HomeMy WebLinkAboutCon Con Amendment 5Kittitas County
Review Form IGlTITM flWFTT
Grants &Contract Agreement
Today's Date PA Camas Request #:6/30/2022
Fund/Department
116-Public Health Agenda Date:
Contract/Grant Information
Contract /Grant Agency:Consolidated Contract Amendment 5
Period Begin Date:January 1,2022 Period End Date:12/31/2024
Total Grant/Contract Amount:Increase of $217,313.00 for a revised maximum consideration of
$3,095,724.00
Grant/Contract Number:CLH31015
Contract/Grant Summary:
The Consolidated Contract Amendment #5 amends the following statement of work:
COVID Mass Vaccination-FEMA-Effective January 1,2022
DCHS-ELC COVID-19 Response-Effective January 1,2022
Exhibit B-5 Allocations,attached and incorporated by this reference,amends and replaces Exhibit B-4
Allocations as follows:
Increase of $217,313.00 for a revised maximum consideration of $3,095,724.00
Recommendation for Board of Health Review on
Department Head Signature:,Director Date:
Kittitas County Prosecutor,Auditor,and Board of Health Review and Comment:
APPROVED AS TO FORM:
Signature of Prosecutor's Office Date
Signature of Auditor's Office Date
Verification the contracting Agency is not Suspended/Disbarred:
Agency is not suspended/disbarred [¯¯]Not Checked (reason)
Grant/Contract Review Page 1
Financial Information
Total Amount State Funds $Federal Funds $217,313.00
Percentage County Funds Matching Funds $CFDA#21.027
In-Kind $
Explain
Is Equipment being purchased?Who owns equipment?
New Personnel being hired?Contact HR hiring-reportingrequirements
Future impacts or liability to Kittitas County:
Budget Information
Budget Amendment Needed?Yes [X]attach budget form No why not
New Division Created?
Revenue Code 116.61239273332102
Expense Code 116.6123927 (51001/52001/50098/54101)
Pass Through Information
Agency to Pass Through
Amount to Pass Through Expense Code:
Sub-Contract Approved Date:
Prosecutor Review
Has the Prosecutor reviewed this agreement?Yes No O
County Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
BOCC Approval Needed?
Yes [Xj No O
Staff Member Presenting:Chelsey Loeffers
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Reviewer Date
Grant/Contract Review Page 2
KITTITAS COUNTY PUBLIC HEALTHDEPARTMENT
2022-2024 CONSOLIDATED CONTRACT
CONTRACT NUMBER:CLH31015 AMENDMENT NUMBER:5
PURPOSE OF CHANGE:To amend this contract between the DEPARTMENT OF HEALTH hereinafterreferredto as
"DOH",and KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT,a Local Health Jurisdiction,hereinafterreferred
to as "LHJ",pursuant to the Modifications/Waivers clause,and to make necessary changes within the scope of this
contract and any subsequent amendments thereto.
IT IS MUTUALLY AGREED:That the contract is hereby amended as follows:
1.Exhibit A Statements of Work,includes the following statements of work,which are incorporatedby this reference
and located on the DOH Finance SharePoint site in the Upload Center at the following URL:
https://stateofwa.sharepoint.com/sites/doh-ofsfundineresources/sitepages/home.aspx?=el;9a94688da2d94d3eaS0ac7fbc32e4d7c
Adds Statements of Work for the following programs:
Amends Statements of Work for the following programs:
COVID-19 Mass Vaccination-FEMA -Effective January 1,2022
DCHS-ELC COVID-19 Response -Effective January 1,2022
Deletes Statements of Work for the following programs:
2.Exhibit B-5 Allocations,attached and incorporated by this reference,amends and replaces Exhibit B-4 Allocations as
follows:
Increase of $217,313 for a revised maximum consideration of $3,095,724.
Decrease of for a revised maximum consideration of
No change in the maximum consideration of
Exhibit B Allocations are attached only for informational purposes.
Unless designated otherwise herein,the effective date of this amendment is the date of execution.
ALL OTHER TERMS AND CONDITIONS of the original contract and any subsequent amendments remain in full force
and effect.
IN WITNESS WHEREOF,the undersigned has affixed his/her signature in execution thereof.
