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Home My WebLink AboutContract AmendmentKittitas County Review Form Grants & Contract Agreement Contract/G ra nt I nformation Recommendation for Board of Health Review on Department Head Signature Director Date tltslzz Verification the Contracting Agency is not Suspended/Disbarred: Agency is not suspended/disbarred ! Not Checked (reason) Today's Date 6/30/2022 PA Camas Request #{7?r'- Fund/Department 116-Public Health Agenda Date: Contract /Grant Agency: Consolidated Contract Amendment 5 Period Begin Date: January 1,,2022 /Period End Date: L2/31"/2024 Total Grant/Contract Amount: lncrease of 52L7,313.00 for a revised maximum consideration of / 53,ogs,724.oo Grant/Contract Number: CLH310L5 Contract/Grant Su mmary: 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 bythis reference, amends and replaces Exhibit B-4 Allocations as follows: lncrease of 5217,313.00 for a revised maximum consideration of 53,095,724.00 Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: APPROVED AS TO FORM: Signature of Au ce (" 7 r'Da vk ft^I 1-L- utor's OfficePsroceSignatu Date z$+'| Grant/Contract Review Page 1 Financial lnformation Bud lnformation Pass Throu lnformation Prosecutor Review TotalAmount State Funds 5 Federal Funds Sztz,3tg.oo Percentage County Funds Matching Funds S CFDA# 2L.027 ln-Kind S Explain ls Equipment being purchased?Who owns equipment? New Personnel being hired?Contact HR hiring - reporting requirements Future impacts or liability to Kittitas County: Budget Amendment Needed? New Division Created? Yes [] attach budget form No f] why not Revenue Code 1.16.6L239273332102 Expense Code 1L6.6123927 (s LOO]/ s200 1/s 00s 8 / s 4l1rl Agency to Pass Through Amount to Pass Through Expense Code: DateSub-Contract Approved Has the Prosecutor reviewed this agreement?Yes No County Departments lmpacted BOCC A I Needed? Ass ment of Trackin lnformation Auditor Facilities Maintenance lnformation Services Fluman Resource Prosecutor Treasurer NonYes I Staff Member Presenting: Chelsey Loeffers Auditor's Office Human Resource Prosecutor's Office ."?L( ?+ F*t ,R* \^t"- Sr Who Signed the grant application \U Reviewer Date Grant/Contract Review Page 2 KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT 2022.2024 CONSOLIDATED CONTRACT CONTRACT NUMBER: CLH310I5 AMENDMENT NUMBER: 5 PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as "DOH", and KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT, a Local Health Jurisdiction, hereinafter refered to as "LHJ", pursuant to the ModificationsMaivers clause, and to make necessary changes within the scope of this contract and any subsequent ameudments thereto. IT lS MUTUALLY AGREED: That the contract is hereby amended as follows: Exhibit A Statements of Work, includes the following statements of work, which are incorporated by this reference and located on the DOH Finance SharePoint site in the Upload Center at the following URL: https://stateofwa.sharepoint.com/sites/doh-ofsfundingresources/sitepases/home.aspx?:e I :9a94688da2d94d3ea80ac7{bc32e4d7c I Adds Statements of Work for the following progralns: 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: X Increase of $217.313 for a revised maximum consideration of $3.095.724. n Decrease of - for a revised maximum consideration of -.l-l No change in the maximum consideration of -. .