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Home My WebLink AboutWalla Walla County Dept of Community Health and KCPHD (YCCTPP) Amend 2� sc M�cs...•n Yr �. Kittitas County Review Form Grants & Contract Agreement Today's Date PBK #: 06/28/2023 Fund/Department Agenda Date: 116-Public Health Contract/Grant Information Contract /Grant Agency: Walla Wallla County Dept of Community Health and KCPHD (YCCTPP) Amend#2 Period Begin Date: July 1, 2022 Period End Date: June 30, 2024 Total Grant/Contract Amount: Adds $16,000.00 for a new total of $48,500.00 Grant/Contract Number: Contract/Grant Summary: The Amendment 2 to the Service Agreement between Walla Wallla County Dept of Community Health and KCPHD (YCCTPP) is established to amend the Statement of Work, Add $16,000.00 to the budget, extends the performance period, and changes the billing due date. Recommendation for Board of Health Review on i - 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: Cxi 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? I Yes ❑ attach budget form New Division Created? Revenue Code Expense Code No x0 Why not ALREADY BUDGETED 116-612.44.05.334.04.93/612.44.04.334.04.93/612.91.334.06.902 51001, 5100 2, 5 009 8, 5 419 9 Pass Through Information Agency to Pass Through Amount to Pass Through i Expense Code - Sub -Contract Approved Date: Prosecutor Review LHas the Prosecutor reviewed this agreement? Yes ❑ No ❑ County Departments Impacted Tuditor Facilities Maintenance nformation Services Human Resource Prosecutor Treasurer BOCC Approval Needed? I Yes Staff Member Presenting: Assignment of Tracking Information Auditor's Office Human Resource Prosecutor's Office Who Signed the grant LReviewer Grant/Contract Review Page 2 Service Agreement # 22-20 Amendment # 2 Between WALLA WALLA COUNTY DEPARTMENT OF COMMUNITY HEALTH And KITTITAS COUNTY PUBLIC 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, Exhibit B, Exhibit C, and Attachment 1, Amendment 1: Amends Statement of Work Extends Period of Performance to June 30, 2024 Adds $16,000 in funding, for a new total of $48,500 Changes billing due date to the 25"' working day following the end of the month. Attachments; Exhibit A — Statement of Work Exhibit B — Budget Exhibit C — Expenditure Report Form All other conditions of Service agreement #22-20 and Amendment #1 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: Chairman/Vice-Chairman Date Walla Walla County Board of Commissioners c/o Department of Community Health 314 W Main Street Walla Walla, WA 99362 Phone: (509) 524-2650 Fax: (509) 524-2642 CONTRACTOR: Authorized By Chelsev Loeffers, Director Print Name & Title of Person Signing Date 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 CFDA# (if applicable): n/a Ellensburia, WA 98926-2886 UBI#: State Industrial Account ID # (if applicable): 004.093-00 22-20.2 GT&C Kittitas YCCTPP 1 of 1 Exhibit A STATEMENT OF WORK Grantee Name: Kittitas County Public Health Department Agreement Number: 22-20 Amend. 2 Contract Period: 07/01/2023-06/30/2024 Task Task/Activity/ Deliverables/Outcomes Due Date/Time Number Description 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 Report Complete quarterly report provided by YCCTPP The 15th of the of contractor that focuses on narrative successes and each month on a challenges for subcontractor. quarterly basis, starting September 2023 3 Annual Report Complete annual report provided by YCCTPP Completed no 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 YCCTPP Attend monthly YCCTPP subcontractors meetings Monthly until June regional meetings and attend a minimum of 3 Southeast Regional 30, 2024 and trainin _ s Prevention Network meetings 5 State Attend at least 2 Practice collaborative meetings. Before June 30th collaboration Optional to join a state workgroup meeting 2024 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 Completed before Work Tans Organization and Network Administrative Plan December 2023 8 PSE Goals Identify and complete network activities for at least Throughout contract two identified goals in the workplan: • Schools • Cessation and Public S aces 