The URL can be used to link to this page

Home My WebLink AboutSigned DOH Amendment 1Kittitas County Review Form Grants & Contract Agreement Contract/G ra nt I nformation Recommendation for Board of Health Review on Department Head Signature Director Date: lo/>t lzz verification the contracting Agency is not suspended/Disbarred: Today's Date e/20/2022 PA camas Request r,T4+ll,ll Fund/Department 116-Public Health Agenda Date t0 llbt?h I Grant Agency: DOH lnteragency Agreement Contract Amendment 1 (GV126649- Health u Contract / Period Begin Date: March 15,2O2I Period End Date: December 3t,2OZ3 Total Grant/Contract Amount: Not to Exceed $SOO,OOO.OOO G rant/Contract N umber: The purpose of the no-cost amendment to the DOH lnteragency Agreement is to extend the period of performance from May 3L, 2023, to December 3L, 2023. The statement of work remains the same as in the original contract and is attached and no increases or decreases in contractual consideration. Contract/G rant Summary: Kittitas county Prosecutor, Auditor, and Board of Health Review and comment: APP ROVED AS TO RM: .zQTl )o H*/""Signature of P utor's Office Date o L Signature of Auditor's ce Date I Agency is not suspended/disbarred ! Not Checked (reason) Grant/Contract Review Page L Financial lnformation Bu lnformation Pass Through lnformation Prosecutor Review Total Amount 5300,000.000 State Funds S Federal Funds S300,000.000 Percentage County Funds Matching Funds $CFDA# ln-Kind $ tn ls Equipment being purchased?Who owns equipment? New Personnel bei hired?Contact HR hirin - reporti u irementsre Future impacts or liability to Kittitas County: Budget Amendment Needed? New Division Created? Yes I attach budgetform No E why not No cost amendment Revenue Code @ tllz Io\2b4,'LJa.7bV.q13q I Expense Code Agency to Pass Through Amount to Pass Through Expense Code: Sub-Contract Approved Date Has the Prosecutor reviewed this agreement?Yes No County De rtments lm ed BOCC A I Needed? Assignment of Tracki ng lnformation Auditor's Office Human Resource Prosecutor's Office Who Signed the grant application Auditor Facilities Maintenance lnformation Services Human Resource Prosecutor Treasurer Yes f,NoE Staff Member Presenting: Reviewer Date Grant/Contract Review Page 2 trtii;;Tri;CONTRACT AMENDMENT This document has been DOH Anrendm ent GY L26649 - | Revision 04/2020 I. NAMEOFCONTRACTOR Kittitas Public Health Department 2. CONTRACTNUMBER GVL26649la. ADDRESS OF CONTRACTOR (STREET) 507 N Nanum St Ste 102 2a. AMENDMENT NUMBER I Ib. CITY. STATE, ZIP CODE Ellensburg, WA 98926 Unique Entity Identifier: WQ23XPBSAU44 J I TUIS ITE,M APPLIES oNLY To BILATERAL AMENDMENTS. The Contract identified herein, including any previous amendments thereto, is hereby amended as set forlh in Item 5 below by mutual consent of all parties hereto. 4. LI THIS ITEM APPLIES ONLY TO UNILATERAL A MENDMENTS. The Contract identified herein, including any previous amendments thereto, is hereby unilaterally amended as set forth in Itern 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 3 1,2023 to December 31,2023; to continue the work laid out in the Original Contract. All other Tenns and Conditions rernain the same and in full effect. 5a. Statement of Work: Exhibit A is revised in accordance with Exhibit A-10 attached hereto and incorporated herein. 5b. Consideration: This amendment neither increases nor decreases the Contract Consideration; therefore, the maximuln 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 5c. Period of Performance: is extended through December 31,2023. 5d. The Effective Date of this Amendment: is the Date of Execution. of the original contract and any subsequent amendments thereto6 7 All other terms and conditions remain in full force and effect. nfnis is a unilateral amendment. Signature of contractor is not required below. Xl Contractor hereby acknowledges ind accepts the tenns and conditions of this amendment. Signature is required below Public Health 8.CONTRACTOR SIGNATURE (also, please prinr/type your name)DATE Chelsey (Oct 08:46 PDT)Oct28,2022, Chelsey Loeffers DATE Oct28,2022 Department of Health Contract Specialist ttl DOH CONTRACTING OFFICER SIGNATTJRE WA Department of Health Contracts Office Cfu *Dila&f Frank L Webley approved as to form only by the Assistant Attorney General. Page 1 of4 EXHIBIT A-1, DOH CONTRACT GVL26649-I Sub-recipient Statement of Work KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT Period of Performance for this Amendment: Date of Execution through December 31, 2023 Purpose of thk 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. DOH Amendnr ent GY L26649 -l Purpose statement: To lead and coordinate efforts to reduce Covid-l9 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), hnplementation Leads will advance health equity in their communities and collaboratively work to reduce Covid- l9 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: 31 1 512021 - 1 2/3 1/2023 Budget: $300,000 Task # Task/Activity Deliverable/Outcome Due Date I Form and facilitate a local Rural Equity Advisory Tearn (REAT) to inform project implementation and identiff strategies that align with the CDC grant expectations. Advisory tearn will use data sources including, but not limited to:o Local population demographics. Covid-19 indicator data and social vulnerability indexo Stakeholder input