-- Exhibit B Allocations are attached only for inforrnational purposes. Unless designated otherwise herein, the effective date of this atnendment is the date of execution. ALL OTHER TERMS AND CONDITIONS of the original contract and any subsequent atnendments remain in full force and effect. IN WITNESS WHEREOF, the undersigned has affixed his/her signature in execution thereof. APPROVED AS TO FORM ONLY Assistant Attorney General X n KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT STATE OF WASHINGTON DEPARTMENT OF HEALTH Signature: Chelreq /tegetr chdsryLo€f6lAuR5,16x 16 l3 Porl Signature 2.*)".sqnlw. Br.ndr Heniik3D. lAug3, 20210723 PDIl Date: Aug5,2022 Date: AugB,2022 Page I of I EXHIBIT B-5Kittitas County Public Health Department ALLOCATIONSContract Term: 2022-2024Indirect Rate January l, 2022 through December 31, 2022:2loh Public Heatth Dept & 157o County Central Svcs333. l 0.56333.10.56333.2r.02333.93.06333.93.07333.93.07333.93.07333.93.26333.93.26333.93.26333.93.32333.93.32333.93.32333.93.32333.93.43333.93.43333.93.99333.93.99334.04.90336.04.2s336.04.2s346.26.64346.26.64$ r2,090$30,8 l 8$2 l 7,3 13q)q ag)$83,000gt4,7 t9$2 I,000q??5 t?{$35 9,803$4,980st7 4($8,897)$ 14,588$7s4,494$19,470$34,000s2,1 3 1s33, l 47925,877$605,000$605,000$ r,600$3,600Contract Number:Date:FundingPeriodSubTotal$42,908$2r7J13529,492s83,000$35,7 I 9$225,t25$359,803s4,98 0$17 4$s,69 ls'7 54,494s53,470$35,278$2s,877$60s,000$605,000ss,200cLH3r0lsJune 1,2022Chart ofAccountsTotal$42,908$2 l 7,3 13s29,492$83,000s35,7 I 9s225,t25s359,803$4,980$ 174$5,69 Is754,494$53,470$3s,278$25,877$ I,2 r 0,000$5,200Amend #-4.ssistList #*DOH Use OnlyBARS Statement of Work Chart of AccountsRevenue LHJ Funding Period Funding PeriodCode** Start Date End Date Start Date End DateAmountChart of Accounts Proeram TitleFFY22 tAR SNAP Ed Prog Mgnt-Region 2FFY22 IAR SNAP Ed Plog MgnrRegion 2CSFR-F CTS LHJ AllocationFFY2I PHEP BP3 LHJ FundingFFY22 CDC EHC EHR SupplementalFFY20 Envir Hcalrh Capacity{ (CDC) NCEFFY20 Envir Hcalth Capacity-C (CDC) NCECOVIDI9 VaccinesCOVIDl9 Vaccines R4FFY22 VFC OpsFFYI9 COVID CARESFFYI9 ELC COVID Ed LHJ AllocationFFYI9 ELC COVID Ed LHJ AllocationFFY20 ELC EDE LHJ AllocationFFY2I Phys Actvty & Nutrition ProgFFY2I Phys Acwry & Nutrition ProgFFY22 MCHBG LHJ ContractsFFY22 MCHBG LHJ ContractsCFS-Group B (FO-E)FPHS-LHJ-Proviso (YR2)FPHS-LHJ-Proviso (YR1)YR24 SRF - Local Asst (15%) (FO-E) SSYR24 SRF - Local Asst (15%) (FO-E) SSFederal ArvardIdentitication #207WAWA5Q3903207WAWA5Q3903NGA Not ReceivedNU90TP922043NGA Not ReceivedNUE IEHOOI445NUE IEHOO I445NH23IP9226 I 9NH23IP9226 I 9NH23tP9226 I 9NUsOCKOO05 L5N U50CK0005 r sNU50CK000s r 5NU50CK0005 I 5NU5ttDP006504NU58DP00650480445251B044525 IAmd 4Amd IAmd 5Amd 2Amd IAmd 2Amd IAmd 4Amd IAmd 3Amd 2Amd 4Amd 2Arnd 2Arnd 4Amd IAmd 4Amd IAmd IAmd IAmd IAmd 4Amd I10.56 r10.56 