency, type):Occasional visits from DOH or IMT/IMO personnel for the purpose of monitoring and surveillance of mass vaccination activities may be expected.DefinitionsSpecial Billing Requirements:Monthly invoices must be submitted timely to the regional lMT/Organization for reviedapproval prior to submission to DOH for reimbursement.Conhact (MI) Code: 934V0200 General Mass VaccinationBARS Revenue Code: 333.97.03 Mass Vaccination ReimbursementSpecial Instructions:The LHJ is considered a CONTRACTOR of DOH not a subrecipient for this portion of the statement of work. An allocation of funds is not provided as these FEMA funds are onlyavailable as reimbursement of costs associated with implementation of the mass vaccination plan.Detailed documentation must be maintained as directed by the regional IMT/Organizationand DOH to substantiate costs associated with these activities for submission to FEMAupon request by DOH.Eligible costs from the timeframe of January 21,2021through December 31,2021 include facility rentals, medical and support stafffor planning, management, support, andproject and must be billed as a direct charge; timesheets are required documentation and must be available upon request by DOH. Indirect rates are not applicable to these funds.portable vaccine units for transportation, supplies such as emergency medical supplies (for emergency medical care needs that may arise in the adminisfation of the vaccine),Equipment over $5,000 a piece must be preapproved by the IMT and should be leased rather than purchased. Any diversion from the list of pre-approved expenses will require adetailed/specific description is required for those not working at the vaccine site.Exhibit A, Statements of Work Page l7 of 39 Contract Number CLHlB24g-23Revised as of September 15,2021
DOIf Program ContactAlyssa Lavin, LHJ Contract ManagerDOH, PHOCIS1610 NE 1506 St, Shoreline, WA 98155alyssa.lavin@doh.wa. gov / 3 60-236-327 3DOII BITV-COVID ED LHJ Allocation-CARES and DOH ELC Allocation Fiscal Contact (Tasks I and 2)Christie DurkinDOH, Office of Program Financial ManagementPO Box 47840, Olympia, WA 98504-7841Ph: 360-2364235 / christie.durkin@doh.wa.gwDOH COVID19 Vaccine Services Program Contacts (Task 3)Tawney HarpeE MPA Sonja Morris, COVID-I9 Operations SupervisorDeputy Director I Operations Manager Enhanced Influenza and COVID-I9 ResponseOfFrce of Immunization and Child Profile Office of Immunizationand Child ProfileDeparfrnent of Health Department of HealthPo Box 47843, olympia wA 98504-7843 po Box 47}43,olympia, wA 98504-2843tawney.harper@doh.wa.gov / 3 60-236-3525 sonja.morris@doh.wa.gov / 360436-3545DOH General Mass Vaccination Program and Fiscal Contact (Task 4)Patrick Plumb Janice BaumgardtcovlD FEMA Project Management Analyst Financial operations ManagerWashington State Departrnent of Health Washington State Department of HealthOffice of Financial Services Office of Financial Servicesl l l Israel Road SE, Tumwater, wA 98501 l l I Israel Road SE, Tumwater, wA 9g501patrick.plumb@doh.wa.gov / (360) 236-4291 ianice.baumgardt@doh.wa.gov / (360) 2364505Exhibit d Statements of WorkRevised as of September 15,2O2lAMENDMENT #23Page l8 of39Contract Number CLHI 8249 -23
AMENDMENT #23Exhibit AStatement of WorkContract Term: 2018-2021DOH Program Name or Title: Foundational public Health Services(FPHS) - Effective July 1. 2021Local Health Jurisdiction Name: Kittitas countv public Health DepartrnentContract Number: CLH|8249Type ofPaymentf] Reimbursement[lleriodicDistributionFederal Compliance(check if applicable)nnFFATA (Transparency Act)Research & DevelopmentFunding Sourcen Federal <Select One>xnStateOtherStatement of Work Purpose: The purpose of this statement of work (SolV) is to specifr how state funds for Foundational public Health Services (FPHS) will be used for theperiod of perfotmance' Per RCW 43.70'512, these funds are for the governmental public-health system to deliver FPHS services statewide in the most effective, efficient andequitable mnnner possible with the funds available.The FPHS Steering Committee with input from FPHS Subject Matter Expgrt (SME) workgroups and the Tribal Technical workgroup is the decision making body for FpHSfunds' For the 2021 -2023 biennium, the Steering committee is using an iterative approac-n to aecisiott *utirr!. n"i"r"itt*g investrnents first for sFy22 (July l, z02l -June 30, 2022),then for SFY23 (July 1, 2022 - June 30, 2023). This means tlat additional tasks and/or funds may be added to an LHJ,s FpHS SOW as these decisions are made.These firnds are to be used as directed and allocated_by the FPHS Steering committee. As the global covlD-I9 pandemic and the public health response to it continues andbegins to abate, these FPHS funds can be braided with and used to supplelnent other short+er;pandemic ..rponr" funding as needid for FpHS activities during this period ofperformance (07101/21 12/31/21). Responding to pandemics, epidemics and public health emergencies are foundational ,J,ui.", of the governmental public health system.Note:The total biennial funding allocation is for the period of July 1,2021through June 300 2023, 2021-2023 biennial funding allocations will be divided into four six-monthlump sum amounts that will be disbursed at the beginning of each six month period as follows: July 1, 2021; January 1,2022; July l, 2022; January l,2023.Each year,the July payment witl be disbursed upon completion of the FpHS Annual Refort.The disbursement of funds scheduled for January 1,2022, July 1, 2022 and January 1,2023 and deliverable due dates after Decemb er 3l,202lare included in thisstatement of work for informational purposes only and will be carried forward into a new statement of work in the new consolidated contract term beginning January l,2022.FPHS funds must be spent in the state fiscal year (SFY) in which they are appropriated by the legislature, allocated, and disbursed. Legistative appropriations lapse atthe end of each state fiscal year (RCW 43.E8.f40).Spending and spending projections must be reported as required by the FPHS Steering Committee. Funds that are projected to be unspent by the close of the stateliscal year must be reallocated per the process developed by the FPIIS Steering Committee to assure that all funds appropriated by the tegislature can be spent by thegovernmental public health system to deliver FPHS within the year that the funds are appropriated. Unspent funds^revert to the state treasury and must be returned toDOII by July 15th of each year for return to the Office of Financial Management (OFM).2021-2023 Biennium:SFY22 (July 1,2021-June 30,2022)SFY23 (July l, 2O22-Jwe30,2023)Revision Purpose: The purpose of this revision is to revise language and add funding and tasks forFFy22.SOW Type: Revision Reyision # (for this SOW) IPeriod of Performance: July 1 . 2021 through December 3 l. 2021Exhibit d Statements of WorkRevised as of Septemb er 15, 2021Page l9 of39Contract Number CLH I 8249 -23
0Increase (*)50s0CurrentConsiderationI0l2l3U2tFunding Period(LHJ Use Only)Start Date End Date07lILt2tMasterIndexCode9920211rBARSRevenueCode336.04.25CF'DA#N/Aof Accounts Program Name or TifleFPHS-LHJ-PROVISONote: Total Consideration is for SFY22ll21TOTALSExhibit A,, Statements of WorkRevised as of September 15,2021AMENDMENT #23426,00060,000304,000420,000I213,00030,000152,000210,000213,00030,000152,000210,000XXXXReinforcing Capacity (Assessment, CD, EPH, CCC)CHA/CHIPCommunicable Disease (CD)Environmental Public Health @PH)_CD,EPH, CCC,AssessmentAssessmentCDEPH10-17,20,21,23-29I020, 21,23-29,9340-53, 93TOTALPayment Information and/orAmountFunds are available beginningJlly 1,2021. Half of the annualallocation will be disbursed eachJuly upon reeeiptcompletion ofthe inPFffAnnual Report for theprevious statefiscal year and thesecond halfwill be disbursed eachJanuary.Note: Funds must be spent inthe state fiscal year (SFY) inwhich they are appropriated bythe legislature, allocated, anddisbursed. Unspent funds mustbe returned to DOH byJuly 15th ofeach yearfor retarnto OFM.DueDate/Timetr'rameDeliverables/OutcomesIn coordinationwith FPHS Steering Committeeand Subject Mafter Expert (SME) workgroups:aIncrease delivery of FPHS services in-eaehju+XaWien-an+statewide as measured yrethrough FPHS annual reporting indicators,metrics and other data compiled andanalyzed,by contractors, DOH and SubjectMatter Expert (SME) Workgroups. ,4ll-ef@Resultsarepublished rz the annual FPHS InvestmentReport. FPHS indicator metrics areavailablehqe.Routine reporting ofspending andspending projections. Process andreporting template TBD and provided bythe FPHS Steering Committee via DOH.Task/Activity/DescriptionF'OT]IIDATIONAL PUBLIC HEALTH F'T]IIDING - ALLTaskNumber0Page 20 of39Contract Number CLHL8249 -23
Exhibit A, Statements of WorkRevised as of September 15,2021AMENDMENT #23Payment Information and/orAmountReinforcing CapacityThesefunds are to each LHJ to deliver FPHS in their own iurisdiction - In coordination with the FPHS Steering Committee and Subject Matter Expert (SME)lTorkgroups, provide FPHS Communicable Disease (CD), Environmental Public Health (EPH), Assessment (Sirveitlance & Epidemiologt) and / or any or all of theother FPHS Cross-cutting Capabilities (CCC) as defined in the most cunent version oJ'the FPHS definitions.Assessment - CHA/CHIP (FPHS definitions G.3)These-funds are to each LHJ to deliver FPHS in their owniurisdiction * In coordination with the FPHS Steering Committee and Subject Maaer Expert (SME)Workgroups, conduct and complete a comprehensive community health assessment and identify health prioritiei arisingfrom that aisessment, incl)ding anaiysis ofhealth disparities and the social determinants of health as de/ined in the most current version of the FpHS definitions.t Conduct a local and/or regional comprehensive community health assessment (CHA) every three to five years in conjunction with community partners.t Develop a local and/or regional community health improvement plan (CHIP) in conjunction with cornmunity partners.These funds can be used for any CHA/CHIP activity or sentice (e.g., data analysis, focus grotups, report writing, prociss .facilitation) and may be used to contractyvith other LHJs for staff time or services.Communicable Disease (CD) (FPHS definitions C.I, 2, 3, 4, 6)These funds are to each LHJ to deliver FPHS in their owniurisdiction - In coordination with the FPHS Steering Committee and Subject Matter Expert (SME)Workgroups, provide FPHS CD services as defined in the most current version of the FPHS definitions. Thesefunds can (and actuaily are intendid to) be braidedwith temporary pandemic emergencyfitnding such that when thosefunds run out, FPHSfunds can be used to ritain staff there were h'ired with pandemic emergencyfunds if the iurisdictions desires to retain them and/or to hire additional staff if needed, and/or contract with other LHii for staff time or senic)s for deliverinl FpHSCD- As the pandemic response wains, staffunded with FPHS funds are to shift focus to providing some or all or the FPHS CD serttices. This iicludes mainlainingAccess to and use ofdata systems created during the pandemic and others under development and case investigation and contact tracingfor sexually transmitteddisease and other communicable and notifiable conditions vvithin the mandated timeframes. Emphasis should be placed on addresstng srytlit* and gonoryhea cases.I. Provide timely, statewide, locally relevant and accurate information statewide and to communities on prevention and control of communicable disease andother noffiable conditions.Identify statewide and local community assets for the control of communicable diseases and other notifiable conditions, develop and implement a prioritizedcontrol plan addressing communicable diseases and other notifiable conditions and seek resources and advocatefor high prio,rity prevention oni "ortrolpolicies and initiatives regarding communicable diseases and other notiJiable conditions.Promote immunization through evidence-based strategies and collaboration with schools, health care providers and other community partners to increaseimmunization rates.Ensure disease surveillance, investigation and control for communicable disease and notifiable conditions in accordance with local, state and federalmandates and guidelines.t3.,t-DueDate/TimeFrameBy 08/15122By 08115/23DeliverableVOutcomesaFPHS annual reporting (template providedbylhe FPHS Steering Committee viaDOH)o For SFY22 (07/0r/2146130/22)Wpr@i@o For SFY23 (0710112246/30123)Task/Activity/DescriptionTaskNumber1,3.Page2l of39Contract Number CLHI 8249 -23
