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Home My WebLink AboutWalla Walla County Dept Amendment 1Kittitas County Review Form Grants &Contract Agreement Today's Date PA Camas Request #:11.17.2022 Fund/Department Agenda Date:116-Public Health Contract|Grant Information Contract /Grant Agency:Walla Walla County Department of Community Health Period Begin Date:July 1,2022 Period End Date:June 30,2023 Total Grant/Contract Amount:Increase of $14,000.00 for a revised maximum of $32,500.00 Grant/Contract Number:22-20 Contract/Grant Summary: The amendment is entered into by and between Walla Walla County Department of Community Health for services relative to Youth Cannabis and Commercial Tobacco Prevention Program and amends the Statement of Work,Budget,and Reporting Requirements as attached in the agreement. 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 O Not Checked (reason) Grant/Contract Review Page 1 Financial Information Total Amount NTE $32,500.00 State Funds $32,500.00 Federal Funds $ Percentage County Funds Matching Funds $CFDA# In-Kind $ Explain is Equipment being purchased?Who owns equipment? New Personnel being hired?Contact HR hiring -reporting requirements Future impacts or liability to Kittitas County: Budget Information Budget Amendment Needed?Yes attach budget form No [X]why not New Division created?Already Budgeted Revenue Code 116.612.44.334.04.93 Expense Code 116.612.44.04.53115 /116.612.44.05.51001 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 O Staff Member Presenting:Kasey Knutson Assignment of Tracking Information Auditor's Office Human Resource Prosecutor's Office Who Signed the grant application Reviewer Date Grant/Contract Review Page 2 Service Agreement #22-20 Amendment #1 Between WALLA WALLA COUNTY DEPARTMENTOF COMMUNITYHEALTH And KITTITAS COUNTYPUBLIC HEALTH DEPARTMENT Agreement 22-20 by and between Walla Walla County Department of Community Health, hereinafter "County,"and KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT hereinafter "Contractor,"is amended as follows and in the attached Exhibit A Statement of Work,Exhibit B Budget,and Exhibit F Reporting Requirements. Amendment 1:Amends Statement of Work and Budget eligible tasks Adds $14,000 in funding,for a new total of $32,500 Replaces Exhibit E Report Form with Exhibit F Attachments:Exhibit A -Statement of Work Exhibit B -Budget Exhibit F -Reporting Requirements Exhibit G -YCCTPP 2022-23 Implementation Guide,page 28 All other conditions of Service agreement #22-20 remain in full force and effect. By their signatures below,the parties agree to the terms and conditions of this Agreement and all documents incorporated by reference.The parties signing below certify that they are authorized to sign this Agreement. IN WITNESS WHEREOF,the parties hereto have signed this Agreement. COUNTY:CONTRACTOR: Chairman/Vice-Chairman Date Authorized By Date Walla Walla County Board of Commissioners c/o Department of Community Health 314 W Main Street Chelsey Loeffers,Director Walla Walla,WA 99362 Print Name &Title of Person Signing Phone:(509)524-2650 Fax:(509)524-2642 Telephone Number /Email Address:509-962-7515 /chelsey.loeffers@co.kittitas.wa.us Mailing Address (Street address required in addition to PO Box ):507 N.Nanum,#102 Ellensburg,WA 98926-2886 CFDA#(if applicable):n/a UBI#: State Industrial Account ID #(if applicable):004.093-00 22-20.1 GT&C Kittitas YCCTPP 1 of 1 Exhibit A STATEMENTOF WORK Grantee Name:Kittitas County Public Health Department Agreement Number:22-20 Amend.1 Contract Period:07/01/2022-06/30/2023 Task Task/Activity/Due Date/TimeDeliverables/OutcomesNumberDescription Frame 1 Monthly Report Complete monthly report provided by YCCTPP 15th of the month contractor and email to coordinator for the previous month in the contract 2 Quarterly Complete quarterly report provided by YCCTPP The 15th of the of Report contractor that focuses on narrative successes and each month on a challenges for subcontractor.quarterly basis, starting September 2022 3 Annual Report Complete annual report provided by YCCTPP Completedno later contractor that includes data from monthly and than 25 calendar quarterly reports to summarize year progress,days after period of successes,and