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HomeMy WebLinkAboutCONCON AMEND 22Kittitas County Review Form Grants &Contract Agreement Today's Date Agenda Date 08/31/2021 ÍÛ Fund/Department 116-Public Health Contract/Grant Information Contract /Grant Agency:Consolidated Communications Amendment 22 Period Begin Date:01/01/2018 Period End Date:12/31/2021 Total Grant/Contract Amount:Increase of $182,929.00 for a revised maximum consideration of $3,779,101.00 Grant/Contract Number:CLH18249 Contract/Grant Summary: The Consolidated Contract Adds a statement of work for the following programs •Emergency Preparedness and Response PHEP-Effective July 1,2021 •Foundational Public Health Services-Effective July 1,2021 Amends Statements of Work for the following programs •COVID 19 Coordinated Response-Effective July 1,2020 •LSPAN-Local Strategies for Physical Activity and Nutrition-Effective February 19,2019 •Maternal and Child Health Block Grant-Effective January 1,2018 •Office of Drinking Water Group A Program-Effective January 1,2018 Exhibit B-22 Allocations •Increase of $182,929.00 for a revised maximum consideration of $3,779,101.00 Recommendation for Board of Health and Board of Health Review on Department Head Signature:,Administrator Date: Kittitas County Prosecutor,Auditor,and Board of Health Review and Comment: A ED AS TO FORM Signatur of Pro ecutor's Offi Date Signatur.itor's Office Date Grant/Contract Review Page 1 Signature of Board of Health member Date 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 O attach budget form No why not New Division created? Revenue Code Pass Through Information Agency to Pass Through Amount to Pass Through $ 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 Submitted Signature:Date: Department: Grant/Contract Review Page 2 Assignment of Tracking Information Auditor's Office Human Resource Prosecutor's Office Who Signed the grant application Reviewer Date Grant/Contract Review Page 3 KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT 2018 -2021 CONSOLIDATED CONTRACT CONTRACT NUMBER:CLH18249 AMENDMENT NUMBER:22 PURPOSE OF CHANGE:To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as "DOH",and KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT,a Local Health Jurisdiction,hereinafter referred to as "LHJ",pursuant to the Modifications/Waivers clause,and to make necessary changes within the scope of this contract and any subsequent amendments thereto. IT IS MUTUALLY AGREED:That the contract is hereby amended as follows: 1.Exhibit A Statements of Work,attached and incorporated by this reference,are amended as follows: Adds Statements of Work for the following programs: •Emergency Preparedness &Response PHEP -Effective July 1,2021 •Foundational Public Health Services (FPHS)-Effective July 1,2021 Amends Statements of Work for the following programs: •COVID-19 Coordinated Response -Effective July 1,2020 •LSPAN-Local Strategies for Physical Activity &Nutrition -Effective February 19,2019 •Maternal &Child Health Block Grant -Effective January 1,2018 •Office of Drinking Water Group A Program -Effective January 1,2018 Deletes Statements of Work for the following programs: 2.Exhibit B-22 Allocations,attached and incorporated by this reference,amends and replaces Exhibit B-21 Allocations as follows: Increase of $182,929 for a revised maximum consideration of $3,779,101. O Decrease of for a revised maximum consideration of . O No change in the maximum consideration of . Exhibit B Allocations are attached only for informational purposes. 3.Exhibit C-19 Schedule of Federal Awards,attached and incorporated by this reference,amends and replaces Exhibit C-18. Unless designated otherwise herein,the effective date of this amendment is the date of execution. ALL OTHER TERMS AND CONDITIONS of the original contract and any subsequent amendments remain in full force and effect. IN WITNESS WHEREOF,the undersigned has affixed his/her signature in execution thereof. KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT STATE OF WASHINGTON DEPARTMENT OF HEALTH Date Date APPROVED AS TO FORM ONLY Assistant Attorney General Page 1 of 50 AM E N D M E N T #2 2 20 1 8 - 2 0 2 1 CO N S O L I D A T E D CO N T R A C T EX H I B I T A ST A T E M E N T S OF WO R K TA B L E OF CO N T E N T S DO H Pr o g r a m Na m e or Ti t l e : CO V I D - 1 9 Co o r d i n a t e d Re s p o n s e - Ef f e c t i v e Ju l y 1, 20 2 0 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 DO H Pr o g r a m Na m e or Ti t l e : Em e r g e n c y Pr e p a r e d n e s s & Re s p o n s e - P H E P - Ef f e c t i v e Ju l y 1, 20 2 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . 15 DO H Pr o g r a m Na m e or Ti t l e : Fo u n d a t i o n a l Pu b l i c He a l t h Se r v i c e s (F P H S ) - Ef f e c t i v e Ju l y 1, 20 2 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 DO H Pr o g r a m Na m e or Ti t l e : LS P A N - L o c a l St r a t e g i e s fo r Ph y s i c a l Ac t i v i t y & Nu t r i t i o n - Ef f e c t i v e Fe b r u a r y 19 , 20 1 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 DO H Pr o g r a m Na m e or Ti t l e : Ma t e r n a l & Ch i l d He a l t h Bl o c k Gr a n t - Ef f e c t i v e Ja n u a r y 1, 20 1 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 DO H Pr o g r a m Na m e or Ti t l e : Of f i c e of Dr i n k i n g Wa t e r Gr o u p A Pr o g r a m - Ef f e c t i v e Ja n u a r y 1, 20 1 8 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 2 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ex h i b i t A St a t e m e n t of Wo r k Co n t r a c t Te r m : 20 1 8 - 2 0 2 1 DO H Pr o g r a m Na m e or Ti t l e : CO V I D - 1 9 Co o r d i n a t e d Re s p o n s e - Lo c a l He a l t h Ju r i s d i c t i o n Na m e : Ki t t i t a s Co u n t y Pu b l i c He a l t h De p a r t m e n t Ef f e c t i v e Ju l v I, 20 2 0 Co n t r a c t Nu m b e r : CL H l 8 2 4 9 SO W Ty p e : Re v i s i o n Re v i s i o n # (f o r th i s SO W ) 4 Fu n d i n g So u r c e Fe d e r a l Co m p l i a n c e Ty p e of Pa y m e n t Fe d e r a l Su b r e c i p i e n t (c h e c k if ap p l i c a b l e ) Re i m b u r s e m e n t Pe r i o d of Pe r f o r m a n c e : Ju l y 1, 20 2 0 th r o u g h De c e m b e r 31 , 20 2 1 St a t e Ot h e r FF A T A (T r a n s p a r e n c y Ac t ) Fi x e d Pr i c e Fe d e r a l *C o n t r a c t o r Re s e a r c h & De v e l o p m e n t St a t e m e n t of Wo r k Pu r p o s e : Th e pu r p o s e of t h i s st a t e m e n t of wo r k is to pr o v i d e su p p l e m e n t a l fu n d i n g fo r th e LH J to en s u r e ad e q u a t e cu l t u r a l l y an d li n g u i s t i c a l l y re s p o n s i v e te s t i n g , in v e s t i g a t i o n an d co n t a c t tr a c i n g re s o u r c e s to li m i t th e sp r e a d of CO V I D - 1 9 NO T E : Pe n d i n g ex e c u t i o n of a ne w co n s o l i d a t e d co n t r a c t te r m or an ex t e n s i o n to th e 20 1 8 - 2 0 2 1 co n s o l i d a t e d co n t r a c t s wh i c h cu r r e n t l y en d De c e m b e r 31 , 20 2 1 , DO H pl a n s to co n t i n u e th e ta s k ac t i v i t i e s an d fu n d i n g as no t e d in th e ta s k ( s ) be l o w in a ne w or re v i s e d st a t e m e n t of wo r k ef f e c t i v e Ja n u a r y 1, 20 2 2 . Re v i s i o n Pu r p o s e : Th e pu r p o s e of th i s re v i s i o n is to up d a t e th e MI co d e fo r FF Y 2 0 EL C ED E LH J AL L O C A T I O N in th e Pa y m e n t In f o r m a t i o n co l u m n , re v i s e la n g u a g e an d ad d ne w de l i v e r a b l e in Ta s k 2. 1 . h , an d re v i s e pr o g r a m sp e c i f i c la n g u a g e fo r DC H S CO V I D - 1 9 Re s p o n s e - T a s k s 1 an d 2; an d ex t e n d th e fu n d i n g pe r i o d fo r MA S S VA C C I N A T I O N FE M A 10 0 % fr o m Ju l y 20 , 20 2 1 to De c e m b e r 31 , 20 2 1 fo r Ma s s Va c c i n a t i o n Cl i n i c s - T a s k 4. Ch a r t of Ac c o u n t s Pr o g r a m Na m e or Ti t l e CF D A # BA R S Ma s t e r Fu n d i n g Pe r i o d Cu r r e n t Ch a n g e To t a l Re v e n u e In d e x (L H J Us e On l y ) Co n s i d e r a t i o n Co n s i d e r a t i o n No n e Co d e Co d e St a r t Da t e En d Da t e BI T V - C O V I D ED LH J AL L O C A T I O N - C A R E S 21 . 0 1 9 33 3 . 2 1 . 0 1 18 9 7 1 2 9 V 07 / 0 1 / 2 0 12 / 3 1 / 2 1 25 2 , 0 3 6 0 25 2 , 0 3 6 FE M A - 7 5 CO V I D LH J AL L O C A T I O N 97 . 0 3 6 33 3 . 9 7 . 0 3 18 9 7 1 2 9 W 07 / 0 1 / 2 0 12 / 3 0 / 2 0 0 0 0 FF Y 2 1 CO V I D 1 9 VA C C I N E SE R V I C E S - C A R E S 93 . 2 6 8 33 3 . 9 3 . 2 6 74 3 1 0 2 0 9 07 / 0 1 / 2 0 12 / 3 1 / 2 1 14 , 5 8 2 0 14 , 5 8 2 FF Y 2 0 EL C ED E LH J AL L O C A T I O N 93 . 3 2 3 33 3 . 9 3 . 3 2 18 9 7 1 2 0 E 01 / 1 5 / 2 1 12 / 3 1 / 2 1 53 0 , 1 6 1 0 53 0 , 1 6 1 FF Y l 9 EL C CO V I D ED LH J AL L O C A T I O N 93 . 3 2 3 33 3 . 9 3 . 3 2 18 9 7 1 2 9 G 01 / 0 1 / 2 1 12 / 3 1 / 2 1 23 7 , 0 7 7 0 23 7 , 0 7 7 *M A S S VA C C I N A T I O N FE M A 10 0 % 97 . 0 3 6 33 3 . 9 7 . 0 3 93 4 V 0 2 0 0 01 / 2 1 / 2 1 12 / 3 1 / 2 1 0 0 0 CO V I D 19 VA C C I N E S [ 93 . 2 6 8 | 33 3 . 9 3 . 2 6 74 3 1 0 2 2 9 07 / 0 1 / 2 0 12 / 3 1 / 2 1 35 4 , 8 0 3 0 35 4 , 8 0 3 TO T A L S 1, 3 8 8 , 6 5 9 0 1, 3 8 8 , 6 5 9 Ta s k Pa y m e n t *M a y Su p p o r t PH A B Nu m b e Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n an d / o r St a n d a r d s / M e a s u r e s r Am o u n t Pa r t i c i p a t e in pu b l i c he a l t h em e r g e n c y pr e p a r e d n e s s an d re s p o n s e ac t i v i t i e s fo r CO V I D - 1 9 . Th i s ma y in c l u d e su r v e i l l a n c e , ep i d e m i o l o g y , la b o r a t o r y ca p a c i t y , in f e c t i o n co n t r o l , mi t i g a t i o n , co m m u n i c a t i o n s an d or ot h e r pr e p a r e d n e s s an d re s p o n s e ac t i v i t i e s fo r CO V I D - 1 9 . Ex a m p l e s of ke y ac t i v i t i e s in c l u d e : • In c i d e n t ma n a g e m e n t fo r th e re s p o n s e • Te s t i n g • Ca s e In v e s t i g a t i o n / C o n t a c t Tr a c i n g Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 3 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ta s k Pa y m e n t *M a y Su p p o r t PH A B Nu m b e Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n an d / o r St a n d a r d s / M e a s u r e s r Am o u n t • Su s t a i n a b l e is o l a t i o n an d qu a r a n t i n e • Ca r e co o r d i n a t i o n • Su r g e ma n a g e m e n t • Da t a re p o r t i n g NO T E : Th e pu r p o s e of th i s ag r e e m e n t is to su p p l e m e n t ex i s t i n g fu n d s fo r lo c a l he a l t h ju r i s d i c t i o n s to ca r r y ou t su r v e i l l a n c e , ep i d e m i o l o g y , ca s e in v e s t i g a t i o n s & co n t a c t tr a c i n g , la b o r a t o r y ca p a c i t y , in f e c t i o n co n t r o l , mi t i g a t i o n , co m m u n i c a t i o n s , co m m u n i t y en g a g e m e n t , an d ot h e r pu b l i c he a l t h pr e p a r e d n e s s an d re s p o n s e ac t i v i t i e s fo r CO V I D - 1 9 . DC H S CO V I D - 1 9 Re s p o n s e - Ta s k s 1 an d 2 -U n s p e n t EL C fu n d i n g ca n be ca r r i e d fo r w a r d in t o ne w co n t r a c t te r m ef f e c t i v e Ja n u a r y 1, 20 2 2 . 1 Es t a b l i s h a bu d g e t pl a n an d na r r a t i v e to be su b m i t t e d to th e Su b m i t th e bu d g e t pl a n Wi t h i n 30 da y s of Re i m b u r s e m e n t of De p a r t m e n t of He a l t h (D O H ) Co n t r a c t Ma n a g e r . DO H wi l l an d na r r a t i v e us i n g th e re c e i v i n g an y ne w ac t u a l co s t s se n d th e "B u d g e t na r r a t i v e Te m p l a t e " , "B u d g e t Gu i d a n c e " te m p l a t e pr o v i d e d . aw a r d fo r DC H S in c u r r e d , no t to an d an y ot h e r ap p l i c a b l e do c u m e n t s th a t ma y be id e n t i f i e d . CO V I D - 1 9 Re s p o n s e ex c e e d $1 , 0 1 9 , 2 7 4 ta s k s . to t a l . DO H do e s re c o g n i z e th e pu b l i c he a l t h re s p o n s e go e s be y o n d De c e m b e r 20 2 1 an d au t h o r i z e s lo c a l he a l t h $2 5 2 , 0 3 6 BI T V - ju r i s d i c t i o n s th e ab i l i t y to ma x i m i z e fu n d i n g st r e a m s CO V I D ED LH J av a i l a b l e to th e m by us i n g sh o r t te r m fu n d i n g fi r s t to AL L O C A T I O N - ha v e lo n g e r te r m fu n d i n g av a i l a b l e to co n t i n u e to CA R E S Fu n d i n g su p p o r t th e lo c a l he a l t h ju r i s d i c t i o n re s p o n s e ac t i v i t i e s (M I 18 9 7 1 2 9 V ) be y o n d De c e m b e r 20 2 1 as ap p l i c a b l e . $5 3 0 , 1 6 1 FF Y 2 0 2 1) LH J Ac t i v e mo n i t o r i n g ac t i v i t i e s . In pa r t n e r s h i p wi t h Da t a co l l e c t e d an d En t e r pe r f o r m a n c e EL C ED E LH J WA DO H an d ne i g h b o r i n g Tr i b e s , th e LH J mu s t en s u r e re p o r t e d in t o DO H me t r i c s da i l y in t o DO H AL L O C A T I O N ad e q u a t e cu l t u r a l l y an d li n g u i s t i c a l l y re s p o n s i v e te s t i n g , sy s t e m s da i l y . id e n t i f i e d sy s t e m s Fu n d i n g in v e s t i g a t i o n an d co n t a c t tr a c i n g re s o u r c e s to li m i t th e (M I 18 9 7 1 2 0 9 E ) sp r e a d di s e a s e . LH J s mu s t co n d u c t th e fo l l o w i n g Qu a r t e r l y pe r f o r m a n c e Fu n d i n g en d da t e ac t i v i t i e s in ac c o r d a n c e wi t h th e gu i d a n c e to be pr o v i d e d re p o r t i n g up d a t e s 7/ 3 1 / 2 0 2 3 by DO H . 52 3 7 , 0 7 7 FF Ÿ l 9 a. Al l o c a t e en o u g h fu n d i n g to en s u r e th e fo l l o w i n g EL C CO V I D ED Co n t a c t Tr a c i n g an d Ca s e In v e s t i g a t i o n Su p p o r t : LH J Hi r e a mi n i m u m of 1. 0 da t a en t r y FT E to as s u r e AL L O C A T I O N sy s t e m re q u i r e m e n t s fo r ta s k 2. 1 . a · . Fu n d i n g i. Co n t a c t tr a c i n g En t e r al l co n t a c t tr a c m g (M I 18 9 7 1 2 9 G ) 1 St r i v e to ma i n t a i n th e ca p a c i t y to su r g e a da t a in CR E S T fo l l o w i n g Fu n d i n g en d da t e mi n i m u m of fi v e (5 ) co n t a c t tr a c e r s fo r gu i d a n c e fr o m - D O H . 10 / 1 8 / 2 0 2 2 ev e r y 10 0 , 0 0 0 pe o p l e in th e ju r i s d i c t i o n , as ne e d e d , ba s e d on di s e a s e ra t e s . DO H ce n t r a l i z e d in v e s t i g a t i o n s wi l l co u n t to w a r d s th i s mi n i m u m . I Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 4 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ta s k Pa y m e n t *M a y Su p p o r t PH A B Nu m b e Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n an d / o r St a n d a r d s / M e a s u r e s r Am o u n t 2. Ha v e st a f f th a t re f l e c t th e de m o g r a p h i c ma k e u p of th e ju r i s d i c t i o n an d wh o ca n pr o v i d e cu l t u r a l l y an d li n g u i s t i c a l l y co m p e t e n t an d re s p o n s i v e se r v i c e s . In ad d i t i o n , or al t e r n a t i v e l y , en t e r in t o an ag r e e m e n t ( s ) wi t h Tr i b a l , co m m u n i t y - ba s e d an d / o r cu l t u r a l l y - s p e c i f i c or g a n i z a t i o n s to pr o v i d e su c h se r v i c e s . DO H ce n t r a l i z e d in v e s t i g a t i o n s wi l l co u n t to w a r d s th i s mi n i m u m . 3. En s u r e al l co n t a c t tr a c i n g st a f f ar e tr a i n e d in ac c o r d a n c e wi t h DO H in v e s t i g a t i v e gu i d e l i n e s an d da t a en t r y pr o t o c o l s . 4. Co o r d i n a t e wi t h Tr i b a l pa r t n e r s in co n d u c t i n g co n t a c t tr a c i n g fo r Tr i b a l me m b e r s . 5. En s u r e co n t a c t tr a c i n g an d ca s e in v e s t i g a t i o n s ac t i v i t i e s me e t DO H ca s e an d Co n t a c t Tr a c i n g Me t r i c s . (M e t r i c s to be de t e r m i n e d co l l a b o r a t i v e l y by DO H , LH J s an d Tr i b e s . ) Wo r k wi t h DO H to de v e l o p a co r r e c t i v e ac t i o n pl a n if un a b l e to me e t me t r i c s . 6. Pe r f o r m da i l y mo n i t o r i n g fo r sy m p t o m s du r i n g qu a r a n t i n e pe r i o d of co n t a c t s En t e r al l ca s e ii . Ca s e in v e s t i g a t i o n in v e s t i g a t i o n da t a in 1. St r i v e to ma i n t a i n th e ca p a c i t y to su r g e a WD R S - f o l l o w i n g mi n i m u m of fi v e (5 ) ca s e in v e s t i g a t o r s an d gu i d a n c e fr o m - D O H . co n t a c t tr a c e r s fo r ev e r y 10 0 , 0 0 0 pe o p l e in th e ju r i s d i c t i o n , as ne e d e d , ba s e d on di s e a s e ra t e s . DO H ce n t r a l i z e d in v e s t i g a t i o n wi l l co u n t to w a r d th i s mi n i m u m . 2. En t e r al l ca s e in v e s t i g a t i o n an d ou t b r e a k da t a in WD R S fo l l o w i n g DO H gu i d a n c e . a) St r i v e to en t e r al l ca s e in v e s t i g a t i o n an d ou t b r e a k da t a in t o CR E S T as di r e c t e d by DO H . b) En s u r e al l st a f f de s i g n a t e d to ut i l i z e WD R S ha v e ac c e s s an d ar e tr a i n e d in | th e sy s t e m . Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 5 of 50 Co n t r a c t Nu m b e r CL H 1 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ta s k Pa y m e n t Nu m b e Ta s k / A c t i v i t y / D e s c r i p t i o n *M a y Su p p o r t PH A B De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n an d / o r St a n d a r d s / M e a s u r e s r Am o u n t c) In c l u d e if ne w po s i t i v e ca s e s ar e ti e d to a kn o w n ex i s t i n g po s i t i v e ca s e or in d i c a t e co m m u n i t y sp r e a d . d) Co n d u c t ca s e in v e s t i g a t i o n an d mo n i t o r ou t b r e a k s . e) Co o r d i n a t e wi t h Tr i b a l pa r t n e r s in co n d u c t i n g ca s e in v e s t i g a t i o n s fo r tr i b a l me m b e r s . 3. En s u r e co n t a c t tr a c i n g an d ca s e in v e s t i g a t i o n ac t i v i t i e s me e t DO H Ca s e an d Co n t a c t Tr a c i n g Me t r i c s . (M e t r i c s to be de t e r m i n e d co l l a b o r a t i v e l y by DO H , LH J s , an d Tr i b e s . ) Wo r k wi t h DO H to de v e l o p a co r r e c t i v e ac t i o n pl a n if un a b l e to me e t me t r i c s . Ma i n t a i n a cu r r e n t li s t of b. Te s t i n g en t i t i e s pr o v i d i n g i. Wo r k wi t h pa r t n e r s an d Tr i b e s to en s u r e CO V I D - 1 9 te s t i n g an d at te s t i n g is av a i l a b l e to ev e r y pe r s o n wi t h i n th e wh a t vo l u m e . Pr o v i d e ju r i s d i c t i o n me e t i n g cu r r e n t DO H cr i t e r i a fo r re p o r t s to DO H Co n t r a c t te s t i n g an d ot h e r lo c a l te s t i n g ne e d s . ma n a g e r on te s t i n g ii . Wo r k wi t h pa r t n e r s an d Tr i b e s to en s u r e lo c a t i o n s an d vo l u m e as te s t i n g is pr o v i d e d in a cu l t u r a l l y an d re q u e s t e d . li n g u i s t i c a l l y re s p o n s i v e ma n n e r wi t h an em p h a s i s on ma k i n g te s t i n g av a i l a b l e to di s p r o p o r t i o n a t e l y im p a c t e d co m m u n i t i e s an d as a pa r t of th e ju r i s d i c t i o n ' s co n t a c t tr a c i n g st r a t e g y . ii i . Ma i n t a i n a cu r r e n t li s t of en t i t i e s pr o v i d i n g CO V I D - 1 9 te s t i n g an d at wh a t vo l u m e . Pr o v i d e re p o r t s to DO H on te s t i n g lo c a t i o n s an d vo l u m e as re q u e s t e d . c. Su r v e i l l a n c e FT E su p p o r t at a mi n i m u m of .5 FT E Ep i d e m i o l o g i s t to su p p o r t da i l y re p o r t i n g ne e d s be l o w . i. En s u r e al l CO V I D po s i t i v e la b te s t re s u l t s fr o m LH J ar e en t e r e d in to WD R S by 1) en t e r i n g da t a di r e c t l y in to WD R S , 2) se n d i n g te s t re s u l t s to DO H to en t e r , or 3) wo r k i n g wi t h DO H an d en t i t i e s co n d u c t i n g te s t s to im p l e m e n t an el e c t r o n i c me t h o d fo r te s t re s u l t su b m i s s i o n . Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 6 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ta s k Pa y m e n t *M a y Su p p o r t PH A B Nu m b e Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n an d / o r St a n d a r d s / M e a s u r e s r Am o u n t ii . Ma i n t a i n re c o r d s of al l CO V I D ne g a t i v e la b te s t re s u l t s fr o m th e LH J an d en t e r in t o WD R S wh e n re s o u r c e s pe r m i t or se n d te s t re s u l t s to DO H . ii i . Co l l a b o r a t e wi t h Tr i b e s to en s u r e Tr i b a l en t i t i e s wi t h ap p r o p r i a t e pu b l i c he a l t h au t h o r i t y ha v e re a d / w r i t e ac c e s s to WD R S an d CR E S T to en s u r e th a t al l CO V I D la b re s u l t s fr o m th e i r ju r i s d i c t i o n s ar e en t e r e d in WD R S or sh a r e d wi t h th e LH J or DO H fo r en t r y . Qu a r t e r l y pe r f o r m a n c e d. Tr i b a l Su p p o r t . En s u r e al i g n m e n t of co n t a c t tr a c i n g up d a t e s re l a t e d to an d su p p o r t fo r pa t i e n t s an d fa m i l y by co o r d i n a t i n g cu l t u r a l l y an d li n g u i s t i c wi t h lo c a l tr i b e s if a pa t i e n t id e n t i f i e d as Am e r i c a n co m p e t e n c y an d In d i a n / A l a s k a Na t i v e an d / o r a me m b e r of a WA re s p o n s i v e n e s s , tr i b a l tr i b e . su p p o r t , in f e c t i o n pr e v e n t i o n an d co n t r o l fo r e. Su p p o r t In f e c t i o n Pr e v e n t i o n an d co n t r o l fo r hi g h - hi g h - r i s k po p u l a t i o n s , ri s k po p u l a t i o n s co m m u n i t y ed u c a t i o n an d i. Mi g r a n t an d se a s o n a l fa r m w o r k e r su p p o r t . re g i o n a l ac t i v e mo n i t o r i n g Pa r t n e r wi t h fa r m e r s , ag r i c u l t u r e se c t o r an d ac t i v i t i e s . Pe r f o r m a n c e fa r m w o r k e r se r v i c e or g a n i z a t i o n s to de v e l o p up d a t e sh o u l d in c l u d e an d ex e c u t e pl a n s fo r te s t i n g , qu a r a n t i n e an d st a t u s of al l pr o j e c t s is o l a t i o n , an d so c i a l se r v i c e ne e d s fo r mi g r a n t li s t e d . an d se a s o n a l fa r m w o r k e r s . ii . Co n g r e g a t e ca r e fa c i l i t i e s : In co l l a b o r a t i o n wi t h th e st a t e li c e n s i n g ag e n c y (D S H S ) , su p p o r t in f e c t i o n pr e v e n t i o n as s e s s m e n t s , te s t i n g . In f e c t i o n co n t r o l an d is o l a t i o n an d qu a r a n t i n e pr o t o c o l s in co n g r e g a t e ca r e fa c i l i t i e s . ii i . Hi g h ri s k bu s i n e s s e s or co m m u n i t y - b a s e d op e r a t i o n s . In co l l a b o r a t i o n wi t h st a t e li c e n s i n g ag e n c i e s an d La b o r an d In d u s t r i e s , pa r t n e r wi t h fo o d pr o c e s s i n g an d ma n u f a c t u r i n g bu s i n e s s e s to en s u r e ad e q u a t e pr a c t i c e s to pr e v e n t CO V I D - 1 9 ex p o s u r e , co n d u c t te s t i n g an d re s p o n d to ou t b r e a k s . iv . He a l t h c a r e : Su p p o r t in f e c t i o n pr e v e n t i o n an d co n t r o l as s e s s m e n t s , te s t i n g , co h o r t i n g , an d is o l a t i o n pr o c e d u r e s . Pr o v i d e ed u c a t i o n a l re s o u r c e s to a va r i e t y of he a l t h c a r e se t t i n g Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 7 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ta s k Pa y m e n t *M a y Su p p o r t PH A B Nu m b e Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n an d / o r St a n d a r d s / M e a s u r e s r Am o u n t ty p e s (e . g . , nu r s i n g ho m e s , ho s p i t a l s , de n t a l , di a l y s i s ) . v. No n - h e a l t h c a r e se t t i n g s th a t ho u s e vu l n e r a b l e po p u l a t i o n s : In co l l a b o r a t i o n wi t h st a t e co r r e c t i o n s ag e n c y (D O C ) an d ot h e r st a t e pa r t n e r s , su p p o r t te s t i n g , in f e c t i o n co n t r o l , is o l a t i o n an d qu a r a n t i n e an d so c i a l se r v i c e s an d wr a p a r o u n d su p p o r t s fo r in d i v i d u a l s li v i n g or te m p o r a r i l y re s i d i n g in co n g r e g a t e li v i n g se t t i n g s , in c l u d i n g de t e n t i o n ce n t e r s , pr i s o n s , ja i l s , tr a n s i t i o n ho u s i n g , ho m e l e s s sh e l t e r s , an d ot h e r vu l n e r a b l e po p u l a t i o n s . vi . Sc h o o l s : In co l l a b o r a t i o n wi t h OS P I an d lo c a l he a l t h ju r i s d i c t i o n s , su p p o r t in f e c t i o n pr e v e n t i o n an d co n t r o l an d ou t b r e a k re s p o n s e in K- 1 2 an d un i v e r s i t y sc h o o l se t t i n g s . f. En s u r e ad e q u a t e re s o u r c e s ar e di r e c t e d to w a r d s H2 A ho u s i n g fa c i l i t i e s wi t h i n co m m u n i t i e s , fi s h i n g in d u s t r i e s an d lo n g - t e r m ca r e fa c i l i t i e s to pr e v e n t an d co n t r o l di s e a s e tr a n s m i s s i o n . Fu n d s ca n be us e d to hi r e su p p o r t st a f f , pr o v i d e in c e n t i v e s or fa c i l i t y - ba s e d fu n d i n g fo r on s i t e in f e c t i o n pr e v e n t i o n ef f o r t s , et c . g. Co m m u n i t y ed u c a t i o n . Wo r k wi t h Tr i b e s an d pa r t n e r s to pr o v i d e cu l t u r a l l y an d li n g u i s t i c a l l y re s p o n s i v e co m m u n i t y ou t r e a c h an d ed u c a t i o n re l a t e d to CO V I D - 1 9 . h. Es t a b l i s h su s t a i n a b l e is o l a t i o n an d qu a r a n t i n e Qu a r t e r l y pe r f o r m a n c e me a s u r e s . up d a t e s to in c l u d e na m e , i. Ha v e at le a s t on e (1 ) lo c a t i o n id e n t i f i e d an d ad d r e s s an d ca p a c i t y of co n f i r m e d th r o u g h co n t r a c t / f o r m a l ag r e e m e n t id e n t i f i e d lo c a t i o n th a t th a t ca n su p p o r t is o l a t i o n an d qu a r a n t i n e ca n su p p o r t is o l a t i o n an d ad e q u a t e to th e po p u l a t i o n fo r yo u r ju r i s d i c t i o n qu a r a n t i n e , wi t h th e ab i l i t y to ex p a n d ; al t e r n a t i v e l y , es t a b l i s h wi t h an ad j a c e n t ju r i s d i c t i o n a fo r m a l an d co n f i r m a t i o n of ag r e e m e n t to pr o v i d e th e is o l a t i o n an d ap p r o p r i a t e pl a n n i n g an d qu a r a n t i n e ca p a c i t y ad e q u a t e to th e po p u l a t i o n co o r d i n a t i o n as re q u i r e d . fo r yo u r ju r i s d i c t i o n wi t h th e ab i l i t y to ex p a n d . Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 8 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ta s k Pa y m e n t *M a y Su p p o r t PH A B Nu m b e Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n an d / o r St a n d a r d s / M e a s u r e s r Am o u n t ii . Re p o r t ce n s u s nu m b e r s to ai n t a i n on g o i n g ce n s u s da t a fo r is o l a t i o n in c l u d e hi s t o r i c to t a l by an d qu a r a n t i n e fo r yo u r po p u l a t i o n . mo n t h an d mo n t h l y to t a l ii i . Pl a n n i n g mu s t in c o r p o r a t e tr a n s f e r or re c e i p t of fo r cu r r e n t qu a r t e r to is o l a t i o n an d qu a r a n t i n e pa t i e n t s to fr o m da t e . ad j a c e n t ju r i s d i c t i o n s or st a t e fa c i l i t i e s in th e ev e n t of lo c a l i z e d in c r e a s e d ne e d . iv . Pl a n n i n g mu s t in c o r p o r a t e tr i g g e r s an d co o r d i n a t i o n to re q u e s t st a t e is o l a t i o n an d qu a r a n t i n e su p p o r t ei t h e r th r o u g h mo b i l e te a m s or th e st a t e fa c i l i t y to in c l u d e si t e id e n t i f i c a t i o n an d ac c e s s CO V I D - 1 9 Va c c i n e Se r v i c e s - Ta s k 3 -- wi l l be ex t e n d e d th r o u g h Ju n e 30 , 20 2 2 in ne w co n t r a c t te r m ef f e c t i v e Ja n u a r y 1, 20 2 2 . An y un s p e n t fu n d s ma y be ca r r i e d fo r w a r d . 3. A Id e n t i f y ac t i v i t y / a c t i v i t i e s to su p p o r t CO V I D va c c i n e Su m m a r y of th e Ja n u a r y 31 , An n u a l l y Re i m b u r s e m e n t of re s p o n s e in yo u r co m m u n i t y , us i n g th e ex a m p l e s be l o w as a en g a g e m e n t st r a t e g i e s to ac t u a l co s t s gu i d e l i n e . be us e d wi t h he a l t h ca r e in c u r r e d , no t to Ex a m p l e 1: De v e l o p an d im p l e m e n t co m m u n i c a t i o n pr o v i d e r s an d ot h e r ex c e e d : st r a t e g i e s wi t h he a l t h ca r e pr o v i d e r s , co m m u n i t y , an d / o r pa r t n e r s , an d th e lo c a l l y ot h e r pa r t n e r s to he l p bu i l d va c c i n e co n f i d e n c e br o a d l y an d id e n t i f i e d po p u l a t i o n to be $1 4 , 5 8 2 FF Y 2 1 am o n g gr o u p s an t i c i p a t e d to re c e i v e ea r l y va c c i n a t i o n , as re a c h e d . CO V I D l 9 we l l as di s p e l va c c i n e mi s i n f o r m a t i o n . Do c u m e n t an d VA C C I N E pr o v i d e a pl a n th a t sh o w s th e co m m u n i c a t i o n st r a t e g i e s us e d SE R V I C E S - C A R E S wi t h he a l t h ca r e pr o v i d e r s an d ot h e r pa r t n e r s an d th e lo c a l l y Fu n d i n g id e n t i f i e d po p u l a t i o n an t i c i p a t e d to re a c h . (M I 74 3 1 0 2 0 9 ) Ex a m p l e 2: En g a g e in ot h e r va c c i n a t i o n pl a n n i n g ac t i v i t i e s $3 5 4 , 8 0 3 CO V I D l 9 su c h as pa r t n e r s h i p de v e l o p m e n t , pr o v i d e r ed u c a t i o n , VA C C I N E S fu n d i n g va c c i n a t i o n po i n t of di s p e n s i n g (P O D ) pl a n n i n g , ta b l e t o p (M I 74 3 1 0 2 2 9 ) ex e r c i s e s , en g a g e m e n t wi t h co m m u n i t i e s , le a d e r s , no n - tr a d i t i o n a l pr o v i d e r , or vu l n e r a b l e po p u l a t i o n s to de v e l o p st r a t e g i e s to en s u r e eq u i t a b l e ac c e s s to va c c i n a t i o n se r v i c e s 3. B Im p l e m e n t th e co m m u n i c a t i o n st r a t e g i e s or ot h e r ac t i v i t i e s , Mi d - t e r m wr i t t e n re p o r t Ju n e 30 , An n u a l l y wo r k i n g wi t h he a l t h ca r e pr o v i d e r s an d ot h e r pa r t n e r s to de s c r i b i n g xh i b i t A, E ta t e m e n t s of Wo r k Pa g e 9 of 50 Co n t r a c t Nu m b e r CL H 1 8 2 4 9 - 2 2 le v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ta s k Pa y m e n t *M a y Su p p o r t PH A B Nu m b e Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n an d / o r St a n d a r d s / M e a s u r e s r Am o u n t re a c h th e lo c a l l y id e n t i f i e d po p u l a t i o n , su p p o r t pr o v i d e r s in ac t i v i t y / a c t i v i t i e s an d va c c i n a t i o n pl a n s , an d su p p o r t eq u i t a b l e ac c e s s to pr o g r e s s ma d e to - d a t e an d va c c i n a t i o n se r v i c e s . st r a t e g i e s us e d (t e m p l a t e to be pr o v i d e d ) 3. C Ca t a l o g ac t i v i t i e s an d co n d u c t an ev a l u a t i o n of th e st r a t e g i e s Fi n a l wr i t t e n re p o r t , De c e m b e r 31 , An n u a l l y us e d sh o w i n g th e st r a t e g i e s us e d an d th e fi n a l pr o g r e s s of th e re a c h (t e m p l a t e to be pr o v i d e d ) Re g i o n a l In c i d e n t Ma n a g e m e n t Te a m (I M T ) Ma s s Va c c i n a t i o n Cl i n i c s - Ta s k 4 *N O T E : Ta s k 4 ac t i v i t i e s fo r Ma s s Va c c i n a t i o n Cl i n i c s *R e i m b u r s e m e n t of in th i s st a t e m e n t of wo r k ar e NO T CO N S I D E R E D el i g i b l e co s t s . SU B R E C I P I E N T bu t ar e as a CO N T R A C T O R of DO H . MA S S DO H re i m b u r s e m e n t pr o v i d e d fo r lo c a l ma s s VA C C I N A T I O N va c c i n a t i o n cl i n i c (s e e de f i n i t i o n be l o w ) pl a n n i n g , FE M A 10 0 % im p l e m e n t a t i o n an d op e r a t i o n s in co o r d i n a t i o n be t w e e n Fu n d i n g Un i f i e d Co m m a n d an d th e Re g i o n a l IM T to ad m i n i s t e r (M I 93 4 V O 2 0 0 ) th e va c c i n e as ef f i c i e n t l y , qu i c k l y , eq u i t a b l y , an d sa f e l y in al l re g i o n s of Wa s h i n g t o n St a t e . St a t e Su p p o r t e d , (S e e Pr o g r a m Re g i o n a l l y Co o r d i n a t e d , Lo c a l l y Im p l e m e n t e d . Sp e c i f i c Re q u i r e m e n t s fo r De f i n i t i o n : Ma s s va c c i n a t i o n cl i n i c s de f i n e d as th o s e Ma s s Va c c i n a t i o n ou t s i d e of th e us u a l he a l t h c a r e de l i v e r y . me t h o d su c h as Ta s k 4 be l o w ) po p - u p cl i n i c s , mo b i l e cl i n i c s , no n - cl i n i c a l fa c i l i t y (f a i r g r o u n d s , ar e n a s , et c . ) . Le a d e r s In t e n t ab o u t th i s wo r k fr o m DO H is in c l u d e d as an at t a c h m e n t . Gu i d a n c e on va c c i n a t i o n pr o t o c o l s mu s t be fo l l o w e d as pr o v i d e d by DO H an d CD C . 4. A Lo c a l he a l t h ju r i s d i c t i o n (L H J ) wi l l co o r d i n a t e pl a n n i n g an d Su b m i t to DO H a ma s s Wi t h i n 30 da y s of im p l e m e n t a t i o n of ma s s va c c i n a t i o n cl i n i c s / s i t e s pr o v i d e d va c c i n a t i o n pl a n co n t r a c t am e n d m e n t wi t h i n th e co u n t y ( s ) wi t h a re g i o n a l in c i d e n t ma n a g e m e n t in c l u d i n g : ex e c u t i o n . te a m / o r g a n i z a t i o n as ap p r o v e d by DO H . • ty p e of si t e , • si t e lo c a t i o n s , Re q u e s t fo r re g i o n a l IM T sh o u l d be su b m i t t e d th r o u g h th e • th r o u g h p u t , no r m a l pr o c e s s th r o u g h We b E O C - • co n s i d e r a t i o n s ma d e to en s u r e Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 10 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ta s k Pa y m e n t *M a y Su p p o r t PH A B Nu m b e Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n an d / o r St a n d a r d s / M e a s u r e s r Am o u n t Lo c a l he a l t h ju r i s d i c t i o n is th e co o r d i n a t i n g ag e n c y fo r th e eq u i t y to ma s s va c c i n a t i o n pl a n wi t h i n th e co u n t y . hi s t o r i c a l l y ma r g i n a l i z e d Re g i o n a l IM T wi l l be un d e r th e de l e g a t i o n au t h o r i t y of po p u l a t i o n s , DO H an d th e y ar e to pr o v i d e su p p o r t an d co o r d i n a t i o n fo r • an d to th e ex t e n t al l ef f o r t s ar o u n d va c c i n e pl a n n i n g , re s o u r c e su p p o r t an d po s s i b l e a ge n e r a l gu i d a n c e an d in f o r m a t i o n sh a r i n g in or d e r to re g i o n a l ma p of re g i o n a l l y co o r d i n a t e ef f o r t s . Lo c a l ju r i s d i c t i o n s wi l l si t e s / l o c a t i o n s . ma i n t a i n al l de c i s i o n a l au t h o r i t y ar o u n d va c c i n a t i o n pl a n n i n g an d ex e c u t i o n wi t h i n th e i r ju r i s d i c t i o n / d i s t r i c t . Pr o v i d e an y in f o r m a t i o n as re q u e s t e d by th e re g i o n a l IM T . 4. B Fu n d i n g fo r el i g i b l e Ma s s Va c c i n a t i o n ac t i v i t i e s ar e Su b m i t es t i m a t e d bu d g e t Wi t h i n 30 da y s of re i m b u r s e d on ac t u a l co s t s as ou t l i n e d in th e DO H gu i d a n c e fo r th e ma s s va c c i n a t i o n co n t r a c t am e n d m e n t to pr o v i d e th e se r v i c e s an d to ca r r y ou t th e mi s s i o n . Fu n d i n g pl a n . ex e c u t i o n . wi l l be de p e n d e n t on fu l l pa r t i c i p a t i o n in th e LH J an d IM T pr o c e s s e s an d al l do c u m e n t a t i o n wi l l be re q u i r e d to be Mo n t h l y Co s t Su m m a r y Mo n t h l y pr o v i d e d to fu l l y cl o s e ou t fu n d i n g re q u e s t s by th e en d of th e Sp r e a d s h e e t to th e mi s s i o n pe r i o d of pe r f o r m a n c e . IM T / I M O by th e fi f t h of th e fo l l o w i n g mo n t h . Al l o w a b l e co s t s in c l u d e ex p e n s e s su c h as fa c i l i t y re n t a l s , st a f f to co n d u c t pl a n n i n g , ma n a g e m e n t , su p p o r t an d op e r a t i o n of th e si t e , me d i c a l pe r s o n n e l fo r va c c i n a t i o n s , si t e se c u r i t y pe r s o n n e l , wr a p ar o u n d se r v i c e s fo r st a f f (m e a l s , tr a v e l , lo d g i n g ) , eq u i p m e n t (w h i c h mu s t be pr e - a p p r o v e d by IM T / D O H if it ex c e e d s $5 , 0 0 0 ea c h ) , su p p l i e s fo r va c c i n a t i o n s an d si t e op e r a t i o n . LH J s sh o u l d pr o v i d e na r r a t i v e s to he l p as s i s t IM T an d DO H fi n a n c e kn o w wh a t ex p e n d i t u r e s we r e ne c e s s a r y to ca r r y ou t th e mi s s i o n . 4. C Va c c i n a t i o n da t a - wi l l be ma i n t a i n e d ac c o r d i n g to cu r r e n t Su b m i s s i o n of va c c i n e Da i l y st a t e an d fe d e r a l re q u i r e m e n t s . us e in t o WA II S da t a b a s e wi t h i n 24 h r s of us e . Va c c i n e Re g i s t r a t i o n Sy s t e m s - If a lo c a l ju r i s d i c t i o n or Ju r i s d i c t i o n / R e g i o n s wi l l re g i o n do e s no t ha v e a re g i s t r a t i o n sy s t e m ( s ) th e in c l u d e en s u r e a fa i r an d eq u i t a b l e in t e r n e t ba s e d , ph o n e op t i o n an d ot h e r me t h o d s to en s u r e pr o c e s s fo r re g i s t r a t i o n of eq u i t a b l e re g i s t r a t i o n , th e st a t e Pr e p M o d sy s t e m an d to o l s el i g i b l e Wa s h i n g t o n i a n s wi l l be av a i l a b l e fo r us e . ac r o s s al l av a i l a b l e mo d a l i t i e s . Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 11 of 50 Co n t r a c t Nu m b e r CL H 1 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ta s k Pa me n t *M a y Su p p o r t PH A B Nu m b e Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n an d / o r St a n d a r d s / M e a s u r e s r Am o u n t 4. D Re g u l a r l y re p o r t on va c c i n a t i o n s si t e s an d op e r a t i o n a l Pr o v i d e mo n t h l y si t u a t i o n Mo n t h l y ac t i v i t i e s (n u m b e r of va c c i n a t i o n s , pe r s o n n e l to op e r a t e th e re p o r t to IM T / I M O on si t e , ch a l l e n g e s , su c c e s s e s to sh a r e fo r le a r n i n g ac r o s s th e st a t u s of im p l e m e n t a t i o n pu b l i c he a l t h sy s t e m ) . of ma s s va c c i n a t i o n pl a n , or mo r e fr e q u e n t l y if th a t is th e LH J pr o c e d u r e . Si t e s op e r a t i n g fo r th e ti m e pe r i o d , va c c i n e s ad m i n i s t e r e d by si t e fo r th e ti m e pe r i o d , es t i m a t e d co s t s fo r th e ti m e pe r i o d , an y ch a l l e n g e s / s u c c e s s e s of no t e , in c l u d i n g as s i s t a n c e re q u e s t e d . *F o r In f o r m a t i o n On l y : Fu n d i n g is no t ti e d to th e re v i s e d St a n d a r d s / M e a s u r e s li s t e d he r e . Th i s in f o r m a t i o n ma y be he l p f u l in di s c u s s i o n s of ho w pr o g r a m ac t i v i t i e s mi g h t co n t r i b u t e to me e t i n g a St a n d a r d / M e a s u r e . Mo r e de t a i l on th e s e an d / o r ot h e r Pu b l i c He a l t h Ac c r e d i t a t i o n Bo a r d (P H A B ) St a n d a r d s / M e a s u r e s th a t ma y ap p l y ca n be fo u n d at : ht t p : / / w w w . p h a b o a r d . o r g / w p - c o n t e n t l u p l o a d s / P H AB - S t a n d a r d s - a n d - M e a s u r e s - V e r s i o n - L O . p d f Sp e c i a l Re q u i r e m e n t s Fe d e r a l Fu n d i n g Ac c o u n t a b i l i t y an d Tr a n s p a r e n c y Ac t (F F A T A ) Th i s st a t e m e n t of wo r k is su p p o r t e d by fe d e r a l fu n d s th a t re q u i r e co m p l i a n c e wi t h th e Fe d e r a l Fu n d i n g Ac c o u n t a b i l i t y an d Tr a n s p a r e n c y Ac t (F F A T A or th e Tr a n s p a r e n c y Ac t ) . Th e pu r p o s e of t h e Tr a n s p a r e n c y Ac t is to ma k e in f o r m a t i o n av a i l a b l e on l i n e so th e pu b l i c ca n se e ho w th e fe d e r a l fu n d s ar e sp e n t . To co m p l y wi t h th i s ac t an d be el i g i b l e to pe r f o r m th e ac t i v i t i e s in th i s st a t e m e n t of wo r k , th e LH J mu s t ha v e a Da t a Un i v e r s a l Nu m b e r i n g Sy s t e m (D U N S ® ) nu m b e r . In f o r m a t i o n ab o u t th e LH J an d th i s st a t e m e n t of wo r k wi l l be ma d e av a i l a b l e on US A S p e n d i n a . g o v by DO H as re q u i r e d by P. L . 10 9 - 2 8 2 . Pr o g r a m Sp e c i f i c Re q u i r e m e n t s / N a r r a t i v e BI T V - C O V I D ED LH J AL L O C A T I O N - C A R E S DC H S CO V I D - 1 9 Re s p o n s e - Ta s k s 1 an d 2 FF Y l 9 EL C CO V I D ED LH J AL L O C A T I O N FF Y 2 0 EL C ED E LH J AL L O C A T I O N FF Y 2 1 CO V I D 19 VA C C I N E SE R V I C E S - C A R E S CO V I D - 1 9 Va c c i n e Se r v i c e s - Ta s k 3 CO V I D 19 VA C C I N E S Re g i o n a l In c i d e n t Ma n a g e m e n t Te a m (I M T ) Ma s s Va c c i n a t i o n Cl i n i c s -- Ta s k MA S S VA C C I N A T I O N FE M A 10 0 % 4 Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 12 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 DC H S CO V I D - 1 9 Re s p o n s e - Ta s k s 1 an d 2 Re s t r i c t i o n s on Fu n d s : In d i r e c t s ar e NO T al l o w a b l e fo r CA R E S fu n d i n g fr o m Se p t e m b e r 2, 20 2 0 fo r w a r d -L H J ca n ch a r g e ad m i n i s t r a t i v e ac t i v i t i e s as di r e c t co s t s bu t no t in c u r in d i r e c t s fr o m Se p t e m b e r 2, 20 2 0 th r o u g h De c e m b e r 29 , 20 2 0 31 , 20 2 1 fo r ac t i v i t i e s fu n d e d wi t h CA R E S fu n d s (C O V I D LO C A L CA R E S - CO V I D LH J OF M AL L O C A T I O N - C A R E S , BI T V - C O V I D ED LH J AL L O C A T I O N - C A R E S , FE M A - 7 5 CO V I D LH J AL L O C A T I O N ) o Si n c e th e fe d e r a l gu i d a n c e wa s no t up d a t e d un t i l Se p t e m b e r 2, 20 2 0 , DO H un d e r s t a n d s th a t in d i r e c t s co u l d be ch a r g e d fr o m Ma r c h - A u g u s t , 20 2 0 . Pa y m e n t : Up o n ap p r o v a l of de l i v e r a b l e s an d re c e i p t of an in v o i c e vo u c h e r , DO H wi l l re i m b u r s e fo r ac t u a l al l o w a b l e co s t s in c u r r e d . Bi l l i n g s fo r se r v i c e s on a mo n t h l y fr a c t i o n of th e bu d g e t wi l l no t be ac c e p t e d or ap p r o v e d . Su b m i s s i o n of In v o i c e Vo u c h e r s : Th e LH J sh a l l su b m i t co r r e c t mo n t h l y A1 9 - 1 A in v o i c e vo u c h e r s fo r am o u n t s bi l l a b l e un d e r th i s st a t e m e n t of wo r k to DO H by th e 25 t h of t h e fo l l o w i n g mo n t h or on a fr e q u e n c y no le s s of t e n th a n qu a r t e r l y . CO V I D - 1 9 Va c c i n e Se r v i c e s - Ta s k 3- a l l o w a b l e ac t i v i t i e s ht t p s : / / w w w . d o h . w a go v / P o r t a l s / 1 / D o c u m e n t s / 9 2 4 0 / A l l o w a b l e U s e F e d O o s F u n d s . p d f Ma s s Va c c i n a t i o n - Ta s k 4 Pr o g r a m Ma n u a l , Ha n d b o o k , Po l i c y Re f e r e n c e s Em e r g e n c y Re s p o n s e Pl a n (o r eq u i v a l e n t ) Me d i c a l Co u n t e r m e a s u r e / M a s s Va c c i n a t i o n Pl a n Re s t r i c t i o n s on Fu n d s (w h a t fu n d s ca n be us e d fo r wh i c h ac t i v i t i e s , no t di r e c t pa y m e n t s , et c . ) : No n - m a s s va c c i n a t i o n ef f o r t s ar e no t al l o w a b l e th r o u g h th i s fu n d i n g st r e a m . Du p l i c a t i o n of bi l l i n g (s e n d i n g re q u e s t fo r re i m b u r s e m e n t ) to en t i t i e s ou t s i d e of th i s ag r e e m e n t is pr o h i b i t e d . In d i r e c t ra t e s ar e no t ap p l i c a b l e to th e s e fu n d s . Sp e c i a l Re f e r e n c e s (R C W s , WA C s , et c . ) Co u n t y He a l t h Em e r g e n c y Do c u m e n t a t i o n if ap p l i c a b l e Mo n i t o r i n g Vi s i t s (f r e q u e n c y , ty p e ) : Oc c a s i o n a l vi s i t s fr o m DO H or IM T / I M O pe r s o n n e l fo r th e pu r p o s e of mo n i t o r i n g an d su r v e i l l a n c e of ma s s va c c i n a t i o n ac t i v i t i e s ma y be ex p e c t e d . De f i n i t i o n s Ma s s va c c i n a t i o n cl i n i c ar e th o s e ou t s i d e of th e us u a l he a l t h c a r e de l i v e r y me t h o d s su c h as po p - u p cl i n i c s , mo b i l e cl i n i c s , no n - c l i n i c a l fa c i l i t y cl i n i c s (i . e . , fa i r g r o u n d s , ar e n a s , et c . ) . Sp e c i a l Bi l l i n g Re q u i r e m e n t s : Mo n t h l y in v o i c e s mu s t be su b m i t t e d ti m e l y to th e re g i o n a l IM T / O r g a n i z a t i o n fo r re v i e w l a p p r o v a l pr i o r to su b m i s s i o n to DO H fo r re i m b u r s e m e n t . Co n t r a c t (M I ) Co d e : 93 4 V O 2 0 0 Ge n e r a l Ma s s Va c c i n a t i o n BA R S Re v e n u e Co d e : 33 3 . 9 7 . 0 3 Ma s s Va c c i n a t i o n Re i m b u r s e m e n t Sp e c i a l In s t r u c t i o n s : Th e LH J is co n s i d e r e d a CO N T R A C T O R of DO H no t a su b r e c i p i e n t fo r th i s po r t i o n of th e st a t e m e n t of wo r k . An al l o c a t i o n of fu n d s is no t pr o v i d e d as th e s e FE M A fu n d s ar e on l y av a i l a b l e as re i m b u r s e m e n t of co s t s as s o c i a t e d wi t h im p l e m e n t a t i o n of th e ma s s va c c i n a t i o n pl a n . De t a i l e d do c u m e n t a t i o n mu s t be ma i n t a i n e d as di r e c t e d by th e re g i o n a l IM T / O r g a n i z a t i o n an d DO H to su b s t a n t i a t e co s t s as s o c i a t e d wi t h th e s e ac t i v i t i e s fo r su b m i s s i o n to FE M A up o n re q u e s t by DO H . Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 13 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 El i g i b l e co s t s fr o m th e ti m e f r a m e of Ja n u a r y 21 , 20 2 1 th r o u g h Al s 22 2f D I De c e m b e r 31 , 20 2 1 in c l u d e fa c i l i t y re n t a l s , me d i c a l an d su p p o r t st a f f fo r pl a n n i n g , ma n a g e m e n t , su p p o r t , an d op e r a t i o n s ; as we l l as wr a p - a r o u n d se r v i c e s fo r st a f f (i . e . , me a l s , tr a v e l , lo d g i n g ) . Re g u l a r an d ov e r t i m e pa y as s o c i a t e d wi t h th i s pr o j e c t is al l o w a b l e fo r al l st a f f wo r k i n g un d e r th i s pr o j e c t an d mu s t be bi l l e d as a di r e c t ch a r g e ; ti m e s h e e t s ar e re q u i r e d do c u m e n t a t i o n an d mu s t be av a i l a b l e up o n re q u e s t by DO H . In d i r e c t ra t e s ar e no t ap p l i c a b l e to th e s e fu n d s . El i g i b l e eq u i p m e n t in c l u d e s fa c i l i t y in f e c t i o n co n t r o l me a s u r e s , pe r s o n a l pr o t e c t i v e eq u i p m e n t (P P E ) , st o r a g e eq u i p m e n t , co o l e r s , fr e e z e r s , te m p e r a t u r e mo n i t o r i n g de v i c e s , po r t a b l e va c c i n e un i t s fo r tr a n s p o r t a t i o n , su p p l i e s su c h as em e r g e n c y me d i c a l su p p l i e s (f o r em e r g e n c y me d i c a l ca r e ne e d s th a t ma y ar i s e in th e ad m i n i s t r a t i o n of th e va c c i n e ) , co n t a i n e r s fo r me d i c a l wa s t e , as we l l as pr o p e r st o r a g e as ne e d e d fo r ca n i s t e r s of li q u i d ni t r o g e n or dr y ic e . El i g i b l e eq u i p m e n t pu r c h a s e co s t s sh o u l d no t ex c e e d $5 , 0 0 0 pe r pi e c e . Eq u i p m e n t ov e r $5 , 0 0 0 a pi e c e mu s t be pr e a p p r o v e d by th e IM T an d sh o u l d be le a s e d ra t h e r th a n pu r c h a s e d . An y di v e r s i o n fr o m th e li s t of pr e - a p p r o v e d ex p e n s e s wi l l re q u i r e a na r r a t i v e on th e pu r c h a s e ra t i o n a l e an d wi l l be su b j e c t to IM T ap p r o v a l pr i o r to re i m b u r s e m e n t . Ti m e s h e e t s ar e re q u i r e d do c u m e n t a t i o n fo r al l ac t i v i t i e s re l a t e d to th i s pr o j e c t . St a f f ti m e - i n / ti m e - o u t mu s t be re c o r d e d , as we l l as a br i e f de s c r i p t i o n of th e i r ac t i v i t i e s . A ge n e r a l de s c r i p t i o n of ac t i v i t i e s is ac c e p t a b l e fo r th o s e wo r k i n g at th e va c c i n e si t e ; mo r e de t a i l e d / s p e c i f i c de s c r i p t i o n is re q u i r e d fo r th o s e no t wo r k i n g at th e va c c i n e si t e . DO H Pr o g r a m Co n t a c t Al y s s a La v i n , LH J Co n t r a c t Ma n a g e r DO H , PH O C I S 16 1 0 NE 15 0 * St , Sh o r e l i n e , WA 98 1 5 5 al v s s a . l a v i n @ d o h . w a . g o v / 36 0 - 2 3 6 - 3 2 7 3 DO H BI T V - C O V I D ED LH J Al l o c a t i o n - C A R E S an d DO H EL C Al l o c a t i o n Fi s c a l Co n t a c t (T a s k s 1 an d 2) Ch r i s t i e Du r k i n DO H , Of f i c e of Pr o g r a m Fi n a n c i a l Ma n a g e m e n t PO Bo x 47 8 4 0 , Ol y m p i a , WA 98 5 0 4 - 7 8 4 1 Ph : 36 0 - 2 3 6 - 4 2 3 5 / ch r i s t i e . d u r k i n @ d o h . w a . g o v DO H CO V I D 1 9 Va c c i n e Se r v i c e s Pr o g r a m Co n t a c t s (T a s k 3) Ta w n e y Ha r p e r , MP A So n j a Mo r r i s , CO V I D - 1 9 Op e r a t i o n s Su p e r v i s o r De p u t y Di r e c t o r | Op e r a t i o n s Ma n a g e r En h a n c e d In f l u e n z a an d CO V I D - 1 9 Re s p o n s e Of f i c e of Im m u n i z a t i o n an d Ch i l d Pr o f i l e Of f i c e of Im m u n i z a t i o n an d Ch i l d Pr o f i l e De p a r t m e n t of He a l t h De p a r t m e n t of He a l t h PO Bo x 47 8 4 3 , Ol y m p i a WA 98 5 0 4 - 7 8 4 3 PO Bo x 47 8 4 3 , Ol y m p i a , WA 98 5 0 4 - 7 8 4 3 ta w n e y . h a r p e r @ d o h . w a . g o v / 36 0 - 2 3 6 - 3 5 2 5 so n i a . m o r r i s do h . w a . e o v / 36 0 - 2 3 6 - 3 5 4 5 DO H Ge n e r a l Ma s s Va c c i n a t i o n Pr o g r a m an d Fi s c a l Co n t a c t (T a s k 4) Pa t r i c k Pl u m b Ja n i c e Ba u m g a r d t CO V I D FE M A Pr o j e c t Ma n a g e m e n t An a l y s t Fi n a n c i a l Op e r a t i o n s Ma n a g e r Wa s h i n g t o n St a t e De p a r t m e n t of He a l t h Wa s h i n g t o n St a t e De p a r t m e n t of He a l t h Of f i c e of Fi n a n c i a l Se r v i c e s Of f i c e of Fi n a n c i a l Se r v i c e s 11 1 Is r a e l Ro a d SE , Tu m w a t e r , WA 98 5 0 1 11 1 Is r a e l Ro a d SE , Tu m w a t e r , WA 98 5 0 1 pa t r i c k . p l u m b @ d o h . w a . g o v / (3 6 0 ) 23 6 - 4 2 9 1 ia n i c e . b a u m e a r d t do h . w a . a o v / (3 6 0 ) 23 6 - 4 5 0 5 Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 14 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ex h i b i t A St a t e m e n t of Wo r k Co n t r a c t Te r m : 20 1 8 - 2 0 2 1 DO H Pr o g r a m Na m e or Ti t l e : Em e r g e n c y Pr e p a r e d n e s s & Re s p o n s e - P H E P - Lo c a l He a l t h Ju r i s d i c t i o n Na m e : Ki t t i t a s Co u n t y Pu b l i c He a l t h De p a r t m e n t Ef f e c t i v e Ju l v 1, 20 2 1 Co n t r a c t Nu m b e r : CL H l 8 2 4 9 SO W Ty p e : Or i g i n a l Re v i s i o n # (f o r th i s SO W ) Fu n d i n g So u r c e Fe d e r a l Co m p l i a n c e Ty p e of Pa y m e n t Fe d e r a l Su b r e c i p i e n t (c h e c k if ap p l i c a b l e ) Re i m b u r s e m e n t Pe r i o d of Pe r f o r m a n c e : Ju l v 1, 20 2 1 th r o u g h De c e m b e r 31 , 20 2 1 St a t e FF A T A (T r a n s p a r e n c y Ac t ) Fi x e d Pr i c e Ot h e r Re s e a r c h & De v e l o p m e n t St a t e m e n t of Wo r k Pu r p o s e : Th e pu r p o s e of th i s st a t e m e n t of wo r k is to es t a b l i s h fu n d i n g an d ta s k s to su p p o r t an d su s t a i n LH J pu b l i c he a l t h em e r g e n c y pr e p a r e d n e s s as pa r t of st a t e w i d e pu b l i c he a l t h em e r g e n c y pr e p a r e d n e s s an d re s p o n s e . Re v i s i o n Pu r p o s e : NA NO T E : Th e cu r r e n t co n s o l i d a t e d co n t r a c t en d s De c e m b e r 31 , 20 2 1 . On c e a ne w co n t r a c t is in pl a c e , Ja n u a r y 1, 20 2 2 , th e pr o g r a m pl a n s to su b m i t a ne w st a t e m e n t of wo r k th r o u g h Ju n e 30 , 20 2 2 . De l i v e r a b l e du e da t e s af t e r De c e m b e r 31 , 20 2 1 ar e re f e r e n c e d fo r in f o r m a t i o n a l pu r p o s e s on l y an d wi l l be up d a t e d in th e Ja n u a r y - Ju n e 20 2 2 st a t e m e n t of wo r k . Th i s st a t e m e n t of wo r k (e n d i n g 12 / 3 1 / 2 1 ) in c l u d e s 60 % of th e to t a l al l o c a t i o n of th e s e fu n d s . Th e Ja n u a r y - Ju n e 20 2 2 st a t e m e n t of wo r k wi l l re f l e c t th e re m a i n i n g 40 % . On c e al l in v o i c e s ha v e be e n su b m i t t e d an d ba l a n c e s ar e re c o n c i l e d fo r th i s st a t e m e n t of wo r k (e n d i n g 12 / 3 1 / 2 1 ) , an y re m a i n i n g fu n d s wi l l be ad d e d to a re v i s e d Ja n u a r y - Ju n e 20 2 2 st a t e m e n t of wo r k . Ch a r t of Ac c o u n t s Pr o g r a m Na m e or Ti t l e CF D A # BA R S Ma s t e r Fu n d i n g Pe r i o d Cu r r e n t Ch a n g e To t a l Re v e n u e In d e x (L H J Us e On l y ) Co n s i d e r a t i o n Co n s i d e r a t i o n In c r e a s e (+ ) Co d e Co d e St a r t Da t e En d Da t e FF Y 2 1 PH E P BP 3 LH J Fu n d i n g 93 . 0 6 9 | 33 3 . 9 3 . 0 6 31 1 0 2 3 8 0 07 / 0 1 / 2 1 12 / 3 1 / 2 1 _ 0 29 , 4 8 0 29 , 4 8 0 TO T A L S 0 29 , 4 8 0 29 , 4 8 0 Pa y m e n t Ta s k *M a y Su p p o r t PH A B Du e Da t e / T i m e Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s In f o r m a t i o n an d / o r Nu m b e r St a n d a r d s / M e a s u r e s Fr a m e Am o u n t 1 Ac r o s s Do m a i n s an d Ca p a b i l i t i e s Mi d - y e a r re p o r t on te m p l a t e De c e m b e r 31 , 20 2 1 Re i m b u r s e m e n t fo r pr o v i d e d by DO H . ac t u a l co s t s no t to Co m p l e t e re p o r t i n g te m p l a t e s as re q u e s t e d by ex c e e d to t a l fu n d i n g DO H to co m p l y wi t h pr o g r a m an d fe d e r a l gr a n t En d - o f - y e a r re p o r t on te m p l a t e Ju n e 30 , 20 2 2 co n s i d e r a t i o n am o u n t . re q u i r e m e n t s , in c l u d i n g mi d - y e a r an d en d - o f - y e a r pr o v i d e d by DO H . re p o r t s . Ad d i t i o n a l re p o r t i n g ma y be re q u i r e d if fe d e r a l re q u i r e m e n t s ch a n g e . Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 15 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Pa y m e n t Ta s k *M a y Su p p o r t PH A B Du e Da t e / T i m e Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s In f o r m a t i o n an d / o r Nu m b e r St a n d a r d s / M e a s u r e s Fr a m e Am o u n t 2 Ac r o s s Do m a i n s an d Ca p a b i l i t i e s Su b m i t in f o r m a t i o n by Au g u s t 1, Au g u s t 1, 20 2 1 20 2 1 an d an y ch a n g e s wi t h i n 30 2. 1 Su b m i t na m e s , po s i t i o n ti t l e s , em a i l ad d r e s s e s da y s of th e ch a n g e . an d ph o n e nu m b e r s of ke y LH J st a f f re s p o n s i b l e fo r th i s st a t e m e n t of wo r k , in c l u d i n g ma n a g e m e n t , Mi d - y e a r re p o r t on te m p l a t e De c e m b e r 31 , 20 2 1 Em e r g e n c y Re s p o n s e Co o r d i n a t o r , an d ac c o u n t i n g pr o v i d e d by DO H . No t e an y an d / o r fi n a n c i a l st a f f . ch a n g e s or no ch a n g e . 2. 2 Su b m i t em e r g e n c y co n t a c t s to be pu b l i s h e d in En d - o f - y e a r re p o r t on te m p l a t e Ju n e 30 , 20 2 2 th e co n f i d e n t i a l Ye l l o w Bo o k , in c l u d i n g bu t no t pr o v i d e d by DO H . No t e an y li m i t e d to Ad m i n i s t r a t o r , He a l t h Of f i c e r , an d ch a n g e s or no ch a n g e . Em e r g e n c y Re s p o n s e Co o r d i n a t o r . Fo r ea c h co n t a c t in c l u d e na m e , ro l e , em a i l , da y t i m e ph o n e nu m b e r an d af t e r ho u r s ph o n e nu m b e r . 3 Ac r o s s Do m a i n s an d Ca p a b i l i t i e s DO H wi l l ma i n t a i n do c u m e n t a t i o n Up o n re q u e s t fr o m of si t e vi s i t pa r t i c i p a t i o n . DO H . Pa r t i c i p a t e in a si t e vi s i t wi t h DO H st a f f to di s c u s s LH J re s p o n s e ca p a b i l i t i e s , up o n re q u e s t fr o m DO H . Si t e vi s i t ma y be he l d vi r t u a l l y du e to pa n d e m i c re s t r i c t i o n s . 4 Ac r o s s Do m a i n s an d Ca p a b i l i t i e s Bu d g e t , us i n g te m p l a t e pr o v i d e d Up o n re q u e s t fr o m by DO H . DO H . De v e l o p a bu d g e t de m o n s t r a t i n g ho w th e LH J pl a n s to sp e n d fu n d s du r i n g th i s pe r i o d of pe r f o r m a n c e , us i n g a bu d g e t te m p l a t e pr o v i d e d by DO H . No t e : 20 % of th e LH J ' s an n u a l al l o c a t i o n wi l l be wi t h h e l d un t i l th i s re q u i r e m e n t is me t . Fa i l u r e to me e t th i s re q u i r e m e n t ma y re s u l t in DO H re d i r e c t i n g fu n d s fr o m th e LH J . 5 Ac r o s s Do m a i n s an d Ca p a b i l i t i e s Mi d - y e a r re p o r t on te m p l a t e De c e m b e r 31 , 20 2 1 pr o v i d e d by DO H . Re v i e w an d pr o v i d e in p u t to DO H on pu b l i c he a l t h em e r g e n c y pr e p a r e d n e s s pl a n s de v e l o p e d by DO H , En d - o f - y e a r re p o r t on te m p l a t e Ju n e 30 , 20 2 2 up o n re q u e s t fr o m DO H . pr o v i d e d by DO H . In p u t pr o v i d e d to DO H up o n re q u e s t fr o m DO H . Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 16 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Pa y m e n t Ta s k *M a y Su p p o r t PH A B Du e Da t e / T i m e Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s In f o r m a t i o n an d / o r Nu m b e r St a n d a r d s / M e a s u r e s Fr a m e Am o u n t 6 Do m a i n l Co m m u n i t y Re s i l i e n c e Mi d - y e a r re p o r t on te m p l a t e De c e m b e r 31 , 20 2 1 Ca p a b i l i t y 1 Co m m u n i t y Pr e p a r e d n e s s pr o v i d e d by DO H . Pa r t i c i p a t e in em e r g e n c y pr e p a r e d n e s s ev e n t s (f o r En d - o f - y e a r re p o r t on te m p l a t e Ju n e 30 , 20 2 2 ex a m p l e , tr a i n i n g s , me e t i n g s , co n f e r e n c e ca l l s , an d pr o v i d e d by DO H . co n f e r e n c e s ) to ad v a n c e LH J , re g i o n a l , or st a t e w i d e pu b l i c he a l t h pr e p a r e d n e s s . Do c u m e n t a t i o n of tr a i n i n g av a i l a b l e up o n re q u e s t . 7 Ac r o s s Do m a i n s an d Ca p a b i l i t i e s Mi d - y e a r re p o r t on te m p l a t e De c e m b e r 31 , 20 2 1 pr o v i d e d by DO H . No t e tr a i n i n g DO H / E P R an t i c i p a t e s ma n y ch a n g e s in th e ne x t an d br i e f l y de s c r i b e ke y le a r n i n g mo n t h s to ye a r s as we in c o r p o r a t e le s s o n s le a r n e d an d an y re s u l t i n g ch a n g e s in fr o m th e CO V I D - 1 9 re s p o n s e . In pr e p a r a t i o n fo r pr a c t i c e an d / o r po l i c y . th e s e ch a n g e s , th e LH J ma y us e PH E P fu n d i n g to pa r t i c i p a t e in tr a i n i n g an d / o r le a r n i n g di s c u s s i o n s En d - o f - y e a r re p o r t on te m p l a t e Ju n e 30 , 20 2 2 in th e fo l l o w i n g ar e a s : pr o v i d e d by DO H . No t e tr a i n i n g • Ad a p t i v e Le a d e r s h i p an d br i e f l y de s c r i b e ke y le a r n i n g • Ch a n g e Ma n a g e m e n t an d an y re s u l t i n g ch a n g e s in • Tr a u m a - I n f o r m e d Ch a n g e Ma n a g e m e n t pr a c t i c e an d / o r po l i c y . • Ou t w a r d Mi n d s e t • Gr o w t h Mi n d s e t • Ra c i a l Eq u i t y an d / o r So c i a l Ju s t i c e • Co m m u n i t y Re s i l i e n c e • Re l a t e d to p i c s - pr i o r ap p r o v a l fr o m EP R re q u i r e d . No t e : Pr i o r ap p r o v a l fr o m DO H / E P R is re q u i r e d fo r an y ou t - o f - s t a t e tr a v e l . 8 Do m a i n 1 Co m m u n i t y Re s i l i e n c e Mi d - y e a r re p o r t on te m p l a t e De c e m b e r 31 , 20 2 1 Ca p a b i l i t y 1 Co m m u n i t y Pr e p a r e d n e s s pr o v i d e d by DO H . Br i e f l y Co n n e c t wi t h ne w an d / o r ex i s t i n g pa r t n e r s in or d e r de s c r i b e co n n e c t i o n s , le s s o n s to de v e l o p wo r k i n g re l a t i o n s h i p s th a t pr o m o t e le a r n e d , an d an y ch a n g e s ma d e . ca p a b i l i t i e s , ca p a c i t y an d co m m u n i t y re s i l i e n c e , in c l u d i n g , bu t no t li m i t e d to : En d - o f - y e a r re p o r t on te m p l a t e Ju n e 30 , 20 2 2 • Lo c a l an d / o r Em e r g e n c y Ma n a g e r ( s ) . pr o v i d e d by DO H . Br i e f l y • Lo c a l an d / o r re g i o n a l ho s p i t a l s . de s c r i b e co n n e c t i o n s , le s s o n s • Lo c a l an d / o r re g i o n a l el e c t e d of f i c i a l s . le a r n e d , an d an y ch a n g e s ma d e . • Lo c a l an d / o r re g i o n a l or g a n i z a t i o n s th a t wo r k wi t h vu l n e r a b l e po p u l a t i o n s . (F o r RE R C s , th i s ma y in c l u d e so m e or al l of xh i b i t A, Et a t e m e n t s of Wo r k Pa g e 17 of 5 0 Co n t r a c Nu m b e r CL H l 8 2 4 9 - 2 2 te v i s e d as t. f Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ta s k *M a y Su p p o r t PH A B Du e Da t e / T i m e Pa y m e n t Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s In f o r m a t i o n an d / o r Nu m b e r St a n d a r d s / M e a s u r e s Fr a m e Am o u n t th e pr i m a r y gr o u p s id e n t i f i e d in Ac t i v i t y 6 - Al l Ha z a r d s Pl a n - Vu l n e r a b l e Po p u l a t i o n s . ) 9 Do m a i n 2 In c i d e n t Ma n a g e m e n t Mi d - y e a r re p o r t on te m p l a t e De c e m b e r 31 , 20 2 1 Ca p a b i l i t y 3 Em e r g e n c y Op e r a t i o n s Co o r d i n a t i o n - pr o v i d e d by DO H . Tr a i n i n g & Ex e r c i s e En d - o f - y e a r re p o r t on te m p l a t e Ju n e 30 , 20 2 2 Ba s e d on av a i l a b i l i t y of tr a i n i n g , pa r t i c i p a t e in at pr o v i d e d by DO H . le a s t on e Fo u n d a t i o n a l Pu b l i c He a l t h Em e r g e n c y Pr e p a r e d n e s s Tr a i n i n g pr o v i d e d by re g i o n , DO H , DO H - c o n t r a c t e d pa r t n e r , or DO H - a p p r o v e d tr a i n e r in pe r s o n or vi a we b i n a r . No t e s : • Fo r so m e LH J s th i s tr a i n i n g wo n ' t be av a i l a b l e un t i l th e ne x t St a t e m e n t of Wo r k pe r i o d , Ja n u a r y 1 - Ju n e 30 , 20 2 2 . DO H wi l l wo r k wi t h re g i o n s an d LH J s to cu s t o m i z e an d sc h e d u l e tr a i n i n g ( s ) . • Th i s is on e or mo r e sp e c i f i c tr a i n i n g s co o r d i n a t e d by DO H . DO H wi l l wo r k wi t h LH J to im p l e m e n t . • Pa r t i c i p a t i o n in an ac t i v a t i o n , ex e r c i s e or re a l - wo r l d ev e n t ma y be co n s i d e r e d ad d i t i o n a l tr a i n i n g , bu t do e s no t ta k e th e pl a c e of th e re q u i r e m e n t to pa r t i c i p a t e in at le a s t on e tr a i n i n g as de s c r i b e d ab o v e . 10 Do m a i n 2 In c i d e n t Ma n a g e m e n t Mi d - y e a r re p o r t on te m p l a t e De c e m b e r 31 , 20 2 1 Ca p a b i l i t y 3 Em e r g e n c y Op e r a t i o n s Co o r d i n a t i o n - pr o v i d e d by DO H . Tr a i n i n g & Ex e r c i s e En d - o f - y e a r re p o r t on te m p l a t e Ju n e 30 , 20 2 2 10 . 1 Re v i e w LH J pu b l i c he a l t h pr e p a r e d n e s s an d pr o v i d e d by DO H . re s p o n s e ca p a b i l i t i e s an d id e n t i f y ga p s , pr i o r i t i e s , an d tr a i n i n g ne e d s . 10 . 2 In p u t in t o Re g i o n a l In t e g r a t e d 10 . 2 As re q u e s t e d by Pr e p a r e d n e s s Pl a n an d In t e g r a t e d RE R C s . 10 . 2 Pr o v i d e in p u t to Re g i o n a l Em e r g e n c y Pr e p a r e d n e s s Pl a n n i n g Wo r k s h o p Re s p o n s e Co o r d i n a t o r s (R E R C s ) fo r Re g i o n a l Gu i d e pr o v i d e d to RE R C s . In t e g r a t e d Pr e p a r e d n e s s Pl a n an d In t e g r a t e d Pr e p a r e d n e s s Pl a n n i n g Wo r k s h o p Gu i d e . Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 18 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ta s k *M a y Su p p o r t PH A B Du e Da t e / T i m e Pa y m e n t Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s In f o r m a t i o n an d / o r Nu m b e r St a n d a r d s / M e a s u r e s Fr a m e Am o u n t No t e s : • In t e g r a t e d Pr e p a r e d n e s s Pl a n n i n g Wo r k s h o p is pl a n n e d fo r Ja n u a r y 20 2 2 . LH J s wi l l be re q u i r e d to pa r t i c i p a t e in ne x t st a t e m e n t of wo r k . • LH J ma y op t to de v e l o p , up d a t e an d ma i n t a i n a lo c a l In t e g r a t e d Pr e p a r e d n e s s Pl a n . Th e y st i l l ne e d to pa r t i c i p a t e in re g i o n a l pr o c e s s de s c r i b e d ab o v e . 11 Do m a i n 2 In c i d e n t Ma n a g e m e n t Mi d - y e a r re p o r t on te m p l a t e De c e m b e r 31 , 20 2 1 Ca p a b i l i t y 3 Em e r g e n c y Op e r a t i o n s Co o r d i n a t i o n pr o v i d e d by DO H . In d i c a t e th a t th i s wa s do n e or th a t no re s p o n s e 11 . 1 Pr o v i d e im m e d i a t e no t i f i c a t i o n to DO H Du t y in c i d e n t oc c u r r e d . Of f i c e r at 36 0 - 8 8 8 - 0 8 3 8 or ha n a l e r t @ d o h . w a . g o v fo r al l re s p o n s e in c i d e n t s in v o l v i n g us e of En d - o f - y e a r re p o r t on te m p l a t e Ju n e 30 , 20 2 2 em e r g e n c y re s p o n s e pl a n s an d / o r in c i d e n t pr o v i d e d by DO H . In d i c a t e th a t co m m a n d st r u c t u r e s . th i s wa s do n e or th a t no re s p o n s e in c i d e n t oc c u r r e d . 11 . 2 Pr o d u c e an d pr o v i d e si t u a t i o n re p o r t s (s i t r e p s ) do c u m e n t i n g LH J ac t i v i t y du r i n g al l in c i d e n t s . 11 . 1 No t i f i c a t i o n to DO H Du t y Si t r e p ma y be de v e l o p e d by th e LH J or an o t h e r Of f i c e r wi t h i n 60 mi n u t e s of ju r i s d i c t i o n th a t in c l u d e s in p u t fr o m LH J . ac t i v a t i o n . 11 . 2 Si t r e p s su b m i t t e d to DO H Du t y Of f i c e r 12 Do m a i n 2 In c i d e n t Ma n a g e m e n t Mi d - y e a r re p o r t on te m p l a t e De c e m b e r 31 , 20 2 1 Ca p a b i l i t y 3 Em e r g e n c y Op e r a t i o n s Co o r d i n a t i o n pr o v i d e d by DO H . Br i e f l y de s c r i b e ke y le s s o n s le a r n e d an d Co m p l e t e or pa r t i c i p a t e in Af t e r Ac t i o n Re p o r t s ch a n g e s ma d e an d / o r pl a n n e d - or (A A R s ) af t e r ea c h in c i d e n t or ex e r c i s e . no t e th a t no AA R s we r e co m p l e t e d . Su b m i t AA R ( s ) . No t e : An AA R ma y be co m p l e t e d pa r t - w a y th r o u g h an ex t e n d e d re s p o n s e , fo r ex a m p l e , En d - o f - y e a r re p o r t on te m p l a t e Ju n e 30 , 20 2 2 CO V I D - 1 9 . pr o v i d e d by DO H . Br i e f l y de s c r i b e ke y le s s o n s le a r n e d an d ch a n g e s ma d e an d / o r pl a n n e d - or no t e th a t no AA R s we r e co m p l e t e d . Su b m i t AA R ( s ) . Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 19 of 50 Co n t r a c t Nu m b e r CL H 1 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Pa y m e n t Ta s k *M a y Su p p o r t PH A B Du e Da t e / T i m e Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s In f o r m a t i o n an d / o r Nu m b e r St a n d a r d s / M e a s u r e s Fr a m e Am o u n t 13 Do m a i n 2 In c i d e n t Ma n a g e m e n t Mi d - y e a r re p o r t on te m p l a t e De c e m b e r 31 , 20 2 1 Ca p a b i l i t y 3 Em e r g e n c y Op e r a t i o n s Co o r d i n a t i o n pr o v i d e d by DO H . Br i e f l y de s c r i b e ke y le s s o n s le a r n e d an d Co n v e n e a co u n t y Em e r g e n c y Su p p o r t Fu n c t i o n ch a n g e s ma d e an d / o r pl a n n e d - or (E S F ) 8 AA R fo r CO V I D - 1 9 . Pa r t i c i p a n t s in c l u d e , no t e th a t no AA R s we r e bu t no t li m i t e d to : co m p l e t e d . Su b m i t AA R ( s ) . • Lo c a l He a l t h Of f i c e r • Pu b l i c He a l t h Of f i c i a l ( s ) En d - o f - y e a r re p o r t on te m p l a t e Ju n e 30 , 20 2 2 • Em e r g e n c y Ma n a g e r pr o v i d e d by DO H . Br i e f l y • Re g i o n a l He a l t h Ca r e Co a l i t i o n de s c r i b e ke y le s s o n s le a r n e d an d • Lo c a l an d re g i o n a l ho s p i t a l s ch a n g e s ma d e an d / o r pl a n n e d - or • Fe d e r a l l y Qu a l i f i e d He a l t h Ce n t e r ( s ) if no t e th a t no AA R s we r e th e y ar e in yo u r co u n t y co m p l e t e d . Su b m i t AA R ( s ) . • Ac c o u n t a b l e Co m m u n i t y of He a l t h No t e s : • Fo l l o w Ho m e l a n d Se c u r i t y Ex e r c i s e an d Ev a l u a t i o n Pr o g r a m (H S E E P ) gu i d e l i n e s fo r pr o c e s s an d do c u m e n t a t i o n . • In c l u d e na m e , ti t l e , an d or g a n i z a t i o n of ea c h pa r t i c i p a n t in do c u m e n t a t i o n (A A R ) . • Ou t r e a c h ma y ne e d to be co n d u c t e d to ga t h e r in p u t fr o m en t i t i e s no t ab l e to pa r t i c i p a t e in an AA R me e t i n g . • Th i s ma y be co m p l e t e d pa r t - w a y th r o u g h th e CO V I D - 1 9 re s p o n s e • Th i s AA R ma y be us e d to me e t th e re q u i r e m e n t ab o v e as we l l (T a s k #1 2 ) . 