KITTITAS COUNTY PUBLIC HEALTH STATE OF WASHINGTON
DEPARTMENT DEPARTMENT OF HEALTH
Signature:Signature:
Date:Date:
APPROVED AS TO FORM ONLY
Assistant Attorney General
Page 1 of 1
EXHIBITB-5KittitasCountyPublicHealthDepartmentALLOCATIONSContractNumber:CLH31015ContractTerm:2022-2024Date:June1,2022IndirectRateJanuary1,2022throughDecember31,2022:21%PublicHealthDept&15%CountyCentralSvcsDOHUseOnlyBARSStatementofWorkChartofAccountsFundingChartofFederalAwardAssistRevenueLHJFundingPeriodFundingPeriodPeriodAccountsChartofAccountsProgramTitleIdentification#Amend#List#*Code**StartDateEndDateStartDateEndDateAmountSubTotalTagg¡FFY22lARSNAPEdProgMgnt-Region9907WAWA5Q3903Amd410561333.105601/0I/2209/30/2210/0I/2109/30/22$12,090$42,908542,908FFY22IARSNAPEdProgMgnt-Region9907WAWASQ3903Amd110.56I333.105601/01/2209/30/2210/01/2109/30/22530,818CSFRFCTSLHJAllocationNGANotReceivedAmd521.027333.21.0201/01/2212/31/2201/01/2212/31/22$217,3135217,313$217,313FFY21PHEPBP3LHJFundingNU90TP922043Amd293069333.930601/01/2206/30/2207/01/2\06/30/22$29,492529,492$29,492FFY22CDCEHCEHRSupplementalNGANotReceivedAmdl93070333.93.0701/01/2208/31/2209/01/2008/31/22$83,000$83,000583,000FFY20EnvirHealthCapacity-C(CDC)NCENUElEH001445Amd293.070333.930701/01/2208/31/2209/01/2008/31/22$14,719$35,719535.719FFY20EnvirHealthCapacity-C(CDC)NCENUElEH001445Amdl93070333.930701/01/2208/31/2209/01/2008/3L/22$21,000COVID19VaccinesNH23lP922619Amd493268333.93.2601/01/2206/30/2407/01/2006/30/24$225,1255225,1255225,125COVID19VaccinesR4NH23IP922619Amdl93268333.932601/01/2206/30/2407/01/2006/30/24$359,803$359,803$359,803FFY22VFCOpsNH23IP922619Amd393.268333.93.2601/01/2206/30/2207/01/2106/30/22$4,980$4,980$4,980FFYl9COVIDCARESNU50CKOOO515Amd293.323333.93.3201/01/2204/22/2204/23/2007/31/24$l74$174$174FFYl9ELCCOVIDEdLHJAllocationNUSOCK000515Amd493.323333933201/01/2210/18/2205/19/2010/18/22($8,897)$5,691$5,691FFYl9ELCCOVIDEdLHJAllocationNUSOCKOOO515Amd293.32333393.3201/0\/2210/18/2205/19/2010/18/22$14,588FFY20ELCEDELHJAllocationNU50CKOOO515Amd293.323333.933201/01/2212/31/2201/15/2107/31/24$754,494$754,494$754,494FFY21PhysActvty&NutritionProgNUS8DPOO6504Amd493.43933393.4301/01/2209/29/2209/30/2109/29/22$19,470553,470$53,470FFY21PhysActvty&NutritionProgNUS8DPOO6504Amd193.439333.93.4301/01/2209/29/2209/30/2I09/29/22$34,000FFY22MCHBGLHJContractsBO44525lAmd493994333.939901/01/2209/30/2210/01/2109/30/22$2,131$35,278$35,278FFY22MCHBGLHJContractsBO445251AmdI93.994333.939901/01/2209/30/2210/01/2109/30/22533,147GFS-GroupB(FO-E)Amd1N/A334.049001/01/2206/30/2207/0\/2106/30/22$25,877525,877$25,877FPHS-LHJ-Proviso(YR2)AmdlN/A336.04.2507/01/2206/30/2307/01/2106/30/23$605,000$605,00051,210,000FPHS-LHJ-Proviso(YRl)AmdlN/A33604.2501/01/2206/30/2207/0l/2106/30/23$605,000$605,000YR24SRF-LocalAsst(15%)(FO-E)SSAmd4N/A346.26.6401/01/2212/31/2207/01/2106/30/23$1,600$5,200$5,200YR24SRF-LocalAsst(15%)(FO-E)SSAmd1N/A346.26.6401/01/2212/31/2207/01/2106/30/2353,600Pagelof2