Exhibit A, Statements of WorkRevised as of September 15,2021AMENDMENT #23Expert(sME)mostcarrentverston: Develop, implement and enforce laws, rules, policies and procedures,for maintaining the health and safet-v of retail.food serttice inspections and shelffishmonitoring, that address environmental public health concerns. (8.3.b)t Develop, implement and enforce laws, rules, policies and procedures.for ensuring the health and safety of wastewater andfacilities, including onsite septicdesign and inspections, wastewater treatment and reclaiied water, that address environmental public health concems. (8.3.e)t Develop, implement and enforce laws, rules, policies and procedures for ensuring the health and safety of solid waste andfacilities, including hazardouswaste streams (e.g. animal waste, solid waste permitting and solid waste inspectins), that addresslnv*onmentat public iealth concerns 1ti s.11e Develop, implement and enforce laws, rules, policies and procedures for ensuring the health and safety ofschools, including through education and planreview that address environmental public health concerns. (8.3.g)Thesefunds can be used to retain, hire and/or cotxtract with other LHJs for staf time or services andfor staff training as needed to provide thefollowing F1HS EpHservices that are not appropriatelyfunded withfees. Each LHJ witl be iesponilble to report on their progress on FpHS deliverables even if contracted with otherLHJs (FPHSfimds are intended to build capacity and not intended to.iusttfy the reductiin of existingJbe revenue);t Food Safety (FPHS definitions 8.3.b.) - Respond to.food safety concerns that are not appropriatelyfunded such asfoodborne illness threats, requests.fortechnical assistance and addressing nqw and emerging business models. Every locatiirrsirctronii l{ashrngton is"expected to respond tofoodborne illnessoutbreal$, food safety inquiries and provide preventative educationfor the general piblic and technical assistance.o Sewage Safety (FPHS definitions B'3'e-fl - Respond to sewage concerns and public health threats and provide technical assistance that are notappropriatelyfunded to ensure that sewage is handled appropriately to limit potential exposure to sewage. Every local jurisdiction in LTashington isexpected to ensure sewage is properly managed- on-Site Septic (oSS) permiiting, enforclment and providing teihnical assistance and education to oSSowners are fee funded activities and should be funded through fees or local govirnment who sets th-e fees. T\ese FpHS funds provide resources to supportactivitiesforwhich afee cannot be charged such as: responding to osSfailures, surfacing sewage, oSS safety concerns, and similar issues. Thesefundscan also be usedfor concerns related to large on-site sewage systems, oiher OSS-reiatedioncerns that do not involve locally permittable systems, and othersewage-related issues, regardless of whether they lye related to a fee-for-service activity. Examples of activities FpHS funci ion be ur"d.fo,o lV'ork with partners to educate and inform public on OSS monitoring and mainteninceo lTork with the public, policy makers and partners to assess needs and develop plans and solutions for wastewater mcmagement in their communities.o Respond to complaints, act as needed, and assure thatfailing OSS are tdentifiid and promptly repaired.o Conduct Pollution ldentification and Correction (PIC) investigations where water qiatity'* i-p)rred to identififailing septic systems and otherpollution sources.o Ensure that sewagefrom both OSS and other sources is adequately handled to create barriers to potential exposure to sewage.o Adequate qualiJied staffto evaluate proposals, inspect nevv installations and repair.r, 4s.ress causi of OSS faiiure, and compl-y with requirements in statelaw.t Schools Safety (FPHS definition 8.3'g) -Assure safe and ffictive learning environmentsfor children attending K-12 schools -public, private andparochial. Every local jurisdiction in ll'ashington is expected to work collaborativety wiih OOH, ESDs and loial school districts and ise the model programtoassureconsistencytoregularlyevaluateeachK-l2forhealthandsafetyconcernsandprovidemandatedservicesperWAC246-366. Initialprioritiisinclude:o Build partnerships with school oflicials, local boards ofeducation, parent teacher associations, education service districts, and other schoolfocusedentifies.ooParticipatewithstatewidepublicgroupsstandardizeschoolprogramimplementation.Focusontoa.ttesscurrentschoolsthathavenothealthbeentoconditions4.Page22 of39Contract Number CLHI8249 -23
AMENDMENT #23Prosram Snecifi c Requirements/NarrativeSpeciat References (RCWs, WACs, etc)Link to RCW 43'70.512 - RCW 43.70.512: Public health system-Foundational public health services-Intent. (wa.gov)Link to Rcw 43.70.515 - RCW 43.70.515: Foundational public hea@)FPHS Definitionshttps://wsalpho.box. com/s/qb6ss I 0mxbraixOfl aT42lw6zcfxzohkAII FPIIS Resourceswww.doh.wa.gov/&hs or FPHS I powered by BoxSpecial InstructionsThere are two different BARS Revenue codes for "state flexible funds" to be tracked separately and reported separately on your annual BARS report. These two BARS Revenuecodes and definitions from the state Auditor's office (sAo's) are listed below alongrvittt u tirrt to the sARs Manual.- zsi.oq.zsis the new BARS Revenue code to use for theFoundational Public Health Services (FPHS) funds included in this statement of work.336.04.24 - County Public Health Assistanceto the legislature from this revenue source.336.04.25 - Foundational Public Ilealth ServicesUse this account for the funding designated for the local health jurisdictions to provide a set of core services that govemment is responsible for in all communities in the wAstate' This set of core services provides the foundation to support the work of tie broader public health system aid community partners. At this time the funding from thisaccount is for delivering ANY or all of the FPHS communicable disease services (listed above) and can also be used for the FpHS capabilities that support FpHS communicabledisease sorvices as defined in the most curent version ofFpHS Definitions.Public Health Budgeting, Accounting and Reporting system (BARS) Resourceswww.doh.wa. gov/lhj fundingDeliverables are to be submitted to Marie Flake at marie.flake@doh.wa.sovDOH Program ContactMarie Flake, Special Projects, Foundational public Health ServicesWashington State Department of HealthPO Box 47890, Olympia, WA 985M-7890Mobile Phone 360-95 l-7566 I Fax 360.236.4024 / maie.flake@.doh.wa.govExhibit A, Statements of WorkRevised as of September I5,202IPayment Information and/orAmountDueDate/TimeFrameDeliverables/OutcomesTask/Activity/Description' Classroom. Healthy cleaning and indoor environrnents. Playgroundwaterop has e of inspect ions p ro gramFocus on existing elementary schools forfirst. Indoor Air QualityTaskNumberPage23 of39Contract Numb er CLHI 8249 -23
DoH Program Name or Title: ol-promotion of Immunizations to ImproveVaccination Rates - Effective July l. 2021AMENDMENT #23Local Health Jurisdiction Name: Kittitas county public Health DeparfrnentContract Number: CLH|8249Exhibit AStatement of WorkContract Term: 2018-2021SOW Type: Original Revision # (for this SOW)Period of Performance: July l. 2021 through December 31. 2021Statement of work Purpose: The purpose of this statement of work is to contact with local health to conduct activities to improve immunization coverage rates.Revision Purpose: N/AExhibitA, Statements of WorkRevised as of September 15,2021Type of Payment[l Reimbursement! Fixed Pricetr'ederal Compliance(check if applicable)X fnefe (Transparency Act)E Research & Developmentx!Funding SourcenFederal SubrecipientStateOther600(+)5CurrentConsideration00tzl31l2tFunding Period(LHJ Use Only)Start Date End Date07/0r/2tMasterIndexCode74310212BARSRevenueCode333.93.26CFDA #93.268of Accounts Program Name or TifleFFY22 VFCTOTALSPayment Informationand/or AmountReimbursement foractual costs incurred,not to exceed totalfunding considerationamount.*See Restrictions onFunds belowDue Date/Timetr'rameAugust 1,2021November 30,202tDeliverables/OutcomesWritten proposal and a report thatshows starting immunization rates forthe target populationWritten report describing the progressmade on reaching milestones foractivities identified in the planwill be*May Support PHABStandardVMeasuresTask/Activity/DescriptionDevelop aproposal to improve immunizationcoverage rates for childhood vaccinations agesbirth to l8 years of age by increasing promotionactivities and collaborating with communityparfirers. The proposal must meet guidelinesoutlined inthe Local Health JurisdictionFunding Opporntnity, Promotion ofImmunizations to Increase Vaccination Ratesannouncement.Upon approval of proposal, implement the planto increase immunization coverage rates with thetarget population identifi ed.This statement of work wilt be extended through June 30,forward.2022 in the new consolidated contract term effective January 1r 2022. Any unspent funds may be carriedTaskNumber2Page24 of39Contract Number CLHI 8249 -23
AMENDMENT #23aEor Information Onlv:Funding is not tied to the revised StandardVMeasures listed here. This information may be hetpful in discussions of how program activities might contribute to meeting aStandard/IVleasure' More detail on these and./or other Public Health Accreditation noara pfnb) Standards/Lleasures thajt may apply can be folund at:httP:/hwvw.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-l.O.pdf 'Prosram Snecific ResuirementyNarrativeSpecial RequirementsFederal Fundine Accountabilitv and Transnarencv Act (FFATA)This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act).The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent.To comply with this act and be eligible to perform the activities in this statement of worlg 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. rcg-2g2.Restrictions on Funds (what funds can be used for which activities, not direct payments, etc)Allowable Uses of Federal Operations Funds document (dated 1212\/2017) is postJd on the DOH Consolidated Contract website at this link. These federal funds may not be usedfor expenses related to tavel or attendance at any non-DOH sponsored conferince, training, or event without prior written approval from the DOH Office of Immunization.DOH Program ContactTawney Harper, MPADeputy Director I Operations ManagerOffice of ImmunizationDepartrnent of HealthPO Box 47843, Olympia WA 98504-7843tawney.harper@doh.wa. gov, 360-236-3525Exhibit d Statements of WorkRevised as of September 15,202IPage25 of39Contract Number CLHI 8249 -23