14 Do m a i n 3 In f o r m a t i o n Ma n a g e m e n t Mi d - y e a r re p o r t on te m p l a t e De c e m b e r 31 , 20 2 1 Ca p a b i l i t y 4 Em e r g e n c y Pu b l i c In f o r m a t i o n an d pr o v i d e d by DO H . Wa r n i n g - Co m m u n i c a t i o n En d - o f - y e a r re p o r t on te m p l a t e Ju n e 30 , 20 2 2 14 . 1 Pa r t i c i p a t e in Mo n t h l y Pu b l i c He a l t h pr o v i d e d by DO H . Co m m u n i c a t o r Ca l l / W e b i n a r by jo i n i n g ca l l / w e b i n a r an d / o r fo l l o w i n g in f o r m a t i o n on th e pu b l i c he a l t h co m m u n i c a t o r on l i n e co l l a b o r a t i v e wo r k s p a c e (e . g . Ba s e c a m p ) . 14 . 2 Pa r t i c i p a t e in at le a s t on e ri s k co m m u n i c a t i o n dr i l l of f e r e d by DO H be t w e e n Ju l y 1, 20 2 1 an d Ju n e 30 , 20 2 2 . Dr i l l wi l l oc c u r vi a we b i n a r , ph o n e an d em a i l . DO H wi l l of f e r on e in Ju l y 1 - Ex h i b i t A, Et a t e m e n t s of Wo r k Pa g e 20 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as < f Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Pa y m e n t Ta s k *M a y Su p p o r t PH A B Du e Da t e / T i m e Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s In f o r m a t i o n an d / o r Nu m b e r St a n d a r d s / M e a s u r e s Fr a m e Am o u n t De c e m b e r 31 , 20 2 1 an d on e dr i l l be t w e e n Ja n u a r y 1 - Ju n e 30 , 20 2 2 . 14 . 3 Co n d u c t a ho t wa s h ev a l u a t i n g LH J 14 . 3 an d 14 . 4 Ho t w a s h or Af t e r pa r t i c i p a t i o n in th e dr i l l . . Ac t i o n Re v i e w (A A R ) OR su m m a r y of co m m u n i c a t i o n 14 . 4 Id e n t i f y i n g an d im p l e m e n t i n g co m m u n i c a t i o n ac t i v i t i e s an d on e sa m p l e . st r a t e g i e s in re a l wo r l d in c i d e n t wi l l sa t i s f y ne e d to pa r t i c i p a t e in dr i l l . Co n d u c t a ho t wa s h or Af t e r Ac t i o n Re v i e w (A A R ) ev a l u a t i n g LH J pa r t i c i p a t i o n in co m m u n i c a t i o n st r a t e g i e s du r i n g th e in c i d e n t . If , th e re a l - w o r l d ev e n t re s p o n s e is on g o i n g , LH J ma y op t to co n d u c t a ho t wa s h or AA R ev a l u a t i n g co m m u n i c a t i o n st r a t e g i e s to da t e OR in c l u d e a su m m a r y of co m m u n i c a t i o n ac t i v i t i e s in mi d - y e a r an d / o r en d - o f ye a r re p o r t s _a n d _ o n e sa m p l e of co m m u n i c a t i o n . No t e : Pa r t i c i p a t i o n in a re a l wo r l d ev e n t ma y me e t th e re q u i r e m e n t fo r 14 . 2 , 14 . 3 an d 14 . 4 . 15 Do m a i n 3 In f o r m a t i o n Ma n a g e m e n t Mi d - y e a r re p o r t on te m p l a t e De c e m b e r 31 , 20 2 1 Ca p a b i l i t y 6 In f o r m a t i o n Sh a r i n g pr o v i d e d by DO H . 15 . 1 Ma i n t a i n Wa s h i n g t o n Se c u r e El e c t r o n i c En d - o f - y e a r re p o r t on te m p l a t e Ju n e 30 , 20 2 2 Co m m u n i c a t i o n s , Ur g e n t Re s p o n s e an d Ex c h a n g e pr o v i d e d by DO H . Sy s t e m (W A S E C U R E S ) as pr i m a r y no t i f i c a t i o n sy s t e m . 15 . 2 Pa r t i c i p a t e in DO H - l e d no t i f i c a t i o n dr i l l s . 15 . 3 Co n d u c t at le a s t on e LH J dr i l l us i n g LH J - pr e f e r r e d st a f f no t i f i c a t i o n sy s t e m . No t e s : • Re g i s t e r e d us e r s mu s t lo g in qu a r t e r l y at a mi n i m u m . • DO H wi l l pr o v i d e te c h n i c a l as s i s t a n c e to LH J s on us i n g WA S E C U R E S . Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 21 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Pa y m e n t Ta s k *M a y Su p p o r t PH A B Du e Da t e / T i m e Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s In f o r m a t i o n an d / o r Nu m b e r St a n d a r d s / M e a s u r e s Fr a m e Am o u n t • LH J ma y ch o o s e to us e an o t h e r no t i f i c a t i o n sy s t e m in ad d i t i o n to WA S E C U R E S to al e r t st a f f du r i n g in c i d e n t s . • 15 . 3 do e s n ' t ne e d to be co m p l e t e d un t i l Ju n e 30 , 20 2 2 . LH J s ma y be g i n wo r k in th i s St a t e m e n t of Wo r k pe r i o d or ma y op t to do al l th e wo r k in th e ne x t St a t e m e n t of Wo r k pe r i o d . 16 Do m a i n 3 In f o r m a t i o n Ma n a g e m e n t Pr o v i d e EE l s up o n re q u e s t . Up o n re q u e s t . Ca p a b i l i t y 6 In f o r m a t i o n Sh a r i n g No t e in th e mi d - y e a r an d en d - o f - De c e m b e r 31 , 20 2 1 Pr o v i d e Es s e n t i a l El e m e n t s of In f o r m a t i o n (E E l s ) ye a r re p o r t s th a t EE I s we r e du r i n g in c i d e n t re s p o n s e up o n re q u e s t fr o m DO H . pr o v i d e d or no n e we r e re q u e s t e d . Ju n e 30 , 20 2 2 No t e : DO H wi l l re q u e s t sp e c i f i c da t a el e m e n t s fr o m th e LH J du r i n g an in c i d e n t re s p o n s e , as ne e d e d to in f o r m de c i s i o n ma k i n g by DO H an d st a t e le a d e r s , as we l l as fe d e r a l pa r t n e r s wh e n re q u e s t e d . 17 Do m a i n 4 Co u n t e r m e a s u r e s an d Mi t i g a t i o n Re p o r t pr o g r e s s an d / o r pl a n s in De c e m b e r 31 , 20 2 1 Ca p a b i l i t y 8 Me d i c a l Co u n t e r m e a s u r e s Di s p e n s i n g mi d - y e a r re p o r t on te m p l a t e Ca p a b i l i t y 9 Me d i c a l Co u n t e r m e a s u r e s pr o v i d e d by DO H . Ma n a g e m e n t an d Di s t r i b u t i o n En d - o f - y e a r re p o r t on te m p l a t e Ju n e 30 , 20 2 2 Up d a t e an d ma i n t a i n Me d i c a l Co u n t e r m e a s u r e pr o v i d e d by DO H . (M C M ) Pl a n s fo r LH J an d / o r Re g i o n . If th e r e is a re g i o n a l pl a n , pr o v i d e No t e s : in p u t to th e RE R C . • MC M pl a n s in c l u d e nu m b e r of lo c a l di s t r i b u t i o n si t e s an d nu m b e r fo r wh i c h a Up d a t e d MC M pl a n s wi l l be du e de t a i l e d po i n t - t o - p o i n t di s t r i b u t i o n pl a n fr o m Ju n e 30 , 20 2 2 . RS S to di s t r i b u t i o n si t e ha s be e n jo i n t l y co n f i r m e d by LH J an d DO H . • MC M pl a n s in c l u d e nu m b e r of lo c a l po i n t s of di s p e n s i n g (P O D s ) an d nu m b e r fo r wh i c h a de t a i l e d po i n t - t o - p o i n t di s t r i b u t i o n pl a n fr o m lo c a l di s t r i b u t i o n si t e to di s p e n s i n g si t e ha s be e n jo i n t l y co n f i r m e d by LH J an d PO D op e r a t o r (n u r s i n g ho m e , lo c a l ag e n c y , pu b l i c PO D , an d in d e p e n d e n t ph a r m a c y ) . I • LH J s ar e no t re q u i r e d to ma i n t a i n a hu b . LH J s ma y pa r t n e r wi t h ot h e r or g a n i z a t i o n s to | xh i b i t A, Et a t e m e n t s of Wo r k Pa g e 22 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 te v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ta s k *M a y Su p p o r t PH A B Du e Da t e / T i m e Pa y m e n t Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s In f o r m a t i o n an d / o r Nu m b e r St a n d a r d s / M e a s u r e s Fr a m e Am o u n t ce n t r a l i z e di s t r i b u t i o n . If LH J s op t to ma i n t a i n a hu b , th i s sh o u l d be in c l u d e d in th e MC M pl a n . • DO H wi l l pr o v i d e te c h n i c a l as s i s t a n c e to LH J s on co r e el e m e n t s of an MC M pl a n . 18 Do m a i n 5 Su r g e Ma n a g e m e n t Mi d - y e a r re p o r t on te m p l a t e De c e m b e r 31 , 20 2 1 Ca p a b i l i t y 10 Me d i c a l Su r g e pr o v i d e d by DO H . En g a g e m e n t wi t h re g i o n a l He a l t h Ca r e Co a l i t i o n En d - o f - y e a r re p o r t on te m p l a t e Ju n e 30 , 20 2 2 (H C C ) pr o v i d e d by DO H . Pa r t i c i p a t e in : - At le a s t on e re g i o n a l HC C me e t i n g , in pe r s o n or vi r t u a l l y . - Th e in f o r m a t i o n sh a r i n g pr o c e s s du r i n g in c i d e n t s . - At le a s t on e pl a n n i n g pr o c e s s or ex e r c i s e co n d u c t e d to in f o r m on th e ro l e s an d re s p o n s i b i l i t i e s of pu b l i c he a l t h . - Re v i e w i n g HC C pl a n s fo r al i g n m e n t wi t h lo c a l ES F 8 pl a n s . No t e : Th i s ta s k do e s n ' t ne e d to be co m p l e t e d un t i l Ju n e 30 , 20 2 2 . LH J s ma y be g i n wo r k in th i s St a t e m e n t of Wo r k pe r i o d or ma y op t to do al l th e wo r k in th e ne x t St a t e m e n t of Wo r k pe r i o d . *F o r In f o r m a t i o n On l y : Fu n d i n g is no t ti e d to th e re v i s e d St a n d a r d s / M e a s u r e s li s t e d he r e . Th i s in f o r m a t i o n ma y be he l p f u l in di s c u s s i o n s of ho w pr o g r a m ac t i v i t i e s mi g h t co n t r i b u t e to me e t i n g a St a n d a r d / M e a s u r e . Mo r e de t a i l on th e s e an d / o r ot h e r Pu b l i c He a l t h Ac c r e d i t a t i o n Bo a r d (P H A B ) St a n d a r d s / M e a s u r e s th a t ma y ap p l y ca n be fo u n d at : ht t e : / / w w w . o h a b o a r d . o r g / w o - c o n t e n t / u p l o a d s / P H AB - S t a n d a r d s - a n d - M e a s u r e s - V e r s i o n - L 0 . p d f Pr o g r a m Sp e c i f i c Re q u i r e m e n t s / N a r r a t i v e An y su b c o n t r a c t / s mu s t be ap p r o v e d by DO H pr i o r to ex e c u t i n g th e co n t r a c t / s . De l i v e r a b l e s ar e to be su b m i t t e d to th e Co n C o n de l i v e r a b l e s ma i l b o x at co n c o n d e l i v e r a b l e s ( a d o h . w a g o v , un l e s s ot h e r w i s e sp e c i f i e d . Sp e c i a l Re q u i r e m e n t s Fe d e r a l Fu n d i n g Ac c o u n t a b i l i t y an d Tr a n s p a r e n c y Ac t (F F A T A ) Th i s st a t e m e n t of wo r k is su p p o r t e d by fe d e r a l fu n d s th a t re q u i r e co m p l i a n c e wi t h th e Fe d e r a l Fu n d i n g Ac c o u n t a b i l i t y an d Tr a n s p a r e n c y Ac t (F F AT A or th e Tr a n s p a r e n c y Ac t ) . Th e pu r p o s e of th e Tr a n s p a r e n c y Ac t is to ma k e in f o r m a t i o n av a i l a b l e on l i n e so th e pu b l i c ca n se e ho w th e fe d e r a l fu n d s ar e sp e n t . Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 23 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 To co m p l y wi t h th i s ac t an d be el i g i b l e to pe r f o r m th e ac t i v i t i e s in th i s st a t e m e n t of wo r k , th e LH J mu s t ha v e a Da t a Un i v e r s a l Nu m b e r i n g Sy s t e m (D U N S ® ) nu m b e r . In f o r m a t i o n ab o u t th e LH J an d th i s st a t e m e n t of wo r k wi l l be ma d e av a i l a b l e on US A c e n d i n e . a o v by DO H as re q u i r e d by P. L . 10 9 - 2 8 2 . Re s t r i c t i o n s on Fu n d s (w h a t fu n d s ca n be us e d fo r wh i c h ac t i v i t i e s , no t di r e c t pa y m e n t s , et c ) Pl e a s e re f e r e n c e th e Co d e of Fe d e r a l Re g u l a t i o n s : ht t p s : / / w w w . e e f r . a o v / c g i - b i n / r e t r i e v e E C F R ? c o = I& S1 D = 5 8 f f d d b 5 3 6 3 a 2 7 f 2 6 e 9 d i2 c c e c 4 6 2 5 4 9 & tv = H T M L & b = L & m e -t r u e & r = P A R T & n = p t 2 . I. 2 0 0 # s e 2 . 1 . 2 0 0 14 3 9 DO H Pr o g r a m Co n t a c t To r y He n d e r s o n , Co n t r a c t s an d Fi n a n c e Sp e c i a l i s t Em e r g e n c y Pr e p a r e d n e s s an d Re s p o n s e De p a r t m e n t of He a l t h PO Bo x 47 9 6 0 , Ol y m p i a , WA 98 5 0 4 - 7 9 6 0 Mo b i l e 36 0 - 7 8 9 - 7 2 6 2 to r y . h e n d e r s o n @ d o h . w a . g o v Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 24 of 50 Co n t r a c t Nu m b e r CL H 1 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ex h i b i t A St a t e m e n t of Wo r k Co n t r a c t Te r m : 20 1 8 - 2 0 2 1 DO H Pr o g r a m Na m e or Ti t l e : Fo u n d a t i o n a l Pu b l i c He a l t h Se r v i c e s Lo c a l He a l t h Ju r i s d i c t i o n Na m e : Ki t t i t a s Co u n t y Pu b l i c He a l t h De p a r t m e n t (F P H S ) - Ef f e c t i v e Ju l v 1, 20 2 1 Co n t r a c t Nu m b e r : CL H l 8 2 4 9 SO W Ty p e : Or i g i n a l Re v i s i o n # (f o r th i s SO W ) Fu n d i n g So u r c e Fe d e r a l Co m p l i a n c e Ty p e of Pa y m e n t O Fe d e r a l < S e l e c t On e > (c h e c k if ap p l i c a b l e ) Re i m b u r s e m e n t Pe r i o d of Pe r f o r m a n c e : Ju l y 1, 20 2 1 th r o u g h De c e m b e r 31 , 20 2 1 ee r FR F e ea r h De p v le n p c m y e t Ds ut n St a t e m e n t of Wo r k Pu r p o s e : Th e pu r p o s e of th i s st a t e m e n t of wo r k (S O W ) is to sp e c i f y ho w st a t e fu n d s fo r Fo u n d a t i o n a l Pu b l i c He a l t h Se r v i c e s (F P H S ) wi l l be us e d fo r th e pe r i o d of pe r f o r m a n c e . Pe r RC W 43 . 7 0 . 5 1 2 , th e s e fu n d s ar e fo r th e go v e r n m e n t a l pu b l i c he a l t h sy s t e m to de l i v e r FP H S se r v i c e s st a t e w i d e in th e mo s t ef f e c t i v e , ef f i c i e n t an d eq u i t a b l e ma n n e r po s s i b l e wi t h th e fu n d s av a i l a b l e . Th e FP H S St e e r i n g Co m m i t t e e wi t h in p u t fr o m FP H S Su b j e c t Ma t t e r Ex p e r t (S M E ) Wo r k g r o u p s an d th e Tr i b a l Te c h n i c a l Wo r k g r o u p is th e de c i s i o n ma k i n g bo d y fo r FP H S fu n d s . Fo r th e 20 2 1 -2 0 2 3 bi e n n i u m , th e St e e r i n g Co m m i t t e e is us i n g an it e r a t i v e ap p r o a c h to de c i s i o n ma k i n g . De t e r m i n i n g in v e s t m e n t s fi r s t fo r SF Y 2 2 (J u l y 1, 20 2 1 - Ju n e 30 , 20 2 2 ) , th e n fo r SF Y 2 3 (J u l y 1, 20 2 2 - Ju n e 30 , 20 2 3 ) . Th a t me a n s th a t ad d i t i o n a l ta s k s an d / o r fu n d s ma y be ad d e d to an LH J ' s FP H S SO W as th e s e de c i s i o n s ar e ma d e . Th e s e fu n d s ar e to be us e d as di r e c t e d an d al l o c a t e d by th e FP H S St e e r i n g Co m m i t t e e . As th e gl o b a l CO V I D - 1 9 pa n d e m i c an d th e pu b l i c he a l t h re s p o n s e to it co n t i n u e s an d be g i n s to ab a t e , th e s e FP H S fu n d s ca n be us e d to su p p l e m e n t ot h e r sh o r t - t e r m pa n d e m i c re s p o n s e fu n d i n g as ne e d e d du r i n g th i s pe r i o d of pe r f o r m a n c e (0 7 / 0 1 / 2 1 - 1 2 / 3 1 / 2 1 ) . Re s p o n d i n g to pa n d e m i c s , ep i d e m i c s an d pu b l i c he a l t h em e r g e n c i e s ar e fo u n d a t i o n a l se r v i c e s of th e go v e r n m e n t a l pu b l i c he a l t h sy s t e m . No t e : Th e to t a l bi e n n i a l fu n d i n g al l o c a t i o n is fo r th e pe r i o d of Ju l y 1, 20 2 1 th r o u g h Ju n e 30 , 20 2 3 . 20 2 1 - 2 0 2 3 bi e n n i a l fu n d i n g al l o c a t i o n s wi l l be di v i d e d in t o fo u r si x - mo n t h lu m p su m am o u n t s th a t wi l l be di s b u r s e d at th e be g i n n i n g of ea c h si x mo n t h pe r i o d as fo l l o w s : Ju l y 1, 20 2 1 ; Ja n u a r y 1, 20 2 2 ; Ju l y 1, 20 2 2 ; Ja n u a r y 1, 20 2 3 . Th e di s b u r s e m e n t of fu n d s sc h e d u l e d fo r Ja n u a r y 1, 20 2 2 , Ju l y 1, 20 2 2 an d Ja n u a r y 1, 20 2 3 an d de l i v e r a b l e du e da t e s af t e r De c e m b e r 31 , 20 2 1 ar e in c l u d e d in th i s st a t e m e n t of wo r k fo r in f o r m a t i o n a l pu r p o s e s on l y an d wi l l be ca r r i e d fo r w a r d in t o a ne w st a t e m e n t of wo r k in th e ne w co n s o l i d a t e d co n t r a c t te r m be g i n n i n g Ja n u a r y 1, 20 2 2 . FP H S fu n d s mu s t be sp e n t in th e st a t e fi s c a l ye a r (S F Y ) in wh i c h th e y ar e di s b u r s e d : SF Y 2 2 07 / 0 1 / 2 1 - 0 6 / 3 0 / 2 2 an d SF Y 2 3 07 / 0 1 / 2 2 - 0 6 / 3 0 / 2 3 . Un s p e n t fu n d s mu s t be re t u r n e d to DO H by Ju l y 15 * of ea c h ye a r . 20 2 1 - 2 0 2 3 Bi e n n i a l Al l o c a t i o n : $2 0 0 , 0 0 0 SF Y 2 2 Al l o c a t i o n : $1 0 0 , 0 0 0 SF Y 2 3 Al l o c a t i o n : $1 0 0 , 0 0 0 Re v i s i o n Pu r p o s e : N/ A Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 25 of 50 Co n t r a c t Nu m b e r CL H 1 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ch a r t of Ac c o u n t s Pr o g r a m Na m e or Ti t l e CF D A # BA R S Ma s t e r Fu n d i n g Pe r i o d Cu r r e n t Ch a n g e To t a l Re v e n u e In d e x (L H J Us e On l y ) Co n s i d e r a t i o n Co n s i d e r a t i o n In c r e a s e (+ ) Co d e Co d e St a r t Da t e En d Da t e FP H S - L H J - P R O V I S O (Y R l ) - R E I N F O R C I N G CA P A C I T Y N/ A 33 6 . 0 4 . 2 5 99 2 0 2 1 1 1 07 / 0 1 / 2 1 12 / 3 1 / 2 1 0 | 10 0 , 0 0 0 | 10 0 , 0 0 0 FP H S - L H J - P R O V I S O (Y R l ) - N E W SE R V I C E DE L I V E R Y 0 0 0 MO D E L S TO T A L S 0 10 0 , 0 0 0 10 0 , 0 0 0 Du e Ta s k Pa y m e n t In f o r m a t i o n an d / o r Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Da t e / T i m e Nu m b e r Am o u n t Fr a m e 0 FO U N D A T I O N A L PU B L I C HE A L T H FU N D I N G - In c r e a s e d de l i v e r y of FP H S se r v i c e s Fu n d s ar e av a i l a b l e be g i n n i n g Ju l y 1, in ea c h ju r i s d i c t i o n an d st a t e w i d e as 20 2 1 . Ha l f of th e an n u a l al l o c a t i o n me a s u r e d vi a FP H S an n u a l re p o r t i n g wi l l be di s b u r s e d ea c h Ju l y up o n fr o m al l ag e n c i e s re c e i v i n g FP H S re c e i p t of th e An n u a l Re p o r t fo r th e fu n d s , me t r i c s an d ot h e r da t a co m p i l e d pr e v i o u s ye a r an d th e se c o n d ha l f wi l l an d an a l y z e d by DO H an d Su b j e c t be di s b u r s e d ea c h Ja n u a r y . Ma t t e r Ex p e r t (S M E ) Wo r k g r o u p s . Al l of wh i c h is in c l u d e d as pa r t of th e No t e : Fu n d s mu s t be sp e n t in th e an n u a l FP H S In v e s t m e n t Re p o r t . st a t e fi s c a l ye a r (S F Y ) in wh i c h th e y ar e di s b u r s e d . Un s p e n t fu n d s mu s t FP H S an n u a l re p o r t i n g (t e m p l a t e By 08 / 1 5 / 2 2 be re t u r n e d to DO H by Ju l y 15 t h Of pr o v i d e d by DO H ) fo r SF Y 2 2 ea c h ye a r . (0 7 / 0 1 / 2 1 - 06 / 3 0 / 2 2 ) FP H S an n u a l re p o r t i n g (t e m p l a t e By 08 / 1 5 / 2 3 pr o v i d e d by DO H ) fo r SF Y 2 3 (0 7 / 0 1 / 2 2 -0 6 / 3 0 / 2 3 ) 1 FP H S - RE I N F O R C I N G CA P A C I T Y SF Y 2 2 Al l o c a t i o n : $1 0 0 , 0 0 0 Fu n d s to de l i v e r FP H S in ea c h ju r i s d i c t i o n . Th e s e fu n d s ar e fo r SF Y 2 3 Al l o c a t i o n : $1 0 0 , 0 0 0 de l i v e r i n g AN Y , or AL L , of th e FP H S co m m u n i c a b l e di s e a s e , 21 - 2 3 Bi e n n i a l Al l o c a t i o n : $2 0 0 , 0 0 0 en v i r o n m e n t a l pu b l i c he a l t h or as s e s s m e n t se r v i c e an d ca n al s o be us e d fo r an y of th e ot h e r FP H S ca p a b i l i t i e s th a t su p p o r t th e s e FP H S as de f i n e d in th e mo s t cu r r e n t ve r s i o n of FP H S De f i n i t i o n s . 2 FP H S - NE W SE R V I C E DE L I V E R Y MO D E L S SF Y 2 2 Al l o c a t i o n : Fu n d s to de l i v e r FP H S in mu l t i p l e ju r i s d i c t i o n s in co o r d i n a t i o n SF Y 2 3 Al l o c a t i o n : wi t h FP H S Su b , j e c t Ma t t e r Ex p e r t (S M E ) wo r k g r o u p s . 21 - 2 3 Bi e n n i a l Al l o c a t i o n : Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 26 of 50 Co n t r a c t Nu m b e r CL H 1 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ta s k s / A c t i v i t i e s / D e s c r i p t i o n Im p a c t Me a s u r e s Co n t r o l of Co m m u n i c a b l e Di s e a s e an d Ot h e r No t i f i a b l e Co n d i t i o n s Pe r c e n t of to d d l e r s an d sc h o o l ag e ch i l d r e n th a t ha v e 1. Pr o v i d e ti m e l y , st a t e w i d e , lo c a l l y re l e v a n t an d ac c u r a t e in f o r m a t i o n st a t e w i d e an d to co m m u n i t i e s on co m p l e t e d th e st a n d a r d se r i e s of re c o m m e n d e d va c c i n a t i o n s . pr e v e n t i o n an d co n t r o l of co m m u n i c a b l e di s e a s e an d ot h e r no t i f i a b l e co n d i t i o n s . . Pe r c e n t of ne w po s i t i v e He p a t i t i s C la b re p o r t s th a t ar e 2. Id e n t i f y st a t e w i d e an d lo c a l co m m u n i t y as s e t s fo r th e co n t r o l of co m m u n i c a b l e di s e a s e s an d ot h e r re c e i v e d el e c t r o n i c a l l y wh i c h ha v e a co m p l e t e d ca s e re p o r t . no t i f i a b l e co n d i t i o n s , de v e l o p an d im p l e m e n t a pr i o r i t i z e d co n t r o l pl a n ad d r e s s i n g co m m u n i c a b l e di s e a s e s an d ot h e r no t i f i a b l e co n d i t i o n s an d se e k re s o u r c e s an d ad v o c a t e fo r hi g h pr i o r i t y pr e v e n t i o n an d Pe r c e n t of ne w po s i t i v e He p a t i t i s C ca s e re p o r t s wi t h co n t r o l po l i c i e s an d in i t i a t i v e s re g a r d i n g co m m u n i c a b l e di s e a s e s an d ot h e r no t i f i a b l e co n d i t i o n s . co m p l e t e d in v e s t i g a t i o n s . 3. Pr o m o t e im m u n i z a t i o n th r o u g h ev i d e n c e - b a s e d st r a t e g i e s an d co l l a b o r a t i o n wi t h sc h o o l s , he a l t h ca r e pr o v i d e r s an d ot h e r co m m u n i t y pa r t n e r s to in c r e a s e im m u n i z a t i o n ra t e s . Pe r c e n t of Go n o r r h e a ca s e s in v e s t i g a t e d . 4. En s u r e di s e a s e su r v e i l l a n c e , in v e s t i g a t i o n an d co n t r o l fo r co m m u n i c a b l e di s e a s e an d no t i f i a b l e co n d i t i o n s in ac c o r d a n c e wi t h lo c a l , st a t e an d fe d e r a l ma n d a t e s an d gu i d e l i n e s . Pe r c e n t of Go n o r r h e a ca s e s in v e s t i g a t e d th a t ar e re c e i v i n g du a l 5. En s u r e av a i l a b i l i t y of pu b l i c he a l t h la b o r a t o r y se r v i c e s fo r di s e a s e in v e s t i g a t i o n s an d re s p o n s e , an d tr e a t m e n t (t r e a t m e n t fo r bo t h Go n o r r h e a an d Ch l a m y d i a at th e re f e r e n c e an d co n f i r m a t o r y te s t i n g re l a t e d to co m m u n i c a b l e di s e a s e s an d no t i f i a b l e co n d i t i o n s . sa m e ti m e ) 6. Wh e n Ad d i t i o n a l Im p o r t a n t Se r v i c e s (A I S ) ar e de l i v e r e d re g a r d i n g pr e v e n t i o n an d co n t r o l of co m m u n i c a b l e di s e a s e an d ot h e r no t i f i a b l e co n d i t i o n s , en s u r e th a t th e y ar e we l l co o r d i n a t e d wi t h Pe r c e n t of ne w l y di a g n o s e d sy p h i l i s ca s e s th a t re c e i v e pa r t n e r fo u n d a t i o n a l se r v i c e s . se r v i c e s in t e r v i e w . En v i r o n m e n t a l Pu b l i c He a l t h TB D 1. Pr o v i d e ti m e l y , st a t e an d lo c a l l y re l e v a n t an d ac c u r a t e in f o r m a t i o n st a t e w i d e an d to co m m u n i t i e s on en v i r o n m e n t a l pu b l i c he a l t h is s u e s an d he a l t h im p a c t s fr o m co m m o n en v i r o n m e n t a l or to x i c ex p o s u r e s . 