9 Cessation Promote cessation tools and resources Throughout contract 10 Youth Support youth empowerment clubs, and bring club to Throughout contract Empowerment youth summit 11 Media Promote and update Positive Community Norms Throughout contract cam ai n (social media/posters) 12 Data gathering Ensure a minimum of 66% of schools in county sign October 2023 u for Hcalthy Youth Survey 13 Policy Maker Reach out to local policy makers to educate on June 30, 2024 (o tional) Outreach importance of prevention Contractor's expected performance under this Contract includes, but is not limited to, the following: 1. Knowledge of applicable state and federal laws and regulations pertaining to subject of this Contract; 22-20.2 EXHIBIT A SOW Kittitas YCCTPP Page 1 of 2 2. Use of professional judgment; 3. Collaboration with WWCDCH staff in Contractor's conduct of the services; Conformance with WWCDCH directions regarding the delivery of the services; 4. Timely, accurate, and informed communications; 5. Regular and on -time completion and updating of project plans, reports, documentation, and communications; 6. Attendance at all required and necessary meetings; 7. Provision of high -quality services; and 8. Assurance that all services and activities provided by the Contractor or subcontractors are designed and delivered in a manner sensitive to the needs of all diverse populations; Prior to payment of invoices, County will review and evaluate the performance of Contractor in accordance with the Contract and these performance expectations and may withhold payment if expectations are not met or Contractor's performance is unsatisfactory. 22-20.2 EXHIBIT A SOW Kittitas YCCTPP Page 2 of 2 Exhibit B BUDGET Agency Name: Kittitas County Public Health Department Agreement Number: 22-20 Amend.2 Contract Period: 07/01/2022 - 06/30/2024 Line Item/Description SFY23 Youth Tobacco Vapor Products SFY23 Dedicated Cannabis Account SFY24 Dedicated Cannabis Account SFY23 Tobacco Prevention Proviso SFY24 Tobacco Prevention Proviso TOTAL: Eligible Tasks from sow Original Award 7/1/22-6/30/23 Amend. 1 7/1/22-6/30/23 Amend. 2 7/1/23-6/30/24 Total Award $6,000 1-13 $ 6,000 1-13 $12,500 $12,500 1-13 $14,000 $12,000 $12,000 1-13 $14,000 $4,000 $4,000 $18,500 $14,000 $16,000 $48,500 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 22-20.2 EXHIBIT B Budget Kittitas YCCTPP Page 1 of 1 Expenditure Report Form (ERF) INSTRUCTIONS TO VENDOR OR CLAIMANT. STATEMENT FOR SERVICES - Claim payment 1 Upload an electronic copy of this completd ERF to your eCivis portal every month along with any other backup documentation for your monthly financial report (reimbursement request) in eCivis. Please submit a financial report each month, even if you are not requesting a reimbursement. for materials, merchandise or services. Show complete Vendor's Certificate. I hereby certify under penalty of perjury that the items and totals listed herein are proper charges for materials, merchandise or services furnished to the County of Walla Walla and that all goods furnished and/or services rendered have been provided without discrimination because of age, sex, marital status, race, creed, color, national origin, handicap, religion, or Vietnam era or disabled veterans status and the claim is just, due and unpaid obligation against the County of Walla Walla and that I am authorized to authenticate and certify to said claim. BY: /s/ Authorizing Official (electronic signature) Submit this form t0 Contractor: County of Walla Walla, Washington Department of Community Health PO Box 1753 Walla Walla, WA 99362 CLAIMANT Kittitas County Public Health 507 N. Nanum, #102 Ellensburg, WA98926-2886 (TITt E) (DATE) Program: Agreement Number: Reporting Period: 2023-24YCCTPP 22-20.2 Jul-23 LINE ITEM DESCRIPTION AMOUNT THIS INVOICE Tobacco Prevention Proviso $0.00 Dedicated Cannabis Account $0.00 TOTAL PAYMENT REQUESTED WITH THIS ERF: $0.00 PREPARED BY TELEPHONE NUMBER DATE FOR COUNTY FINANCE USE ONLY VENDOR NUMBER UBI NUMBER FUND Code Distribution ACCOUNTING APPROVAL FOR PAYMENT DATE WARRANTTOTAL $0.00 WARRANT NUMBER He VV1ed IJ!/lS