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Home My WebLink About22-20 Amendment 2 Walla Walla DCHService Agreement #22-20 Amendment # 2 Between WALLA WALLA COUNTY DEPARTMENT OF COMMUNITY HEALTH And KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT Agrcement 22-20by and between Walla Walla County Depaltment of Community Health, hereinafter "County," and KITTITAS COUNTY PUBLIC HEALTII DEPARTMENT hereinafter "Contractot," is amended as follows and in the attached Exhibit A, Exhibit B, Exhibit C, and Attachment I Anrendment l;Amends Statelnent of Work Extends Period ofPerformance to June 30,2024 Adds $ 16,000 irr funding, for a new total of $48,500 changes billing due date to tlre 25tl' working day following the end of the montlr Attachments Exhibit A - Statenrerrt of Wor.k Exhibit B - Budget Exhibit C - Expenditure Report Form All other conditions of Service agrcement #22-20 and Amendment #l remain in ftrll force and effect. By their signaturcs below, tlre parties agree to the teuns and conditions of this Agreement and all documents incorpomted by refetence. The parties signing below certifi that they al.e authorized to sign this Agreement. IN WITNESS WHEREOF, the parties hereto have signed this Agreement. COUNTY: CONTRACTOR: //-^ g 2 E )3 at ice-Chairman Date Walla Walla County Board of Conrnrissioners c/o Department of Community Health 314 W Main Street Chelsey Loeffers, Director Walla Walla, WA 99367 Phone: (509) 524-2650 Fax: (509) 524-2642 Print Name &'fitle of Person Sigrring Telephone Number / Email Address . 509-962'7515 / chelsey.loeffers@co.kittitas.wa.us Mailing Address (Strcel a<tdrcss rcquircd in acldition to pO Box.):507 N. Nanum. #102 Ellensbure. WA 98926.2886 CFDA# (if applicablc): nla UBI#: State lndustrial Account lD # (ifappticabtc): \ By 22-20.2 GT&C Kittitas YCCTPP 004.093-00 I of I Exhibit A STATEMENT OF WORK Grantee Name: Agreement Number: Kittitas County Public Health Deparhnent 22-2A Amend.2 ContractPeriod: 0710112023-06130/2024 Task Number Task/Activity/ DescriDtion Delivera bles/Outcomes Due Date/Time Frame Monthly Report Complete rnonthly repolt provided by YCCTPp contmctof and enrail to coordinator lSth of the month for the previous rnonth in the contmct)Quartelly Report Cornplete quarterly report provided by YCCTpp contractor that focuses on narrative successes and chal lenges for subcontractor. The l5th of the of each month on a quarterly basis, starting September 2023 3 Annual Report Complete annual report provided by YCCTPP contractor that includes data fi'om rnonthly and quarterly teports to sulnrnarize year pt.ogtess, successes, and chal lenges. Completed no later than 25 calendar days after period of perfonnance 4 Attend YCCTPP regional meetings and traininss Attend rnontlrly YCCTPP subcontlactors meetings and attend a minimum of 3 Southeast Regional Preve!rtion Network meetings Monthly untilJune 30,2024 5 State collaboration Attend at least 2 Practice collaborative rneetings. Optional to ioin a state workgroup meeting Before June 30th 2024 6 Assist witlr Assessments Provide requested data and input to assist with completion of Needs assesstnent, Network Equity Assessrnent, and additional assessments tlut are rtquired frorn DOH. Througlrout contract 1 Assist with Workplans Assist with cornpletion of Regionalworkplan and Organization and Network Administrative Plan Completed before December 2023 8 PSE Coals Identify arrd complete network activities for at least two identified goals in the workplan: r Schools r Cessation and Public Spaces Throughout contract 9 Cessation Promote cessation tools and resoutces Throughout contract l0 Youth Empowemrent Support youtlr empowefluent clubs, and bling club to youth summit Throrrghout contract ll Media Promote