2. Id e n t i f y st a t e w i d e an d lo c a l co m m u n i t y en v i r o n m e n t a l pu b l i c he a l t h as s e t s an d pa r t n e r s an d de v e l o p an d im p l e m e n t a pr i o r i t i z e d pr e v e n t i o n pl a n to pr o t e c t th e pu b l i c ' s he a l t h by pr e v e n t i n g an d re d u c i n g ex p o s u r e s to he a l t h ha z a r d s in th e en v i r o n m e n t , se e k re s o u r c e s an d ad v o c a t e fo r hi g h pr i o r i t y po l i c y in i t i a t i v e s . 3. Co n d u c t en v i r o n m e n t a l pu b l i c he a l t h in v e s t i g a t i o n s , in s p e c t i o n s , sa m p l i n g , la b o r a t o r y an a l y s i s an d ov e r s i g h t to pr o t e c t fo o d , re c r e a t i o n a l wa t e r , dr i n k i n g wa t e r an d li q u i d wa s t e an d so l i d wa s t e sy s t e m s in ac c o r d a n c e wi t h lo c a l , st a t e an d fe d e r a l la w s an d re g u l a t i o n s . 4. Id e n t i f y an d ad d r e s s pr i o r i t y no t i f i a b l e zo o n o t i c co n d i t i o n s (e . g . th o s e tr a n s m i t t e d by bi r d s , in s e c t s , ro d e n t s , et c . ) , ai r - b o r n e co n d i t i o n s an d ot h e r pu b l i c he a l t h th r e a t s re l a t e d to en v i r o n m e n t a l ha z a r d s . 5. Pr o t e c t th e po p u l a t i o n fr o m un n e c e s s a r y ra d i a t i o n ex p o s u r e in ac c o r d a n c e wi t h lo c a l , st a t e an d fe d e r a l la w s an d re g u l a t i o n s . 6. Pa r t i c i p a t e in br o a d la n d us e pl a n n i n g an d su s t a i n a b l e de v e l o p m e n t to en c o u r a g e de c i s i o n s th a t pr o m o t e po s i t i v e pu b l i c he a l t h ou t c o m e s 7. Wh e n Ad d i t i o n a l Im p o r t a n t Se r v i c e s (A I S ) ar e de l i v e r e d re g a r d i n g en v i r o n m e n t a l pu b l i c he a l t h , as s u r e th a t th e y ar e we l l co o r d i n a t e d wi t h fo u n d a t i o n a l se r v i c e s . As s e s s m e n t (S u r v e i l l a n c e an d Ep i d e m i o l o g y ) TB D 1. Ab i l i t y to co l l e c t su f f i c i e n t , st a t e w i d e an d co m m u n i t y le v e l da t a an d de v e l o p an d ma i n t a i n el e c t r o n i c in f o r m a t i o n sy s t e m s to gu i d e pu b l i c he a l t h pl a n n i n g an d de c i s i o n ma k i n g at th e st a t e , re g i o n a l an d lo c a l le v e l . 2. Ab i l i t y to ac c e s s , an a l y z e , us e an d in t e r p r e t da t a . 3. Ab i l i t y to co n d u c t a co m p r e h e n s i v e co m m u n i t y or st a t e w i d e he a l t h as s e s s m e n t an d id e n t i f y he a l t h pr i o r i t i e s ar i s i n g fr o m th a t as s e s s m e n t , in c l u d i n g an a l y s i s of he a l t h di s p a r i t i e s an d th e so c i a l de t e r m i n a n t s of he a l t h . lx h i b i t A, St a t e m e n t s of Wo r k Pa g e 27 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 te v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ta s k s / A c t i v i t i e s / D e s c r i p t i o n Im p a c t Me a s u r e s Em e r g e n c y Pr e p a r e d n e s s (A l l Ha z a r d s ) . TB D 1. Ab i l i t y to de v e l o p em e r g e n c y re s p o n s e pl a n s fo r na t u r a l an d ma n - m a d e pu b l i c he a l t h ha z a r d s ; tr a i n pu b l i c he a l t h st a f f fo r em e r g e n c y re s p o n s e ro l e s an d ro u t i n e l y ex e r c i s e re s p o n s e pl a n s . 2. Ab i l i t y to le a d th e Em e r g e n c y Su p p o r t Fu n c t i o n 8 - Pu b l i c He a l t h & Me d i c a l an d / o r a pu b l i c he a l t h re s p o n s e fo r th e co u n t y , re g i o n , ju r i s d i c t i o n an d st a t e . 3. Ab i l i t y to ac t i v a t e an d mo b i l i z e pu b l i c he a l t h pe r s o n n e l an d re s p o n s e te a m s ; re q u e s t an d de p l o y re s o u r c e s ; co o r d i n a t e wi t h pu b l i c se c t o r , pr i v a t e se c t o r an d no n - p r o f i t re s p o n s e pa r t n e r s an d ma n a g e pu b l i c he a l t h an d me d i c a l em e r g e n c i e s ut i l i z i n g th e in c i d e n t co m m a n d sy s t e m . 4. Ab i l i t y to co m m u n i c a t e wi t h di v e r s e co m m u n i t i e s ac r o s s di f f e r e n t me d i a , wi t h em p h a s i s on po p u l a t i o n s th a t ar e di s p r o p o r t i o n a t e l y ch a l l e n g e d du r i n g di s a s t e r s , to pr o m o t e re s i l i e n c e in ad v a n c e of di s a s t e r s an d pr o t e c t pu b l i c he a l t h du r i n g an d fo l l o w i n g di s a s t e r s . Co m m u n i c a t i o n . 1. Ab i l i t y to en g a g e an d ma i n t a i n on g o i n g re l a t i o n s wi t h lo c a l an d st a t e w i d e me d i a . 2. Ab i l i t y to de v e l o p an d im p l e m e n t a co m m u n i c a t i o n st r a t e g y , in ac c o r d a n c e wi t h Pu b l i c He a l t h Ac c r e d i t a t i o n St a n d a r d s , to in c r e a s e vi s i b i l i t y of pu b l i c he a l t h is s u e s . Th i s in c l u d e s th e ab i l i t y to pr o v i d e in f o r m a t i o n on he a l t h ri s k s , he a l t h y be h a v i o r s , an d di s e a s e pr e v e n t i o n in cu l t u r a l l y an d li n g u i s t i c a l l y ap p r o p r i a t e fo r m a t s fo r th e va r i o u s co m m u n i t i e s se r v e d . Po l i c y De v e l o p m e n t an d Su p p o r t 1. Ab i l i t y to de v e l o p ba s i c pu b l i c he a l t h po l i c y re c o m m e n d a t i o n s . Th e s e po l i c i e s mu s t be ev i d e n c e - b a s e d , or , if in n o v a t i v e / p r o m i s i n g , mu s t in c l u d e ev a l u a t i o n pl a n s . 2. Ab i l i t y to wo r k wi t h pa r t n e r s an d po l i c y ma k e r s to en a c t po l i c i e s th a t ar e ev i d e n c e - b a s e d (o r ar e in n o v a t i v e or pr o m i s i n g an d in c l u d e ev a l u a t i o n pl a n s ) an d th a t ad d r e s s th e so c i a l de t e r m i n a n t s of he a l t h an d he a l t h eq u i t y . 3. Ab i l i t y to ut i l i z e co s t - b e n e f i t in f o r m a t i o n to de v e l o p an ef f i c i e n t an d co s t - e f f e c t i v e ac t i o n pl a n to re s p o n d to th e pr i o r i t i e s id e n t i f i e d in a co m m u n i t y an d / o r st a t e w i d e he a l t h as s e s s m e n t . Co m m u n i t y Pa r t n e r s h i p De v e l o p m e n t 1. Ab i l i t y to cr e a t e an d ma i n t a i n re l a t i o n s h i p s wi t h di v e r s e pa r t n e r s , in c l u d i n g he a l t h - r e l a t e d na t i o n a l , st a t e w i d e an d co m m u n i t y - b a s e d or g a n i z a t i o n s ; co m m u n i t y gr o u p s or or g a n i z a t i o n s re p r e s e n t i n g po p u l a t i o n s ex p e r i e n c i n g he a l t h in e q u i t y ; pr i v a t e bu s i n e s s e s an d he a l t h ca r e or g a n i z a t i o n s ; Tr i b a l Na t i o n s , an d lo c a l , st a t e an d fe d e r a l go v e r n m e n t ag e n c i e s an d le a d e r s . 2. Ab i l i t y to se l e c t an d ar t i c u l a t e go v e r n m e n t a l pu b l i c he a l t h ro l e s in pr o g r a m m a t i c an d po l i c y ac t i v i t i e s an d co o r d i n a t e wi t h th e s e pa r t n e r s . Bu s i n e s s Co m p e t e n c i e s - Le a d e r s h i p Ca p a b i l i t i e s ; Ac c o u n t a b i l i t y an d Qu a l i t y As s u r a n c e Ca p a b i l i t i e s ; Qu a l i t y TB D Im p r o v e m e n t In f o r m a t i o n ; Te c h n o l o g y Ca p a b i l i t i e s ; Hu m a n Re s o u r c e s Ca p a b i l i t i e s ; Fi s c a l Ma n a g e m e n t , Co n t r a c t an d Pr o c u r e m e n t Ca p a b i l i t i e s ; Fa c i l i t i e s an d Op e r a t i o n s : Le g a l Ca p a b i l i t i e s . Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 28 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Pr o g r a m Sp e c i f i c Re q u i r e m e n t s / N a r r a t i v e Sp e c i a l Re f e r e n c e s (R C W s , WA C s , et c ) Li n k to RC W 43 . 7 0 . 5 1 2 - RC W 43 . 7 0 . 5 1 2 : Pu b l i c he a l t h sv s t e m - F o u n d a t i o n a l pu b l i c he a l t h se r v i c e s - i n t e n t , (w a . g o v i Li n k to RC W 43 . 7 0 . 5 1 5 - RC W 43 . 7 0 . 5 1 5 : Fo u n d a t i o n a l pu b l i c he a l t h se r v i c e s - F u n d i n e . (w a . g o v ) FP H S De f i n i t i o n s ht t p s : / / w s a l p h o . b o x . c o m / s / q b 6 s s 1 0 m x b r a i x 0 f 1 a 7 4 2 l w 6 z e f x z o h k Al l FP H S Re s o u r c e s ww w . d o h . w a . g o v / f p h s or FP H S I Po w e r e d by Bo x Sp e c i a l In s t r u c t i o n s Th e r e ar e tw o di f f e r e n t BA R S Re v e n u e Co d e s fo r "s t a t e fl e x i b l e fu n d s " to be tr a c k e d se p a r a t e l y an d re p o r t e d se p a r a t e l y on yo u r an n u a l BA R S re p o r t . Th e s e tw o BA R S Re v e n u e Co d e s an d de f i n i t i o n s fr o m th e St a t e Au d i t o r ' s Of f i c e (S A O ' s ) ar e li s t e d be l o w al o n g wi t h a li n k to th e BA R S Ma n u a l . 33 6 . 0 4 . 2 5 is th e ne w BA R S Re v e n u e Co d e to us e fo r th e Fo u n d a t i o n a l Pu b l i c He a l t h Se r v i c e s (F P H S ) fu n d s in c l u d e d in th i s st a t e m e n t of wo r k . 33 6 . 0 4 . 2 4 -- Co u n t y Pu b l i c He a l t h As s i s t a n c e Us e th i s ac c o u n t fo r th e st a t e di s t r i b u t i o n au t h o r i z e d by th e 20 1 3 2E S S B 50 3 4 , se c t i o n 71 0 . Th e lo c a l he a l t h ju r i s d i c t i o n s ar e re q u i r e d to pr o v i d e re p o r t s re g a r d i n g ex p e n d i t u r e s to th e le g i s l a t u r e fr o m th i s re v e n u e so u r c e . 33 6 . 0 4 . 2 5 - Fo u n d a t i o n a l Pu b l i c He a l t h Se r v i c e s Us e th i s ac c o u n t fo r th e fu n d i n g de s i g n a t e d fo r th e lo c a l he a l t h ju r i s d i c t i o n s to pr o v i d e a se t of co r e se r v i c e s th a t go v e r n m e n t is re s p o n s i b l e fo r in al l co m m u n i t i e s in th e WA st a t e . Th i s se t of co r e se r v i c e s pr o v i d e s th e fo u n d a t i o n to su p p o r t th e wo r k of th e br o a d e r pu b l i c he a l t h sy s t e m an d co m m u n i t y pa r t n e r s . At th i s ti m e th e fu n d i n g fr o m th i s ac c o u n t is fo r de l i v e r i n g AN Y or al l of t h e FP H S co m m u n i c a b l e di s e a s e se r v i c e s (l i s t e d ab o v e ) an d ca n al s o be us e d fo r th e FP H S ca p a b i l i t i e s th a t su p p o r t FP H S co m m u n i c a b l e di s e a s e se r v i c e s as de f i n e d in th e mo s t cu r r e n t ve r s i o n of FP H S De f i n i t i o n s . Pu b l i c He a l t h Bu d g e t i n g , Ac c o u n t i n g an d Re p o r t i n g Sy s t e m (B A R S ) Re s o u r c e s ww w . d o h . w a . g o v / l h j f u n d i n e De l i v e r a b l e s ar e to be su b m i t t e d to Ma r i e Fl a k e at ma r i e . f l a k e do h . w a . g o v DO H Pr o g r a m Co n t a c t Ma r i e Fl a k e , Sp e c i a l Pr o j e c t s , Fo u n d a t i o n a l Pu b l i c He a l t h Se r v i c e s Wa s h i n g t o n St a t e De p a r t m e n t of He a l t h PO Bo x 47 8 9 0 , Ol y m p i a , WA 98 5 0 4 - 7 8 9 0 Mo b i l e Ph o n e 36 0 - 9 5 1 - 7 5 6 6 Fa x 36 0 . 2 3 6 . 4 0 2 4 / ma r i e . f l a k e @ d o h . w a . g o v Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 29 of 5 0 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ex h i b i t A St a t e m e n t of Wo r k Co n t r a c t Te r m : 20 1 8 - 2 0 2 1 DO H Pr o g r a m Na m e or Ti t l e : LS P A N - L o c a l St r a t e g i e s fo r Ph y s i c a l Ac t i v i t y & Lo c a l He a l t h Ju r i s d i c t i o n Na m e : Ki t t i t a s Co u n t y Pu b l i c He a l t h De p a r t m e n t Nu t r i t i o n - Ef f e c t i v e Fe b r u a r y 19 , 20 1 9 Co n t r a c t Nu m b e r : CL H 1 8 2 4 9 SO W Ty p e : Re v i s i o n Re v i s i o n # (f o r th i s SO W ) 5 Fu n d i n g So u r c e Fe d e r a l Co m p l i a n c e Ty p e of Pa y m e n t Fe d e r a l Su b r e c i p i e n t (c h e c k if ap p l i c a b l e ) Re i m b u r s e m e n t Pe r i o d of Pe r f o r m a n c e : Fe b r u a r y 19 , 20 1 9 th r o u g h De c e m b e r 31 , 20 2 1 St a t e FF A T A (T r a n s p a r e n c y Ac t ) Fi x e d Pr i c e O Ot h e r Re s e a r c h & De v e l o p m e n t St a t e m e n t of Wo r k Pu r p o s e : Th e pu r p o s e of th i s st a t e m e n t of wo r k is to es t a b l i s h fu n d i n g fo r Lo c a l St r a t e g i e s fo r Ph y s i c a l Ac t i v i t y an d Nu t r i t i o n (L S P A N ) , a pr o j e c t of th e St a t e Ph y s i c a l Ac t i v i t y an d Nu t r i t i o n Pr o g r a m (S P A N ) . No t e : Th e FF Y 2 1 fu n d i n g co n s i d e r a t i o n is fo r th e pe r i o d of Se p t e m b e r 30 , 20 2 1 th r o u g h Se p t e m b e r 29 , 20 2 2 fo r Ye a r 4 ac t i v i t i e s . De l i v e r a b l e du e da t e s af t e r De c e m b e r 31 , 20 2 1 ar e fo r re f e r e n c e on l y . Un s p e n t fu n d s an d de l i v e r a b l e s du e af t e r De c e m b e r 31 , 20 2 1 wi l l be ca r r i e d fo r w a r d to a ne w st a t e m e n t of wo r k in th e ne w co n s o l i d a t e d co n t r a c t te r m be g i n n i n g Ja n u a r y 1, 20 2 2 . Re v i s i o n Pu r p o s e : Th e pu r p o s e of th i s re v i s i o n is to ad d fu n d i n g in su p p o r t of Ye a r 4- F F Y 2 1 pr o g r a m im p l e m e n t a t i o n ac t i v i t i e s . Ch a r t of Ac c o u n t s Pr o g r a m Na m e or Ti t l e CF D A # BA R S Ma s t e r Fu n d i n g Pe r i o d Cu r r e n t Ch a n g e fo t a l Re v e n u e In d e x (L H J Us e On l y ) Co n s i d e r a t i o n Co n s i d e r a t i o n In c r e a s e (+ ) Co d e Co d e St a r t Da t e En d Da t e FF Y l 8 PH Y S AC T V T Y & NU T R I T I O N PR O G 93 . 4 3 9 33 3 . 9 3 . 4 3 77 4 4 0 2 4 8 02 / 1 9 / 1 9 09 / 2 9 / 2 0 60 , 0 0 0 0 60 , 0 0 0 FF Y l 9 PH Y S AC T V T Y & NU T R I T I O N PR O G 93 . 4 3 9 33 3 . 9 3 . 4 3 77 4 4 0 2 3 9 09 / 3 0 / 1 9 09 / 2 9 / 2 0 60 , 0 0 0 0 60 , 0 0 0 FF Y 2 0 PH Y S AC T V T Y & NU T R I T I O N PR O G 93 . 4 3 9 33 3 . 9 3 . 4 3 77 4 4 0 2 4 0 09 / 3 0 / 2 0 09 / 2 9 / 2 1 72 , 3 4 6 0 72 , 3 4 6 FF Y 2 1 PH Y S AC T V T Y & NU T R I T I O N PR O G | 93 . 4 3 9 33 3 . 9 3 . 4 3 | 77 4 4 0 2 4 1 | 09 / 3 0 / 2 1 | 12 / 3 1 / 2 1 0 60 , 0 0 0 60 , 0 0 0 TO T A L S 19 2 , 3 4 6 60 , 0 0 0 25 2 , 3 4 6 Ta s k *M a y Su p p o r t PH A B Pa y m e n t Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n Nu m b e r St a n d a r d s / M e a s u r e s an d / o r Am o u n t la PR O G R A M AD M I N I S T R A T I O N : De s i g n a t e d KC P H D st a f f Fe b r u a r y 19 , 20 1 9 - S e p t e m b e r 29 , 29 N Re i m b u r s e m e n t Pa r t i c i p a t e in ca l l s , at a mi n i m u m of on c e wi l l pa r t i c i p a t e in co n t r a c t 20 2 2 fo r ac t u a l co s t s , ev e r y mo n t h , wi t h DO H co n t r a c t ma n a g e r . ma n a g e m e n t ca l l s . no t to ex c e e d Da t e s an d ti m e fo r ca l l s ar e mu t u a l l y ag r e e d to t a l co n t r a c t up o n be t w e e n DO H an d Ki t t i t a s Co u n t y fu n d i n g . Se e Pu b l i c He a l t h De p a r t m e n t (K C P H D ) . Pr o g r a m Sp e c i f i c Re q u i r e m e n t s Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 30 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Pa y m e n t Ta s k *M a y Su p p o r t PH A B Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n Nu m b e r St a n d a r d s / M e a s u r e s an d / o r Am o u n t 1b PR O G R A M AD M I N I S T R A T I O N : De s i g n a t e d KC P H D st a f f Fe b r u a r y 19 , 20 1 9 - S e p t e m b e r 29 , 24 2 4 - Re i m b u r s e m e n t Pa r t i c i p a t e in DO H - s p o n s o r e d LS P A N wi l l pa r t i c i p a t e in ca l l s , 20 2 2 fo r ac t u a l co s t s , re l a t e d qu a r t e r l y co n f e r e n c e ca l l s an d / o r we b i n a r s , an d me e t i n g s . no t to ex c e e d we b i n a r s , in c l u d i n g up to on e (1 ) in - p e r s o n to t a l co n t r a c t me e t i n g . fu n d i n g . Se e Pr o g r a m Sp e c i f i c Re q u i r e m e n t s le PR O G R A M AD M I N I S T R A T I O N : Qu a r t e r l y pr o g r e s s re p o r t s to Ye a r 1- F F Y 1 8 : Re i m b u r s e m e n t Pe r f o r m ad m i n i s t r a t i v e du t i e s re l a t e d to DO H vi a Sh a r e P o i n t si t e or Ap r i l 15 , 20 1 9 (c o v e r i n g fo r ac t u a l co s t s , LS P A N . em a i l Fe b r u a r y 19 , 20 1 9 - M a r c h 30 , 20 1 9 ) no t to ex c e e d to t a l co n t r a c t Ju l y 15 , 20 1 9 (c o v e r i n g fu n d i n g . Se e Ma r c h 31 , 20 1 9 - J u n e 29 , 20 1 9 ) Pr o g r a m Sp e c i f i c Re q u i r e m e n t s Oc t o b e r 15 , 20 1 9 (c o v e r i n g Ju n e 30 , 20 1 9 - S e p t e m b e r 29 , 20 1 9 ) Ye a r 2- F F Y 1 9 : Ja n u a r y 15 , 20 2 0 (c o v e r i n g Se p t e m b e r 30 , 20 1 9 - D e c e m b e r 30 , 20 1 9 ) Ap r i l 15 , 20 2 0 (c o v e r i n g De c e m b e r 31 , 20 1 9 - M a r c h 30 , 20 2 0 ) Ju l y 15 , 20 2 0 (c o v e r i n g Ma r c h 31 , 20 2 0 - J u n e 29 , 20 2 0 ) Oc t o b e r 15 , 20 2 0 (c o v e r i n g Ju n e 30 , 20 2 0 - Se p t e m b e r 29 , 20 2 0 ) Ye a r 3- F F Y 2 0 : Ja n u a r y 15 , 20 2 1 (c o v e r i n g Se p t e m b e r 30 , 20 2 0 - D e c e m b e r 30 , 20 2 0 ) Ap r i l 15 , 20 2 1 (c o v e r i n g De c e m b e r 31 , 20 2 0 - M a r c h 30 , 20 2 1 ) Ju l y 15 , 20 2 1 (c o v e r i n g Ma r c h 31 , 20 2 1 - J u n e 29 , 20 2 1 ) Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 31 of 50 Co n t r a c t Nu m b e r CL H 1 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM I ND M E N T #2 2 Pa y m e n t Ta s k *M a y Su p p o r t PH A B Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n Nu m b e r St a n d a r d s / M e a s u r e s an d / o r Am o u n t Oc t o b e r 15 , 20 2 1 (c o v e r i n g Ju n e 30 , 20 2 1 - Se p t e m b e r 29 , 20 2 1 ) Ye a r 4- F F Y 2 1 : Ja n u a r y 17 , 20 2 2 (c o v e r i n g Se p t e m b e r 30 , 20 2 1 - D e c e m b e r 30 , 20 2 1 ) Ap r i l 15 , 20 2 2 (c o v e r i n g De c e m b e r 31 , 20 2 1 - M a r c h 30 , 20 2 2 ) Ju l y 15 , 20 2 1 2 (c o v e r i n g Ma r c h 31 , 20 2 2 - J u n e 29 , 20 2 2 ) Oc t o b e r 17 , 20 2 2 (c o v e r i n g Ju n e 30 , 20 2 2 - Se p t e m b e r 29 , 20 2 2 ) 2a PR O G R A M IM P L E M E N T A T I O N : Su b m i t Wo r k Pl a n to DO H Dr a f t du e : Re i m b u r s e m e n t Fi n a l i z e Wo r k Pl a n an d Bu d g e t Wo r k b o o k co n t r a c t ma n a g e r vi a em a i l Ye a r 1- F F Y l 8 : Ma r c h 15 , 20 1 9 fo r ac t u a l co s t s , us i n g DO H - p r o v i d e d te m p l a t e s . Ye a r 2- F F Y l 9 : Ju l y 3, 20 2 0 no t to ex c e e d Ye a r 3- F F Y 2 0 : Ma r c h 26 , 2 0 2 1 to t a l co n t r a c t Ye a r 4- F F Y 2 1 : Ma r c h 25 , 20 2 2 fu n d i n g . Se e Pr o g r a m Sp e c i f i c Fi n a l du e : Re q u i r e m e n t s Ye a r 1- F F Y l 8 : Ma r c h 29 , 20 1 9 Ye a r 2- F F Y l 9 : Ju l y 10 , 20 2 0 Ye a r 3 - FF Y 2 0 : Ju l y 9, 20 2 1 Ye a r 4- FF Y 2 1 : Ju l y 15 , 20 2 2 2b PR O G R A M IM P L E M E N T A T I O N : Qu a r t e r l y pr o g r e s s re p o r t s to Ye a r 1- F F Y 1 8 : Re i m b u r s e m e n t Im p l e m e n t fi n a l i z e d co m m u n i t y wo r k pl a n DO H vi a Sh a r e P o i n t si t e or Ap r i l 15 , 20 1 9 (c o v e r i n g fo r ac t u a l co s t s , fo c u s e d on LS P A N th a t in c l u d e : em a i l Fe b r u a r y 19 , 20 1 9 - M a r c h 30 , 20 1 9 ) no t to ex c e e d - Ad d r e s s i n g at le a s t tw o (2 ) st a t e to t a l co n t r a c t st r a t e g i e s re q u i r e d by th i s gr a n t fu n d i n g . Oc t o b e r 15 , 20 1 9 (c o v e r i n g fu n d i n g . Se e - Ac h i e v i n g po l i c y , sy s t e m s , or Ju n e 30 , 20 1 9 - S e p t e m b e r 29 , 20 1 9 ) Pr o g r a m Sp e c i f i c en v i r o n m e n t a l ch a n g e s co n s i s t e n t wi t h Re q u i r e m e n t s th e st r a t e g i e s . Ye a r 2- F F Y 1 9 : - Id e n t i f y i n g an d re a c h i n g po p u l a t i o n s wi t h Ja n u a r y 15 , 20 2 0 (c o v e r i n g he a l t h di s p a r i t i e s . Se p t e m b e r 30 , 20 1 9 - D e c e m b e r 30 , 20 1 9 ) Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 32 of 50 Co n t r a c t Nu m b e r CL H 1 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Pa y m e n t Ta s k *M a y Su p p o r t PH A B Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n Nu m b e r St a n d a r d s / M e a s u r e s an d / o r Am o u n t Ap r i l 15 , 20 2 0 (c o v e r i n g De c e m b e r 31 , 20 1 9 - M a r c h 30 , 20 2 0 ) Ju l y 15 , 20 2 0 (c o v e r i n g Ma r c h 31 , 20 2 0 - J u n e 29 , 20 2 0 ) Oc t o b e r 15 , 20 2 0 (c o v e r i n g Ju n e 30 , 20 2 0 - Se p t e m b e r 29 , 20 2 0 ) Ye a r 3- F F Y 2 0 : Ja n u a r y 15 , 20 2 1 (c o v e r i n g Se p t e m b e r 30 , 20 2 0 - D e c e m b e r 30 , 20 2 0 ) Ap r i l 15 , 20 2 1 (c o v e r i n g De c e m b e r 31 , 20 2 0 - M a r c h 30 , 20 2 1 ) Ju l y 15 , 20 2 1 (c o v e r i n g Ma r c h 31 , 20 2 1 - J u n e 29 , 20 2 1 ) Oc t o b e r 15 , 20 2 1 (c o v e r i n g Ju n e 30 , 20 2 1 - Se p t e m b e r 29 , 20 2 1 ) Ye a r 4- F F Y 2 1 : Ja n u a r y 17 , 20 2 2 (c o v e r i n g Se p t e m b e r 30 , 20 2 1 - D e c e m b e r 30 , 20 2 1 ) Ap r i l 15 , 20 2 2 (c o v e r i n g De c e m b e r 31 , 20 2 1 - M a r c h 30 , 20 2 2 ) Ju l y 15 , 20 2 1 2 (c o v e r i n g Ma r c h 31 , 20 2 2 - J u n e 29 , 20 2 2 ) Oc t o b e r 17 , 20 2 2 (c o v e r i n g Ju n e 30 , 20 2 2 - Se p t e m b e r 29 , 20 2 2 ) 2c PR O G R A M IM P L E M E N T A T I O N : Re p o r t qu a r t e r l y ex p e n d i t u r e s Ye a r 1- F F Y 1 8 : Re i m b u r s e m e n t Re p o r t qu a r t e r l y ex p e n d i t u r e s us i n g us i n g DO H - p r o v i d e d Ap r i l 15 , 20 1 9 (c o v e r i n g fo r ac t u a l co s t s , DO H - p r o v i d e d te m p l a t e . te m p l a t e . Fe b r u a r y 19 , 20 1 9 - M a r c h 30 , 20 1 9 ) no t to ex c e e d to t a l co n t r a c t fu n d i n g . Se e Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 33 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Pa y m e n t Ta s k *M a y Su p p o r t PH A B Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n Nu m b e r St a n d a r d s / M e a s u r e s an d / o r Am o u n t Ju l y 15 , 20 1 9 (c o v e r i n g Pr o g r a m Sp e c i f i c Ma r c h 31 , 20 1 9 - J u n e 29 , 20 1 9 ) Re q u i r e m e n t s Oc t o b e r 15 , 20 1 9 (c o v e r i n g Ju n e 30 , 20 1 9 - S e p t e m b e r 29 , 20 1 9 ) Ye a r 2- F F Y 1 9 : Ja n u a r y 15 , 20 2 0 (c o v e r i n g Se p t e m b e r 30 , 20 1 9 - D e c e m b e r 30 , 20 1 9 ) Ap r i l 15 , 20 2 0 (c o v e r i n g De c e m b e r 31 , 20 1 9 - M a r c h 30 , 20 2 0 ) Ju l y 15 , 20 2 0 (c o v e r i n g Ma r c h 31 , 20 2 0 - J u n e 29 , 20 2 0 ) Oc t o b e r 15 , 20 2 0 (c o v e r i n g Ju n e 30 , 20 2 0 - Se p t e m b e r 29 , 20 2 0 ) Ye a r 3- F F Y 2 0 : Ja n u a r y 15 , 20 2 1 (c o v e r i n g Se p t e m b e r 30 , 20 2 0 - D e c e m b e r 30 , 20 2 0 ) Ap r i l 15 , 20 2 1 (c o v e r i n g De c e m b e r 31 , 20 2 0 - M a r c h 30 , 20 2 1 ) Ju l y 15 , 20 2 1 (c o v e r i n g Ma r c h 31 , 20 2 1 - J u n e 29 , 20 2 1 ) Oc t o b e r 15 , 20 2 1 (c o v e r i n g Ju n e 30 , 20 2 1 - Se p t e m b e r 29 , 20 2 1 ) Ye a r 4- F F Y 2 1 : Ja n u a r y 17 , 20 2 2 (c o v e r i n g Se p t e m b e r 30 , 20 2 1 - D e c e m b e r 30 , 20 2 1 ) Ap r i l 15 , 20 2 2 (c o v e r i n g De c e m b e r 31 , 20 2 1 - M a r c h 30 , 20 2 2 ) Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 34 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ta s k *M a y Su p p o r t PH A B Pa y m e n t Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n Nu m b e r St a n d a r d s / M e a s u r e s an d / o r Am o u n t Ju l y 15 , 20 2 1 2 (c o v e r i n g Ma r c h 31 , 20 2 2 - J u n e 29 , 20 2 2 ) Oc t o b e r 17 , 20 2 2 (c o v e r i n g Ju n e 30 , 20 2 2 - Se p t e m b e r 29 , 20 2 2 ) 3 PR O G R A M EV A L U A T I O N : Qu a r t e r l y pr o g r e s s re p o r t s to Ye a r 1- F F Y 1 8 : Re i m b u r s e m e n t Pa r t i c i p a t e in pe r f o r m a n c e me a s u r e da t a DO H vi a Sh a r e P o i n t si t e or Ap r i l 15 , 20 1 9 (c o v e r i n g fo r ac t u a l co s t s , co l l e c t i o n an d pr o g r a m ev a l u a t i o n ac t i v i t i e s em a i l Fe b r u a r y 19 , 20 1 9 - M a r c h 30 , 20 1 9 ) no t to ex c e e d in co l l a b o r a t i o n wi t h DO H . to t a l co n t r a c t Ju l y 15 , 20 1 9 (c o v e r i n g fu n d i n g . Ma r c h 31 , 20 1 9 - J u n e 29 , 20 1 9 ) Oc t o b e r 15 , 20 1 9 (c o v e r i n g Ju n e 30 , 20 1 9 - S e p t e m b e r 29 , 20 1 9 ) Ye a r 2- F F Y 1 9 : Ja n u a r y 15 , 20 2 0 (c o v e r i n g Se p t e m b e r 30 , 20 1 9 - D e c e m b e r 30 , 20 1 9 ) Ap r i l 15 , 20 2 0 (c o v e r i n g De c e m b e r 31 , 20 1 9 - M a r c h 30 , 20 2 0 ) Ju l y 15 , 20 2 0 (c o v e r i n g Ma r c h 31 , 20 2 0 - J u n e 29 , 20 2 0 ) Oc t o b e r 15 , 20 2 0 (c o v e r i n g Ju n e 30 , 20 2 0 - Se p t e m b e r 29 , 20 2 0 ) Ye a r 3- F F Y 2 0 : Ja n u a r y 15 , 20 2 1 (c o v e r i n g Se p t e m b e r 30 , 20 2 0 - D e c e m b e r 30 , 20 2 0 ) Ap r i l 15 , 20 2 1 (c o v e r i n g De c e m b e r 31 , 20 2 0 - M a r c h 30 , 20 2 1 ) Ju l y 15 , 20 2 1 (c o v e r i n g Ma r c h 31 , 20 2 1 - J u n e 29 , 20 2 1 ) Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 35 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ta s k *M a y Su p p o r t PH A B Pa y m e n t Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n Nu m b e r St a n d a r d s / M e a s u r e s an d / o r Am o u n t Oc t o b e r 15 , 20 2 1 (c o v e r i n g Ju n e 30 , 20 2 1 - Se p t e m b e r 29 , 20 2 1 ) Ye a r 4- F F Y 2 1 : Ja n u a r y 17 , 20 2 2 (c o v e r i n g Se p t e m b e r 30 , 20 2 1 - D e c e m b e r 30 , 20 2 1 ) Ap r i l 15 , 20 2 2 (c o v e r i n g De c e m b e r 31 , 20 2 1 - M a r c h 30 , 20 2 2 ) Ju l y 15 , 20 2 1 2 (c o v e r i n g Ma r c h 31 , 20 2 2 - J u n e 29 , 20 2 2 ) Oc t o b e r 17 , 20 2 2 (c o v e r i n g Ju n e 30 , 20 2 2 - Se p t e m b e r 29 , 20 2 2 ) 4 PR O G R A M CO M M U N I C A T I O N : Pr o v i d e co p i e s of an y Ye a r 2- F F Y 1 9 : Re i m b u r s e m e n t In f o r m pa r t n e r s an d pu b l i c ab o u t pr o g r a m re l e v a n t co m m u n i c a t i o n Ja n u a r y 15 , 20 2 0 (c o v e r i n g fo r ac t u a l co s t s , su c c e s s e s an d re l a t e d be s t pr a c t i c e s , pr o d u c t s wi t h qu a r t e r l y Se p t e m b e r 30 , 20 1 9 - D e c e m b e r 30 , no t to ex c e e d in c l u d i n g so c i a l me d i a po s t s an d pu b l i c a t i o n . pr o g r e s s re p o r t s to DO H vi a 20 1 9 ) to t a l co n t r a c t Sh a r e P o i n t si t e or em a i l fu n d i n g . Ap r i l 15 , 20 2 0 (c o v e r i n g De c e m b e r 31 , 20 1 9 - M a r c h 30 , 20 2 0 ) Ju l y 15 , 20 2 0 (c o v e r i n g Ma r c h 31 , 20 2 0 - J u n e 29 , 20 2 0 ) Oc t o b e r 15 , 20 2 0 (c o v e r i n g Ju n e 30 , 20 2 0 - Se p t e m b e r 29 , 20 2 0 ) Ye a r 3- F F Y 2 0 : Ja n u a r y 15 , 20 2 1 (c o v e r i n g Se p t e m b e r 30 , 20 2 0 - D e c e m b e r 30 , 20 2 0 ) Ap r i l 15 , 20 2 1 (c o v e r i n g De c e m b e r 31 , 20 2 0 - M a r c h 30 , 20 2 1 ) Ju l y 15 , 20 2 1 (c o v e r i n g Ma r c h 31 , 20 2 1 - J u n e 29 , 20 2 1 ) Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 36 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Pa y m e n t Ta s k *M a y Su p p o r t PH A B Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n Nu m b e r St a n d a r d s / M e a s u r e s an d / o r Am o u n t Oc t o b e r 15 , 20 2 1 (c o v e r i n g Ju n e 30 , 20 2 1 - Se p t e m b e r 29 , 20 2 1 ) Ye a r 4- F F Y 2 1 : Ja n u a r y 17 , 20 2 2 (c o v e r i n g Se p t e m b e r 30 , 20 2 1 - D e c e m b e r 30 , 20 2 1 ) Ap r i l 15 , 20 2 2 (c o v e r i n g De c e m b e r 31 , 20 2 1 - . f la r c h 30 , 20 2 2 ) Ju l y 15 , 20 2 1 2 (c o v e r i n g Ma r c h 31 , 20 2 2 - J u n e 29 , 20 2 2 ) Oc t o b e r 17 , 20 2 2 (c o v e r i n g Ju n e 30 , 20 2 2 - Se p t e m b e r 29 , 20 2 2 ) Wr i t e a su c c e s s st o r y re l a t e d to LS P A N On e su c c e s s st o r y us i n g Ye a r 2- F F Y 1 9 : pr o j e c t s . DO H - p r o v i d e d te m p l a t e Dr a f t du e by Au g u s t 30 , 20 2 0 Fi n a l du e by Oc t o b e r 15 , 20 2 0 Ye a r 4- F F Y 2 1 : Dr a f t du e : Ju l y 1, 20 2 2 Fi n a l du e : Ju l v 29 . 20 2 2 *F o r In f o r m a t i o n On l y : Fu n d i n g is no t ti e d to th e re v i s e d St a n d a r d s / M e a s u r e s li s t e d he r e . Th i s in f o r m a t i o n ma y be he l p f u l in di s c u s s i o n s of ho w pr o g r a m ac t i v i t i e s mi g h t co n t r i b u t e to me e t i n g a St a n d a r d / M e a s u r e . Mo r e de t a i l on th e s e an d / o r ot h e r Pu b l i c He a l t h Ac c r e d i t a t i o n Bo a r d (P H A B ) St a n d a r d s / M e a s u r e s th a t ma y ap p l y ca n be fo u n d at : ht t p : / / w w w . p h a b o a r d . o r g / w p - c o n t e n t l u p l o a d s / P H A B- S t a n d a r d s - a n d - M e a s u r e s - V e r s i o n - 1 . 0 . p d f Pr o g r a m Sp e c i f i c Re q u i r e m e n t s / N a r r a t i v e Th e Lo c a l St r a t e g i e s fo r Ph y s i c a l Ac t i v i t y an d Nu t r i t i o n (L S P A N ) pr o j e c t is pr o v i d i n g fu n d s to Ki t t i t a s Co u n t y Pu b l i c He a l t h De p a r t m e n t to im p l e m e n t po l i c y , sy s t e m s an d en v i r o n m e n t a l ch a n g e s at th e co m m u n i t y le v e l to en a c t he a l t h y nu t r i t i o n gu i d e l i n e s an d su p p o r t br e a s t f e e d i n g - f r i e n d l y en v i r o n m e n t s . Th e s e ch a n g e s mu s t su p p o r t th e he a l t h of pr i o r i t y po p u l a t i o n s wh o ex p e r i e n c e he a l t h di s p a r i t i e s . LS P A N is pa r t of DO H ' s St a t e Ph y s i c a l Ac t i v i t y an d Nu t r i t i o n - W a s h i n g t o n (S P A N W A ) Pr o g r a m . Fu n d i n g fo r SP A N W A is th r o u g h a co o p e r a t i v e ag r e e m e n t aw a r d e d to DO H fr o m th e Ce n t e r s fo r Di s e a s e Co n t r o l an d Pr e v e n t i o n ' s (C D C ) DP 1 8 - 1 8 0 7 : St a t e Ph v s i c a l Ac t i v i t v an d Nu t r i t i o n Pr o e r a m Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 37 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Sp e c i a l Re q u i r e m e n t s Fe d e r a l Fu n d i n g Ac c o u n t a b i l i t y an d Tr a n s p a r e n c y Ac t (F F A T A ) Th i s st a t e m e n t of wo r k is su p p o r t e d by fe d e r a l fu n d s th a t re q u i r e co m p l i a n c e wi t h th e Fe d e r a l Fu n d i n g Ac c o u n t a b i l i t y an d Tr a n s p a r e n c y Ac t (F F A T A or th e Tr a n s p a r e n c y Ac t ) . Th e pu r p o s e of th e Tr a n s p a r e n c y Ac t is to ma k e in f o r m a t i o n av a i l a b l e on l i n e so th e pu b l i c ca n se e ho w th e fe d e r a l fu n d s ar e sp e n t . To co m p l y wi t h th i s ac t an d be el i g i b l e to pe r f o r m th e ac t i v i t i e s in th i s st a t e m e n t of wo r k , th e LH J mu s t ha v e a Da t a Un i v e r s a l Nu m b e r i n g Sy s t e m (D U N S ® ) nu m b e r . In f o r m a t i o n ab o u t th e LH J an d th i s st a t e m e n t of wo r k wi l l be ma d e av a i l a b l e on US A S o e n d i n e x o v by DO H as re q u i r e d by P. L . 10 9 - 2 8 2 . Re q u i r e d Di s c l o s u r e s fo r Fe d e r a l Aw a r d e e Pe r f o r m a n c e an d In t e g r i t y In f o r m a t i o n Sy s t e m (F A P I I S ) : Co n s i s t e n t wi t h 45 CF R 75 . 1 1 3 , ap p l i c a n t s an d re c i p i e n t s mu s t di s c l o s e in a ti m e l y ma n n e r , in wr i t i n g to th e Ce n t e r s fo r Di s e a s e Co n t r o l an d Pr e v e n t i o n (C D C ) , wi t h a co p y to th e He a l t h an d Hu m a n Se r v i c e s (H H S ) Of f i c e of In s p e c t o r Ge n e r a l (O I G ) , al l in f o r m a t i o n re l a t e d to vi o l a t i o n s of fe d e r a l cr i m i n a l la w in v o l v i n g fr a u d , br i b e r y , or gr a t u i t y vi o l a t i o n s po t e n t i a l l y af f e c t i n g th e fe d e r a l aw a r d . Su b r e c i p i e n t s mu s t di s c l o s e , in a ti m e l y ma n n e r in wr i t i n g to th e pr i m e re c i p i e n t (p a s s th r o u g h en t i t y ) an d th e HH S OI G , al l in f o r m a t i o n re l a t e d to vi o l a t i o n s of fe d e r a l cr i m i n a l la w in v o l v i n g fr a u d , br i b e r y , or gr a t u i t y vi o l a t i o n s po t e n t i a l l y af f e c t i n g th e fe d e r a l aw a r d . Di s c l o s u r e s mu s t be se n t in wr i t i n g to th e CD C an d to th e HH S OI G at th e fo l l o w i n g ad d r e s s e s : CD C , Of f i c e of Gr a n t s Se r v i c e s , Ro m e r o St o k e s , Gr a n t s Ma n a g e m e n t Of f i c e r / S p e c i a l i s t , Ce n t e r s fo r Di s e a s e Co n t r o l an d Pr e v e n t i o n Ch r o n i c Di s e a s e an d Bi r t h De f e c t s Se r v i c e s Br a n c h , 29 2 0 Br a n d y w i n e Ro a d , Ma i l s t o p E- 0 9 , At l a n t a , Ge o r g i a 30 3 4 1 , Em a i l : ln i 0 ed e . g o v (I n c l u d e "M a n d a t o r y Gr a n t Di s c l o s u r e s " in su b j e c t li n e ) AN D U. S . De p a r t m e n t of He a l t h an d Hu m a n Se r v i c e s , Of f i c e of th e In s p e c t o r Ge n e r a l , AT T N : Ma n d a t o r y Gr a n t Di s c l o s u r e s , In t a k e Co o r d i n a t o r , 33 0 In d e p e n d e n c e Av e n u e SW , Co h e n Bu i l d i n g , Ro o m 55 2 7 , Wa s h i n g t o n , DC 20 2 0 1 , Fa x : (2 0 2 ) 20 5 - 0 6 0 4 (I n c l u d e "M a n d a t o r y Gr a n t Di s c l o s u r e s " in su b j e c t li n e ) or Em a i l : Ma n d a t o r v G r a n t e e D i s c l o s u r e s @ o i ; hh s . a o v Re s t r i c t i o n s on Fu n d s (w h a t fu n d s ca n be us e d fo r wh i c h ac t i v i t i e s , no t di r e c t pa y m e n t s , et c ) • On l y DO H - a p p r o v e d bu d g e t ex p e n d i t u r e s wi l l be re i m b u r s e d . • Su b r e c i p i e n t s ma y no t us e fu n d s to pu r c h a s e fu r n i t u r e or eq u i p m e n t . • Fu n d s ca n n o t be sp e n t on ca p i t a l pr o j e c t s to su p p o r t bu i l t en v i r o n m e n t ch a n g e s . • Re i m b u r s e m e n t of pr e - a w a r d co s t s ge n e r a l l y is no t al l o w e d , un l e s s DO H pr o v i d e s wr i t t e n ap p r o v a l to th e su b r e c i p i e n t . • Th e di r e c t an d pr i m a r y re c i p i e n t in a co o p e r a t i v e ag r e e m e n t pr o g r a m mu s t pe r f o r m a su b s t a n t i a l ro l e in ca r r y i n g ou t pr o j e c t ou t c o m e s an d no t me r e l y se r v e as a co n d u i t fo r an aw a r d to an o t h e r pa r t y or pr o v i d e r wh o is in e l i g i b l e . Mo n i t o r i n g Vi s i t s (f r e q u e n c y , ty p e ) • In - p e r s o n si t e vi s i t s at le a s t on c e a ye a r Sp e c i a l Bi l l i n g Re q u i r e m e n t s • Mu s t us e th e bu d g e t wo r k b o o k su p p l i e d by th e pr o g r a m DO H Pr o g r a m Co n t a c t Ch r i s Zi p p e r e r , Ph y s i c a l Ac t i v i t y Co o r d i n a t o r Wa s h i n g t o n St a t e De p a r t m e n t of He a l t h PO Bo x 47 8 4 8 Ol y m p i a , WA 98 5 0 4 36 0 - 2 3 6 - 3 6 1 4 (d e s k ) / ch r i s . z i p p e r e r @ d o h . w a . g o v Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 38 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ex h i b i t A St a t e m e n t of Wo r k Co n t r a c t Te r m : 20 1 8 - 2 0 2 1 DO H Pr o g r a m Na m e or Ti t l e : Ma t e r n a l & Ch i l d He a l t h Bl o c k Gr a n t - Lo c a l He a l t h Ju r i s d i c t i o n Na m e : Ki t t i t a s Co u n t y Pu b l i c He a l t h De p a r u n e n t Ef f e c t i v e Ja n u a r y 1 20 1 8 Co n t r a c t Nu m b e r : CL H l 8 2 4 9 SO W Ty p e : Re v i s i o n Re v i s i o n # (f o r th i s SO W ) 6 Fu n d i n g So u r c e Fe d e r a l Co m p l i a n c e Ty p e of Pa y m e n t Fe d e r a l Su b r e c i p i e n t (c h e c k if ap p l i c a b l e ) Re i m b u r s e m e n t Pe r i o d of Pe r f o r m a n c e : Ja n u a r y 1, 20 1 8 th r o u g h De c e m b e r 31 , 20 2 1 St a t e FF A T A (T r a n s p a r e n c y Ac t ) Fi x e d Pr i c e Ot h e r Re s e a r c h & De v e l o p m e n t St a t e m e n t of Wo r k Pu r p o s e : Th e pu r p o s e of th i s st a t e m e n t of wo r k is to su p p o r t lo c a l in t e r v e n t i o n s th a t im p a c t th e ta r g e t po p u l a t i o n of th e Ma t e r n a l an d Ch i l d He a l t h Bl o c k Gr a n t . Re v i s i o n Pu r p o s e : Th e pu r p o s e of th i s re v i s i o n is to pr o v i d e ad d i t i o n a l fu n d i n g , ad d ac t i v i t i e s an d de l i v e r a b l e du e da t e s , an d ex t e n d th e pe r i o d of pe r f o r m a n c e an d fu n d i n g fr o m Se p t e m b e r 30 , 20 2 1 to De c e m b e r 31 , 20 2 1 fo r co n t i n u a t i o n of MC H B G - r e l a t e d ac t i v i t i e s . Ch a r t of Ac c o u n t s Pr o g r a m Na m e or Ti t l e CF D A # BA R S Ma s t e r Fu n d i n g Pe r i o d Cu r r e n t Ch a n g e To t a l Re v e n u e In d e x (L H J Us e On l y ) Co n s i d e r a t i o n Co n s i d e r a t i o n In c r e a s e (+ ) Co d e Co d e St a r t Da t e En d Da t e FF Y l 8 MC H B G LH J CO N T R A C T S 93 . 9 9 4 33 3 . 9 3 . 9 9 78 1 2 0 2 8 1 01 / 0 1 / 1 8 09 / 3 0 / 1 8 34 , 0 4 0 0 34 , 0 4 0 FF Y l 9 MC H B G LH J CO N T R A C T S 93 . 9 9 4 33 3 . 9 3 . 9 9 78 1 2 0 2 9 1 10 / 0 1 / 1 8 09 / 3 0 / 1 9 44 , 1 9 6 0 44 , 1 9 6 FF Y 2 0 MC H B G LH J CO N T R A C T S 93 . 9 9 4 33 3 . 9 3 . 9 9 78 1 2 0 2 9 2 10 / 0 1 / 1 9 09 / 3 0 / 2 0 44 , 1 9 6 0 44 , 1 9 6 FF Y 2 1 MC H B G LH J CO N T R A C T S 93 . 9 9 4 33 3 . 9 3 . 9 9 78 1 2 0 2 9 3 10 / 0 1 / 2 0 09 / 3 0 / 2 1 44 , 1 9 6 0 44 , 1 9 6 FF Y 2 2 MC H B G LH J CO N T R A C T S 93 . 9 9 4 33 3 . 9 3 . 9 9 78 1 0 1 2 2 1 10 / 0 1 / 2 1 12 / 3 1 / 2 1 0 11 , 0 4 9 11 , 0 4 9 TO T A L S 16 6 , 6 2 8 11 , 0 4 9 17 7 , 6 7 7 Ta s k *M a y Su p p o r t PH A B Pa y m e n t Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n an d / o r Nu m b e r St a n d a r d s / M e a s u r e s Am o u n t Ma t e r n a l an d Ch i l d He a l t h Bl o c k Gr a n t (M C H B G ) Ad m i n i s t r a t i o n la Pa r t i c i p a t e in ca l l s , at a mi n i m u m of ev e r y De s i g n a t e d LH J st a f f wi l l pa r t i c i p a t e Se p t e m b e r 30 , 20 1 8 Re i m b u r s e m e n t fo r qu a r t e r , wi t h DO H co n t r a c t ma n a g e r . Da t e s an d in co n t r a c t ma n a g e m e n t ca l l s . Se p t e m b e r 30 , 20 1 9 ac t u a l co s t s , no t to ti m e fo r ca l l s ar e mu t u a l l y ag r e e d up o n be t w e e n Se p t e m b e r 30 , 20 2 0 ex c e e d to t a l fu n d i n g DO H an d LH J co n s i d e r a t i o n . Ib Re p o r t ac t u a l ex p e n d i t u r e s fo r Oc t o b e r 1, 20 1 7 Su b m i t ac t u a l ex p e n d i t u r e s us i n g th e Ma y 26 , 20 1 8 Ac t i o n Pl a n an d th r o u g h Ma r c h 31 , 20 1 8 MC H B G Bu d g e t Wo r k b o o k to DO H Pr o g r e s s Re p o r t s co n t r a c t ma n a g e r mu s t on l y re f l e c t Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 39 of 50 Co n t r a c t Nu m b e r CL H 1 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ta s k *M a y Su p p o r t PH A B Pa y m e n t Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n an d / o r Nu m b e r St a n d a r d s / M e a s u r e s Am o u n t le De v e l o p 20 1 8 - 2 0 1 9 MC H B G Bu d g e t Wo r k b o o k Su b m i t MC H B G Bu d g e t Wo r k b o o k Se p t e m b e r 5, 20 1 8 ac t i v i t i e s pa i d fo r fo r Oc t o b e r 1, 20 1 8 th r o u g h Se p t e m b e r 30 , 20 1 9 to DO H co n t r a c t ma n a g e r wi t h fu n d s pr o v i d e d us i n g DO H pr o v i d e d te m p l a t e . in th i s st a t e m e n t of wo r k fo r th e sp e c i f i e d fu n d i n g ld Re p o r t ac t u a l ex p e n d i t u r e s fo r Oc t o b e r 1, 20 1 8 Su b m i t ac t u a l ex p e n d i t u r e s us i n g th e Ma y 24 , 20 1 9 pe r i o d . th r o u g h Ma r c h 31 , 20 1 9 MC H B G Bu d g e t Wo r k b o o k to DO H co n t r a c t ma n a g e r . Se e Pr o g r a m Sp e c i f i c Re q u i r e m e n t s an d le De v e l o p 20 1 9 - 2 0 2 0 MC H B G Bu d g e t Wo r k b o o k Su b m i t MC H B G Bu d g e t Wo r k b o o k Se p t e m b e r 5, 20 1 9 Sp e c i a l Bi l l i n g fo r Oc t o b e r 1, 20 1 9 th r o u g h Se p t e m b e r 30 , 20 2 0 to DO H co n t r a c t ma n a g e r Re q u i r e m e n t s . us i n g DO H pr o v i d e d te m p l a t e . If Re p o r t ac t u a l ex p e n d i t u r e s fo r Oc t o b e r 1, 20 1 7 Su b m i t ac t u a l ex p e n d i t u r e s us i n g th e No v e m b e r 30 , 20 1 8 th r o u g h Se p t e m b e r 30 , 20 1 8 MC H B G Bu d g e t Wo r k b o o k to DO H co n t r a c t ma n a g e r . lg Pa r t i c i p a t e in DO H sp o n s o r e d MC H B G fa l l De s i g n a t e d LH J st a f f wi l l at t e n d Se p t e m b e r 30 , 20 2 0 re g i o n a l me e t i n g . re g i o n a l me e t i n g . Ih Re p o r t ac t u a l ex p e n d i t u r e s fo r Oc t o b e r 1, 20 1 8 Su b m i t ac t u a l ex p e n d i t u r e s us i n g th e De c e m b e r 6, 20 1 9 th r o u g h Se p t e m b e r 30 , 20 1 9 MC H B G Bu d g e t Wo r k b o o k to DO H co n t r a c t ma n a g e r . li De v e l o p 20 2 0 - 2 0 2 1 MC H B G Bu d g e t Wo r k b o o k Su b m i t MC H B G Bu d g e t Wo r k b o o k Se p t e m b e r 6, 20 2 0 fo r Oc t o b e r 1, 20 2 0 th r o u g h Se p t e m b e r 30 , 20 2 1 to DO H co n t r a c t ma n a g e r us i n g DO H pr o v i d e d te m p l a t e . lj Re p o r t ac t u a l ex p e n d i t u r e s fo r th e si x mo n t h Su b m i t ac t u a l ex p e n d i t u r e s us i n g th e Ma y 22 , 20 2 0 pe r i o d fr o m Oc t o b e r 1, 20 1 9 th r o u g h Ma r c h 31 , MC H B G Bu d g e t Wo r k b o o k to DO H 20 2 0 co n t r a c t ma n a g e r . Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 40 of 50 Co n t r a c t Nu m b e r CL H 1 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Pa y m e n t Ta s k *M a y Su p p o r t PH A B Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n an d / o r Nu m b e r St a n d a r d s / M e a s u r e s Am o u n t lk Re p o r t ac t u a l ex p e n d i t u r e s fo r Oc t o b e r 1, 20 1 9 Su b m i t ac t u a l ex p e n d i t u r e s us i n g th e De c e m b e r 4, 20 2 0 th r o u g h Se p t e m b e r 30 , 20 2 0 MC H B G Bu d g e t Wo r k b o o k to DO H co n t r a c t ma n a g e r 11 Re p o r t ac t u a l ex p e n d i t u r e s fo r th e si x mo n t h Su b m i t ac t u a l ex p e n d i t u r e s us i n g th e Ma y 21 , 20 2 1 pe r i o d fr o m Oc t o b e r 1, 20 2 0 th r o u g h Ma r c h 31 , MC H B G Bu d g e t Wo r k b o o k to DO H 20 2 1 . co n t r a c t ma n a g e r . Im De v e l o p 20 2 1 - 2 0 2 2 MC H B G Bu d g e t Wo r k b o o k Su b m i t MC H B G Bu d g e t Wo r k b o o k Se p t e m b e r 10 , 20 2 1 fo r Oc t o b e r 1, 20 2 1 th r o u g h Se p t e m b e r 30 , 20 2 2 to DO H co n t r a c t ma n a g e r us i n g DO H pr o v i d e d te m p l a t e . ln Re p o r t ac t u a l ex p e n d i t u r e s fo r Oc t o b e r 1, 20 2 0 Su b m i t ac t u a l ex p e n d i t u r e s us i n g th e De c e m b e r 3, 20 2 1 th r o u g h Se p t e m b e r 30 , 20 2 ] MC H B G Bu d g e t Wo r k b o o k to DO H co n t r a c t ma n a g e r lo Pa r t i c i p a t e in DO H sp o n s o r e d MC H B G fa l l De s i g n a t e d LH J st a f f wi l l at t e n d De c e m b e r 31 , 20 2 1 re g i o n a l me e t i n g , ei t h e r vi r t u a l l y or in - p e r s o n re g i o n a l me e t i n g . MC H B G As s e s s m e n t an d Ev a l u a t i o n 2a Pa r t i c i p a t e in pr o j e c t ev a l u a t i o n ac t i v i t i e s Do c u m e n t a t i o n us i n g re p o r t Se p t e m b e r 30 , 20 1 8 Re i m b u r s e m e n t fo r de v e l o p e d an d co o r d i n a t e d by DO H , as te m p l a t e pr o v i d e d by DO H Se p t e m b e r 30 , 20 1 9 ac t u a l co s t s , no t to re q u e s t e d . Se p t e m b e r 30 , 20 2 0 ex c e e d to t a l fu n d i n g Se p t e m b e r 30 , 20 2 1 co n s i d e r a t i o n . 2b Re p o r t pr o g r a m le v e l st r a t e g y me a s u r e da t a Do c u m e n t a t i o n us i n g re p o r t Ja n u a r y 15 , 20 1 8 (C S H C N , UD S , AC E s ) . te m p l a t e pr o v i d e d by DO H Ap r i l 15 , 20 1 8 Se e Pr o g r a m Ju l y 15 , 20 1 8 Sp e c i f i c Oc t o b e r 15 , 20 1 8 Re q u i r e m e n t s an d 2c Co n d u c t a Ma t e r n a l an d Ch i l d He a l t h (M C H ) Su b m i t Ne e d s As s e s s m e n t Ma y 24 , 20 1 9 Sp e c i a l Bi l l i n g Ne e d s As s e s s m e n t . do c u m e n t a t i o n to DO H co n t r a c t Re q u i r e m e n t s . ma n a g e r us i n g te m p l a t e s pr o v i d e d by DO H Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 41 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ta s k *M a y Su p p o r t PH A B Pa y m e n t Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n an d / o r Nu m b e r St a n d a r d s / M e a s u r e s Am o u n t 2d Ex p l o r e he a l t h eq u i t y ap p r o a c h e s to ma t e r n a l an d In c l u d e he a l t h eq u i t y pl a n in 20 2 0 - Dr a f t Au g u s t 16 , 20 2 0 ch i l d he a l t h an d de v e l o p im p l e m e n t a t i o n pl a n 20 2 1 MC H B G Ac t i o n Pl a n us i n g Fi n a l Se p t e m b e r 6, 20 2 0 DO H - pr o v i d e d te m p l a t e . MC H B G Im p l e m e n t a t i o n 3a De v e l o p 20 1 8 - 2 0 1 9 MC H B G Ac t i o n Pl a n fo r Su b m i t MC H B G Ac t i o n Pl a n to Dr a f t Au g u s t 17 , 20 1 8 Re i m b u r s e m e n t fo r Oc t o b e r 1, 20 1 8 th r o u g h Se p t e m b e r 30 , 20 1 9 DO H co n t r a c t ma n a g e r Fi n a l - Se p t e m b e r 5, ac t u a l co s t s , no t to us i n g DO H - p r o v i d e d te m p l a t e . 