HomeMy WebLinkAboutDOH Interagency Agreement Amendment 1 (GLV26649)Kittitas County
Review Form
Grants &Contract Agreement
Today's Date PA Camas Request #:9/20/2022
Fund/Department Agenda Date:116-Public Health
Contract/Grant Information
Contract /Grant Agency:DOH Interagency Agreement Contract Amendment 1 (GVL26649-Health
Equity)
Period Begin Date:March 15,2021 Period End Date:December 31,2023
Total Grant/Contract Amount:Not to Exceed $300,000.000
Grant/Contract Number:
Contract/GrantSummary:
The purpose of the no-cost amendment to the DOH Interagency Agreement is to extend the period of
performance from May 31,2023,to December 31,2023.The statement of work remains the same as in
the original contract and is attached and no increases or decreases in contractual consideration.
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:
O Agency is not suspended/disbarred Not Checked (reason)
Grant/Contract Review Page 1
Financial Information
Total Amount $300,000.000 State Funds $Federal Funds $300,000.000
Percentage County Funds Matching Funds $CFDA#
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 O attach budget form No why not
New Division Created?No cost amendment
Revenue Code 116.612.26.333.93.391
Expense Code
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
County Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
BOCC Approval Needed?
Yes No
Staff Member Presenting:
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Reviewer Date
Grant/Contract Review Page 2
CONTRACT AMENDMENTHealth
1.NAME OF CONTRACTOR 2.CONTRACT NUMBER
Kittitas County Public Health Department GVL26649
la.ADDRESS OF CONTRACTOR (STREET)2a.AMENDMENT NUMBER
507 N Nanum St Ste 102 1
l b.CITY,STATE,ZIP CODE Unique Entity Identifier:
Ellensburg,WA 98926 WQ23XPBSAU44
3.THIS ITEM APPLIES ONLY TO BILATERAL AMENDMENTS.
The Contract identified herein,including any previous amendments thereto,is hereby amended as
set forth in Item 5 below by mutual consent of all parties hereto.
4.THIS ITEM APPLIES ONLY TO UNILATERAL AMENDMENTS.
The Contract identified herein,including any previous amendments thereto,is hereby unilaterally
amended as set forth in Item 5 below pursuant to that changes and modifications clause as
contained therein.
5.DESCRIPTION OF AMENDMENT:The purpose of this no-cost amendment is to extend the
Period of Performance from May 31,2023 to December 31,2023;to continue the work laid out in
the Original Contract.All other Terms and Conditions remain the same and in full effect.
Sa.Statement of Work:Exhibit A is revised in accordance with Exhibit A-1,attached hereto and
incorporatedherein.
5b.Consideration:This amendment neither increases nor decreases the Contract Consideration;
therefore,the maximum consideration of this contract and all amendments shall remain the same
and not exceed $300,000.00.
Contractor agrees to comply with applicable rules and regulations associated with these funds.
Sc.Period of Performance:is extended through December 31,2023.
5d.The Effective Date of this Amendment:is the Date of Execution.
6.All other terms and conditions of the original contract and any subsequent amendments thereto
remain in full force and effect.
7.This is a unilateral amendment.Signature of contractor is not required below.
Contractor hereby acknowledges and accepts the terms and conditions of this amendment.
Signature is required below
8.CONTRACTOR SIGNATURE (also,please print/type your name)DATE
9.DOH CONTRACTING OFFICER SIGNATURE DATE
This document has been approved as to form only by the Assistant Attorney General.
DOH Amendment GVL26649-1 Page 1 of 4
Revision 04/2020
EXHIBIT A-1,DOH CONTRACT GVL26649-1
Sub-recipient Statement of Work
KITTITAS COUNTY PUBLIC HEALTHDEPARTMENT
Period of Performance for this Amendment:
Date of Execution through December 31,2023
Purpose ofthis no-cost Amendment:To extend the Period of Performance from May 31,2023 to
December 31,2023.All other Terms and Conditions remain the same and in full effect.
Purpose statement:To lead and coordinate efforts to reduce Covid-19 related health disparities at the
community level as described in Centers for Disease Control and Prevention(CDC)Grant National
Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved,
Including Racial and Ethnic Minority Populations and Rural Communities (CDC-RFA-OT21-2103).
ImplementationLeads will advance health equity in their communities and collaboratively work to
reduce Covid-19 related health disparities,improve and increase testing and contract tracing for rural
populations,and improve local capacity and services to prevent and control Covid-19 infection and
transmission among populations who are rural and underserved.Work will focus in Kittitas County.
See Exhibit C for further detail.
Project Period:3/15/2021 -12/31/2023
Budget:$300,000
Task Task/Activity Deliverable/Outcome Due Date
l Form and facilitate a local Rural Equity Documentationof formed Within 90 days
Advisory Team (REAT)to inform project advisory team,such as after date of
implementation and identify strategies that meeting schedule and execution
align with the CDC grant expectations.minutes,shared with DOH
Advisory team will use data sources program manager.
including,but not limited to:
•Local population demographics Documentationof local data
•Covid-19 indicator data and social used to guide selections of
vulnerability index strategies shared with DOH
•Stakeholder input program manager.
Recommendations from
advisory team shared with
DOH program manager.
2 Upon selection of strategies a workplan and 5/31/2023
budget will be developed.
•Workplan to include objectives,Workplan document
strategies,persons responsible and
target dates
•DOH Program Manager will provide Completed budget template
a budget template.