EXHIBITB-5KittitasCountyPublicHealthDepartmentALLOCATIONSContractNumber:CLH31015ContractTerm:2022-2024Date:Junel,2022IndirectRateJanuary1,2022throughDecember31,2022:21%PublicHealthDept&15%CountyCentralSvcsDOHUseOnlyBARSStatementofWorkChartofAccountsFundingChartofFederalAwardAssistRevenueLHJFundingPeriodFundingPeriodPeriodAccountsChartofAccountsProgramTitleIdentification#Amend#List#*Code**StartDateEndDateStartDateEndDateAmountSubTotalTotalSanitarySurveyFees(FO-E)SS-StateAmd4N/A346.26.6501/01/2212/31/2207/01/2I06/30/23$1,60055,20055,200SanitarySurveyFees(FO-E)SS-StateAmd1N/A34626.6501/01/2212/31/2207/01/2106/30/23$3,600YR24SRF-LocalAsst(15%)(FO-E)TAAmd4N/A346.26.6501/01/2212/31/2207/0l/2106/30/23$1,00052,000$2,000YR24SRF-LocalAsst(15%)(FO-E)TAAmd1N/A34626.6501/01/2212/31/2207/0I/2106/30/23$1,000TOTAL$3,095,724$3,095,724Totalconsideration:$2,878,411GRANDTOTAL$3,095,724$217,313GRANDTOTAL$3,095,724TotalFed$1,847,447TotalState$1,248,277*CatalogofFederalDomesticAssistance**Federalrevenuecodesbeginwith"333"Staterevenuecodesbeginwith"334".Page2of2
KITTITAS COUNTY PUBLIC HEALTHDEPARTMENT
2022-2024 CONSOLIDATED CONTRACT
CONTRACT NUMBER:CLH31015 AMENDMENT NUMBER:5
PURPOSE OF CHANGE:To amend this contract between the DEPARTMENT OF HEALTH hereinafterreferred to as
"DOH",and KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT,a Local Health Jurisdiction,hereinafterreferred
to as "LHJ",pursuant to the Modifications/Waivers clause,and to make necessary changes within the scope of this
contract and any subsequent amendments thereto.
IT IS MUTUALLY AGREED:That the contract is hereby amended as follows:
L Exhibit A Statements of Work,includes the following statements of work,which are incorporatedby this reference
and located on the DOH Finance SharePoint site in the Upload Center at the following URL:
https://stateofwa.sharepoint.com/sites/doh-ofshmdingresources/sitepaaes/home.aspx?=el:9a94688da2d94d3ea80ac7fbc32e4d7e
O Adds Statements of Work for the following programs:
Amends Statements of Work for the following programs:
COVID-19 Mass Vaccination-FEMA -Effective January 1,2022
DCHS-ELC COVID-19 Response -Effective January 1,2022
Deletes Statements of Work for the following programs:
2.Exhibit B-5 Allocations,attached and incorporatedby this reference,amends and replaces Exhibit B-4 Allocations as
follows:
Increase of $217,313 for a revised maximum consideration of $3.,095.,724.
O Decrease of for a revised maximum consideration of
O No change in the maximum consideration of
Exhibit B Allocations are attached only for informational purposes.
Unless designated otherwise herein,the effective date of this amendment is the date of execution.
ALL OTHER TERMS AND CONDITIONS of the original contract and any subsequent amendments remain in full force
and effect.
IN WITNESS WHEREOF,the undersigned has affixed his/her signature in execution thereof.
KITTITAS COUNTY PUBLIC HEALTH STATE OF WASHINGTON
DEPARTMENT DEPARTMENT OF HEALTH
Signature:Signature:
Date:Date:
APPROVED AS TO FORM ONLY
Assistant Attorney General
Page 1 of 1
EXHIBITB-5KittitasCountyPublicHealthDepartmentALLOCATIONSContractNumber:CLH31015ContractTerm:2022-2024Date:June1,2022IndirectRateJanuary1,2022throughDecember31,2022:21%PublicHealthDept&15%CountyCentralSvcsDOHUseOnlyBARSStatementofWorkChartofAccountsFundingChartofFederalAwardAssistRevenueLHJFundingPeriodFundingPeriodPeriodAccountsChartofAccountsProgramTitle[dentification#Amend#List#*Code**StartDateEndDateStartDateEndDateAmountSubTotalTotalFFY22lARSNAPEdProgMgnt-Region]907WAWA5Q3903Amd410.561333105601/01/2209/30/2210/01/2109/30/22$12