20 1 8 ex c e e d to t a l fu n d i n g 3b Re p o r t ac t i v i t i e s an d ou t c o m e s of 20 1 7 - 2 0 1 8 Su b m i t Ac t i o n Pl a n mo n t h l y re p o r t s Mo n t h l y , on or be f o r e co n s i d e r a t i o n . MC H B G Ac t i o n Pl a n us i n g DO H - pr o v i d e d to DO H co n t r a c t ma n a g e r th e 15 * of th e fo l l o w i n g Ac t i o n Pl a n an d te m p l a t e . mo n t h Pr o g r e s s Re p o r t s 3c De v e l o p 20 1 9 - 2 0 2 0 MC H B G Ac t i o n Pl a n fo r Su b m i t MC H B G Ac t i o n Pl a n to Dr a f t Au g u s t 17 , 20 1 9 mu s t on l y re f l e c t Oc t o b e r 1, 20 1 9 th r o u g h Se p t e m b e r 30 , 20 2 0 DO H co n t r a c t ma n a g e r Fi n a l - Se p t e m b e r 5, ac t i v i t i e s pa i d fo r us i n g DO H - p r o v i d e d te m p l a t e . 20 1 9 wi t h fu n d s pr o v i d e d 3d Re p o r t ac t i v i t i e s an d ou t c o m e s of 20 1 8 - 2 0 1 9 Su b m i t Ac t i o n Pl a n mo n t h l y re p o r t s Mo n t h l y , on or be f o r e in th i s st a t e m e n t of MC H B G Ac t i o n Pl a n us i n g DO H - pr o v i d e d to DO H co n t r a c t ma n a g e r th e 15 * of th e fo l l o w i n g wo r k fo r th e te m p l a t e . mo n t h sp e c i f i e d fu n d i n g 3e De v e l o p 20 2 0 - 2 0 2 1 MC H B G Ac t i o n Pl a n fo r Su b m i t MC H B G Ac t i o n Pl a n to Dr a f t Au g u s t 16 , 20 2 0 pe r i o d . Oc t o b e r 1, 20 2 0 th r o u g h Se p t e m b e r 30 , 20 2 1 DO H co n t r a c t ma n a g e r Fi n a l Se p t e m b e r 6, 20 2 0 us i n g DO H - p r o v i d e d te m p l a t e . Se e Pr o g r a m 3f Re p o r t ac t i v i t i e s an d ou t c o m e s of 20 1 9 - 2 0 2 0 Su b m i t Ac t i o n Pl a n mo n t h l y re p o r t s Mo n t h l y , on or be f o r e Sp e c i f i c MC H B G Ac t i o n Pl a n us i n g DO H - pr o v i d e d to DO H co n t r a c t ma n a g e r th e 15 h of th e fo l l o w i n g Re q u i r e m e n t s an d te m p l a t e . mo n t h Sp e c i a l Bi l l i n g 3g Re p o r t ac t i v i t i e s an d ou t c o m e s of 20 2 0 - 2 1 Su b m i t Ac t i o n Pl a n re p o r t s to DO H Oc t o b e r 15 , 20 2 0 Re q u i r e m e n t s . MC H B G Ac t i o n Pl a n us i n g DO H - P r o v i d e d co n t r a c t ma n a g e r Ja n u a r y 15 , 20 2 1 te m p l a t e . Ap r i l 15 , 20 2 1 Ju l y 15 , 20 2 1 Oc t o b e r 15 , 20 2 ] 3h De v e l o p 20 2 1 - 2 0 2 2 MC H B G Ac t i o n Pl a n fo r Su b m i t MC H B G Ac t i o n Pl a n to Dr a f t Au g u s t 20 , 20 2 1 Oc t o b e r 1, 20 2 1 th r o u g h Se p t e m b e r 30 , 20 2 2 DO H co n t r a c t ma n a g e r Fi n a l Se p t e m b e r 10 , us i n g DO H - P r o v i d e d te m p l a t e . 20 2 1 3i De v e l o p 20 2 2 MC H B G Ac t i o n Pl a n fo r Su b m i t MC H B G Ac t i o n Pl a n to Dr a f t No v e m b e r 19 , Ja n u a r y 1, 20 2 2 th r o u g h Se p t e m b e r 30 , 20 2 2 DO H co n t r a c t ma n a g e r 20 2 1 us i n g DO H - p r o v i d e d te m p l a t e . Fi n a l - D e c e m b e r 20 , 20 2 1 Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 42 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Pa y m e n t Ta s k *M a y Su p p o r t PH A B Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Du e Da t e / T i m e Fr a m e In f o r m a t i o n an d / o r Nu m b e r St a n d a r d s / M e a s u r e s Am o u n t Ch i l d r e n an d Yo u t h wi t h Sp e c i a l He a l t h Ca r e Ne e d s (C Y S H C N ) 4a Co m p l e t e Ch i l d He a l t h In t a k e Fo r m (C H I F ) Su b m i t CH I F da t a in t o Ac c e s s Ja n u a r y 15 , 20 1 8 Re i m b u r s e m e n t fo r us i n g th e CH I F Au t o m a t e d Sy s t e m on al l in f a n t s Wa s h i n g t o n we b s i t e : Ap r i l 15 , 20 1 8 ac t u a l co s t s , no t to an d ch i l d r e n se r v e d by th e CY S H C N Pr o g r a m as ht t o s : / / s e c u r e a c c e s s . w a . g o y Ju l y 15 , 20 1 8 ex c e e d to t a l fu n d i n g re f e r e n c e d in CY S H C N Pr o g r a m gu i d a n c e . Oc t o b e r 15 , 20 1 8 co n s i d e r a t i o n . En s u r e cl i e n t da t a is co l l e c t e d on al l ch i l d r e n Ja n u a r y 15 , 20 1 9 Ac t i o n Pl a n an d se r v e d by CY S H C N co n t r a c t o r s , re g i o n a l Ap r i l 15 , 20 1 9 Pr o g r e s s Re p o r t s ma x i l l o f a c i a l co o r d i n a t o r s , an d th e DO H Ju l y 15 , 20 1 9 mu s t on l y re f l e c t Ne w b o r n Sc r e e n i n g Pr o g r a m . Oc t o b e r 15 , 20 1 9 ac t i v i t i e s pa i d fo r Ja n u a r y 15 , 20 2 0 wi t h fu n d s pr o v i d e d Ap r i l 15 , 20 2 0 in th i s st a t e m e n t of Ju l y 15 , 20 2 0 wo r k fo r th e Oc t o b e r 15 , 20 2 0 sp e c i f i e d fu n d i n g Ja n u a r y 15 , 20 2 1 pe r i o d . Ap r i l 15 , 20 2 1 Ju l y 15 , 20 2 1 Se e Pr o g r a m Oc t o b e r 15 , 20 2 1 Sp e c i f i c 4b Id e n t i f y un m e t ne e d s fo r CY S H C N on Me d i c a i d , Su b m i t co m p l e t e d He a l t h Se r v i c e s 30 da y s af t e r fo r m s ar e Re q u i r e m e n t s an d an d re f e r to DO H CY S H C N Pr o g r a m fo r Au t h o r i z a t i o n fo r m s an d Ce n t r a l co m p l e t e d . Sp e c i a l Bi l l i n g ap p r o v a l to ac c e s s Di a g n o s t i c an d Tr e a t m e n t Tr e a t m e n t Fu n d re q u e s t s di r e c t l y to Re q u i r e m e n t s . fu n d s to me e t th e ne e d . th e CY S H C N Pr o g r a m as ne e d e d . *F o r In f o r m a t i o n On l y : Fu n d i n g is no t ti e d to th e re v i s e d St a n d a r d s / M e a s u r e s li s t e d he r e . Th i s in f o r m a t i o n ma y be he l p f u l in di s c u s s i o n s of ho w pr o g r a m ac t i v i t i e s mi g h t co n t r i b u t e to me e t i n g a St a n d a r d / M e a s u r e . Mo r e de t a i l on th e s e an d / o r ot h e r Pu b l i c He a l t h Ac c r e d i t a t i o n Bo a r d (P H A B ) St a n d a r d s / M e a s u r e s th a t ma y ap p l y ca n be fo u n d at : ht t p : / / w w w . p h a b o a r d . o r g / w p - c o n t e n t / u p l o a d s / P H AB - S t a n d a r d s - a n d - M e a s u r e s - V e r s i o n - l . 0 . p d f Pr o g r a m Sp e c i f i c Re q u i r e m e n t s / N a r r a t i v e Sp e c i a l Re q u i r e m e n t s Fe d e r a l Fu n d i n g Ac c o u n t a b i l i t y an d Tr a n s p a r e n c y Ac t (F F A T A ) Th i s st a t e m e n t of wo r k is su p p o r t e d by fe d e r a l fu n d s th a t re q u i r e co m p l i a n c e wi t h th e Fe d e r a l Fu n d i n g Ac c o u n t a b i l i t y an d Tr a n s p a r e n c y Ac t (F F A T A or th e Tr a n s p a r e n c y Ac t ) . Th e pu r p o s e of th e Tr a n s p a r e n c y Ac t is to ma k e in f o r m a t i o n av a i l a b l e on l i n e so th e pu b l i c ca n se e ho w th e fe d e r a l fu n d s ar e sp e n t . To co m p l y wi t h th i s ac t an d be el i g i b l e to pe r f o r m th e ac t i v i t i e s in th i s st a t e m e n t of wo r k , th e LH J mu s t ha v e a Da t a Un i v e r s a l Nu m b e r i n g Sy s t e m (D U N S ® ) nu m b e r . In f o r m a t i o n ab o u t th e LH J an d th i s st a t e m e n t of wo r k wi l l be ma d e av a i l a b l e on US A S p e n d i n e . c o v by DO H as re q u i r e d by P. L . 10 9 - 2 8 2 . Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 43 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Pr o g r a m Ma n u a l , Ha n d b o o k , Po l i c y Re f e r e n c e s Ch i l d r e n an d Yo u t h wi t h Sp e c i a l He a l t h Ca r e Ne e d s Ma n u a l - ht t p s : / / w w w . d o h . w a s o v / F o r P u b l i c H e a l t h a n d H e a l t h e a r e P r o v i d e r s / P u b l i e H e a l t h S y s t e m R e s o u r c e s a n d S e r v i c e s / L o c a l He a l t h R e s o u r c e s a n d T o o l s / M a t e r n a l a n d C h i l d H e a l t h B l o c k G r a n t i Ch i l d r e n a n d Y o u t h Wi t h S o e c i a l H e a l t h C a r e N e e d s He a l t h Se r v i c e s Au t h o r i z a t i o n (H S A ) Fo r m ht t p : / / w w w . d o h . w a . a o v ! P o r t a l s / i / D o c u m e n t s / P u b s | 9 1 0 . 0 0 2 - A p p r o v e d H S A . d o c x Re s t r i c t i o n s on Fu n d s (w h a t fu n d s ca n be us e d fo r wh i c h ac t i v i t i e s , no t di r e c t pa y m e n t s , et c . ) 1. At le a s t 30 % of fe d e r a l Ti t l e V fu n d s mu s t be us e d fo r pr e v e n t i v e an d pr i m a r y ca r e se r v i c e s fo r ch i l d r e n an d at le a s t 30 % mu s t be us e d se r v i c e s fo r ch i l d r e n wi t h sp e c i a l he a l t h ca r e ne e d s . [S o c i a l Se c u r i t y La w , Se c . 50 5 ( a ) ( 3 ) ] . 2. Fu n d s ma y no t be us e d fo r : a. In p a t i e n t se r v i c e s , ot h e r th a n in p a t i e n t se r v i c e s fo r ch i l d r e n wi t h sp e c i a l he a l t h ca r e ne e d s or hi g h ri s k pr e g n a n t wo m e n an d in f a n t s , an d ot h e r pa t i e n t se r v i c e s ap p r o v e d by He a l t h Re s o u r c e s an d Se r v i c e s Ad n i i n i s t r a t i o n (H R S A ) . b. Ca s h pa y m e n t s to in t e n d e d re c i p i e n t s of he a l t h se r v i c e s . c. Th e pu r c h a s e or im p r o v e m e n t of la n d , th e pu r c h a s e , co n s t r u c t i o n , or pe r m a n e n t im p r o v e m e n t of an y bu i l d i n g or ot h e r fa c i l i t y , or th e pu r c h a s e of ma j o r me d i c a l eq u i p m e n t . d. Me e t i n g ot h e r fe d e r a l ma t c h i n g fi m d s re q u i r e m e n t s . e. Pr o v i d i n g fu n d s fo r re s e a r c h or tr a i n i n g to an y en t i t y ot h e r th a n a pu b l i c or no n p r o f i t pr i v a t e en t i t y . f. pa y m e n t fo r an y se r v i c e s fu r n i s h e d by a pr o v i d e r or en t i t y wh o ha s be e n ex c l u d e d un d e r Ti t l e XV I I I (M e d i c a r e ) , Ti t l e XI X (M e d i c a i d ) , or Ti t l e XX (s o c i a l se r v i c e s bl o c k gr a n t ) . [ S o c i a l Se c u r i t y La w , Se c 50 4 ( b ) ] . 3. If an y ch a r g e s ar e im p o s e d fo r th e pr o v i s i o n of he a l t h se r v i c e s us i n g Ti t l e V (M C H Bl o c k Gr a n t ) fu n d s , su c h ch a r g e s wi l l be pu r s u a n t to a pu b l i c sc h e d u l e of ch a r g e s ; wi l l no t be im p o s e d wi t h re s p e c t to se r v i c e s pr o v i d e d to lo w in c o m e mo t h e r s or ch i l d r e n ; an d wi l l be ad j u s t e d to re f l e c t th e in c o m e , re s o u r c e s , an d fa m i l y si z e of th e in d i v i d u a l pr o v i d e d th e se r v i c e s . [S o c i a l Se c u r i t y La w , Se c . 50 5 (1 ) (D ) ] . Mo n i t o r i n g Vi s i t s (f r e q u e n c y , ty p e ) Te l e p h o n e ca l l s wi t h co n t r a c t ma n a g e r as ne e d e d . Sp e c i a l Bi l l i n g Re q u i r e m e n t s Pa y m e n t is co n t i n g e n t up o n DO H re c e i p t an d ap p r o v a l of al l de l i v e r a b l e s an d an ac c e p t a b l e A1 9 - 1 A in v o i c e vo u c h e r . Pa y m e n t to co m p l e t e l y ex p e n d th e "T o t a l Co n s i d e r a t i o n " fo r a sp e c i f i c fu n d i n g pe r i o d wi l l no t be pr o c e s s e d un t i l al l de l i v e r a b l e s ar e ac c e p t e d an d ap p r o v e d by DO H . In v o i c e s mu s t be su b m i t t e d qu a r t e r l y by th e 30 t h of ea c h mo n t h fo l l o w i n g th e qu a r t e r in wh i c h th e ex p e n d i t u r e s we r e in c u r r e d an d mu s t be ba s e d on ac t u a l al l o w a b l e pr o g r a m co s t s . Bi l l i n g fo r se r v i c e s on a mo n t h l y fr a c t i o n of th e "T o t a l Co n s i d e r a t i o n " wi l l no t be ac c e p t e d or ap p r o v e d . Sp e c i a l In s t r u c t i o n s Co n t a c t DO H co n t r a c t ma n a g e r be l o w fo r ap p r o v a l of ex p e n s e s no t re f l e c t e d in ap p r o v e d bu d g e t wo r k b o o k . MC H B G fu n d s ma y be ex p e n d e d on CO V I D - 1 9 re s p o n s e ac t i v i t i e s th a t al i g n wi t h ma t e r n a l an d ch i l d he a l t h pr i o r i t i e s . Ex a m p l e s ma y in c l u d e : • Pr o v i d i n g su p p o r t in ed u c a t i n g th e MC H po p u l a t i o n ab o u t CO V I D - 1 9 th r o u g h pa r t n e r s h i p s wi t h ot h e r lo c a l ag e n c i e s , me d i c a l pr o v i d e r s , an d he a l t h ca r e or g a n i z a t i o n s . • Wo r k i n g cl o s e l y wi t h st a t e an d lo c a l em e r g e n c y pr e p a r e d n e s s st a f f to as s u r e th a t th e ne e d s of th e MC H po p u l a t i o n ar e re p r e s e n t e d . • Fu n d i n g in f r a s t r u c t u r e th a t su p p o r t s th e re s p o n s e to CO V I D - 1 9 . Fo r ex a m p l e , Pu b l i c He a l t h Nu r s e s wh o ar e ro u t i n e l y su p p o r t e d th r o u g h th e Ti t l e V pr o g r a m ma y be ab l e to be mo b i l i z e d , us i n g Ti t l e V fu n d s or se p a r a t e em e r g e n c y fu n d i n g , to su p p o r t a ca l l ce n t e r or de l i v e r he a l t h se r v i c e s . Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 44 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 • Pa r t n e r i n g wi t h pa r e n t ne t w o r k s an d he a l t h ca r e pr o v i d e r s to pr o v i d e ac c u r a t e an d re l i a b l e in f o r m a t i o n to al l fa m i l i e s . • En g a g i n g co m m u n i t y le a d e r s , in c l u d i n g fa i t h - b a s e d le a d e r s , to ed u c a t e co m m u n i t y me m b e r s ab o u t st r a t e g i e s fo r pr e v e n t i n g il l n e s s Re s t r i c t i o n s li s t e d ab o v e co n t i n u e to ap p l y . DO H Pr o g r a m Co n t a c t Ma r y Du s s o l , Co m m u n i t y Co n s u l t a n t Of f i c e of Fa m i l y an d Co m m u n i t y He a l t h Im p r o v e m e n t Wa s h i n g t o n St a t e De p a r t m e n t of He a l t h St r e e t Ad d r e s s : 31 0 Is r a e l Rd SE , Tu m w a t e r , WA 98 5 0 1 Ma i l i n g Ad d r e s s : PO Bo x 47 8 4 8 , Ol y m p i a , WA 98 5 0 4 Te l e p h o n e : 36 0 - 2 3 6 - 3 7 8 1 / Fa x : 36 0 - 2 3 6 - 3 6 4 6 Em a i l : Ma r y . D u s s o l do h . w a . g o v Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 45 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ex h i b i t A St a t e m e n t of Wo r k Co n t r a c t Te r m : 20 1 8 - 2 0 2 1 DO H Pr o g r a m Na m e or Ti t l e : Of f i c e of Dr i n k i n g Wa t e r Gr o u p A Pr o g r a m - Lo c a l He a l t h Ju r i s d i c t i o n Na m e : Ki t t i t a s Co u n t y Pu b l i c He a l t h De p a r t m e n t Ef f e c t i v e Ja n u a r y 1, 20 1 8 Co n t r a c t Nu m b e r : CL H l 8 2 4 9 SO W Ty p e : Re v i s i o n Re v i s i o n # (f o r th i s SO W ) 9 Fu n d i n g So u r c e Fe d e r a l Co m p l i a n c e Ty p e of Pa y m e n t Fe d e r a l Co n t r a c t o r (c h e c k if ap p l i c a b l e ) Re i m b u r s e m e n t Pe r i o d of Pe r f o r m a n c e : Ja n u a r y 1, 20 1 8 th r o u g h De c e m b e r 31 , 20 2 1 St a t e FF A T A (T r a n s p a r e n c y Ac t ) Fi x e d Pr i c e Ot h e r Re s e a r c h & De v e l o p m e n t St a t e m e n t of Wo r k Pu r p o s e : Th e pu r p o s e of th i s st a t e m e n t of wo r k is to pr o v i d e fu n d i n g to th e LH J fo r co n d u c t i n g sa n i t a r y su r v e y s an d pr o v i d i n g te c h n i c a l as s i s t a n c e to sm a l l co m m u n i t y an d no n - c o m m u n i t y Gr o u p A wa t e r sy s t e m s . Re v i s i o n Pu r p o s e : Th e pu r p o s e of th i s re v i s i o n is to co r r e c t di s t r i b u t i o n of Sa n i t a r y Su r v e y s be t w e e n ye a r s Ja n u a r y 1, 20 2 0 th r u De c e m b e r 31 , 20 2 0 an d Ja n u a r y 1, 20 2 1 th r u De c e m b e r 31 , 20 2 1 as s i g n e d in SO W Re v i s i o n 8. Ch a r t of Ac c o u n t s Pr o g r a m Na m e or Ti t l e CF D A # BA R S Ma s t e r Fu n d i n g Pe r i o d Cu r r e n t Ch a n g e To t a l Re v e n u e In d e x (L H J Us e On l y ) Co n s i d e r a t i o n Co n s i d e r a t i o n De c r e a s e (- ) Co d e Co d e St a r t Da t e En d Da t e Yr 20 SR F - Lo c a l As s t (1 5 % ) (F S ) SS N/ A 34 6 . 2 6 . 6 4 24 1 3 9 2 2 0 01 / 0 1 / 1 8 12 / 3 1 / 1 8 0 0 0 Sa n i t a r y Su r v e y Fe e s (F O - E ) SS - S t a t e N/ A 34 6 . 2 6 . 6 5 24 2 4 2 5 2 2 01 / 0 1 / 1 8 12 / 3 1 / 2 1 19 , 4 0 0 -7 , 8 0 0 11 , 6 0 0 Yr 20 SR F - Lo c a l As s t (1 5 % ) (F S ) TA N/ A 34 6 . 2 6 . 6 6 24 1 3 9 2 2 0 01 / 0 1 / 1 8 12 / 3 1 / 1 8 0 0 0 Yr 21 SR F - Lo c a l As s t (1 5 % ) (F S ) SS N/ A 34 6 . 2 6 . 6 4 24 1 3 9 2 2 1 01 / 0 1 / 1 8 06 / 3 0 / 1 9 2, 4 0 0 0 2, 4 0 0 Yr 21 SR F - Lo c a l As s t (1 5 % ) (F S ) TA N/ A 34 6 . 2 6 . 6 6 24 1 3 9 2 2 1 01 / 0 1 / 1 8 06 / 3 0 / 1 9 0 0 0 Yr 22 SR F - Lo c a l As s t (1 5 % ) (F O - E ) SS N/ A 34 6 . 2 6 . 6 4 24 2 4 9 2 2 2 01 / 0 1 / 1 9 12 / 3 1 / 2 0 4, 4 0 0 0 4, 4 0 0 Yr 22 SR F - Lo c a l As s t (1 5 % ) (F O - E ) TA N/ A 34 6 . 2 6 . 6 6 24 2 4 9 2 2 2 01 / 0 1 / 1 9 12 / 3 1 / 2 0 2, 0 0 0 0 2, 0 0 0 Yr 23 SR F - Lo c a l As s t (1 5 % ) (F O - E ) SS N/ A 34 6 . 2 6 . 6 4 24 2 4 9 2 2 3 01 / 0 1 / 2 1 01 / 3 1 / 2 1 12 , 6 0 0 -7 , 8 0 0 4, 8 0 0 Yr 23 SR F - Lo c a l As s t (1 5 % ) (F O - E ) TA N/ A 34 6 . 2 6 . 6 6 24 2 4 9 2 2 3 01 / 0 1 / 2 1 01 / 3 1 / 2 1 4, 0 0 0 -2 , 0 0 0 2, 0 0 0 TO T A L S 44 , 8 0 0 -1 7 , 6 0 0 27 , 2 0 0 Ta s k *M a y Su p p o r t PH A B Du e Da t e / T i m e Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Pa y m e n t In f o r m a t i o n an d / o r Am o u n t Nu m b e r St a n d a r d s / M e a s u r e s Fr a m e 1 Tr a i n e d LH J st a f f wi l l co n d u c t Pr o v i d e Fi n a l * Sa n i t a r y Fi n a l Sa n i t a r y Su r v e y Up o n OD W ac c e p t a n c e of th e Fi n a l sa n i t a r y su r v e y s of sm a l l co m m u n i t y Su r v e y Re p o r t s to OD W Re p o r t s mu s t be Sa n i t a r y Su r v e y Re p o r t , th e LH J sh a l l an d no n - c o m m u n i t y Gr o u p A wa t e r Re g i o n a l Of f i c e . Co m p l e t e re c e i v e d by th e OD W be pa i d $4 0 0 fo r ea c h sa n i t a r y su r v e y of sy s t e m s id e n t i f i e d by th e DO H Of f i c e Sa n i t a r y Su r v e y Re p o r t s sh a l l Re g i o n a l Of f i c e a no n - c o m m u n i t y sy s t e m wi t h th r e e or of Dr i n k i n g Wa t e r (O D W ) Re g i o n a l in c l u d e : wi t h i n 30 ca l e n d a r fe w e r co n n e c t i o n s . Of f i c e . 1. Co v e r le t t e r id e n t i f y i n g da y s of co n d u c t i n g si g n i f i c a n t de f i c i e n c i e s , th e sa n i t a r y su r v e y . Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 46 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ta s k *M a y Su p p o r t PH A B Du e Da t e / T i m e Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Pa y m e n t In f o r m a t i o n an d / o r Am o u n t Nu m b e r St a n d a r d s / M e a s u r e s Fr a m e Se e Sp e c i a l In s t r u c t i o n s fo r ta s k si g n i f i c a n t fi n d i n g s , Up o n OD W ac c e p t a n c e of th e Fi n a l ac t i v i t y . ob s e r v a t i o n s , Sa n i t a r y Su r v e y Re p o r t , th e LH J sh a l l re c o m m e n d a t i o n s , an d be pa i d 58 0 0 fo r ea c h sa n i t a r y su r v e y of re f e r r a l s fo r fu r t h e r a no n - c o m m u n i t y sy s t e m wi t h fo u r or OD W fo l l o w - u p . mo r e co n n e c t i o n s an d ea c h co m m u n i t y 2. Co m p l e t e d Sm a l l Wa t e r sy s t e m . Sy s t e m ch e c k l i s t . 3. Up d a t e d Wa t e r Fa c i l i t i e s Pa y m e n t is in c l u s i v e of al l as s o c i a t e d In v e n t o r y (W F I ) . co s t s su c h as tr a v e l , lo d g i n g , pe r di e m . 4. Ph o t o s of wa t e r sy s t e m wi t h te x t id e n t i f y i n g Pa y m e n t is au t h o r i z e d up o n re c e i p t an d fe a t u r e s ac c e p t a n c e of th e Fi n a l Sa n i t a r y Su r v e y 5. An y ot h e r su p p o r t i n g Re p o r t wi t h i n th e 30 - d a y de a d l i n e . do c u m e n t s . La t e or in c o m p l e t e re p o r t s ma y no t be *F i n a l Re p o r t s re v i e w e d an d ac c e p t e d fo r pa y m e n t . ac c e p t e d by th e OD W Re g i o n a l Of f i c e . 2 Tr a i n e d LH J st a f f wi l l co n d u c t Pr o v i d e co m p l e t e d SP I Co m p l e t e d SP I Up o n ac c e p t a n c e of th e co m p l e t e d SP I Sp e c i a l Pu r p o s e In v e s t i g a t i o n s (S P I ) Re p o r t an d an y su p p o r t i n g Re p o r t s mu s t be Re p o r t , th e LH J sh a l l be pa i d $8 0 0 fo r of sm a l l co m m u n i t y an d no n - do c u m e n t s an d ph o t o s to re c e i v e d by th e OD W ea c h SP I . co m m u n i t y Gr o u p A wa t e r sy s t e m s OD W Re g i o n a l Of f i c e . Re g i o n a l Of f i c e id e n t i f i e d by th e OD W Re g i o n a l wi t h i n 2 wo r k i n g Pa y m e n t is in c l u s i v e of al l as s o c i a t e d Of f i c e . da y s of th e se r v i c e co s t s su c h as tr a v e l , lo d g i n g , pe r di e m . re q u e s t . Se e Sp e c i a l In s t r u c t i o n s fo r ta s k Pa y m e n t is au t h o r i z e d up o n re c e i p t an d ac t i v i t y . ac c e p t a n c e of co m p l e t e d SP I Re p o r t wi t h i n th e 2 wo r k i n g da y de a d l i n e . La t e or in c o m p l e t e re p o r t s ma y no t be ac c e p t e d fo r pa y m e n t . 3 Tr a i n e d LH J st a f f wi l l pr o v i d e di r e c t Pr o v i d e co m p l e t e d TA Co m p l e t e d TA Up o n ac c e p t a n c e of th e co m p l e t e d TA te c h n i c a l as s i s t a n c e (T A ) to sm a l l Re p o r t an d an y su p p o r t i n g Re p o r t mu s t be Re p o r t , th e LH J sh a l l be pa i d fo r ea c h co m m u n i t y an d no n - c o m m u n i t y do c u m e n t s an d ph o t o s to re c e i v e d by th e OD W te c h n i c a l as s i s t a n c e ac t i v i t y as fo l l o w s : Gr o u p A wa t e r sy s t e m s id e n t i f i e d by OD W Re g i o n a l Of f i c e . Re g i o n a l Of f i c e • Up to 3 ho u r s of wo r k : 52 5 0 th e OD W Re g i o n a l Of f i c e . wi t h i n 30 ca l e n d a r • 3- 6 ho u r s of wo r k : $5 0 0 da y s of pr o v i d i n g • Mo r e th a n 6 ho u r s of wo r k : $7 5 0 Se e Sp e c i a l In s t r u c t i o n s fo r ta s k te c h n i c a l as s i s t a n c e . ac t i v h y - Pa y m e n t is in c l u s i v e of al l as s o c i a t e d co s t s su c h as co n s u l t i n g fe e , tr a v e l , lo d g i n g , pe r di e m . Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 47 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Ta s k *M a y Su p p o r t PH A B Du e Da t e / T i m e Ta s k / A c t i v i t y / D e s c r i p t i o n De l i v e r a b l e s / O u t c o m e s Pa y m e n t In f o r m a t i o n an d / o r Am o u n t Nu m b e r St a n d a r d s / M e a s u r e s Fr a m e Pa y m e n t is au t h o r i z e d up o n re c e i p t an d ac c e p t a n c e of co m p l e t e d TA Re p o r t wi t h i n th e 30 - d a y de a d l i n e . La t e or in c o m p l e t e re p o r t s ma y no t be ac c e p t e d fo r pa y m e n t . 