DoH Program Name or Title: Supplemental Nutrition Assistance program-Education - Effective October l. 2020SOW Type: Revision Revision # (for this SOW) IPeriod of Performance: October l. 2020 through December 3 l. 2021Statement of Work Purpose: The purposethat persons eligible for SNep pasic food,dietary guidelines.AMENDMENT #23Local Irealth Jurisdiction Name: Kittitas county public Health DeparftnentContract Number: CLHLB249Exhibit AStatement of lYorkContract Term: 2018-2021Type ofPavment[l Reimbursement! Fixed PriceFederal Compliance(check if applicable)FFATA (Transparency Act)Research &DevelopmentFunding Source[l Federal SubrecipientD staten ottrerof this statement of work is to provide Supplemental Nutrition Assistance Program-Education (SNAp-Ed) to improve the liketihoodFood Stamps) will make healthy food choices within a limited budget and choise active lifestyies consistent with the current USDARevision Purpose: The purpose of this revision is to add FFY22IAR SNAP ED PROGAM MANAGMENT-REGION 2 funds and to extend the period of performance fromSeptember 30, 2021 to December 31, 2021.Exhibit d Statements of WorkRevised as of September 15,20211ChangeIncrease (+)0l5CurrentConsideration046009/30/2112/3U21Funding Period(LHJ Use Only)Start Date End Datet0/0v20t0/0U21MasterIndexCode76701912937BARSRevenueCode333.1 0.56333.10.s6CFDA #10.561l0.s6rof Accounts Program Name or TiUe2-REGIONMGNTPROGEDAPSNIARIFFY22-REGIONMGNTPROGEDAPSNIARFFY22TOTALSPayment Informationand/or AmountReimbursement uponon-time receip andapproval ofacceptabledeliverables/ outcomesfor the funding periodwill not exceed $261046$41,455. KittitasCounty Public HealthDepartment will bepaid the allowable costsincurred based on theirapproved budget andprogmm allowability.F'FY21Due Date/Time FrameFor the Period:10/01120 to 098e21r2/sr/21Due: per the approved workplan and per the requireddue dates during the federalfiscal year, andfor FFY2 Ino later than09/30/21.Measure (whereapplicable)Sites and audiencesincluded in Project bySubrecipient documentedas approved eligible sitesor audiences.Documented completereporting by Subrecipientof the delivery,implementation, andevaluation ofapprovedProject activities in therequired PEARS onlinelqrorting modules, whereDeliverables/Outcomes1. Projectprovides 100% ofSNAP-Ed activiries at eligiblesites and/or with eligibleaudiences.2. On-time delivery,implementation, andevaluation of Proj ect activitiesas scheduled in approved stateplan and project work plan,3. SatisfactoryprogresstowardsState SNAP-Ed project goal(s)selected by Subrecipient isdemonstrated and reported.Task/Activity/DescriptionProject Planning, Implementation,and PerformanceFor SNAP-Ed, the Subrecipient willdevelop, implement, and evaluate aSNAP-Ed project included in theWashington SNAP-Ed State Planapproved by Departrnent of Social andHealth Services (DSHS) and UnitedStates Department of Agriculture(USDA); and, as described in theSubrecipient's project work planapproved by Department of HealthTaskNumber1.0Page26 of39Contract Number CLH|8249 -23
ExhibitA" Statements of WorkRevised as of September 15,2021AMENDMENT #23Payment Informationand,/or AmountSee special billingrequirements section.**NOTE: The DOHSNAP-Ed program willdeny payrnent for anycosts not submitted bythe required due dateswithout prior DOHapproval in writing.See paymentinformation asreferenced in tasknurnber 1.0FFY21Due Date/Time tr'rameFor the Period:10/01/20 to 09/3091I2/31/21Due: Progress reviews.Occur at minimum quarterlywithin the fiscal year, andno later than 30 businessdays after the end ofthefederal fiscal quarter, exceptfor the last quarter of FFY2Iwhich must be completed by09/30121. Progress reviewscan be scheduled morefrequently if deemednecessary by DOH, or ifagreed upon by both parties.Federal quarters listedbelow:FFY2I Ql: Oct 1-Dec 3lFFY2I Q2: Jan I -Mar 3lFFY2I Q3: Apr I - June 30FFY2ll-30Measure (whereapplicable)relevant to Project(Program Activities, PSESite Activities, IndirectActivities, Coalitions,Partnerships, and SuccessStories).Documented completereviews of SubrecipientProj ect activities throughrequired reporting andproject and fiscalmonitoring reviews andreports.Cost per reach reported bySubrecipient in approvedform/system provided byDOH.Progress reviews -documentation of one-on-one meeting(s) with DOHSNAP-Ed staff person(s)and Subrecipientcompleted in person, webconference, phone, or viaemail as needed.Documentation of progressreview notes.Project monitoring -documentation of one-on-one meeting(s) with DOHSNAP-Ed staff person(s),Subrecipient, other SNAP-Ed funded staff, andcommunity partners and/orparticipants completed inperson, web conference,phone, or via email asneeded. Completion of on-site program observationsDeliverables/Outcomes4. Satisfactory progress towardsproj ect objective(s) andadditional project goal(s)determined by Subrecipient isdemonstrated and reported.5. Project maintains cost-effectiveness per currentapproved cost-effectivemeasure provided by DOH orDSHS.I2.345.6.On-time delivery of proposedlist of Project site(s) oraudience(s) to DOH.All sites and./or audiences aredetermined to be eligible percurrent SNAP-Ed eligibilityguidance before programmingbegins with site(s) oraudience(s).Demographic data of classparticipants collected andreported for all directeducation strategies.On-time reporting of actualparticipant reach to DOH inapproved method.form.Intervention strategiesimplemented as planned, orusing approved altematestrategies.Approved evaluation plansand methods implemented fortheandTask/Activity/DescriptionProject Progress: Monitoring andComplianceFor SNAP-Ed, the Subrecipient willdemonstrate satisfactory progress ofthe approved Project as documented inDOH SNAP-Ed progress reports,progress reviews, and project andfiscal monitoring reports.Monitoring of Subrecipient Projectprogress includes but is not limited tothe following activities:i. one-on-one progress reviews withDOH,ii. progress reports submitted toDOH,iii. project monitoring completedwith DOH or DSHS or USDA,andiv. project monitoring site visitscompleted by SNAP-Ed statewideinitiative teams.TaskNumbert.lPage27 of39Contract Number CLHI 8249 -23
Exhibit d Statements of WorkRevised as of September 15,2021AMENDMENT #23Payment Informationand/or AmountFFY2lDue Date/Time FrameFFY22 Q|: Oct I - Dec 3IDue: Project monitoring.Occurs at minimum oncewithin the fiscal year. Ifproject monitoringdocuments majordefi ciencies or correctiveaction, the Subrecipient willbe monitored again withinthe fiscal year. Projectmonitoring can bescheduled more frequentlyif deemed necessary byDOH, or if agreed upon byboth parties.Due: Fiscal monitoring.Each Subrecipient receivesone (l) annual fiscalmonitoring visit every otheryear, unless Subrecipientmonitoring results incorrective action or finding,in which case Subrecipientwill be monitored again thefollowing year. Fiscalmonitoring can bescheduled more frequentlyif deemed necessary byDOH, or if agreed upon byboth parties.Measure (whereapplicable)where applicable.Completion of projectmonitoring report forms,with monitoring resultsdocumented and providedto Subrecipient.Fiscal monitoring -documentation ofcompleted fi scal reviewsscheduled by SNAP-Edfiscal analyst or DOHfiscal monitoring unit, withcorresponding reportswhere applicable. Fiscalmonitoring completed inperson, web conferenceophone, or via email asneeded.D eliverables/Outcomessurveys for direct education;PSE assessments).7. Evaluation results used toreport progress and outcomesofproject, and to adapt theproject as needed.8. Evidence ofpositive changeor improvement in SNAP-Edeligible site(s) or audience(s)based on project activities isdemonstrated and reported.9. If positive change orimprovement in SNAP-Edeligible site(s) or audience(s)not apparent, project mustdemonstrate acceptableimplementation of approvedinterventions and strategiesand use results ofprocessevaluation to improve projectplan so that positive change inSNAP-Ed eligible sire(s) oraudience(s) can occw.10. Strategy for working with oneor more CSOs implementedand demonstrated to increaseknowledge, awareness, orparticipation in SNAP-Edeligible audience.11. Strategy for promotingavailable Federal, state, orlocal fruit and vegetableincentive program(s)implemented anddemonstrated to increaseknowledge, awareness, orparticipation of program(s) inSNAP-Ed eligible audience.12. Direct education strategiesonly: Statewide SNAP-EdCurriculum team or DOHmonitoring reviews showTask/Activity/DescriptionS atisfactory progress of theSubrecipient's Project includesprogress shown in the following areasand documented in reporting and./ormonitoring completed:L Progress demonstrated inachieving goal(s) outlined in theproject.2. Progress demonstrated inachieving obj ective(s) outlined inthe project's interventions.3. Progress demonstrated in creatinga sustainable project.4. Progress demonstrated inengaging or involving thecommunity in project planning,implementation, and./orevaluation.5. Progress demonstrated in workingwith DSHS community servicesoffices (CSOs).6. Progress demonstrated inpromoting available Federal,state, or local fruit and vegetableincentive progfttms to SNAPclients.7. Progress demonstrated in usingstrategies that are evidence-basedand delivered with fidelity, whereapplicable.8. Compliance with current SNAP-Ed financial and cost policyguidance and 2 CFR 200 federalUniform AdministrativeRequirements (OMB guidance).TaskNumberPage 28 of39Contract Numb er CLHI 8249 -23