challenges.performance 4 Attend YMPEP Attend monthly YCCTPP subcontractors meetings Monthly until June regional and attend a minimum of 3 Southeast Regional 30,2023 meetings and PreventionNetwork meetings trainings 5 State Attend at least 2 Practice collaborative meetings.Before June 30th collaboration Optional to join a state workgroup meeting 2023 6 Assist with Provide requested data and input to assist with Throughout contract Assessments completion of Needs assessment,Network Equity Assessment,and additional assessments that are required from DOH. 7 Assist with Assist with completion of Regional workplan and Completedbefore Workplans Organization and Network Administrative Plan December 2022 8 PSE Goals Identify and complete network activities for at least September 2022- two identified goals in the workplan:June 30th 2023 •Schools •Cessation and Public Spaces 9 Cessation Pron ote cessation tools and resources _Throughout contract 10 Youth Support youth empowerment clubs,and bring club to July 2022-June 2023 Empowerment youth summit 11 Media Promote and update Positive Community Norms September 2022- campaign (social media/posters)June 30th 2023 12 Data gathering Ensure a minimum of 66%of schools in county sign Starting in second up for Healthy Youth Survey _half of contract year 13 Policy Maker Reach out to local policy makers to educate on June 30,2023 (optional)Outreach importance of prevention 22-20.1 EXHIBIT A SOW Kittitas YCCTPP Page 1 of 1 Exhibit B BUDGET Agency Name:Kittitas County Public Health Department Agreement Number:22-20 Amend.l Contract Period:07/01/2022 -06/30/2023 Line Item/Description Eligible Tasks from Award Amendment Total SOW 1 Award SFY23 Youth Tobacco Vapor 1-13 $6,000 $6,000 Products SFY23 Dedicated Cannabis 1-13 $12,500 $12,500 Account SFY23 Tobacco Prevention 1-13 $14,000 $14,000 Proviso TOTAL:$18,500 $14,000 $32,500 Please reference 2022-23 Implementation Guide for specific guidance on eligible expenses. Funded By: WA State Department of Health Youth Cannabis and Commercial Tobacco Prevention Program 22-20.1 EXHIBIT B Budget Kittitas YCCTPP Page 1 of 1 Exhibit F Contractor Name:Kittitas County Public Health Department Agreement Number:22-20 Amend.l Contract Period:7/1/2022 -6/30/2023 YCCTPP Reporting forms FY 22-23 Reporting forms are due by the 15th of the month following the end of the service month. To access reporting forms click on the link- https://forms.office.com/Pages/ResponsePage.aspx?id=pDWWEoryxEeSAY90eueEGOiRIdnO3 ixEplUVYBlE2nNUQzk0QzNITU44NUNJWkEl TEQ2REFVOIU2Ri4u Quarterly reports are a new requirement this year to help address specific challenges,barriers you are experiencing,success,technical assistance needs,ad process evaluation requests for DOH.These reports are due September 2022,December 2022,March 2022,&June 2022,but can be completed more often. To access the quarterly reporting forms click on the link- https://www.surveymonkey.com/r/Oreport Annual reports are another new requirement this year based on monthly and quarterly reports previously submitted and is due 25 days after the period of performance.Report guidelines and expectations will be provided by coordinator once DOH provides more information. 22-20.1 Exhibit F_Kittitas YCCTPP Page 1 of 1 WhatCanIDowithMyFunding?ActivitiesanditemsthatcontractorshaveproposedtheannualworkplanandannualbudgetandhavebeenapprovedbyDOHcontractmanagerdonotrequireadditionalapprovaltoimplementunlesstherearechangesmadetooriginalproposalortheitemismediawhichrequiresfollowingthemediaprocess.DedicatedStateDedicatedStateCommercialAdditionalCommercialCDCTobaccoCannabisFundingTobaccoFundingTobaccoFundingFundingElectronicEquipmentcase-by-casecase-by-casecase-by-casecase-by-caseSubscriptionscase-by-casecase-by-casecase-by-casecase-by-caseIncentives-MonetaryYouth\ncentives-Monetarycase-by-casecase-by-casecase-by-caseIncentives-NonMonetarycase-by-casecase-by-casecase-by-casePromotionalItemsFoodYCCTPPCoordinator/StafftraveltoconferencelmeetingNetworkMembersTraveltoconferencecase-by-casecase-by-casecase-by-casecase-bycaseRegistrationforconferenceltrainingVNetworkTrainingscase-by-casecase-by-casecase-by-casecase-by-caseRentalSpaceforMeetingsandTrainingsVVVcase-by-caseVaporProductsWWWW2022-23IMPLEMENTATIONGUIDE-28