Docurnentation of formed advisory team, such as meeting schedule and minutes, shared with DOH program manager. Documentation of local data used to guide selections of strategies shared with DOH program manager. Recommendations from advisory team shared with DOH program manager. Within 90 days after date of execution 2 Upon selection of strategies a workplan and budget will be developed. . Workplan to include objectives, strategies, persons responsible and target dates o DOH Program Manager will provide a budget template. Workplan document Completed budget template 513112023 J Subrecipients will identify, award, and manage subcontractors or subrecipients as needed to implement project activities in alignrnent with grant expectations.o Subcontracts should include key partnerships with organizations who have existing community or social service delivery programs for Subcontracts in place and managed in accordance with federal guidelines. Copies of subcontracts shared with DOH program manager. Duration of project Revision 04/2020 Page2 of 4 EXHIBIT A-1, DOH CONTRACT GVL26649-I Sub-recipient Statement of Work KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT Period of Perfornancefor this Amendment: Date of Execution through December 31, 2023 underserved populations disproporlionately i mpacted by Covid-19 and health disparities 5 Progress and Perforrnance Reporting: Subrecipient will submit a quarterly progress report using a template provided by DOH manager. Progress and Performance reports are submitted in accordance with CDC grant requirements Quarterly 6 Develop a plan for sustainability. Sustainability plan includes but is not limited to: r Covid-19 community recovery strategies o Emergency preparedness planning Sustainability Plan in place and shared DOH program manager 12/3 I/2023 Special Requirements: This is a federally funded contract. All expenditures incurred and reimbursements made for performance under 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 equiprnent (including shipping, handling and associated costs) is $5,000 or lnore, the contractor shall obtain written prior approval from the Washington State Department of Health, and adhere to all federal requirements as referenced in; 2 CFR 200.313' Equipment at:https://www.gpo.gov/fdsys/granule/CFR-2014-title2-vol1/CFR-2014- title2-vol I -sec200-3 13, and 2 CFR 200.439, Equipment and other Capital Expenditures at: httos://www.soo.I 4title2-vol I /CFR-20 1 4 title2-vol I -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 received prior to approval and payrnent. A scanned copy of your A-19 with signature is acceptable. Please ernail the signed A-l9s and backup documentation to: Washington State Department of Health ATTN: Eileen Kazura Community Health Systems PO Box 47850 Olympia, WA 98504-7850 Ei leen.kazura@doh.wa.gov DOH Anrendnr ert GY L2 66 49 - | Revision 04/2020 Page 3 of4 EXHIBIT A-1, DOH CONTRACT GVL26649-ISub-recipient Statement of WorkKITTITAS COUNTY PUBLIC HEALTH DEPARTMENTPeriod of Performance for this Amendment:Date of Execution through December 31, 2023Certifications and Assurances - all requirements imposed on the subrecipient by the federal awarding agency:The contract boilerplate covers all standard certifications and assurances.Are there any additional requirements imposed by the pass-through entity (DOH) to meet its own responsibilities to the awarding agency Yes E No X:If applicable, this is identified by the DOH program staff writing the contract. This can also be found in the "statement of Work" section ofthe contract.All subrecipients are required to make their accounting records available and accessible to the awarding agency.You can find this requirement in the "Records Maintenance" section of the contract.Closeout Requirements:(1) Submit all final billings within 60 days of the end ofthe contract (This is required per standard contract language)(2) Submit all required program reports and deliverables within 60 days (This is required per standard contract language)(3) Dispose of property purchased with subaward funds and dispose of or retum government-fumished property no longer used for subaward related activities(If applicable DOH must be contacted for disposal requirements)(4) Additional DOH program specific contract closeout requirements: (lf applicable, see SOW for additional closeout requirements)DOH Amendm ent GVL26649 -lRevision 04/2020This table includes only active funding sources.Federal Grant Information SheetKittitas County Health Dept26649DOH Contract Manager:Eileen KazuraApproved Indirect Rate: yes X No nWQ23XPBSAU44 Contact Information: Limiting Indirect Cost Rate? yes n No XStart Date: End Date: dohcon.mgmt@doh.wa.gov Research and Development? yes n No X3t1st202r 12/31/2023National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and EthnicMinority Populations and Rural Communities.Total Amount of FederalFunds Obligated for ThisFundins Source$300,000Amount of FederalFunds Obligated byThis Artion$300,000Name of Pass-Through AgencyWashingtonState DepartmentolHealthCFDA ProgramTitleCovid l9 HealthDisparitiesCFDA No.93.391Total Amountoff the FederalAward to DOH$29,0 1 5,58 rFederal AgencyNameCDCFederalAward Date5/21n021Subrecipient/Contractor:Contract No.UEI No.Period ofPerformance:Project Description:Federal Award ldentificationNumber1NH750T000042-0 lPage 4 of 4