I2t.02793.06993.07093.07093.07093.76893.26893.26893.32393.32393.32393.32393.43993.43993.99493.994N/AN/AN/AN/AN/A0v0y220tl0v220u0t!220|01t220t/0u22alt0l/220'110l/2201/0U22ar/0t/22011011220t/0v220v0v2201/0|220t/0u2201t01t220t/at/220t/0v220U0lt2201t0v2207/01/220lt0v220t/0v220U0t/220913012209130122t2t3u22061302208t31/ZZ08/3y22a8/311220613012406t30/2406t30t2204t22t22t0il8t22t0n8t22r2/3v22091291220917917209/30t2209/30/2206/30/2206/30t2306/30t22rzt3v22t2t3t/22t0t0tl2t10/0vzt0y0lt220'7/0v2109/0t2409t0t/2009/0t/2a07/0v2007t0t/200'7t0t/2104t23t2005t19/2005^9/200t/t5/21a9/3012ta9t30t2t1Al01t2ttot0U2107/0v2107101/2t07/0t/2107/aInl07t0t/2109t30t?2$9130i22tzt3u2206/30t2208/3v2208t3v220813v2206130t2406/30t2406/30t2207/3U24I0/t8122tot tgt2207t31t2409/29t220912912209130t2209t30t2206/3012206/30t2306t30t2306/30t2306t30t23Pagc I ol2 EXHIBIT B-5Kittitas County Public Health Department ALLOCATIONSContract Term: 2022:2024Indirect Rate January l, 2022 through December 31, 2022:2lo/o Public Health Dept & 157. County Central Svcs346.26.65 0lltJlt22346.76.6s 0U0V22t2/3|22 07l0v2lL7/3U22 07/0U21Contract Number:Date:FundingPeriodSubTotal$5,200cLH3r0lsJune l, 2022Chart ofAccountsTotal$5,200$2,000$3,095,724s1,847,447sl,248,277Federal AwardIdentilication #DOH Use OnlyBARS Statement of Work Chart of AccountsRevenue LHJ Funding Period Funding PeriodCode** Start Date End Date Start Date End DateAmountChart of Accounts Proqram TitleSanitary Survey Fees (FO-E) SS-StateSanitary Suruey Fees (FO-E) SS-StateYR24 SRF - Local Asst ( I 5%) (FO-E) TAYR24 SRF - Local Asst ( I 5%) (FO-E) TATOTALTotal consideration:GRAND TOTAL.{ssistList #*Amend #Amd 4Amd IAmd 4Amd IN/AN/A06/30t2306/30123$ l,600$3,600$ 1,000$ l,000NiANiA346.26.65 0t/At/22346.26.6s 0v0v22l7l3v22t)/31/2207/0v2ta7/0U2106/30123a6/30t23$2,000s3,095,724 83,095,724GRAND TOTALTotal FedTotal State$2,878,41 l$217,313$3,095,724*Catalog of Federal Domestic Assistance*tFederal revenue codes begin with "333". State revenue codes begin with "334"Pagc 2 of 2 Created: By: Status: Transaction lD: 2022-06-30 Brenda Henrikson (Brenda.Henrikson@DOH.WA.GOV) Signed CBJCHBCAABAA0HSPIjTQ4h la-I40XYGEScffrlgdjRV6 CLH31015 Kittitas Amend #5 FinalAudit Report 2022-O8-08 "CLH31015 Kittitas Amend #5" History fr Docur"nt created by Brenda Henrikson (Brenda.Henrikson@DOH.WA.GOV) 2022-06-30 - 8:25:16 PM GMT- lP address: 192.230.13.106 4 Document emailed to candi. blackford@co. kittitas.wa.us for signature 2022-06-30 - 8:26:05 PM GMT fi Email viewed by candi.blackford@co.kittitas.wa.us 2022-06-30 - 8'27'.07 PM GMT- lP address: 66.243.254.18 fl Emait viewed by candi.blackford@co.kittitas.wa.us 2022-08-05 - 4:18:28 PM GMT- lP address: 66.243.254.18 /s Signer candi.blackford@co.kittitas.wa.us entered name at signing as Chelsey Loeffers 2022-08-05 - 11:18:43 PM GMT- lP address: 66.243.254.18 ds Document e-signed by Chelsey Loeffers (candi.blackford@co.kittitas.wa.us) Signature Date:2022-O8-05 - 1'1 :18:44 PM GMT - Time Source: server- lP address: 66.243.254.18 B Document emailed to Brenda Henrikson (Brenda.Henrikson@DOH.WA.GOV) for signature 2O22-08-OS - 11:18:46 PM GMT *s Document e-sig ned by Brenda Henrikson (Brenda. Henrikson@DOH.WA.GOV) Signature Date:2022-08-08 - 2:23:21 PM GMT - Time Source: server- lP address: 75.172.118.98 g Agreement completed. 2O22-O8-O8 - 2:23:21 PM GMT ffnffiiffi I Porr'€red by Adobc Acrobat Sign