ExhibitA, Statements of WorkRevised as of September 15,2021AMENDMENT #23Payment Informationand/or AmountSee paymentinformation asreferenced in tasknumber 1.0FFY2lDue Date/Time FrameFor the Period:l0l0l/20 to 09/308tI2/31/21Progress Reports: Due atminimum quarterly, and nolater than l0 calendar daysafter the end ofthe quarter,except for the last month ofthe FFY which is due by09/15/21.Ifthe 1Ofrcalendar day falls on aweekend day, the report isdue the next business day.r lst Progless report due0t/lt/21o 2nd Progress report due04/12/21r 3rd Progress report due07/t2/21r Final Progress reportdue 09/15/21, or followclose-out procedures.PEARS: Project evaluationand reporting requiredbetween 10/01/20 tog9l1-92+ I 2/3 1/2 I .Measure (whereapplicable)Documentation showingcompletion of progressreport and submission toDOH on orbefore therequired due dates, or byapproved extension date.Completion of requiredevaluation data in progressreports and PEARSelectronically, or usingapproved reportingmethod/form, on or beforethe required due dates, orby approved extensiondate.Direct educationstrategies only:l. Submission ofrequired SNAP-Edparficipant surveys toDOH using approvedsubmission method,on or before therequired due dates forsubmission, or byDeliverables/Outcomesfidelity, with no majordeficiencies. Ifmajordefi ciencies documented,corrected properly withintimeline required.13. Compliance maintained withcurrent SNAP-Ed financialand cost policy guidance, 2CFR 200 federal UniforsrAdministrative Requirements(OMB guidance), and relatedDOH SNAP-Ed fiscal policydelivered witheducationandand correct submission ofreporting, data, and materials forall SNAP-Ed funded activitiesimplemented, including:l. Progress for all interventionstrategies reported forapproved project plan.2. All evaluation results reportedfor approved project plan(formative, process, outcome,qualitative, PSE).3. All qualitative evaluationresults (success stories,pictures, etc.) reported forapproved project plandescribing progress or successofproject activities, or positivechange or improvement inSNAP-Ed eligible site(s) oraudience(s).4. Required release form(s) forall photos submitted.5. Direct education strategiesonly: All required infomrationfor scheduled direct educationlessons submitted to StatewideSNAP-Ed Curriculum team,On-timeTask/Activity/DescriptionEvaluation Data and ReportsFor SNAP-Ed, the Subrecipient willreport progress of the approvedproject and work plan, includingongoing evaluation ofthe project andoutcomes, using an approvedform./system on a regular basis thatwill at aminimum include:1. Progress reports2. Reporting in PEARS onlinereporting system ofallSNAP-Ed activitiesSNAP-Ed activities implemented andevaluation of the project and outcomesare reported in an online programevaluation and reporting system(PEARS) tbrough the followingrequired modules as appropriate forthe approved project: ProgramActivity (direct education), IndirectActivity (health promotion, indirecteducation channels), PSE SiteActivities, Partnerships, Coalitions,Success Stories, and Social Marketing.TaskNumber2.0Page29 of39Contract Number CLHI 8249 -23
Exhibit A, Statements of WorkRevised as of September 15,2021AMENDMENT #23Pa)rynent Informationand./or AmountFTY2lDue Date/Time FrameDirect educationstrategies only:PEARS ProgramActivities moduleupdated with completedactivities no later thantwo (2) weeks afterservices are provided.Due: PEARS IndirectActivities, PSE SiteActivities, Partnerships,Coalitions, SuccessStories, and SocialMarketing modulescompleted no later thanthe last business day ofthe month followingwhen the activity tookplace, except forthelast month of *&eFFY2I which is dueby09n5/21.Activities completed inOct 2020 due inPEARS by ll/30120Nov 2e192020byt2/31/20Dec 2e1*2020 by01129/2tIan2020by 02126/21Feb 2020by 03l3ll2lMar 2020by 04/30/21Apr 2020by 05l3ll2lMay 2020by 06130/21Jun 2020 by 07/30/21Jul2020by O8l3l/21Aug2020by 09/15/21Final data entry for allFFY2I activities notdueaaaaaaaaaaaaMeasure (whereapplicable)approved extensiondate.2. When survey data isentered by theSubrecipient,completion ofrequired evaluationdata into PEARSelectronically, orusing approvedreporting method, onor before the requireddue dates for data€ntry, or by approvedextension date-D eliverables/Outcomesusing approved form/system,by dates required.On-time and correct submission ofrequired evaluation data for directeducation sfrategies into PEARSelectronically, or using approvedreporting method, according totime frame provided, including:6. Direct education strategiesonly: Pre-test surveys for eachproject class series received byDOH, or data entered intoPEARS by Subrecipient, nolater than two weeks aftercompletion of the pre-testsurvey.7. Direct education strategiesonly: Post-test surveys foreach project class seriesreceived by DOH, or dataentered into PEARS bySubrecipient, no later than twoweeks after completion of thepost-test survey.8. Direct education strategiesonly: Demographic cards foreach class series received byDOH, or data entered intoPEARS by Subrecipient, nolater than two weeks aftercollection of the demographiccards.Task/Activity/DescriptionThe following evaluation activitiesand information are required based onthe Subrecipient's approved projectand work plan.r Formative evaluationr Process evaluationr Outcome evaluationr Qualitativeevaluationr Evaluation of PSE strategiesPlease Note: the deliverables maychange based on state SNAP-EdEvaluation guidance, DSHS, or USDArequirements.Please Note: Topics included inProgress Report subject to changebased on Department of Health(DOH), Department of Social andHealth Services (DSHS), WashingtonSNAP-Ed (WA SNAP-Ed), or UnitedStates Department of Agriculture(USDA) Food and Nutrition Services(USDA) requirements.TaskNumberPage 30 of39Contract Numb er CLHI 8249 -23
Exhibit A, Statements of WorkRevised as of September 15,2021AMENDMENT #23Payment Informationand/or AmountSee paymentinformation asreferenced in tasknumber 1.0F'FY21Due Date/Time Framea09/15/21, or followclose-out schedule.Activities completed inOct 2021 due in PEARShy I l/j0/21Nov 2021 by I2/31/21aSNAP-Ed Direct educationconducted between 10/01/20and,0915/21 I2/31/21.r Direct educationstrategies only:Completed Pre-and post-testsurveys receivedby DOH, or dataentered intoPEARS databaseby Subrecipient,no later than twoweeks aftercompletion of thesurvey. Allcompleted pre-and post-testsurveys must bereceived, or dataentered bySubrecipient, nolater than COB09/l5l2l, orfollow close-outschedule.For the Period:10101120 to 094e#-trI2/3t/21FFY2| Duez l2/3-l/20I2/31/21 for all SNAP-Edfunded staff. New hires tocomplete within 30 days ofhire.Measure (whereapplicable)Submission ofdocumentation showingcompleted Civil Rightstraining for all SNAP-Edfunded staff on or beforethe required due date.Deliverables/OutcomesOn-time completion of anapproved Civil Rights training forall SNAP-Ed funded staff.Task/Activity/DescriptionCivil Rights TrainingAll SNAP-Ed funded staff mustcomplete training each fiscal year incivil rights.*See special requirements section-Civil RightsTaskNumber3.0Page 3l of39C ontract Number CLHI 8249 -23
AMENDMENT #23Exhibit A, Statements of WorkRevised as of September 15,2021Payment Informationand/or AmountSee paymentinformation asreferenced in tasknumber 1.0.FFY2lDue Date/Time FrameFFY22 Due: I2/31/21For the Period:10/01120 to 09/30&II2/3r/21Fiscal: Annually, and tnFFY2I no later than March31,2021.SNAP-Ed Curriculum:New direct education stafftrained within 30 days forspecific curriculum to beused in direct educationstrategy, or before providingSNAP-Ed direct educationactivities to sNAP-Edaudience. Projectcoordinator or qualifieddesignated staff person tocomplete additional SNAP-Ed Curriculum trainingwhen new information isprovided for specificcurriculum to be used indirect education strategy.Data collection andreporting: Annually, ormore often as needed. Ifapproved data collectionsystem changes, everySNAP-Ed tunded staffmember entering data willbe required to completetraining on any newexpectations or systemchanges on the dav of. orMeasure (whereapplicable)Documentation showingrequired person(s) anddate(s) of attendance for allweb-based and in-personrequired meetings.Documentation showingrequired person(s); date(s)ofattendance; and,completion of training forall web-based and in-person required trainings.Documentation ofsatisfactory understandinggained from requiredtrainings, and applicationof applicable knowledgeand skills in progressreviews and,/or monitoringreports.D eliverables/OutcomesOn-time completion of all requiredtrainings by required SNAP-Edstaff.Attendance of required orappropriate staffperson(s) at allrequired meetings.Demonstration of satisfactoryunderstanding of the informationand concepts included in requiredtrainings.SNAP-Ed Curriculum: On-timecompletion of required fraining forspecific curriculum to be used indirect education strategy by projectcoordinator or qualified designatedstaff person responsible fordelivering SNAP-Ed curricula toSNAP-Ed eligible audience.Food handler training:Completion of a Washington Stateauthorized food handler or foodworker training by all staff whowill handle and serve food to thepublic.Coordinator meetings:Attendance of project coordinatoror qualified" designated staffperson to at least 75%, of allcoordinator meetings provided.Regional meetings: Attendance ofcoordinator orTask/Activity/DescriptionDocumentation must include:r Training and sourcer Who attendedr Date completedOther Required Training andMeetingsThe following trainings or meetingsare required for all Subrecipientswhen provided by DOH or WASNAP-Ed for the staff listed. Unlessmore staffattendance is required,minimum of one (l) staffpersonrequired to attend to satisfrrequirements. Multiple staff mayattend if costs for attendance arecovered in Subrecipient's annualbudget.aFiscal training - fiscal agent orproject coordinator, whoever ismost responsible for creating andmonitoring budgeq procurements,invoices, budget decisions, orbudget amendments for theSNAP-Ed program.Food handler training - all staffwho will handle, prepare, cook,assemble, and.ior serve food ordrink to participants or the public.aaTraining on data collection andreporting - project coordinatoror any staffperson responsible forcollecting, reporting, or enteringSNAP-Ed related data.Regional meeting(s), whenprovided - project coordinator orTaskNumber3.1Page32 of39Contract Number CLHL 8249 -23
Exhibit Ar Statements of WorkRevised as of September 15,2021AMENDMENT #23Payment Informationand/or AmountSee paymentinformation asreferenced in tasknumber 1.0.F'r'Y21Due Date/Time tr'ramewithin 30 days of when thetraining is provided.Annual Forum: Annually,when provided, and.forFFY2I no later than09/30t21.Coordinator meetings:Completed on datesscheduled by DOH, whenprovided.Regional meetings:Completed on datesscheduled by DOH, whenprovided.SNAP-Ed systemsapproaches trainingonline: At least once withinthe three year period ofperformance, and no laterthan the end of the f,rstsecond fiscal year within thethree year period ofperformance..---Wg9B€t2+SNAP-Ed systemsapproaches training I@qg: Once annually,when provided, on datesscheduled by WA SNAP-Ed.For the Period:10/01120 to 09/388+I 2/3 1/2 tDue: Inventory list isrequired to be updated noMeasure (whereapplicable)Completed documentafi onshowing updated SNAP-Edinventory using approvedform/system provided.D eliverables/Outcomesdesignated staffperson to at least50Vo of all regional meetingsprovided.State Forum: Attendance ofproject coordinator or qualified,designated staffperson to all stateforums provided.SNAP-Ed Systems Approachesfor Healthy Communities:Demonstrate satisfactoryunderstanding of the inforrnationand concepts included in thetraining. Satisfactory application ofknowledge and skill learned fromtraining to SNAP-Ed project, asneeded.If required meeting or training isnot provided" Subrecipient is notrequired to make up requirementsfor attendance and will be incompliance. Attendance at requiredmeetings and completion ofrequired trainings required onlywhen provided.On-time updates to SNAP-Edinventory list.1. Inventory listupdatedper duedates required.Task/Activify/Descriptionany qualified designated staffperson.aAnnual State SNAP-Ed forum,when provided - projectcoordinator or any qualifieddesignated staff person.aSNAP-Ed Curriculum training(either in person or online)(only required for dtecteducation strategies) - projectcoordinator or qualifi eddesignated staff personresponsible for delivering SNAP-Ed curricula to SNAP-Ed eligibleaudience.aSNAP-Ed Systems Approachesfor Healthy Communitiestraining (online, whenprovided) - project coordinatorand all staffinvolved in planning,implementing, and evaluatin gSNAP-Ed project activities.aSNAP-Ed Systems Approachesfor Healthy Communitiestraining (in person, whenprovided) - project coordinator orqualifi ed designated staff person.aProject coordinator meetings(conference calls or in person) -project coordinator or qualifiedstaffSNAP-Ed InventorySNAP-Ed Subrecipients are requiredby regulation to keep an up-to-dateinventory list that includes all non-capital equipment, approved capitalTaskNumber4.0Page 33 of39Contract Number CLHI 8249 -23
