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Home My WebLink AboutWSDOH Contract Amendmentr3f Washlngton Stare Department ot HEALTH CONTRACT AMENDMENT This document has been DOI-I Anrerrdrn ent GY L26649 -2 Revisron 04/2020 I. NAMEOFCONTRACTOR Kittitas County Public Health Department 2. CONTRACTNUMBER GVL26649 1a. ADDRESS OF CONTRACTOR (STREET) 507 N Nanum St Ste 102 2a. AMENDMENT NUMBER 1 Ib. CITY, STATE, ZIP CODE Ellensbu rg, wA 98926 Unique Entity Identifi er: WQ23XPBSAU44 3. I rurs rTEM APPLIES ONLY TO BILATERAL AMENDMENTS. The Contract identified herein, including any previons arnendments thereto, is hereby amended as set forth in Itern 5 below by mutual consent of all parties hereto. 4. L_l THIS ITEM APPLIES ONLY TO UNILATERAL AMENDMENTS. The Contract identified herein, including any previous arnendrnents thereto, is hereby unilaterally amended as set forlh in ltern 5 below pursuant to tliat changes and modifications clause as contained therein. D M The purpose of this non-cost amendment is to revise the ent 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 amendtnent neither increases nor decreases the Contract Consideration; therefore, the maximum consideration of this contract and all amendrnents 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 A mendment: 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. nfnls is a unilateral amendment. Signature of contractor is not required below. I 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) Cheke,q l-oeffe,rr Cheley r oplFs ( run )6: /o/3 t3 qr pot I DATE Jun26,2023 9. DOH CONTRACTING OFFICER SIGNATURE -4--/ -LLJ,t-&r--(r-* U DATE Jun26,2023 approved as to form only by the Assistant Attorney General. Page l of4 BXHIBIT A-2, DOH CONTRACT GVL26649-2 Sub-recipient Statement of Work KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT Period of Perfornance for this Amendment: Date of Execution through May 31, 2024 Purpose statement: To lead and community level as described in coordinate efforts to reduce covid-19 related health disparities at the Centers for Disease Control and Prevention (CDC) Grant National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and (Jnderserved, Including Racial and Ethnic Minority Populations and Rural Communities (CDC-RFA-OT2t-2103). Implementation Leads will advance health equity in their communities and collaboratively work to reduce Covid- I 9 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 infeciion and transmission among populations who are rural and underserved. Work will focus in Kittitas County. See Exhibit C for further detail. Project Period: DOE - 513112024 Budget: $300,000 Task # Task/Activity Deliverable/Outcome Due Date I Form and facilitate a local Rural Equity Advisory Team (REAT) to infonn project implementation and identiff strategies that align with the CDC grant expectations. Advisory team will use data sources including, but not lirnited to:o Local population demograpl-ricso Covid- l9 indicator data and social vulnerability indexo Stakeholder input 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 program manager. Within 90 days after date of execution 2 Upon selection of strategies a workplan and budget will be developed. o Workplan to include objectives, strategies, persons responsible and target dateso DOH Program Manager will provide a budget template. Workplan document Cornpleted budget template 513U2023 J Subrecipients will identify, award, and manage subcontractors or subrecipients as needed to implement project activities in alignment with grant expectations.o 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 Subcontracts in place and managed in accordance with federal guidelines. Copies of subcontracts shared with DOH program manager. Duration of project DOH Anrerrdm ent GY L26649 -2 Revision 04/2020 Page 2 of 4 EXHIBIT A-2, DOH CONTRACT GVL26649-2 Sub-recipient Statement of Work KITTITAS COUNTY PUBLIC HBALTH DEPARTMENT Period of Performance for this Amendment; Date of Execution through May 3l , 2024 5 Progress and Perforrnance Reporting: Subrecipient will subrnit a quarlerly progress report using a template provided by DOH Progress and Perfonnance reports are submitted in accordance with CDC grant requirements Quarterly 6 Develop a plan for sustainability. Sustainability plan includes but is not limited to: . Covid-19 community recovery strategies o Emergency preparedness planning Sustainability Plan in place and shared DOH program rnanager 12/31/2024 SDecial 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 $5,00b or,r',ore, the contractor shall obtain written prior approval from the Washington State Deparlment of Health, and adhere to all federal requirements as referenced in; 2 CFR 200.313, Equipment at: https://www.gpo.gov/fdsys/eranule/CFR-2014-title2-vollICFR-2014- title2-vol 1 -sec200-3 I 3, arid 2 CFR 200,439, Equipment and other Capital Expenditares at: 4-tiIle2- 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 lirnited to; receipts, invoices, billing records, work orders, positive time, and attendance records (timesheets), travel vouchers and accounting expense reports.. Additional backup docurnentation llay be requested if needed. Signed A-19 invoices mltst be received prior to approval and payment. A scanned copy of your A-19 with signature is acceptable. Please email the signed A-l9s and backup documentation to: Washington State Deparlment of Health ATTN: Eileen Kazura Community Health Systems PO Box 47850 Olympia, WA 98504-7850 Ei I een. k azura(@doh.wa. gov DOH Anendnr ent GY L26649 -2 Revision 04/2020 Page 3 of 4 BXHIBTT A-2, DOFI CONTRACT GVL26649_2 Sub-recipient Statement of Work KITTITAS COUNTY PUBLIC HBALTH DEPARTMENT Period of Performance for this Amendment: Dale of Execution through May 3 I , 2024 Certi Assurances - all requirements tnposed on the subrecipient by awarding agency: The contract boilerplate covers all standard certifi catrons and assurances. DOI{ Arnendrnent GV L26649 -2 Revision 04/2020 Are there any additional requiretnents irnposed by the pass-through entity (DOH) to meet its own responsibilities to the awarding agency yes n No E:If.applicable, this ls identified by the DOH program staffwriting the contract, This can also be found rn the "staternent of worki section ofthe contract.All subreclpients are required to make their accounting records available and accessrble to the awarding agency. You can find this requirelnent in the "Records Maintenance" section ofthe contract. Closeout Requiretnents: ( I ) Submit all final billings within 60 days of the end of the contract (This is required per standard contract language) (2) Submit all required program repofts and deliverables within 60 days (This isrequiied per standard contractianluage) (3) Dispose ofproperty purchased with subaward funds and dispose ofor return governrnent-furnished property nJtoi'ger used for subaward related activities(lfapplicable DOH rnust be contacted for disposal requirernents) (4) Additional DOH prograrn specific contract closeout requirements: (lfapplicable, see SOW for additional closeout requirernents) Page 4 of 4 This table includes only active funding sources, Federal Grant Information Sheet Subrecipient/Contractor: Contract No. UEI No. Period of Performance: Project Description: WQ23XPBSAU44 Contact Information: Limiting Indirect Cost Rate? yes tr No trStartDate: EndDate: dohcon.mqmt@doh.rva.gov ResearchandDevelopment? yesn NoE3/ts12021 5/31/2024 National Initiative to Address COVID-19 Health Disparities Arnong Populations at High-Risk and Underserved, Includtng Racial and EthnicMinority Populations and Rural Cornrnunities. Health Dept DOH Contract Managcr:Approved IndirectRate: yes E No tr Bileen KazuraGVL26649-2 Kittitas F€dcral Award Identificttion Number Federal Award Date Federnl Agcncy Name offlhc Federal Amount CFDA No.CFDA Program Title Name ofPass- Through Agcncy Funds Obligated by Amount This Total Amount of Frnds Obligated for This Source l NH750T000042-0t CDC 5,581 93.39t l9 Health Disparities Washington State DepanNent $-0-