3 Subrecipients will identify,award,and Duration of
manage subcontractors or subrecipients as project
needed to implement project activities in Subcontracts in place and
alignment with grant expectations.managed in accordance with
•Subcontracts should include key federal guidelines.
partnerships with organizations who
have existing community or social Copies of subcontracts shared
service delivery programs for with DOH program manager.
DOH Amendment GVL26649-1 Page 2 of 4
Revision 04/2020
EXHIBIT A-1,DOH CONTRACT GVL26649-1
Sub-recipient Statement of Work
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
Period of Performance for this Amendment:
Date of Execution through December 31,2023
underserved populations
disproportionately impacted by
Covid-19 and health disparities
5 Progress and Performance Reporting:Progress and Performance Quarterly
Subrecipient will submit a quarterly progress reports are submitted in
report using a template provided by DOH accordance with CDC grant
manager.requirements
6 Develop a plan for sustainability·12/31/2023
Sustainability plan includes but is not Sustainability Plan in place
limited to:and shared DOH program
•Covid-19 community recovery manager
strategies
•Emergency preparedness planning
Special Requirements:
This is a federally funded contract.All expenditures incurred and reimbursements made for performanceunder this
contract shall be based on actual,allowable,and allocable costs.See Exhibit C for further detail.
For activities that require the purchase of equipment:For purchases of pieces of equipment in which the aggregate
unit price of the equipment (including shipping,handling and associated costs)is $5,000 or more,the contractor shall
obtain written prior approval from the Washington State Department of Health,and adhere to all federal requirements
as referencedin;
2 CFR 200.313,Equipment at:https://www.epo.gov/fdsys/granule/CFR-2014-title2-vol l/CFR-20 14-
title2-voll-sec200-313 ,and
2 CFR 200.439,Equipment and other Capital Expenditures at:
https://www.epo.gov/fdsys/granule/CFR-2014-title2-voll/CFR-2014-title2-voll-sec200-439
Invoicing must include backup documentation as described in the statement of work deliverables:
Billings/invoices shall include copies of backup documentation for all expenses.Backup documentation can include,
but is not limited to;receipts,invoices,billing records,work orders,positive time,and attendance records (timesheets),
travel vouchers and accounting expense reports.
•Additional backup documentation may be requested if needed.
Signed A-19 invoices must be receivedprior to approvaland payment.A scanned copy of your A-19 with signature is
acceptable.Please email the signed A-19s and backup documentation to:
Washington State Departmentof Health
ATTN:Eileen Kazura
Community Health Systems
PO Box 47850
Olympia,WA 98504-7850
Eileen.kazura@doh.wa.cov
DOH Amendment GVL26649-1 Page 3 of 4
Revision 04/2020
EXHIBITA-1,DOHCONTRACTGVL26649-1Sub-recipientStatementofWorkKITTITASCOUNTYPUBLICHEALTHDEPARTMENTPeriodofPerformanceforthisAmendment:DateofExecutionthroughDecember31,2023Thistableincludesonlyactivefundingsources.FederalGrantInformationSheetSubrecipient/Contractor:KittitasCountyHealthDeptDOHContractManager:ApprovedIndirectRate:YesUNoOContractNo.26649EileenKazuraUEINo.WQ23XPBSAU44ContactInformation:LimitingIndirectCostRate?YesONoElPeriodofPerformance:StartDate:EndDate:dohcon.mgmtdoh.wa.govResearchandDevelopment?YesONoEl3/15/202112/31/2023ProjectDescription:NationalInitiativetoAddressCOVID-19HealthDisparitiesAmongPopulationsatHigh-RiskandUnderserved,IncludingRacialandEthnicMinorityPopulationsandRuralCommunities.TotalAmountAmountofFederalTotalAmountofFederalFederalAwardIdentificationFederalFederalAgencyofftheFederalCFDANo.CFDAProgramNameofPass-FundsObligatedbyFundsObligatedforThisNumberAwardDateNameAwardtoDOHTitleThroughAgencyThisActionFundingSource1NH75OTOOOO42-Ol5/27/2021CDC$29,015,58193.391Covid19HealthWashington5300,000$300,000DisparitiesStateDepartmentofHealthCertificationsandAssurances-allrequirementsimposedonthesubrecipientbythefederalawardingagency:Thecontractboilerplatecoversallstandardcertificationsandassurances.Arethereanyadditionalrequirementsimposedbythepass-throughentity(DOH)tomeetitsownresponsibilitiestotheawardingagencyYesONoO:Ifapplicable,thisisidentifiedbytheDOHprogramstaffwritingthecontract.Thiscanalsobefoundinthe"StatementofWork"sectionofthecontract.Allsubrecipientsarerequiredtomaketheiraccountingrecordsavailableandaccessibletotheawardingagency.Youcanfindthisrequirementinthe"RecordsMaintenance"sectionofthecontract.CloseoutRequirements:(1)Submitallfinalbillingswithin60daysoftheendofthecontract(Thisisrequiredperstandardcontractlanguage)(2)Submitallrequiredprogramreportsanddeliverableswithin60days(Thisisrequiredperstandardcontractlanguage)(3)Disposeofpropertypurchasedwithsubawardfundsanddisposeoforreturngovernment-furnishedpropertynolongerusedforsubawardrelatedactivities(IfapplicableDOHmustbecontactedfordisposalrequirements)(4)AdditionalDOHprogramspecificcontractcloseoutrequirements:(Ifapplicable,seeSOWforadditionalcloseoutrequirements)DOHAmendmentGVL26649-1Page4of4Revision04/2020