Exhibit Ao Statements of WorkRevised as of September 15,2021AMENDMENT #23Payment Informationand/or AmountSee paymentinformation asreferenced in tasknumber 1.0.FFY2lDue Date/Time Framelater than 30 days after theend ofeach quarter. Finalinventory list updated by091t5/20.2r.At the time of a fiscal orproject monitoring review,or when requested, an up-to-date inventory list must bemade available.For the Period:10/01120 to €9Be&II2/31/21Due: Monthly - Submitinvoices to DOH no laterthan 30 calendar days afterthe end of the precedingmonth. (E.g. October A19invoice submitted no laterthan November 30)o Oct. Invoice due:lt/30/20o November:12130120o December:01130/21o January: 02/28/21o February:03130/21o March: 04130/21o April: 05/30/21o May: 06/30121o June: 07/30/21o July: 08/30121o August: 09/30121o September: I I/30/21o October: ll/30/21o November:12/31/21Final FFY2I invoice is dueOetob* November 30.Measure (whereapplicable)SNAP-Ed invoices (Al9)with all documented costsand any requiredaccompanying materialsreceived at DOH by duedates required, or byapproved extension date.DeliverableVOutcomes2. Inventory list containscomplete list of all itemspurchased with SNAP-Edfunds in current fiscal year andprevious fiscal years still inuse and in possession oftheSubrecipient.On-time delivery of correctcompletion of SNAP-Ed Al9invoices, using the current form forthe fiscal year.On-time delivery of detailed ledgersupporting the costs to be reviewedby SNAP-Ed program via the mostcurrent submission procedurebefore approval of payment.Complete documentation of allactual costs incurred shall beaccompanied by the Subrecipient'sfinancial system report. IfSubrecipient does not have afinancial reporting system, theSubrecipient must check with theDOH SNAP-Ed program forfurther guidance.Task/Activity/Descriptionequipment, purchased curriculum, andother SNAP-Ed purchased items thatare not disposable. This list shouldinclude items purchased in prior fiscalyears still in use and in possession ofthe Subrecipient. This list should beupdated per the due dates required.Agencies are required to follow theDOH SNAP-Ed Inventorypolicy andprocedure.*See special requirements section -MonitoringSNAP-Ed Al9InvoicesSubrecipients must use the Al9invoice form specific to the DOHSNAP-Ed program. This documentwill be sent to all Subrecipients priorto October 3l't of the current fiscalyear.TaskNumber5.0Page 34 of39Contract Number CLHI 8249 -23
AMENDMENT #23tFor Information OnIv:Funding is not tied to the revised StandardVMeasures listed here. This information may be helpful in discussions of how program activities might contribute to meeting aStandard/lvleasure' More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Ivleasures thai may apply can be found at:http:/hw*w.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf -Special RequirementsFederal Fundins Accountability and Transnarencv Act (tr'FATA)This statement of work is supported by federal firnds that require compliance with the Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act).The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent.To comply with this act and be eligible to perform the activities in this statement of work, the Subrecipient must have a Data Universal Numbering System (D1INS@) 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. l0g-2g2.*Prosram Snecifi c Reouirements/NarrativeCgntract Noncomnliance and Corrective Action (see CFR 6 200.338 Remedies for noncomnliance)specihed 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 progre-ssSpecific conditions (see https://www.govregs.com/regulations/2i200.20il, DOH reserves the right to withhold up to l0% of firnds from the next applicable payment to theas such. After DOH SNAP-Ed provides documentation of the issue(s) and outlines the appropriate corrective action in writing, and with upp.ouuifro- the DOH SNAp-Edprogram manager' the first withholding of funds up to l0% would occur one time and allow 60 days for the appropriate correitive action to be completed by the Subrecipient. Ifdays, up to 5% of fnds will be withheld fom each subsequent monthly payment until the appropriate corrective action is "o-fl"t"d. If satisfactor corrective action is completedafter the 60day window, the initial 10% of funds withheld will not be provided as reimbursement to the Subrecipient as penalty. The subsequent monthly withholdings (of up toExhibit A, Statements of WorkRevised as of September 15,2021Pa;rment Informationand/or AmountFFY2lDue Date/Time Frrme2021, or follow close-outschedule.Or*If pre-approved inwriting by DOH, agenciescan submit invoices everytwo months. Upon approval,a list of submission dateswill be provided.Measure (whereapplicable)Deliverables/OutcomesTasl/Activity/DescriptionTaskNumberPage 35 of39Contract Number CLHI 8249 -23
AMENDMENT #23Washington Departrnent of Health SNAP-Education, PO Box 47886, Olympia, WA 98504-7886, or in writing via emailio 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 completionincorect or incomplete invoices and will not pay for services that occur outside the period of perlormance or that are deemed unallowable costs.Additional Details Regarding Deliverablesfunds within their current allotted budget to send the minimum number of one (l) stafpeison to the requirea truinirrg. rfrJsuUrecipient may request additional travel fnds fomDOH for required training(s) if necessary and if funds are available.Monitoring ExpectationsThe Subrecipient's premises and records will be made available upon request to DOH, DSHS, and USDA stafffor the purposes of observing project activities and reviewing forfunds should be hacked in an inventory list and available for review upon request. Based on fiscal andproject monitoring results or findings, additional monitoring duriig thefiscal year may be required at the discretion of the DOH SNAP-Ed program,bOH frscal analyst, or DoH fiscal monitori-ng unit. Completed project and fiscal *oiitori.rfr"po.t.with suggestions, observations, comments, feedback, findings, and,/or corrective action will be kept on file at DOH anA shared with Subrecipienis regularly and by request.Staff RecuirementsUpon 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' pennits, qualifications, and training required by DOH.Project Coordinator requirementsThe Subrecipient must maintain a SNAP-Ed project coordinator. The project coordinator is the main contact between Departrnent of Heatth SNAp-Ed team and the Subrecipient.DoH sNAP-Ed expectations for the project coordinator responsibilities include:o Ensure all contract deliverables are met.o Coordinate the planning, implementation, evaluation, and reporting of all parts of the approved project plan.r 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.r Enswe staffand any sub-Subrecipients funded through this contract stay informed of current and new SNAP-Ed policies, and are held accountable to policies when needed.required by WA SNAP-Ed and DOH.r Attend, or designate and send qualified staffmember as proxy to, required DOH and State SNAp-Ed meetings and trainings.r Monitor or maintain knowledge of project budget status, including estimated spend out and total dollars spent to date.r Submit plan and budget amendments for approval as outlined in the current year's policy and procedures.o Coordinate the on-time completion of all data entry and reporting.r Ensure photo and media release forms are obtained for persons featured in SNAP-Ed programming photographs or videos.Exhibit A, Statements of WorkRevised as of September I5,202IPage 36 of39Contract Number CLHI 8249 -23
AMENDMENT #23Communication RequirementsThe Subrecipient must maintain communication with DOH SNAP-Ed. Communication required between DOH SNAP-Ed and the Subrecipient will not be unreasonable orexcessive. DOH SNAP-Ed expectations for communication include:o 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 l0business days ofthe change.r 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.r Maintain or obtain an internet connection for communication with DOH, for access to DOH SharePoint webpages, to view updates and messages from Washington SNAp-Edthrough the WA SNAP-Ed Providers website, and for reliable reporting of SNAP-Ed activities. If reliable intemet connection cannot be ,""*"-d, the SubrecipiJnt and DOHSNAP-Ed will agree on a plan for necessary communication, data entry, and reporting.r 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:/isnaped.fos.usda.gov/program-administration/guidance-and-templates)r The Subrecipient is fiscally responsible for activities funded with Supplemental Nutrition Assistance Program Education funds and is liable for repayment of unallowablecosts.r 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 (EFNEP) may be claimed under the SNAp-Edgrant. Approved activities are those designed to expand the State's current EFNEP coverage in order to serve additionai SNep-gO targete-d individuals. In no case mayactivities funded under the EFNEP grant be included in the budget for SNAp-Ed.r Contracts are procured through competitive bid procedures govemed by State procurement regulations.o Program activities are conducted in compliance with all applicable Federal laws, rules, and regulations including Civil Rights and OMB regulations governing cost issues.as supplement them. This applies to all activities and costs under the Federal budget.r Program activities are reasonable and necessary to accomplish SNAP-Ed objectives and goals.o A11 materials developed with SNAP- Ed funds include the appropriate USDA non-discrimination statement and credit SNAP as a funding sowce in standard font that is easilyreadable.SNAP-Ed Statewide InitiativesSubrecipients are expected to communicate with, respond to, and comply with requests, guidance, requirements, and./or on-site visits fom all contracted SNAp-Ed statewideinitiative entities.Any SNAP-Ed curriculum modifications should be developed and executed based on the most current Guidance for Curriculum Modification, found under "Guidanse andProcess" 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 SNAp-Edand deliberation between the Subrecipient, DOH SNAP-Ed, and the contracted SNAP-Ed statewide initiative entity/entities; and, when necessary, DSHS. Aftir appropriateconsideration and deliberation, the resulting decision about whether or not the Subrecipient must comply or can adjust or deny a specihc will be provided in writing to theSubrecipient from DOH SNAP-Ed and/or DSHS.Exhibit d Statements of WorkRevised as of September 15,202LPage37 of39Contract Number CLHI 8249 -23