,090$42,908542,908FFY22lARSNAPEdProgMgnt-Region7907WAWASQ3903Amd110.561333.105601/01/2209/30/2210/0\/2109/30/22$30,8I8CSFRFCTSLHJAllocationNGANotReceivedAmd521.027333.21.0201/01/2212/31/2201/01/2212/31/22$217,313$217,313$217,313FFY21PHEPBP3LHJFundingNU90TP922043Amd293069333.930601/01/2206/30/2207/01/2\06/30/22$29,492$29,492$29,492FFY22CDCEHCEHRSupplementalNGANotReceivedAmd193.07033393070I/01/2208/3L/2209/01/2008/3\/22$83,000$83,000$83,000FFY20EnvirHealthCapacity-C(CDC)NCENUElEHO0l445Amd29307033393.0701/01/2208/31/2209/0\/2008/31/22514,719$35,719$35,719FFY20EnvirHealthCapacity-C(CDC)NCENUElEHOOl445Amdl93070333.930701/01/2208/31/2209/0\/2008/3\/22521,000COVIDi9VaccinesNH23lP922619Amd49326833393.2601/01/2206/30/2407/01/2006/30/24$225,125$225,125$225,125COVlDl9VaccinesR4NH231P922619Amd193268333.93.2601/01/2206/30/2407/0L/2006/30/24$359,803$359,803$359,803FFY22VFCOpsNH23IP922619Amd393.268333.932601/01/2206/30/2207/01/2I06/30/22$4,98054,980$4,980FFYl9COVIDCARESNU50CKOOO5l5Amd293.323333.933201/01/2204/22/2204/23/2007/31/245174$174$174FFYl9ELCCOVIDEdLHJAllocationNUSOCKOOO515Amd493.323333.93.3201/01/2210/l8/2205/19/2010/18/22($8,897)$5,691$5,691FFYl9ELCCOVlDEdLHJAllocationNU50CKOOOS15Amd293.323333933201/01/2210/L8/2205/19/2010/18/22$14,588FFY20ELCEDELHJAllocationNU50CK000515Amd293.323333.9332OL/01/2212/31/2201/15/2107/31/245754,4945754,494$754,494FFY21PhysActvty&NutritionProgNUS8DPOO6504Amd493439333.934301/01/2209/29/2209/30/2I09/29/22$19,470553,470$53,470FFY2LPl1ysActvty&NutritionProgNU58DPOO6504Amd19343933393.4301/01/2209/29/2209/30/2109/29/22$34,000FFY22MCHBGLHJContractsB044525]Amd493.994333939901/01/2209/30/2210/01/2109/30/22$2,131535,278$35,278FFY22MCHBGLHJContractsB0445251AmdI93994333.939901/01/2209/30/2210/01/2109/30/22$33,147GFS-GroupB(FO-E)Amd1N/A334.04.9001/01/2206/30/2207/0\/2106/30/22$25,877$25,877$25,877FPHS-LHJ-Proviso(YR2)AmdlN/A336.04.2507/01/2206/30/2307/01/2106/30/23$605,000$605,000$1,210,000FPHS-LHJ-Proviso(YRl)Amd1N/A33604.2501/01/2206/30/2207/01/2106/30/23$605,0005605,000YR24SRF-LocalAsst(15%)(FO-E)SSAmd4N/A346.26.6401/01/2212/31/2207/01/2106/30/23$1,60055,200$5,200YR24SRF-LocalAsst(1S%)(FO-E)SSAmd1N/A34626.6401/01/2212/31/2207/0\/2I06/30/23$3,600Pagelof2
EXHIBITB-5KittitasCountyPublicHealthDepartmentALLOCATIONSContractNumber:CLH31015ContractTerm:2022-2024Date:June1,2022IndirectRateJanuary1,2022throughDecember31,2022:21%PublicHealthDept&15%CountyCentralSvesDOHUseOnlyBARSStatementofWorkChartofAccountsFundingChartofFederalAwardAssistRevenueLHJFundingPeriodFundingPeriodPeriodAccountsChartofAccountsProgramTitleIdentification#Amend#List#*Code**StartDateEndDateStartDateEndDateAmountSubTotalTotalSanitarySurveyFees(FO-E)SS-StateAmd4N/A346.26.6501/01/2212/31/2207/01/2106/30/23$L,600$5,200$5,200SanitarySurveyFees(FO-E)SS-StateAmd]N/A346.266501/01/2212/31/2207/01/2106/30/2353,600YR24SRF-LocalAsst(15%)(FO-E)TAAmd4N/A346.26.6501/01/2212/31/2207/0\/2L06/30/2351,000$2,00052,000YR24SRF-LocalAsst(15%)(FO-E)TAAmdlN/A346.266501/01/2212/31/2207/01/2I06/30/23$1,000TOTAL$3,095,724$3,095,724Totalconsideration:$2,878,411GRANDTOTAL$3,095,724$217,313GRANDTOTAL$3,095,724TotalFed$1,847,447TotalState$1,248,277*CatalogofFederalDomesticAssistance**Federalrevenuecodesbeginwith"333"Staterevenuecodesbeginwith"334"Page2of2