HomeMy WebLinkAboutRural Health Equity Grant with WSDOH ExtentionKittitas County
Review Form
Grants & Contract Agreement
Today's Date
05.16.2023 _
Fund/Department
116-Public Health
Contract/Grant Information
PA Camas Request #:
Agenda Date:
�urrrr:�Yn�i •�i
Contract /Grant Agency: Rural Health Equity Grant with Washington State Department of Health
Period Begin Date: Period End Date: 05.31.2024
Total Grant/Contract Amount: $300,000
Grant/Contract Number: GVL26649
Contract/Grant Summary:
No cost extension through May 31, 2024, for Rural Health Equity Grant to lead and coordinate efforts to
reduce Covid19 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).
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:
EN Agency is not suspended/disbarred
❑ Not Checked (reason)
Grant/Contract Review Page 1
Financial Information
Total Amount
State Funds $
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 ❑ why not
New Division Created?
Revenue Code 116.612.39.26. 333.93.391
Expense Code 116.612.39.26.51001 / 52001 / 50098
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? I Yes ❑ No ❑
County Departments Impacted
Auditor
Information Services
Prosecutor
BOCC Approval Needed?
Facilities Maintenance
Human Resource
Treasurer
Yes ❑ No
Staff Member Presenting:
/10J%11IIICIIL U1 I1C1LKlllr, 1111VIIIIdLIUF1
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Reviewer Date
Grant/Contract Review Page 2
Washington State Department of
Toor H E A LT H CONTRACT AMENDMENT
I. NAME OF CONTRACTOR
2. CONTRACT NUMBER
Kittitas County Public Health Department
GVL26649
1 a. ADDRESS OF CONTRACTOR (STREET)
2a. AMENDMENT NUMBER
507 N Nan um St Ste 102
2
lb. CITY, STATE, ZIP CODE
Unique Entity Identifier:
Ellensburg, WA 98926
W 23XPBSAU44
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.
DESCRIPTION OF AMENDMENT: The purpose of this non -cost amendment is to revise the
Statement of Work and to extend the Period of Performance.
5a. Statement of Work: Exhibit A-1 is revised in accordance with Exhibit A-2, attached hereto
and incorporated herein.
5b. Consideration: This amendment neither increases nor decreases the Contract Consideration;
therefore, the maximum consideration of this contract and all amendments shall not exceed
$300,000.00.
Contractor agrees to comply with applicable rules and regulations associated with these funds.
5d. Period of Performance: is extended through May 31, 2024.
5e. 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 prinUtype 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 GVL26649-2 Page 1 of 4
Revision 04/2020
EXHIBIT A-2, DOH CONTRACT GVL26649-2
Sub -recipient Statement of Work
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
Period of Performance for this Amendment:
Date of Execution through May 31, 2024
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-0T21-2103).
Implementation Leads 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: DOE — 5/31/2024
Task Task/Activity
l Form and facilitate a local Rural Equity
Advisory Team (REAT) to inform project
implementation and identify strategies that
align with the CDC grant expectations.
Advisory team will use data sources
including, but not limited to:
• Local population demographics
• Covid-19 indicator data and social
vulnerability index
• Stakeholder input
2 Upon selection of strategies a workplan and
budget will be developed.
• Workplan to include objectives,
strategies, persons responsible and
target dates
• DOH Program Manager will provide
a budget template.
3 Subrecipients will identify, award, and
manage subcontractors or subrecipients as
needed to implement project activities in
alignment with grant expectations.
• Subcontracts should include key
partnerships with organizations who
have existing community or social
service delivery programs for
underserved populations
disproportionately impacted by
Covid-19 and health disparities
DOH Amendment GVL26649-2
Revision 04/2020
Deliverable/Outcome
Documentation 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 nroL)ram manager.
Due Date
Within 90 days
after date of
execution
5/31 /2023
Workplan document
Completed budget template
Duration of
proj ect
Subcontracts in place and
managed in accordance with
federal guidelines.
Copies of subcontracts shared
with DOH program manager.
Page 2 of 4
EXHIBIT A-2, DOH CONTRACT GVL26649-2
Sub -recipient Statement of Work
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
Period of Performance for this Amendment:
Date of Execution through May 31, 2024
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
mana er.
requirements
6
Develop a plan for sustainability.
1213112024
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 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 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 referenced in;
2 CFR 200.313, Equipment at: htt s://www. o. +ov/fds sl raiiule/CFR-2014-title2-vol 1/CFR-2014-
title2-y0�I1-sec200-313 , and
2 CFR 200.439, Equipment and other Capital Expenditures at:
https://www.212Q.gQv/]'dsys/p-raiiul.efCFR-2014-title2-vol I /CFR-2014-title2-vol 1 -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-1 9 invoices must be received prior to approval and payment. A scanned copy of your A-19 with signature is
acceptable. Please email the signed A-19s and backup documentation to:
Washington State Department of Health
ATTN: Eileen Kazura
Community Health Systems
PO Box 47850
Olympia, WA 98504-7850
Eileen.kazui-a@doli.wa.gov
DOH Amendment GVL26649-2 Page 3 of 4
Revision 04/2020
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