Health and Safety AMENDMENT #23SNAP-Ed audience or communit5r members in situations that could endanger their health, safety, or well-beiig. participation in SNAp-Ed by the SNAp-Ed audience is voluntary.sufficient and acceptable technical assistance between Subrecipient and DoH SNAP-Ed and after prior written notifcation to the Subrecipient. Any change in annual fnding due'Contract Noncompliance and Corrective Action' section.AuditsThe subrecipient must make State financial and program audits or reviews conducted by other entities available to the DoH, DSHS, usDA, or its designee.Indirect Rate/Allocation PlanAll 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 thatindirect costs included in the Subrecipient's SNAP-Ed plan and budget are supponed by an indirect rate and./or cost allocati-on plan approved by the appropriate agency. TheSubrecipient cannot bill indirect costs that are determined to be unacceptable ina wiU be disallowed.who supervise 'frontline staff must be provided civil rights taining an annual basis.,'Records Maintenance - Record Retention and Management - State Agency and All SubrecipientsTCER2T2.2DoH SNAP-Ed regulations require that all records related to the SNAP-EI program be retained ior six (6) years from fiscal closure. This requirement applies to fiscaldocumentation and procurement records, confiact related documents and emaits, progress reports, monitoiing reports, and SNAp-Ed client iniormation @relpost surveys,demographic cards, etc.). Supporting documentation may be kept at the Subrecipieni level, but shall be avaiiabli for review within six years fom the daie oith" lurt quartertyclaim submittal. Any costs that cannot be substantiated by source documents wiit be disallowed as charges to SNAp-Ed.TravelThe Subrecipient is expected to comply with the Office of Financial Management's Travel Management Requirement and Restrictions as found in policy 10.10(http://www.ofm.wa.gov/policy/10.htm), with the fiavel requirements found in the current y"u.'s-SNAt-td iederal guidance, and with any travel related nOH SNAp-Ed policyAmendmentsSubrecipients 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 programconsultant to know what changes they can make on their own and what changes requiie an amendment and pre-alproval in writin!. Notifi DOH staffprior to implementingamendments that signifcantly change the scope or direction of the approved project plan, including creating newor completely en-ding inierventions, or adding d-ifferentwritten budget amendment request to DOH, and receive written approval from DOH, prior to making any changes within their project or budget and prior to making any purchasesincluded within the amendment. Any requests needing USDA approval must be submitted to DOH no laier th;April lst of eaih fiscal year,-or no later than date sfecift"a UyUSDA, DSHS, or DOH. Following the current year's guidance when required, if Subrecipients submit plan or budget no cost amendments that do not require DSH-S or USD!approval, DOH can review those and make approvals on a case by case basis during the federal fiscal ylar following the current year's guidance when required. All costamendments that do not require DSHS or USDA approval should be submitted to DOH no later than July 16s of eaih fiscal year.Exhibit d Statements of WorkRevised as of September 15,2021Page 38 of39Contract Number CLHI 8249 -23
overtime AMENDMENT #23Staff ovenime 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 RequirementsPayment for deliverables as specified herein is dependent on receipt of frrnding from the USDA fnditrg sources. In the event funding is not received, DoH is under no obligationto make payments for the deliverables as specified' If funding is reduced or limited in any way after the effective date of this confiact and prior to normal completion, DoH mayterminate task(s), remove funds, or reallocate funds at DOH's discretion under new funding limitations and conditions. DOH will make payments only upon the receipt of tlefunding. DOH will notiff the Subrecipient within l0 working days upon notice by the funding source of funding availability.Special Billing Requirements1' All invoices, billing, and reimbursements must be in compliance with all applicable Federal laws, rules, regulations including the current year SNAp-Ed Guidance and OMBcirculars govenring cost issues.2. Tokl costs billed will not exceed the USDA-approved budget amount listed in the box below.o Bills must be for only SNAP-Ed specific activities, using a DOH Al9-lA Invoice voucher.r A SNAP-Ed specific A19-lA must be submitted to the subrecipient's designated DOH SNAP-Ed staffmember within 30 days of the last day of the month for which thework is being billed, ORo 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 Subrecipient is unable to submit the SNAp-Ed A-19-lA on the due date, the Subrecipient is required to submit a request for an exception to the OOU no later than 7 days prior to due date to the DOH SNAp-Edprogram. The SNAP-Ed program reserves the right and responsibility to eitler upp.oue or deny the request for an exception and will reply to the request.4. Supporting documentation for each month must be submitted with each SNAP-Ed Al9-lA.r At the very least this means a copy ofa Subrecipient's financial expanded./detailed general ledger level report.o 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 furthernotice by DOH.r All new SNAP-Ed Subrecipients within their I't fiscal year.r Subrecipients with current fiscal findings.e Subrecipients who have not submitted adequate or accurate backup documentation within the last year.o Subrecipients who receive a rating of "High" from the DOH Federal Subrecipient Risk Assessment Tool.BUDGETAmount&ffi46 $4t.4ssSourceUSDADOH Program ContactJamie Wells, SNAP-Ed Contract ManagerDepartment of HealthPO Box 47886, Olympia, WA 98504-7886Jamie.Wells@doh.wa. gov / 3 60-23 6-3668Exhibit A, Statements of WorkRevised as of September 15,2021DOH Fiscal ContactKim Henderson, Fiscal AnalystDeparhnent of HealthPO Box 47886, Olympia, WA 98504-7886Kim.Henderson@doh.wa. gov / 3 60-236-349 IPage 39 of39Contract Number CLHI 8249 -23
Kittitas County Public Health DepartmentIndirect Rate as of January 201t z 29.50Yo Public Health D ept & l2,soo/o county central svcsIndirect Rate rs ofJanuary 2019: 28.25o/o Public Health Dept & lz,7svo county central SvcsIndirect Rate as of January 20212 2s.25vo Public Health D ept & 12.7s/o county central svcsEXHIBIT B-23ALLOCATIONSContract Term: 2018-2021DOH Use OnlyBARS Statement of Work Chart of AccountsReyenue Funding Period Funding PerlodCFDA* g66s** Start Date End Date Stsrt Drte nnd DateContract Number:Date:cLHt8249September 15,2021Chart of Accounts Program TitleFFYI9 CSS IAR SNAP Ed Program MgntFFY19 CSS IAR SNAP Ed Program MgntFFYIS CSS IAR SNAP Ed Program Mgnt CFFFYI8 CSS IAR SNAP Ed Program MgntFFYIS CSS IAR SNAP ED Program MgntFFYIS CSS IAR SNAP ED Program MgntFFY17 CSS IAR SNAP ED Program Mgnt CFFFY22 IAR SNAP Ed Prog Mgnt-Region 2FFY21 L4'R SNAP Ed Prog Mgnt-Region 2FFY20 IAR SNAP Ed Prog Mgnt-Region 2BITV-COVID Ed LHJ Allocation{ARESBITV-COVID Ed LHJ Allocation{ARESBITV-COVID Ed LHJ Allocation-CARESCOVID LHJ OFM Allocation-CARESFFYIT EPR PHEP BPI LHJ FundingFFY17 EPR PHEP BPI LHJ FundingFFYIS EPR PHEP BPI Supp LHJ FundingFFY18 EPR PHEP BPl Supp LHJ FundingFFY21 PHEP BP3 LHJFrmdingFFY20 PHEP BP2 LHJ FrmdingFFY20 PHEP BP2 LHJ FundingFFYI9 PHEP BPI LHJ FundingFFY20 Envir Health Crpacity-C (CDC) NCEFFY20 Envir Health Capacity{ (CDC) NCEFFYIT 317 OpsFFY1TAFD(FFY2I COVIDI9 Vaccine Services-CARESFFY2I COVIDI9 Vaccine Services-CARESFFY21 COVID19 Vaccine Seruices-CARESFederal AwardIdentification #197WAWA5Q3903197WAWA5Q3903187WAWA5Q3903187WAWA5Q3903187WAWA5Q3903187WAWA5Q39031717WAWA5Q3902O7WAWAsQ3903207WAWA5Q3903207WAWA5Q3903NGA Not ReceivedNGANot ReceivedNGA Not ReceivedNGANot ReceivedNU90TP921889-01NU90TP921889-01NU90TP921889-01NU90TP921889-01NU90TP922043NU90TP922043NU90TP922043NU90TP922043NUE1EHOO1445NUE1EHOO14455NH23IPo00762-05-005NH23IP000762-05-00NH23IP9226l9NH23LP9226t9NH23IP922619Amend #,A.motrnt$429$19,745$8sE$3,000sl 1,025$8,830st,472$1s,409$26,046s20,603($120,E07)$189,027$63,009$565$19,833s885948,249s29,480$19,653$29,480$49, l 33($21,000)$1 l r,000(s354,803)$354,803s14,582FundingPeriodSub Totel$20,174$858922,85591,472$1s,409$26,046$20,603$731,229$909,400$20,398$49,r34s29,480$49, l 33$49,133$90,000$616$2,226$ 14,582Chart ofAccountsTotd$4s,3s9$62,058$13 I,229$909,400$20,398$49,134$r27,746$90,000$616$2,226$14,582Amd 9Amd4Amd 4Amd 4tund2N/AN/Al0/0 l/l 8I 0i0ll1 8l0i0\i r 801/0li l801/01/1 80l/01/1 801/01/1 809/30t190913011909t3011909/30/1809/30/1809/30/1809130tr812/3t/2109/30/2109130120l0/01/1810/01/1810/01/18l0l0lt17t0/0t/17to/01/17lo/oL/1710/ov2tt0/01/20l0/01/1909/30n909/30n909/3017909t30n809/30/180913011809/30/1810.56110.56110.56110.561r0.56110.56110.561333.1 0.56333.10.s6333.1 0.56333. I 0.56333.10.56333. l 0.56333.10.s6Amd 23Ard 17tund 10Amd 23Amd 18,21,23Amd 16, 18,21,23Amd 2N/AAmd5Amd4ArlI:d 22Amd l7Amd 16, 17Amd 10Amd 23Amd 18,2lN/AN/AAmd2IAmd 19Amd 18, l9Amd 2l333.10.56333.10.56333. I 0.5610.56110.56110.56121.01921.01921.019t0/0r/2t10t01/201010111909/30/2209/30/2t09/30t20333.21.01333.21.01333.21.0107/0t/20 06t30t2t07/0r/20 06t30/2107t0y20 06t30/2707t0u2007/01t200'7/0u2006/30t2r06t30/2r06/30/2tAmd 16, 18, 21 21.019 333.21.0r 03/01/20 r2t31t2I }3/OL/ZO t2/3t/21 $909,40093.06993.069333.93.06 01/01/18 06t30t18 07tov17333.93.06 01/01/18 06/30/18 07/01n7071o2t7807/02/t893.06993.069333.93.06 07tOUt8333.93.06 07/0U1806t30n9 07/01/18 06t30/1906/30^9 07tovt8 06/30t1993.06993.06993.06993.069333.93.06333.93.0633?.93.06333.93.0607/01/2r07/ot/2007t0v2007/01t1912/31/2106/30/2106/30/2r06t30/2007lov2107/o|2007/01/2007/0ut906/30t2206/30/2106/30/2106/30t2093.07093.070333.93.07 09/0U20333.93.07 09t0U2012/3t/2t 09/O1t20l2t3l/21 09/01120l2t3t/2112t3Lt2l93.268 333.93.26 01/01/18 06t30tr8 04/0U17 06/30/18$61 693.268 333.93.26 01/01/18 06/30/18 04t0v17 06/30/18$2,22693.26893.26893.268333.93.26333.93.26333.93.2607/01/2007/oI/200710t/2012/3Uzr12/3t/2tt2/3r/2r07/olt2007lov2007t0U20t2/3Lt2rt2/3u21t2l3l/2t93.268 333.93.26 07t01120 t2t31t2t o7/ot/20 t2/3U21 $354,803COVID19 VaccinesNH23IP9226t9Page I of4$354,803s354,803