and update Positive Community Nonns campai gn (social media/posters) Throughout contract t2 Data gatheling Enstrre a lninirnum of 66% of schools in courrty sign up for Youth Survey October 2023 r3 (optional) Policy Maker Outreach Reach out to local policy makels to educate on impodance of prevention June30,2024 Contrcctor's expected perfonnance runder this Contract includes, but is not lirnited to, the followirrg: l. I(nowledge of applicable state and federal laws and regulations pertaining to subject of this Contract; 22-20.2 EXHIBITA SOW Kittitas YCCTPP Page I of2 2. Use of professional judgrrrent; 3' Collabomtion with WWCDCFI staff in Contractor's conduct of the services; Conformance with wwcDCFI directions regarding tlre delivery of the services;4. Timely, accurate, and inforrned comnrunications;5' Regularand on-time completion and updating of project plans, repofts, documentation, and comnrunications; 6. Attendance at all rcquired and necessary meetings;7. Provision of lrigh-quality services; and8' Assumnce that all services and activities provided by the Contractor or subcontractols are designed and delivered in a tnanner sensitive to the needs of all diverse populations; Prior to paylnent of invoices, CoLrnty will review and evaluate the perforrnalce of Contractor inaccotdance with the Contract and these performarrce expectations and may withhold payment if expectations are not met or contractor's perfbrmance is unsatisfactory. 22.20.2 EXHIBIT A Sow Kittitas YCCTPP Page2 of2, Exhibit B BUDGBT Agency Nanre: Agreement Number: Kittitas County Public Health Depaftrnent 22-20 Amend.Z Contract Period: 07l0llZ0ZZ - 06/30/2024 Line ltem/Description Eligible Tasks from sow Original Award 7lln2-6n0n3 Amend. 1 7llk2-(tB0l23 Amcnd. 2 7^r8-6t30t24 Total Award SFY23 Youth Tobacco Vapor Products l-t3 $ 6,000 $6,000 SFY23 Dedicated Cannabis Account t-r 3 $ 12,500 $12,500 SFY24 Dedicated Cannabis Account t-l 3 $ 12,000 $ t2,000 SFY23 Tobacco Prevention Proviso I -13 $ 14,000 $14,000 SFY24 Tobacco Prevention Proviso $4,000 $4,000 $18,500 $14,000 $16,000 $48,500TOTAL Please rcference 2022-23lnrplernentation Cuide for specific guidance on eligible expenses. Funded By: WA State Department of Health Youth Cannabis and Commercial Tobacco Prcvention program 22-20.2 EXHIBIT B Budget Kittitas yCCTpp Page I of I an electronic copy of this completd ERF to your 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 relmbursement. Upload Submit this form to Contracton County of Walla Walla, Washington Department of Community Health PO Box 1753 Walla, WA 99352 CIAIMANT I Vendofs Cedtli.ate. I hereby certify unde. penalty of perjury that 'theltemsandtotBlslistedherelnar€properchargesformatedals,merchandiseor I seruices furnlshed to the County oi walla Wella and rhat all goodr furnished and/or seruices rendered have been provided without discrimination because of age, sex, maritel stitus, r!ce, ffeed, color, natlonal origin, handicap, religlon, or Vietnam eE or dirabled vetelans rtatus and the claim is jus! due and unpeid obligation againjt thei County of Walla Walla ard that I am authorized to authenticate and ceriltylo :aid lclaim. Expenditure Report Form (ERF) BY: Official ATEMENT FOR SERVTCES - Claim payment for materials, merchandise or services. Show complete INSTRUCTIONS TO VENDOR OR CLAIMANT: YCCTPP 22-20.2 Kittitas County Public Health 507 N. Nanum, #102 Ellensburg, WA 98926-2886 Program Period: Numberl Jul-23 LINE ITEM DESCRIPTION AMOUNTTHIS lNVOICE Tobacco Prevention Proviso $o.oo Dedicated Cannabis Account So.oo TOTAT PAYMENT REqUESTED WITH THIS ERF;s0.00 PREPARED BY TELEPHONE NUMBER DATE FOR COUNII FINANCE USE ONLY USI NUMBTN FUND Code Dlsattbuilon rccouNltilG APPnov^t to8 PAyMENt DAI€ So,oo WACRANINUMOIB