Kittitas County Public Health DepartmentIndirect Rate es of January 2018l. 29.50vo Public Health Dept & 12,50% County centrat svcsIndirect Rate as of January 2019: 2E,25o/o Public Health Dept & l2.7svo county central svcsIndirect Rate as of January 2021: 25.25vo Public Health D ept & l2.7svo county central svcsChart of Accounts Program TitleFederal AwardIdentification #Amend #EXHIBIT B-23ALLOCATIONSContract Term: 2OlE-2021BARSRevenueCFDA* ge6s**ContractNumber: CLHI8249Date; September15,202lAmd 17Amd 16, 17Amd 3,4Amd 23Amd 17Amd 15, 17Amd 9N/AAmd 23Amd 19An1d22Amd 20Amd 17Amd 10Amd 8, 15At1:d 22Amd 17Amd 10Amd 4Amd 2N/AAmd 18Amd 16Amd 10N/A93.26893.069Amounts2,800s2,800$s,600$2,800$2,800$5,600$l,l 14$270,807$s30,161$60,000$12,346$60,000$60,000s60,000$l 1,049$44,196$44,t96s44,196$893$33,147($ 1 89,027)$ l 89,027$20,000$5,000FundingPeriodSub Total$5,600$5,600$5,600$5,600$s,600$1,1 14$61,177$237,077$800,968978,s22s60,000$72,346$60,000$60,000$ I 1,049$44,196$44,196$44,196$34,040$20,000s5,000Chart ofAccountsTotal$s,600$5,600$17,91496t,177$237,077$800,968978,522$2s2,346$177,677$25,000DOH Use OnlyStatement of Work Chart of AccountsFunding Period Funding Perlodstart Date End Date stsrt Drte End DateFFY2I Enhanced lnfluenza Coverage CARESFFY2 I Enhanced Influenza Coverage CARESFFYIT Increasing Immunization RatesFFY22 VFC OpsFFY21 VFC OpsFFY2I VFC OpsFFY20 VFC OpsFFY17 VFC OpsFFYI9 COVID CARESFFY19 ELC COVID Ed LHJ AllocationFFf20 ELC EDE LHJ AllocationFFY20 ELC EDE LHJ AllocationFFY20 CDC COVID-l9 Crisis Resp LHJ-TribeFFY21 Phys Actuty & Nutrition ProgFFY20 Phys Actvty & Nutrition ProgFFY20 Phys Actvty & Nutrition hogFFY19 Phys AcMy & Nutrition ProgFFY18 Phys Actrity & Nutrition ProgFFY22 MCHBG LHJ ContractsFFY21 MCHBG LHJ ContractsFFY20 MCHBG LHJ ContractsFFY19 MCHBG LHJ ContractsFFYIS MCHBG LHJ ContractsFFYIS MCHBG LHJ ContractsFEMA-75 COVID LHJ AllocationFEMA-75 COVID LHJ AllocationGFSCroup B (FO-E)GFS-GroupB(FO-E)NH23rP922619NH23IP922619NH23IP000762NH23tP9226l9NH23rP922619NH23IP9226l9NH23IP9226l95NH23rP000762-0s-00NU50CK000515NU50CK000515NUs0cK000srsNUs0cK000s15NU9OTP922069NU5EDP0065O4NU58DP006s04NUs8DP006504NUs8DPo06504NUs8DP0065048044525180440169B04MC32s78804MC32578804MC31s24BMMC31524333.93.26 0710U20 06t30t2r 06t05t20 06/30/2t333.93.06 07t0U20 06t30/2t 06/05/20 06/30/2193.268 333.93.26 07t0yr8 06t30n9 07/ot/78 06t30/19$5,60093,26893.26893.26893.26893.268333.93.26333.93.26333.93.26333.93.26333.93.2607/0t/2707101/2007lotl2007/0U1901/01/1812/3t/2r06/30/2106130/2r06/30/2006/30t18a7/ov2t07/0U20o't/0U2007/0u19o4t0u1706t30/2206/301210613012106/30t2006/30/18Arnd 15, 1893.323 333.93.32 06t01t20 t2/3u21 06/01/20 t2t3l/2r$6r,177Amd 1993.323 333.93.32 01t0U21 12/31/2r OU0^U2| t2t31t21 $237,07793.32393323333.93.32 01115/21333.93.32 0u1st21t2/3t/21 01/t5/21t2l3t/21 01/t5t2l12t31/2tt2/3t/21And 13, 18, 19 93.3s4 333.93.3s 01120/20 t2/3t/Zt Olt0lt20 LI|3UZL978,s2293.43993.43993.43993.43993.43993.99493.99493.99493.99493.99493.99497.03697.036333.93.43333.93.43333.93.43333.93.43333.93.430913012109130120091301200913011902t19119t2/3t/2109t29/2109129t2t09t291200912912009l30l2r0913012009t30t2009/30n909/28t1809129122a9129/2r09/29tzr09/29/2009/29t2A333.93.99333.93.99333.93.99333.93.99333.93.99333.93.9910101.1211010U2010/0t/19l0/01/1 801/01/18ollot/18l2/3r/2109/30/zt091301200913011909i30/1809/30/18t0/0lt2ltol0lt2010/0u19l0/01/18t0/0u17to/ot/1709t30t2209/3012109/30t2009/30n909t30/1809/30/18t2/30t20t2/30120333.97.03 0710t120333.97.O3 0710U20t2/30/20 07/01120t2t30t20 07/01t20s0$0N/AN/A334.04.90 07/0t/20 12t31120 oTtol/19334.04.90 01/01/18 06/30/18 07t0vt706/30/2106/30/19N/A 334.04.90 07/01/18 06130/t9 07t0vt7 06/30n9 $10,000FY2 Group B Programs for DW (FO-E)Amd 3Page 2 of 4$ 10,000$10,000
Kittitas County Public Health DepartmentIndirect Rate as of January 2018: 29.50o/o Public Health r) ept & l2.s[o/o county central svcsIndirect Rate as of January 2019 z 28.25vo public Health D ept & 12.7s%o county central svcsrndirectRateasofJanuary202lz 2S.2Sv"PublicHealthDept&L2,7s%ocountycentralsvcsChrrt ofTitleFederal AwardIdentification #End Date Start Drte End334.M.9t 07tolng 06/30t20 07/o!19334.04.91 06t0U19 06t30/19 07tovr7EXHIBIT B-23ALLOCATIONSContract Term: 2018-2021BARSReyenueCFDA* 666s**Statement of WorkFunding PeriodDOH Use OnlyChart of AccountsFundlug Perlod06/30t2106/30/r9Contract Number:Date:cLHl8249September 15,2021ZoonoticsCFSZoonotics4FSFY20/21 COVID-I9 Disaster Response AcctSFY2 kad Environments of ChildrenSFY2 lcad Environments ofChildrenSFY1 kad Environments of ChildrenFPHS-LHJ-Proviso (YRl)FPHS-LHJ-Proviso (YR I )FPHS Funding for LHJsFPHS Funding for LHJsFPHS Funding for LHJsFPHS Funding for LHJsFPHS Funding for LHJs DirYR 20 SRF - Local Asst (ls%) (FS) SSYR 20 SRF - Local Asst (ls%) (FS) SSYR 2l SRF - lncal Asst (15%) (FS) SSYR 2l SRF - Local Asst (157o) (FS) SSYR 2l SRF - Local Asst (15%) (FS) SSYR 21 SRF - lncal Asst (15%) (FS) SSYR 22 SRF - Local Asst (15%) (FO-E) SSYR 22 SRF - Local Asst (15%) (FO-E) SSYR 22 SRF - Local Asst (15%) (FO-E) SSYR 22 SRF - l-ocal Asst (15%) (FO-E) SSYR 23 SRF - Local Asst (15%) (FO-E) SSYR 23 SRF - Local Asst (15%) (FO-E) SSYR 23 SRF - Local Asst (15%) (FO-E) SSSanitary Suwey Fees @O-E) SS-StateSanitary Survey Fees (FO-E) SS-StateSanitary Swey Fees (FO-E) SS-StateSanitary Survey Fees (FO-E) SS-StateSanitary Swvey Fees (FO-E) SS-StateSanitary Survey Fees (FO-E) SS-StateSanitary Survey Fees (FO-E) SS-StateAmd 9Amd 9Amd 8Amd4Amd IAmd 23ArA22Amd 16, 18Amd 10, 18Amd 16Amd 10Amd 3Amd 3N/A, Amd 3Amd 10Arnd 9, 10Arnd 7, 10Amd 3,7, 10Amd 21Amd 14Amd 12Amd 10, 12Amd22Amd2lAmd 19Arnd22Amd 21Amd 14,21Atr:ld 12,21Ar:d,g,12,21Anfr,1,12,21N/A, Amd 3,7, 12,2l334.04.93 07/0U18 06t30t19 07t0In8334.04.93 07t0lt18 06t30^9 07/o1il8334.04.93 0l/01/18 06t30t18 MtoL/17tund 13, 18N/A 334.04.92 0U20/20 06130/21 }t/ottzo 06/30/21 $71,478N/AN/AN/AN/AN/A06t3011906130/1906/30118Amount94,029$97 I($1,500)$ 1,500$2,000($2,400)$2,400($3,200)s400$2,800$2,400FundingPeriodSub Total$4,029$971$71,478$0$2,000$605,000$100,000$100,000$42,000$0$2,400$4,400$4,800$r 1,600Chart ofAccountsTotal$s,000$7r,478s2,000$847,000$2,400$4,400$4,800$1 1,600N/AN/AN/AN/AN/AN/AN/A0710t/210'710t/2107toU2007/oI/200'7/0Ut907t01t1907loU1812/3U2tt2/3r/2106t30t2106/30t2106/30/2006/30/2006t30n907loll2l0710t/2107/ovtg07lollt907lov1907/0v1907/ollt706/30/2306/30/2106B0nl06/30t2106/30t2106/30t2106/30tt9t2/3ut8IA3Uft336.04.25336.04.2s336.04.2s336.O4.2s336.O4.2s336.04.25336.04.25$s05,000s100,000$s8,000$42,000s58,000$42,000$42,000N/AN/A346.26.64 01/01/18346.26.64 01/01/18t2l3tl18 07/OI/t5t2/31/18 07/01t15$0N/AN/AN/AN/A346.26.64346.26.64346.26.64346.26.540l/0v1801/01/1 801/0li 180 l/01/1806t30/19 07/0v1706130t19 07/OU1706/30/19 07t01/t706/30/19 07tolll706/30^906130n906/30n906/30/19N/AN/AN/AN/AN/AN/AN/A01toln901/0r/t901l0Ut901t01t19t2t3v2012/3u2012131/20t2/3r/2001l0Ln901/ov190t/0|1901/0vt906/30t2t06/30t2t06130t2106/30/2t346.26.64 IUOU2t346.26.64 01/0t/21346.26.64 01t0l]21346.26.64346.26.64346.26.64346.26.64($2,200)(s400)$3,800$3,200($7,800)$10,400(s400)$3,800s400$2,800$2,400N/AN/AN/AN/AN/AN/AN/A346.26.65346.26.6s346.26.65346.26.6s346.26-6s346.26.65346.26.6501/0 r/l 801i0li I 801/01/r 801/01/1 801/01/l 801/01/1 801/01/18o7tolir107t0t/t?07/0U170710,/17o7/0111707/ovr70710U1712/31t2112/31/2rl2/31/21t213U2t1213u2l12/3t/2112131/2112t3|2112/31t2112t31t2109/oU2009loll2009/ov201U3Vztl2/3t/2t1U3t/21l2l3Lt2rt2/31/2t1A3V2tta3u2tt2/3v21t2/3v21l2/3lt2t($7,800)$2,200$10,400Page 3 of 4
Kittitas County Public Health DepartmetrtIndirect Rate as of January 20lE: 29.50o/o public Health D ept & l2.s}oh county central SvcsrndirectRateasofJanuary20lgz 2t.2svoPublicHealthDept&l2,7so/ocountycentralsvcsIndirect Rate as of January 2021 z 25.25vo Public Health D ept & l2.Tsvo county central svcsTitleFederal AwardIdentification #Amend #EXHIBIT B-23ALLOCATIONSContrrct Term: 2018-2021BARSRevenueCFDA* g66e**Contract Number: CLHIE249Date: Septenber15,202lStatemeDt of WorkFunding PeriodDOHUrcOnlyChart of AccountsFunding PerlodFundingPeriodSub TotalChart ofAccountsTotalEnd Date SirrtDrte End DateYR 20 SRF - lncal Asst (15%) (FS) TAYR 20 SRF - tocal Asst (157o) (FS) TAYR 21 SR.F - Local Asst (1s%) (FS) TAYR 2l SRF - Incal Asst (15%) (FS) TAYR 2l SRF - Local Asst (15%) (FS) TAYR 22 SR-F - l,ocal Asst (15%) (FO-E) TAYR 22 SRF - local Asst (15%) (FO-E) TAYR 22 SRF - Local Asst (15%o) (FO-E) TAYR 23 SRF - Local Asst (15%) (FO-E) TAYR 23 SRF - Local Asst (15%) (FO-E) TAYR 23 SRF - Local Asst (15%) (FO-E) TATOTALTotal consideration:GRANDTOTALtCatalog of Federal Domestic Assistance+*Federal revenue codes begin with "333"Amd 3N/A, Amd 3Amd 10Amd 7, l0Amd 3,7, 10Amd 14Amd 12Amd 10, 12An:ld.22Amd 21Amd 19N/AN/A346.26.66 01/01/18346.26,66 0l/01/18t2/3r/t& 07t0ut5 12/3v18r2t3ut8 A7/01n5 t?3yftAmount($2,ooo)$2,000$0$0$0$0N/AN/AN/AN/AN/AN/A06t30/t906/30t19068A/B($4,000)$2,000$2,000346.26.66 01i01/18 06t30/19 07/Out7346.26.66 0l/01/18 06t30n9 07/0U11346.26.66 01/01/18 06t30t19 07to1nl346.26.66 01/0!19 t2t3u20 0l/01/t9 06Bat2I346.26.66 0|0r/r9 r2t3!20 01t0vt9 06/30t2t346.26.66 01t'1t19 12/3U20 0t/Ot/t9 06t3012t($2,000)$2,000$2,000($2,000)$4,000$2,000$4,000$4,434,110 $4,434,110GRAND TOTALTotal FedTotal States2,000$2,000N/AN/AN/AOil01t2101loU2101/oU2t346.26.66346.26.66346.26.66t2t3r/2t 09/ov20 lu3vzt12131t2r 09t0U20 t2t3t/21t2/31/21 09/01120 ta3uzt$4,000$4,43{,110s3,444,432$989,678$3,779,101$555,009$4,434,110State revenue codes begin with "334".Page 4 of4
Exhibit C-20 Schedule of FederalAwardsKITTITAS COUNTY HEALTH DEPT-SUwOOiO,f75{7CONTRACT CLHI 8249-lctitas County pubtic Hoatth DeparbnentCONTRACT PERIODi 011O1n018-1,/91 nO21DOHFederalTotal AmtFedenlAwardAllocation PeriodStart EndDaieDateContnctA'nt CFDA CFDAProgmmTifla FedamlAgencyNameState Administrative Matching$15,409 10.561 cEnts forth€ SupplementalNutritaon Assistan@ progEmFederal AmrdHen{ificationDepa.tment ofAgricufture Food andNutrition Sedi@207WAWA5Q3903Department ofAgriculture Food andNutrition Sedi@207WAWA5Q3903Department olAgricufture Food andNutrition Sedie207WAWA503903Department ofAgriculture Food andNutrilion Servi@197WAWA503903Department ofAgricufture Food andNutrilion SeNi@187WAWA5Q3903Departmenl ofAgriculture Food andNutrition Seryice187WAWA5Q3903Department otAgriculture Food andNut.ilion Seryi€1717WAWA50390AMENDMENT #23Date: Septembet 15, 2021Fedahl Gnnt Affird Nam€SUPPLEMENTAL NUTRITIONASSISTANCE PROGRAM EDUCATION(sNAP-ED)SUPPLEMENTAL NUTRITIONASSISTANCE PROGRAM EDUCATION(sMP-ED)2019 SUPPLEMENTAL NUTRITIONASSISTANCE PROGRAM€DUCATION(sNAP-ED)SNAP 2YR NUTRITION ED OBESITY201 8 SUPPLEMENTAL NUTRTTrcNASSISTANCE PROGRAM EDUCATION(sNAP-ED)20''8 SUPPLEMENTAL NUTRTfl ONASSISTANCE PROGRAM EDUCATION(sNAP-ED)2O'I8 SUPPLEMENTAL NUTRTTIONASSISTANCE PROGMM EDUCATION(sNAP-ED)PUBLIC HEALTH EMERGENCYPREPAREDNESS (PHEP)COOPERATIVE AGREEMENTPUBLIC HEALTH EMERGENCYPREPAREDNESS (PHEP}COOPERATIVE AGREEMENTPUBLIC HEALTH EMERGENCYPREPAREDNESS (PHEP)COOPERATIVE AGREEMENTsini'ru ein eiri-ric Er.rvrnoriiLnrl-HEALTH CAPACITY (EHC) TO DETECTPREVENT & CONTROLENVIRONMENTAL HEALTH FIAZARDSChart of Accounts Prcgram TitleFFYZz IAR SI{AP ED PROG TGNT{EGION 2FFY2I IAR SNAP ED PROG MGNT-REGION 2FFY:M NR SilAP ED PROG TGNT-REGIOI{ 2FFYIg CSS I,AR SNAP.ED PROG MGNTFFYI8 CSS IAR SNAP{D PROGRAil TGI{T CFFFYIT CSS IAR SNAP{D PROGRAT' MGiITFFYIT CSS IAR SI{APED PROGMTI MGNT CFCOVID LHJ OFM ALOCATION4ARESBITV4OYD ED LHJ ALLOCATIONCARESFFY2I PHEP BP3 LHJ FUNDINGFFY2O PHEP BP2 LHJ FUNDINGFFYIg PHEP APi LHJ FUNDINGFFYII EPR PHEP BPI SUPP LHJ FUiIDINGFFYIT EPR PHEP BPI LHJ FUNDING333.10.56 lOtO'121 $5,il2,922 1OtO1l21 1231t21333.10.561Ot01t2O $5,045,498 10t01t20 o9t3ot21 $26,046 10.561BARSDateState Administrative lvatchingGEnts for lhe SupplementalNutrition Assisian@ ProgEm333.10.56 09/30/19 $5,300,000 10/01/.19 09/30/20 $20,603333.10.56o9l2g1a $s,386,268 10/01/18 09/30/19 $20J74 10.56110.561 cEnts for the SupplementatNutrition Assistance progEmState Administrative MatchingGrants for the SupplementalNutrition Assistance ProgEm333.10.5509/30/19 $5,300,000 10/01/,t8 09,/3(y19State AdministEtive Matching$858 10.56 1 GEnts for the SupplementalNutrition Assistance programState AdministEtive Matching$22,855 '10.561 GEnts for the SupplementalNutrition Assistan@ progEm333.10.56o9t28t17 $5,300,00001/01/18 O9/30/1S333.10.5609/t0/16 $5,739,85601/01/18 09/30/18State AdministEtive l\,tatching$1,472'10.561 cEntsfortheSupplemenlatNutdtion Assistance progEm333.21.01333.21.01333.93.0605t27t2t $11,574,298 O7tO1t21 1231t21$29,480 93.069Public Health Eme.gencyPreparednes333.9s.06o6t12t2o $11,365.797 O7lO1t2O O6t3Ot21 $49,133 93.069PublicHealth EmergencyPreparedne$333.93.0606/29/19 $11,307,904 O7tO1t19 O6t3Ot2O$49,133 93.069Public Health EmergencyPreparedne$333.93.0608/01/18 $11,062,782 07/01/18 06/30/.19$49,134 93.069Public Health EmergencyPreparedness333.93.0607t18h7 $11,062,782 01/01/18 06i/30/18$20,398 93.069Public Health EmergencyPEparednessNGA NotR@ived1?J3112'l $909,400 2,t.019 Coronavirus Retief FundDepartment of the TreasuryNGA NotR@ivedf;q.Noot OzfOflzo OOSCVzf $13i,229 21.019 CorcnavjrusRetiefFund DepartmentoftheT@suryNGA Not RseivedNGA Not R@ivedNGA Not Re@ivedNGA Not RmivedDepartment ot H@h:h and HumanSeryi€s Cente6 for Disease Contol NU9OTP922043and Preventi@Department of Health and HumanSefli@s CenteE for Disease Control NU9OTP922O43and P€ventionDepartment of Health and HumanServi@s Cente6 for Disease Conlrcl NU90TP922O43and PreventionDepartment of Health and HumanSeili@s CenteE for Oisease Contrcl NU90TP9218E9{jand PreventionHOSPITAL PREPAREDNESSPROGRAM AND PUBLIC HEALTHEMERGENCY PREPAREDNESSCOOPERATIVE AGREEMENTDepartment of Health and HumanSerui@s Centere for Disease Contrcl NU90TP921889{1and PrevehtionHPP AND PHEP COOPEMTIVEAGREEMENT$90,000 93.070EnviEnmentjal pubtic Heahh end Department of Heafth and Humangmercenrynesm* - - SeMeCente6forDiseaseContrel' and PreventionFFY2O ENVR HEALTH CAPCITY4 (CDC} NCE333.93.0704tozoo$489.093 09/01/20 1231121Page 1 of3NUE1EHOO1445
Exhibit C-20 Schedule of FederalAwardsKITTITAS COUNTY HEALTH DEPT\SWVOOIO/I75.07CONTRACT CLH18z4g-Kittitas County pubtic Heafth DepartmentCONTRACT PERIOD| 0110112O1A-n/31nO21Federal AmrdDepa.tment of Health and HumanSetui€s CenteE for Disease Contrct NH23tp922619and PEventionDepartment of Health and HumanSeryices CenteE for Disease Control NH23lp9226 l 9and PreventionDepartment of Health and HumanServi@s Centers for Disease Control NH231p922619and PreventionDepartment ol Health and HumanSeruices CenteE for Disease Control 5NH23lpOOO762{5-00and PreventionDepartment of Health and HumanSeryi@s Cente6 for Disease Control 5NH23tpO0O762{5{0and PreventionDepartment of Health and HumanSerui@s Centec for Disease Contrcl 5NH23lpOO0762-05{0and PreventionDepartment of Health and HumanSerui@s Cente6 for Disease Control NU90IP922069and PreventiohAMENDMENT #23Date: September 1 5, 2O21Federal GEnt Award NameEPIDEMIOLOGY AND LABORATORYCAPACITY FOR INFECTIf,USDISEASES (ELC)-BUILDING ANDSTRENGTHENING EPIDEMIOLOGY,eptoemoLocv a TeBoRAToRYCAPACITY FOR INFECTIOUSDISEASES (ELC)"BUILDING &STRENGTHENING EPIDEMIOLOGY,EPIDEMIOLOGY & LABORATORYCAPACITY FOR INFECTIOUSDISEASES (ELCFBUILDING &STRENGTHENING EPIDEMIOLOGY,CDC COOPERATIVE AGREEMENTFOR EMERGENCY RESPONSEIPUBLIC HEALTH CRISIS RESPONSECDC-RFA-TPl 8-1 802STATE PHYSICAL ACTIVITY ANDNUTRITION-WASHINGTON (SPANWA)Cha.t ofAccounta ProgEm TltleBARSDOHFedenlAward DateTotal AmtFedeElAwardAllocation PeriodSfart EndDate DateFFY22 VFC OPS333.93.26o7to1t2't $1,961,462 O7tO1t21 1231t21$5,600 93.268FFY2I VFC OPS333.93.26o7to1t19 $9.234,83507t01t20 06t3U21$5,600 93.268FFY21 ENHANCED INFLUENZA COVEMGE CARES 333.93.26o8l13l2l $12,548,955 O7tO1t2O 06t3\t21$5,600 93.268FFY2r COVtDr9 VACCtilE SERVTCES4ARES333.93.2601115121 $68,807,05307t01t20 1231t21$14,582 93.268FFY2O VFC OPS333.93.26o7to1t19 $9,234,83s07t01t19 06130t20$s,600 93.268FFYIT VFC OPS333.93.26o3lo3l17 $1,201,605 01/01/,18 06/30/18$1,114 93.268FFYIT INCREASING IMMUNIZATION RATES333.93.26o6t29t18 $1,722,443 07/01/18 06/30/19$5,600 93.268FFYIT AFX333.93.2603V03l/17 $1,672,28901/0t/18 06/30/18$2,226 93.268FFY1T 317 oPS333.93.26 03t03117 $575.969 Oti0t/18 06/30/18$616 93.268covlDr9 vAcctNEs333.93.26o3t3'v2't $60,234,086O7tO1t2O 12t3.U21$354,803 93.268FFYzO ELC EDE LHJ ALLOCAT'ON333.93.3201t14/21 $438,300,92801t15/21'1231t21FFY19 ELC COVID ED LHJ ALLOCATION333.93.32o1to1t21 s177,231,54601t11t21 1'/]31t21 $23?,077Contract Amt CFDA CFDA program Tiile Federal Agency Namelmmunization CooperativeAgr@mentsDepartment of Health and HumanSeryi@s Cente6 for Disease Contrcl NH23lp9226i 9and PreventionIMMUNZATION GRANT ANDVACCINES FOR CHILDREN PROGRAMlmmunization CooperativeAgreementsIMMUNIZATION GRANT ANDVACCINES FOR CHILDREN PROGRAMIMMUNIZATION GRANT ANDVACCINES FOR CHILDREN PROGRAMIMMUNIZATION GRANT ANDVACCINES FOR CHILDREN PROGRAMIMMUNIZATION GRANT ANDVACCINES FOR CHILDREN'SPROGRAMlmmunization CooperativeAgr@mentslmm!niation CoopeEtiveAgreementsDepartment of Health and HumanSeryi@s CenteF for Disease Contrct NH231p922619and PreventionIMMUNIZATION GRANT ANDVACCINES FOR CHILDREN PROGRAMlmmuniation CooperativeAgreementslmmunization CooperativeAgrementslmmunization CooperativeAgremenGDepartment of Health and HumanSeNices Centere for Disease Control NH23|PO0O762and PreventionIMMUNZATION GRANT ANDVACCINES FOR CHILDREN'SPROGRAMIMMUNIZATION GRANT ANDVACCINES FOR CHILDREN'SPROGRAMIMMUNIZATION GRANT ANDVACCINES FOR CHILDREN'SPROGRAMlmmunization coooerative Department of Health and HumanAoremenb Seryi@s Cente6 for Disease Control' and PEventioncoc-RFA-tP19-,1 901 TMMUNZATTONAND VACCINES FOR CHILDRENlmmuniation CooperativeAgrcementslmmunization CooperativeAgreementsNH23tP922619Epidemiology and Laboratory Department of Health and Human$800,968 93.323 Capacity for lnfectious Diseases Ssruices CenleF for Disease Contrcl NUsOCKOOOs 1 5(ELc) and PreventionEpidemiology and Laboratory Department ol Heafth and HumanCapacityforlnfectiousDiseses SeruiesCenteEforDiseaseControl NU5OCKOOO515(ELc) and PreventionEoidemiol@v and Lebo€totuCapacity foiinfectious 9;"""r", DePanment of Health and Human(ELc)€uitdinsand SeryicesCenteEforDiseasecontrcl NU5OCK000515strengtheningEpidemiology, andPrevention93.32393.323FFYI9 COVID CARESFFY2O COC COVID.I9 CRISIS RESP LHJ-TRIBE333.93.3204t23t20 $22,581,799 06t01t20 12t31t21$61,177333.93.3503t16t20 $13,230,799 01t20t20 1231t21 $78,s22 93.354$60,000 93.439Public Health EmergencyResponse: Coope€tiveAgreement for EmergencyRespon*: Public Health CrisisState Physi€l Activity andNutrition (SPAN)Department of Health and HumanServices (HHS) Cente6 for Disease NU58DP006504Control and Prevention (CDC)FFY21 PHYS ACTWY & NUTRITION PROG333.93.4309/30/18$923,OO0 09t30t21'ti,31t21Page 2 of 3
Exhibit G-20 Schedule of FederalAwardsKITTITAS COUNTY HEALTH DEPT$YWooIO.I75{'7CONTRACT ClH1E2$-tfttitas County public Health Depeitmentcol{TRACT pERtOD: o 1 nl m1 a-1 t!1 ns21DOHFodealTotal AmtFcdGralAmtdAlocation PeriodStart EndState Physi€l Activity andNutrition (SPAN)Matemal and Child Heahh93.9S4 ServlE Block cEntto theSiat6triabmat and Chitd H@fth$44, I 96 93.994 Swic Btock c@t to theStatstiratemal and Child H€Ih93.9Ct Sfli€s Blod( G€nt to $ESlat6Matemal and Child Heatths44.196 93.SO4Stat6ltatemal and Child H@lth93.994 Seryices Blod( GEnt to th€Stat6Departm€nt af Health and HumanSeryieAMENDMENT#23Date: Septemb€t 15, ZO21F.danl GBnt Amrd l{amrSTATE PHYSICAL ACTMTT'Y ANDNUTRTfl ON-WASHINGTON (SPANWA)STATE PHYSICAL ACTMTY ANDNUTRITION-WASHINGTON (SPANWA)STATE PHYSICAL ACTV]TY ANDNUTRITION-WASHINGTON (SPANWA)MATERNAL AND CHILD HEALTHSERVICES BLOCK GRANTMATERNAL AND CHILD HEALTHSERI/ICES BLOCK GRANTMATERNAL AND CHILD HEALTHSERVICES BLOCK GRANTMTERNAL AND CHILD HEALTHSERVICES BLOCK GMNTMATERML AND CHILD HEALTHsEF/lcEsChart of Acountr PrcgEm TlgaFFVIO PHYS TCTVTY E ilUTRlNON PROGFFYIg PI'YS ACTVTY & NUTR]TION PROGFFTTI P[N6 ACTVTY E NUTRITION PROGFFY22 ICHBG L}U CONTRACTSFFYzI XCHBG LHJ CONTRACTSFFY2O ICI{BG ]}IJ CONTRACTSFFYI' XCHBG LHJ CONTRACTSFFYI8 TCHBG I.}IJ CONTRACTSBARSDat333.93.4309/30/18$923,000 980J20 0929/21s72,346 93.439333.93.4i]o7Q4l19 $1,846,000 ost3otlg og2gt2o $60.000 93.i89ContEctArt CFDA CFDAprcgramTlfla FsdlnlAgencyNam!State Physi€l Actvity andNufition (SPAN)Oepartmentot H@lth and HumanSeryi6State Physi€l A€.tivity andNutrition (SPAN)Departrent of H€lth and HuronSeryi6NU58DP006504AsdFedrml AradNu58DP006s04NU58DPO065048'0445251B(N40169804MC32578804LrC32578BO4MC3r524Itlunhar333.93.43 09/01/18 $923,000 oz19l19 09[2920 $60.000 93.,139333-93-991U13t21 $1,555,601 1OtO1t21 't231t21 $11,04933:|.93.99 o2t@!21 $2,662,201 .tuolno ogrf,u21333.93.99 1'I14t18 $2,225,977 'toto1t1g ogl3ot2o $,t4,196333.93.9S11t14t18 92,225,9771U01/18 og3(y1eDepartnent of H@lth and HumnSeryies Heal(h RsuE andServi@s Adminisb-ationD€partrent of H€lth and HumnSeNiG Health R@ulE andS€ryi€s AdministrationOepartment of H@lth and HumnSeryi6 Heal(t Re$ur6 andSeryi6 AdministEtionDepanment of H€lltl and HuronSarui6 Healt4t R@uG andSeNi6 AdministrationDepartrngnt of H€lth and HumanSedi€s Health R6outG andSedi6 Administ-ation333.93.991u2ol17 $1,650,528 01/01/18 09/30/18 $34,040TOTAL t3,14/132Page 3 of 3
Kittitas County
Review Form
Grants & Contract Agreement
PA Camas Request #: 5 S t +
Contract/G ra nt lnformation
Recommendation for Board of H ealth Review on
verification the contracting Agency is not suspended/Disbarred:
1
Today's Date
Fund/Department
115-Public Health Agenda Date:
ctContra r ant/a nsoCo idated raContAgency Amct dmeen 23nt
Period Begin Date ouot/20t8 Period End Date: t2/3L/2O2t
Tota Grant/Contract ntAmou ncrease of 00So+g ,409.afor marevised lmX mu of 10.Ls4,434 00
Grant/Contract Number:
The Consolidate Contract Amendment 23 Amends the following Statements of Work for the followingprograms:
. Climate & Health Wildfire Smoke lndoor Air euality pilot Study _ Effective September L, ZOZO. COVID-19 Coordinated Response - Effective July L,2O2O
Contract/Grant Summary
a Fou ationd an Pub lc Hea Ith Services F PHS Effective J)202TulyL,
a o l-Promoti ofon m m un zati no s to rove Vacci atn tonmp Rates Effective Ju 2021lyI,
a s le m Nentalpup ritiout n Assistance m u-Ed cationProgra Effe VEcti rOctobe 2020I,
dsAd an tn secrea of So+g fo409.00 ar mrevised maxi mu of 0.L 00,7
Department Head Signatu Director n/n 2l
bzt
r's Office
uditor's Office Date
2
of
si
/r 2?
nda ofBoard H ealth ewRevi Command ent:Kittitas County
APPROVED AS TO FORM:
Agency is not suspended/disbarredE ! Not Checked (reason)
Grant/Contract Review Page 1
Financial lnformation
lnformation
Pass Th rough lnformation
Prosecutor Review
TotalAmount S State Funds S Federal Funds S
Percentage County Funds Matching Funds S CFDA#
ln-Kind S
ls Equipment being purchased Who owns equipment?
New Personnel bein hired?Contact HR hirin uirements
Future impacts or liability to Kittitas County:
Budget Amendment Needed?
New Division Created?
Yes [] attach budget form No n why not
Revenue Code
116.6L2.94.346.26.65 SNAP Ed 409.005
1 16. 6 12. 3 2.01. 346. 26.65 VFC Ops Ss,6oo.oo
1 16.6 12. 39. 2 3. 346. 26.65 ELC #4 70,907.00
1 16. 612. 39. 17. 346. 26.6s FPHS Seos,ooo.oo
Agency to Pass Through
Amount to Pass Through s
Sub-Contract Approved Date
Has the Prosecutor reviewed this agreement?Yes No
rtments lm cted
BOCC I Needed?
Ass ment of Tracki lnformation
Auditor Facilities Maintenance
lnformation Services Human Resource
Prosecutor Treasurer
Yes []NoE
Staff Member Presenting:
Auditor's Office
Human Resource
Prosecutor's Office F.k.o-7:l-
Who Signed the grant application
Grant/Contract Review
Page 2
Reviewer Date