4 LH J st a f f pe r f o r m i n g th e ac t i v i t i e s Pr i o r to at t e n d i n g th e An n u a l l y LH J sh a l l be pa i d mi l e a g e , pe r di e m , un d e r ta s k s 1, 2 an d 3 mu s t ha v e tr a i n i n g , su b m i t an lo d g i n g , an d re g i s t r a t i o n co s t s as co m p l e t e d th e ma n d a t o r y Sa n i t a r y "A u t h o r i z a t i o n fo r Tr a v e l ap p r o v e d on th e pr e - a u t h o r i z a t i o n fo r m Su r v e y Tr a i n i n g . (N o n - E m p l o y e e ) " DO H in ac c o r d a n c e wi t h th e cu r r e n t ra t e s Fo r m 71 0 - 0 1 3 to th e OD W li s t e d on th e OF M We b s i t e Se e Sp e c i a l In s t r u c t i o n s fo r ta s k Pr o g r a m Co n t a c t be l o w fo r hu p : / / w w w . o f i n . w a . m o v / r e s o u r c e s h r a v e l ac t i v i t y . ap p r o v a l (t o en s u r e th a t _a g ; en o u g h fu n d s ar e av a i l a b l e ) . *F o r In f o r m a t i o n On l y : Fu n d i n g is no t ti e d to th e re v i s e d St a n d a r d s / M e a s u r e s li s t e d he r e . Th i s in f o r m a t i o n ma y be he l p f u l in di s c u s s i o n s of ho w pr o g r a m ac t i v i t i e s mi g h t co n t r i b u t e to me e t i n g a St a n d a r d / M e a s u r e . Mo r e de t a i l on th e s e an d / o r ot h e r Pu b l i c He a l t h Ac c r e d i t a t i o n Bo a r d (P H A B ) St a n d a r d s / M e a s u r e s th a t ma y ap p l y ca n be fo u n d at : ht t a : / / w w w . p h a b o a r d . o r e i w p - c o n t e n t / u p l o a d s / P H AB - S t a n d a r d s - a n d - M e a s u r e s - V e r s i o n - L O . p d f Pr o g r a m Sp e c i f i c Re q u i r e m e n t s / N a r r a t i v e Sp e c i a l Re f e r e n c e s (R C W s , WA C s , et c ) Ch a p t e r 24 6 - 2 9 0 WA C is th e se t of ru l e s th a t re g u l a t e Gr o u p A wa t e r sy s t e m s . By th i s st a t e m e n t of wo r k , OD W co n t r a c t s wi t h th e LH J to co n d u c t sa n i t a r y su r v e y s (a n d SP I s , an d pr o v i d e te c h n i c a l as s i s t a n c e ) fo r sm a l l co m m u n i t y an d no n - c o m m u n i t y wa t e r sy s t e m s wi t h gr o u n d w a t e r so u r c e s . OD W re t a i n s re s p o n s i b i l i t y fo r co n d u c t i n g sa n i t a r y su r v e y s (a n d SP I s , an d pr o v i d e te c h n i c a l as s i s t a n c e ) fo r sm a l l co m m u n i t y an d no n - c o m m u n i t y wa t e r sy s t e m s wi t h su r f a c e wa t e r so u r c e s , la r g e wa t e r sy s t e m s , an d sy s t e m s wi t h co m p l e x tr e a t m e n t . LH J st a f f as s i g n e d to pe r f o r m ac t i v i t i e s un d e r ta s k s I, 2, an d 3 mu s t be tr a i n e d an d ap p r o v e d by OD W pr i o r to pe r f o r m i n g wo r k . Se e sp e c i a l in s t r u c t i o n s un d e r Ta s k 4, be l o w . Sp e c i a l Bi l l i n g Re q u i r e m e n t s Th e LH J sh a l l su b m i t qu a r t e r l y in v o i c e s wi t h i n 30 da y s fo l l o w i n g th e en d of th e qu a r t e r in wh i c h wo r k wa s co m p l e t e d , no t i n g on th e in v o i c e th e qu a r t e r an d ye a r be i n e bi l l e d fo r . Pa y m e n t ca n n o t ex c e e d a ma x i m u m ac c u m u l a t i v e fe e of -5 3 8 4 0 0 $2 3 , 2 0 0 fo r Ta s k 1, an d $4 , 0 0 0 fo r Ta s k 2, Ta s k 3 an d Ta s k 4 co m b i n e d du r i n g th e co n t r a c t i n g pe r i o d , to be pa i d at th e ra t e s sp e c i f i e d in th e Pa y m e n t Me t h o d / A m o u n t se c t i o n ab o v e . Wh e n in v o i c i n g fo r sa n i t a r y su r v e v s , bi H ha l f to BA R S Re v e n u e Co d e 34 6 . 2 6 . 6 4 an d ha l f to BA R S Re v e n u e Co d e 34 6 . 2 6 . 6 5 . Wh e n in v o i c i n g fo r Ta s k 1, su b m i t th e li s t of WS Na m e , ID #, Am o u n t Bi l l e d , Su r v e y Da t e an d Le t t e r Da t e th a t yo u ar e re q u e s t i n g pa y m e n t . Wh e n in v o i c i n g fo r Ta s k 2- 3 , su b m i t th e li s t of WS Na m e , ID #, TA Da t e an d de s c r i p t i o n of TA wo r k pe r f o r m e d , an d Am o u n t Bi l l e d . Wh e n in v o i c i n g fo r Ta s k 4, su b m i t re c e i p t s an d th e si g n e d pr e - a u t h o r i z a t i o n fo r m fo r no n - e m p l o y e e tr a v e l to th e OD W Pr o g r a m Co n t a c t be l o w an d a si g n e d A1 9 - 1 A In v o i c e Vo u c h e r to th e DO H Gr a n t s Ma n a g e m e n t , bi l l i n g to BA R S Re v e n u e Co d e 34 6 . 2 6 . 6 6 un d e r Te c h n i c a l As s i s t a n c e (T A ) . Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 48 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Sp e c i a l In s t r u c t i o n s Ta s k 1 Tr a i n e d LH J st a f f wi l l ev a l u a t e th e wa t e r sy s t e m fo r ph y s i c a l an d op e r a t i o n a l de f i c i e n c i e s an d pr e p a r e a Fi n a l Sa n i t a r y Su r v e y Re p o r t wh i c h ha s be e n ac c e p t e d by OD W . De t a i l e d gu i d a n c e is pr o v i d e d in t h e Fi e l d Gu i d e fo r Sa n i t a r y Su r v e y s , Sp e c i a l Pu r p o s e In v e s t i g a t i o n s an d Te c h n i c a l As s i s t a n c e (F i e l d Gu i d e ) . Th e sa n i t a r y su r v e y wi l l in c l u d e an ev a l u a t i o n of th e fo l l o w i n g ei g h t el e m e n t s : so u r c e ; tr e a t m e n t ; di s t r i b u t i o n sy s t e m ; fi n i s h e d wa t e r st o r a g e ; pu m p s , pu m p fa c i l i t i e s an d co n t r o l s ; mo n i t o r i n g , re p o r t i n g an d da t a ve r i f i c a t i o n ; sy s t e m ma n a g e m e n t an d op e r a t i o n ; an d ce r t i f i e d op e r a t o r co m p l i a n c e . If a sy s t e m is mo r e co m p l e x th a n an t i c i p a t e d or ot h e r si g n i f i c a n t is s u e s ar i s e , th e LH J ma y re q u e s t OD W as s i s t a n c e . • No mo r e th a n 8 su r v e y s of n o n - c o m m u n i t y sy s t e m s wi t h th r e e or fe w e r co n n e c t i o n s to be co m p l e t e d be t w e e n Ja n u a r y 1, 20 1 8 an d De c e m b e r 31 , 20 1 8 . • No mo r e th a n 2 su r v e y s of n o n - c o m m u n i t y sy s t e m s wi t h fo u r or mo r e co n n e c t i o n s an d al l co m m u n i t y sy s t e m s to be co m p l e t e d be t w e e n Ja n u a r y 1, 20 1 8 an d De c e m b e r 31 , 20 1 8 . • No mo r e th a n 4 su r v e y s of n o n - c o m m u n i t y sy s t e m s wi t h th r e e or fe w e r co n n e c t i o n s to be co m p l e t e d be t w e e n Ja n u a r y 1, 20 1 9 an d De c e m b e r 31 , 20 1 9 . • No mo r e th a n 5 su r v e y s of n o n - c o m m u n i t y sy s t e m s wi t h fo u r or mo r e co n n e c t i o n s an d al l co m m u n i t y sy s t e m s to be co m p l e t e d be t w e e n Ja n u a r y 1, 20 1 9 an d De c e m b e r 31 , 20 1 9 . • No mo r e th a n 3 su r v e y s of no n - c o m m u n i t y sy s t e m s wi t h th r e e or fe w e r co n n e c t i o n s to be co m p l e t e d be t w e e n Ja n u a r y 1, 20 2 0 an d De c e m b e r 31 , 20 2 0 . • No mo r e th a n 8 su r v e y s of no n - c o m m u n i t y sy s t e m s wi t h fo u r or mo r e co n n e c t i o n s an d al l co m m u n i t y sy s t e m s to be co m p l e t e d be t w e e n Ja n u a r y 1, 20 2 0 an d De c e m b e r 31 , 20 2 0 . • No mo r e th a n 4 2 su r v e y s of no n - c o m m u n i t y sy s t e m s wi t h th r e e or fe w e r co n n e c t i o n s to be co m p l e t e d be t w e e n Ja n u a r y 1, 20 2 1 an d De c e m b e r 31 , 20 2 1 . • No mo r e th a n 24 11 su r v e y s of no n - c o m m u n i t y sy s t e m s wi t h fo u r or mo r e co n n e c t i o n s an d al l co m m u n i t y sy s t e m s to be co m p l e t e d be t w e e n Ja n u a r y 1, 20 2 1 an d De c e m b e r 31 , 20 2 1 . Th e pr o c e s s fo r as s i g n m e n t of su r v e y s to th e LH J , no t i f i c a t i o n of th e wa t e r sy s t e m , an d OD W fo l l o w - u p wi t h un r e s p o n s i v e wa t e r sy s t e m s ; an d ot h e r ro l e s an d re s p o n s i b i l i t i e s of th e LH J ar e de s c r i b e d in th e Fi e l d Gu i d e . Ta s k 2 Tr a i n e d LH J st a f f wi l l pe r f o r m Sp e c i a l Pu r p o s e In v e s t i g a t i o n s (S P I s ) as as s i g n e d by OD W . SP I s ar e in s p e c t i o n s to de t e r m i n e th e ca u s e of po s i t i v e co l i f o r m sa m p l e s or th e ca u s e of ot h e r em e r g e n c y co n d i t i o n s . SP I s ma y al s o in c l u d e sa n i t a r y su r v e y s of ne w l y di s c o v e r e d Gr o u p A wa t e r sy s t e m s . Ad d i t i o n a l de t a i l ab o u t co n d u c t i n g SP I s is de s c r i b e d in th e Fi e l d Gu i d e . Th e OD W Re g i o n a l Of f i c e mu s t au t h o r i z e in ad v a n c e an y SP I co n d u c t e d by LH J st a f f . Ta s k 3 Tr a i n e d LH J st a f f wi l l co n d u c t Te c h n i c a l as s i s t a n c e as as s i g n e d by OD W . Te c h n i c a l As s i s t a n c e in c l u d e s as s i s t i n g wa t e r sy s t e m pe r s o n n e l in co m p l e t i n g wo r k or ve r i f y i n g wo r k ha s be e n ad d r e s s e d as re q u i r e d , re q u e s t e d , or ad v i s e d by th e OD W to me e t ap p l i c a b l e dr i n k i n g wa t e r re g u l a t i o n s . Ex a m p l e s of te c h n i c a l as s i s t a n c e ac t i v i t i e s ar e de s c r i b e d in th e Fi e l d Gu i d e . Th e OD W Re g i o n a l Of f i c e mu s t au t h o r i z e in ad v a n c e an y te c h n i c a l as s i s t a n c e pr o v i d e d by th e LH J to a wa t e r sy s t e m . Ta s k 4 LH J st a f f as s i g n e d to pe r f o r m ac t i v i t i e s un d e r ta s k s 1, 2, an d 3 mu s t be tr a i n e d an d ap p r o v e d by OD W pr i o r to pe r f o r m i n g wo r k . LH J st a f f pe r f o r m i n g th e ac t i v i t i e s un d e r ta s k s 1, 2 an d 3 mu s t ha v e co m p l e t e d , wi t h a pa s s i n g sc o r e , th e OD W On l i n e Sa n i t a r y Su r v e y Tr a i n i n g an d th e OD W Sa n i t a r y Su r v e y Fi e l d Tr a i n i n g . LH J st a f f pe r f o r m i n g ac t i v i t i e s un d e r ta s k s 1, 2, an d 3 mu s t at t e n d th e An n u a l OD W Sa n i t a r y Su r v e y Wo r k s h o p , an d ar e ex p e c t e d to at t e n d th e Re g i o n a l OD W LH J Dr i n k i n g Wa t e r Me e t i n g s . If re q u i r e d tr a i n i n g s , wo r k s h o p s or me e t i n g s ar e no t av a i l a b l e , no t sc h e d u l e d , or if th e LH J st a f f pe r s o n is un a b l e to at t e n d th e s e ac t i v i t i e s pr i o r to co n d u c t i n g as s i g n e d ta s k s , th e LH J st a f f pe r s o n ma y , wi t h OD W ap p r o v a l , su b s t i t u t e ot h e r tr a i n i n g ac t i v i t i e s to be de t e r m i n e d by OD W . Su c h su b s t i t u t e ac t i v i t i e s ma y in c l u d e on e - o n - o n e tr a i n i n g wi t h OD W st a f f , co - s u r v e y s wi t h OD W st a f f , or ot h e r ac t i v i t i e s as ar r a n g e d an d pr e - a p p r o v e d by OD W . LH J st a f f ma y no t pe r f o r m th e ac t i v i t i e s un d e r ta s k s 1, 2, an d 3 wi t h o u t co m p l e t i n g th e tr a i n i n g th a t ha s be e n ar r a n g e d an d ap p r o v e d by OD W . Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 49 of 50 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 AM E N D M E N T #2 2 Pr o g r a m Ma n u a l , Ha n d b o o k , Po l i c y Re f e r e n c e s ht t p : / / w w w . d o h . w a . g o v / P o r t a l s / 1 / D o c u m e n t s / P u b s / 3 3 1 - 4 8 6 . p d f DO H Pr o g r a m Co n t a c t DO H Fi s c a l Co n t a c t Ma r k St e w a r d Ma r c e a Ka t o DO H Of f i c e of Dr i n k i n g Wa t e r DO H Of f i c e of Dr i n k i n g Wa t e r 16 2 0 1 E. In d i a n a Av e , Su i t e 15 0 0 24 3 Is r a e l Rd SE Sp o k a n e Va l l e y , WA 99 2 1 6 Tu m w a t e r , WA 98 5 0 1 Ma r k . S t e w a r d @ d o h . w a . g o v Ma r c e a . K a t o @ d o h . w a . g o v (5 0 9 ) 32 9 - 2 1 3 6 (3 6 0 ) 23 6 - 3 0 9 4 Ex h i b i t A, St a t e m e n t s of Wo r k Pa g e 50 of 5 0 Co n t r a c t Nu m b e r CL H l 8 2 4 9 - 2 2 Re v i s e d as of Ju l y 15 , 20 2 1 EX H I B I T B- 2 2 Ki t t i t a s Co u n t y Pu b l i c He a l t h De p a r t m e n t AL L O C A T I O N S Co n t r a c t Nu m b e r : CL H 1 8 2 4 9 Co n t r a c t Te r m : 20 1 8 - 2 0 2 1 Da t e : Ju l y 15 , 20 2 1 In d i r e c t Ra t e as of Ja n u a r y 20 1 8 : 29 . 5 0 % Pu b l i c He a l t h De p t & 12 . 5 0 % Co u n t y Ce n t r a l Sv e s In d i r e c t Ra t e as of Ja n u a r y 20 1 9 : 28 . 2 5 % Pu b l i c He a l t h De p t & 12 . 7 5 % Co u n t y Ce n t r a l Sv c s DO H Us e On l y BA R S St a t e m e n t of Wo r k Ch a r t of Ac c o u n t s Fu n d i n g Ch a r t of Fe d e r a l Aw a r d Re v e n u e Fu n d i n g Pe r i o d Fu n d i n g Pe r i o d Pe r i o d Ac c o u n t s Ch a r t of Ac c o u n t s Pr o g r a m Ti t l e Id e n t i f i c a t i o n # Am e n d # CF D A * Co d e * * St a r t Da t e En d Da t e St a r t Da t e En d Da t e Am o u n t Su b To t a l To t a l FF Y l 9 CS S IA R SN A P Ed Pr o g r a m Mg n t 19 7 W A W A 5 Q 3 9 0 3 Am d 9 10 . 5 6 1 33 3 . 1 0 . 5 6 10 / 0 1 / 1 8 09 / 3 0 / 1 9 10 / 0 1 / 1 8 09 / 3 0 / 1 9 $4 2 9 $2 0 , 1 7 4 $4 5 , 3 5 9 FF Y l 9 CS S IA R SN A P Ed Pr o g r a m Mg n t 19 7 W A W A 5 Q 3 9 0 3 Am d 4 10 . 5 6 1 33 3 10 . 5 6 10 / 0 1 / 1 8 09 / 3 0 / 1 9 10 / 0 1 / 1 8 09 / 3 0 / 1 9 51 9 , 7 4 5 FF Y l 8 CS S IA R SN A P Ed Pr o g r a m Mg n t CF 18 7 W A W A 5 Q 3 9 0 3 Am d 4 10 . 5 6 1 33 3 . 1 0 . 5 6 10 / 0 1 / 1 8 09 / 3 0 / 1 9 10 / 0 1 / 1 8 09 / 3 0 / 1 9 $8 5 8 58 5 8 FF Y l 8 CS S IA R SN A P Ed Pr o g r a m Mg n t 18 7 W A W A 5 Q 3 9 0 3 Am d 4 10 . 5 6 1 33 3 . 1 0 . 5 6 01 / 0 1 / 1 8 09 / 3 0 / 1 8 10 / 0 1 / 1 7 09 / 3 0 / 1 8 $3 , 0 0 0 52 2 , 8 5 5 FF Y l 8 CS S IA R SN A P ED Pr o g r a m Mg n t 18 7 W A W A 5 Q 3 9 0 3 Am d 2 10 . 5 6 1 33 3 . 1 0 . 5 6 01 / 0 1 / 1 8 09 / 3 0 / 1 8 10 / 0 1 / 1 7 09 / 3 0 / 1 8 $1 1 , 0 2 5 FF Y l 8 CS S IA R SN A P ED Pr o g r a m Mg n t 18 7 W A W A 5 Q 3 9 0 3 N/ A 10 . 5 6 1 33 3 . 1 0 . 5 6 01 / 0 1 / 1 8 09 / 3 0 / 1 8 10 / 0 1 / 1 7 09 / 3 0 / 1 8 $8 , 8 3 0 FF Y l 7 CS S IA R SN A P ED Pr o g r a m Mg n t CF 17 1 7 W A W A 5 Q 3 9 0 N/ A 10 . 5 6 1 33 3 . 1 0 . 5 6 01 / 0 1 / 1 8 09 / 3 0 / 1 8 10 / 0 1 / 1 7 09 / 3 0 / 1 8 $1 , 4 7 2 $1 , 4 7 2 FF Y 2 1 IA R SN A P Ed Pr o g Mg n t - R e g i o n 2 NG A No t Re c e i v e d Am d 17 10 . 5 6 1 33 3 . 1 0 . 5 6 10 / 0 1 / 2 0 09 / 3 0 / 2 1 10 / 0 1 / 2 0 09 / 3 0 / 2 1 $2 6 , 0 4 6 52 6 , 0 4 6 $4 6 , 6 4 9 FF Y 2 0 IA R SN A P Ed Pr o g Mg n t - R e g i o n 2 20 7 W A W A 5 Q 3 9 0 3 Am d 10 10 . 5 6 1 33 3 . 1 0 . 5 6 10 / 0 1 / 1 9 09 / 3 0 / 2 0 10 / 0 1 / 1 9 09 / 3 0 / 2 0 $2 0 , 6 0 3 $2 0 , 6 0 3 BI T V - C O V I D Ed LH J Al l o c a t i o n - C A R E S NG A No t Re c e i v e d Am d 18 , 21 21 . 0 1 9 33 3 . 2 1 . 0 1 07 / 0 1 / 2 0 12 / 3 1 / 2 1 07 / 0 1 / 2 0 12 / 3 1 / 2 1 $1 8 9 , 0 2 7 $2 5 2 , 0 3 6 $2 5 2 , 0 3 6 BI T V - C O V I D Ed LH J Al l o c a t i o n - C A R E S NG A No t Re c e i v e d Am d 16 , 18 , 21 21 . 0 1 9 33 3 . 2 1 . 0 1 07 / 0 1 / 2 0 12 / 3 1 / 2 1 07 / 0 1 / 2 0 12 / 3 1 / 2 1 56 3 , 0 0 9 CO V I D LH J OF M Al l o c a t i o n - C A R E S NG A No t Re c e i v e d Am d 16 , 18 , 21 21 . 0 1 9 33 3 . 2 1 . 0 1 03 / 0 1 / 2 0 12 / 3 1 / 2 1 03 / 0 1 / 2 0 12 / 3 1 / 2 1 59 0 9 , 4 0 0 59 0 9 , 4 0 0 $9 0 9 , 4 0 0 FF Y l 7 EP R PH E P BP l LH J Fu n d i n g NU 9 0 T P 9 2 1 8 8 9 - 0 1 Am d 2 93 . 0 6 9 33 3 . 9 3 . 0 6 01 / 0 1 / 1 8 06 / 3 0 / 1 8 07 / 0 1 / 1 7 07 / 0 2 / 1 8 $5 6 5 52 0 , 3 9 8 $2 0 , 3 9 8 FF Y l 7 EP R PH E P BP l LH J Fu n d i n g NU 9 0 T P 9 2 1 8 8 9 - 0 1 N/ A 93 . 0 6 9 33 3 . 9 3 . 0 6 01 / 0 1 / 1 8 06 / 3 0 / 1 8 07 / 0 1 / 1 7 07 / 0 2 / 1 8 $1 9 , 8 3 3 FF Y l 8 EP R PH E P BP l Su p p LH J Fu n d i n g NU 9 0 T P 9 2 1 8 8 9 - 0 1 Am d 5 93 . 0 6 9 33 3 . 9 3 . 0 6 07 / 0 1 / 1 8 06 / 3 0 / 1 9 07 / 0 1 / 1 8 06 / 3 0 / 1 9 $8 8 5 $4 9 , 1 3 4 $4 9 , 1 3 4 FF Y l 8 EP R PH E P BP l Su p p LH J Fu n d i n g NU 9 0 T P 9 2 1 8 8 9 - 0 1 Am d 4 93 . 0 6 9 33 3 . 9 3 . 0 6 07 / 0 1 / 1 8 06 / 3 0 / 1 9 07 / 0 1 / 1 8 06 / 3 0 / 1 9 $4 8 , 2 4 9 FF Y 2 1 PH E P BP 2 LH J Fu n d i n g NU 9 0 T P 9 2 2 0 4 3 Am d 22 93 . 0 6 9 33 3 . 9 3 . 0 6 07 / 0 1 / 2 1 12 / 3 1 / 2 1 07 / 0 1 / 2 1 06 / 3 0 / 2 2 52 9 , 4 8 0 52 9 , 4 8 0 51 2 7 , 7 4 6 FF Y 2 0 PH E P BP 2 LH J Fu n d i n g NU 9 0 T P 9 2 2 0 4 3 Am d 17 93 . 0 6 9 33 3 . 9 3 . 0 6 07 / 0 1 / 2 0 06 / 3 0 / 2 1 07 / 0 1 / 2 0 06 / 3 0 / 2 1 $1 9 , 6 5 3 54 9 , 1 3 3 FF Y 2 0 PH E P BP 2 LH J Fu n d i n g NU 9 0 T P 9 2 2 0 4 3 Am d 16 , 17 93 . 0 6 9 33 3 . 9 3 . 0 6 07 / 0 1 / 2 0 06 / 3 0 / 2 1 07 / 0 1 / 2 0 06 / 3 0 / 2 1 $2 9 , 4 8 0 FF Y l 9 PH E P BP 1 LH J Fu n d i n g NU 9 0 T P 9 2 2 0 4 3 Am d 10 93 . 0 6 9 33 3 . 9 3 . 0 6 07 / 0 1 / 1 9 06 / 3 0 / 2 0 07 / 0 1 / 1 9 06 / 3 0 / 2 0 $4 9 , 1 3 3 54 9 , 1 3 3 FF Y 2 0 En v i r He a l t h Ca p a c i t y - C (C D C ) NU E l E H 0 0 1 4 4 5 Am d 18 , 21 93 . 0 7 0 33 3 . 9 3 . 0 7 09 / 0 1 / 2 0 11 / 3 0 / 2 1 09 / 0 1 / 2 0 11 / 3 0 / 2 1 $1 1 1 , 0 0 0 $1 1 1 , 0 0 0 $1 1 1 , 0 0 0 FF Y l 7 31 7 Op s 5N H 2 3 I P O O O 7 6 2 - 0 5 - 0 0 N/ A 93 . 2 6 8 33 3 . 9 3 . 2 6 01 / 0 1 / 1 8 06 / 3 0 / 1 8 04 / 0 1 / 1 7 06 / 3 0 / 1 8 $6 1 6 $6 1 6 $6 1 6 FF Y l 7 AF I X 5N H 2 3 I P O O O 7 6 2 - 0 5 - 0 0 N/ A 93 . 2 6 8 33 3 . 9 3 . 2 6 01 / 0 1 / 1 8 06 / 3 0 / 1 8 04 / 0 1 / 1 7 06 / 3 0 / 1 8 $2 , 2 2 6 $2 , 2 2 6 $2 , 2 2 6 FF Y 2 1 CO V I D l 9 Va c c i n e Se r v i c e s - C A R E S NH 2 3 I P 9 2 2 6 1 9 Am d 21 93 . 2 6 8 33 3 . 9 3 . 2 6 07 / 0 1 / 2 0 12 / 3 1 / 2 1 07 / 0 1 / 2 0 12 / 3 1 / 2 1 ($ 3 5 4 , 8 0 3 ) $1 4 , 5 8 2 $1 4 , 5 8 2 FF Y 2 1 CO V I D 1 9 Va c c i n e Se r v i c e s - C A R E S NH 2 3 I P 9 2 2 6 1 9 Am d 19 93 . 2 6 8 33 3 . 9 3 . 2 6 07 / 0 1 / 2 0 12 / 3 1 / 2 1 07 / 0 1 / 2 0 12 / 3 1 / 2 1 53 5 4 , 8 0 3 FF Y 2 1 CO V I D 1 9 Va c c i n e Se r v i c e s - C A R E S NH 2 3 I P 9 2 2 6 1 9 Am d 18 , 19 93 . 2 6 8 33 3 . 9 3 . 2 6 07 / 0 1 / 2 0 12 / 3 1 / 2 1 07 / 0 1 / 2 0 12 / 3 1 / 2 1 $1 4 , 5 8 2 CO V I D l 9 Va c c i n e s NG A No t Re c e i v e d Am d 21 93 . 2 6 8 33 3 . 9 3 . 2 6 07 / 0 1 / 2 0 12 / 3 1 / 2 1 07 / 0 1 / 2 0 12 / 3 1 / 2 1 53 5 4 , 8 0 3 $3 5 4 , 8 0 3 $3 5 4 , 8 0 3 FF Y 2 1 En h a n c e d In f l u e n z a Co v e r a g e CA R E S NH 2 3 I P 9 2 2 6 1 9 Am d 17 93 . 2 6 8 33 3 . 9 3 . 2 6 07 / 0 1 / 2 0 06 / 3 0 / 2 1 06 / 0 5 / 2 0 06 / 3 0 / 2 1 52 , 8 0 0 55 , 6 0 0 55 , 6 0 0 FF Y 2 1 En h a n c e d In f l u e n z a Co v e r a g e CA R E S NH 2 3 I P 9 2 2 6 1 9 Am d 16 , 17 93 . 0 6 9 33 3 . 9 3 . 0 6 07 / 0 1 / 2 0 06 / 3 0 / 2 1 06 / 0 5 / 2 0 06 / 3 0 / 2 1 $2 , 8 0 0 Pa g e 1 of 4 EX H I B I T B- 2 2 Ki t t i t a s Co u n t y Pu b l i c He a l t h De p a r t m e n t AL L O C A T I O N S Co n t r a c t Nu m b e r : CL H 1 8 2 4 9 Co n t r a c t Te r m : 20 1 8 - 2 0 2 1 Da t e : Ju l y 15 , 20 2 1 In d i r e c t Ra t e as of Ja n u a r y 20 1 8 : 29 . 5 0 % Pu b l i c He a l t h De p t & 12 . 5 0 % Co u n t y Ce n t r a l Sv c s In d i r e c t Ra t e as of Ja n u a r y 20 1 9 : 28 . 2 5 % Pu b l i c He a l t h De p t & 12 . 7 5 % Co u n t y Ce n t r a l Sv c s DO H Us e On l y BA R S St a t e m e n t of Wo r k Ch a r t of Ac c o u n t s Fu n d i n g Ch a r t of Fe d e r a l Aw a n ! Re v e n u e Fu n d i n g Pe r i o d Fu n d i n g Pe r i o d Pe r i o d Ac c o u n t s Ch a r t of Ac c o u n t s Pr o g r a m Ti t l e Id e n t i f i c a t i o n # Am e n d # CF D A * Co d e * * St a r t Da t e En d Da t e St a r t Da t e En d Da t e Am o u n t Su b To t a l To t a l FF Y l 7 In c r e a s i n g Im m u n i z a t i o n Ra t e s NH 2 3 I P 0 0 0 7 6 2 Am d 3, 4 93 26 8 33 3 . 9 3 . 2 6 07 / 0 1 / 1 8 06 / 3 0 / 1 9 07 / 0 1 / 1 8 06 / 3 0 / 1 9 55 , 6 0 0 $5 , 6 0 0 $5 , 6 0 0 FF Y 2 1 VF C Op s NH 2 3 I P 9 2 2 6 1 9 Am d 17 93 . 2 6 8 33 3 . 9 3 . 2 6 07 / 0 1 / 2 0 06 / 3 0 / 2 1 07 / 0 1 / 2 0 06 / 3 0 / 2 1 $2 , 8 0 0 55 , 6 0 0 51 2 , 3 1 4 FF Y 2 1 VF C Op s NH 2 3 I P 9 2 2 6 1 9 Am d 15 , 17 93 . 2 6 8 33 3 . 9 3 . 2 6 07 / 0 1 / 2 0 06 / 3 0 / 2 1 07 / 0 1 / 2 0 06 / 3 0 / 2 1 $2 , 8 0 0 FF Y 2 0 VF C Op s NH 2 3 I P 9 2 2 6 1 9 Am d 9 93 . 2 6 8 33 3 . 9 3 . 2 6 07 / 0 1 / 1 9 06 / 3 0 / 2 0 07 / 0 1 / 1 9 06 / 3 0 / 2 0 55 , 6 0 0 55 , 6 0 0 FF Y l 7 VF C Op s 5N H 2 3 I P 0 0 0 7 6 2 - 0 5 - 0 0 N/ A 93 . 2 6 8 33 3 . 9 3 . 2 6 01 / 0 1 / 1 8 06 / 3 0 / 1 8 04 / 0 1 / 1 7 06 / 3 0 / 1 8 51 , 1 1 4 51 , 1 1 4 FF Y l 9 CO V I D CA R E S NU 5 0 C K O O O 5 1 5 Am d 15 , 18 93 . 3 2 3 33 3 . 9 3 . 3 2 06 / 0 1 / 2 0 12 / 3 1 / 2 1 06 / 0 1 / 2 0 12 / 3 1 / 2 1 $6 1 , 1 7 7 $6 1 , 1 7 7 $6 1 , 1 7 7 FF Y l 9 EL C CO V I D Ed LH J Al l o c a t i o n NU 5 0 C K O O O 5 1 5 Am d 19 93 . 3 2 3 33 3 93 . 3 2 01 / 0 1 / 2 1 12 / 3 1 / 2 1 01 / 0 1 / 2 1 12 / 3 1 / 2 1 $2 3 7 , 0 7 7 $2 3 7 , 0 7 7 $2 3 7 , 0 7 7 FF Y 2 0 EL C ED E LH J Al l o c a t i o n NU 5 0 C K O O O 5 1 5 Am d 19 93 . 3 2 3 33 3 . 9 3 . 3 2 01 / 1 5 / 2 1 12 / 3 1 / 2 1 01 / 1 5 / 2 1 12 / 3 1 / 2 1 $5 3 0 , 1 6 1 $5 3 0 , 1 6 1 55 3 0 , 1 6 1 FF Y 2 0 CD C CO V I D - 1 9 Cr i s i s Re s p LH J - T r i b e NU 9 0 T P 9 2 2 0 6 9 Am d 13 , 18 , 19 93 . 3 5 4 33 3 . 9 3 . 3 5 01 / 2 0 / 2 0 12 / 3 1 / 2 1 01 / 0 1 / 2 0 12 / 3 1 / 2 1 57 8 , 5 2 2 $7 8 , 5 2 2 $7 8 , 5 2 2 FF Y 2 1 Ph y s Ac t v t y & Nu t r i t i o n Pr o g NG A No t Re c e i v e d Am d 22 93 . 4 3 9 33 3 . 9 3 . 4 3 09 / 3 0 / 2 1 12 / 3 1 / 2 1 09 / 3 0 / 2 1 09 / 2 9 / 2 2 $6 0 , 0 0 0 56 0 , 0 0 0 52 5 2 , 3 4 6 FF Y 2 0 Ph y s Ac t v t y & Nu t r i t i o n Pr o g NG A No t Re c e i v e d Am d 20 93 . 4 3 9 33 3 . 9 3 . 4 3 09 / 3 0 / 2 0 09 / 2 9 / 2 1 09 / 3 0 / 2 0 09 / 2 9 / 2 1 51 2 , 3 4 6 $7 2 , 3 4 6 FF Y 2 0 Ph y s Ac t v t y & Nu t r i t i o n Pr o g NG A No t Re c e i v e d Am d 17 93 . 4 3 9 33 3 . 9 3 . 4 3 09 / 3 0 / 2 0 09 / 2 9 / 2 1 09 / 3 0 / 2 0 09 / 2 9 / 2 1 $6 0 , 0 0 0 FF Y 1 9 Ph y s Ac t v t y & Nu t r i t i o n Pr o g NU 5 8 D P O O 6 5 0 4 Am d 10 93 . 4 3 9 33 3 . 9 3 . 4 3 09 / 3 0 / 1 9 09 / 2 9 / 2 0 09 / 3 0 / 1 9 09 / 2 9 / 2 0 $6 0 , 0 0 0 56 0 , 0 0 0 FF Y l 8 Ph y s Ac t v t y & Nu t r i t i o n Pr o g NU 5 8 D P 0 0 6 5 0 4 Am d 8, 15 93 . 4 3 9 33 3 . 9 3 . 4 3 02 / 1 9 / 1 9 09 / 2 9 / 2 0 09 / 2 8 / 1 8 09 / 2 9 / 2 0 56 0 , 0 0 0 56 0 , 0 0 0 FF Y 2 2 MC H B G LH J Co n t r a c t s NG A No t Re c e i v e d Am d 22 93 . 9 9 4 33 3 . 9 3 . 9 9 10 / 0 1 / 2 1 12 / 3 1 / 2 1 10 / 0 1 / 2 1 09 / 3 0 / 2 2 $1 1 , 0 4 9 51 1 , 0 4 9 $1 7 7 , 6 7 7 FF Y 2 1 MC H B G LH J Co n t r a c t s B0 4 4 0 1 6 9 Am d 17 93 . 9 9 4 33 3 . 9 3 . 9 9 10 / 0 1 / 2 0 09 / 3 0 / 2 1 10 / 0 1 / 2 0 09 / 3 0 / 2 1 54 4 , 1 9 6 $4 4 , 1 9 6 FF Y 2 0 MC H B G LH J Co n t r a c t s B0 4 M C 3 2 5 7 8 Am d 10 93 . 9 9 4 33 3 . 9 3 . 9 9 10 / 0 1 / 1 9 09 / 3 0 / 2 0 10 / 0 1 / 1 9 09 / 3 0 / 2 0 $4 4 , 1 9 6 $4 4 , 1 9 6 FF Y l 9 MC H B G LH J Co n t r a c t s BO 4 M C 3 2 5 7 8 Am d 4 93 . 9 9 4 33 3 . 9 3 . 9 9 10 / 0 1 / 1 8 09 / 3 0 / 1 9 10 / 0 1 / 1 8 09 / 3 0 / 1 9 54 4 , 1 9 6 $4 4 , 1 9 6 FF Y l 8 MC H B G LH J Co n t r a c t s BO 4 M C 3 1 5 2 4 Am d 2 93 . 9 9 4 33 3 . 9 3 99 01 / 0 1 / 1 8 09 / 3 0 / 1 8 10 / 0 1 / 1 7 09 / 3 0 / 1 8 58 9 3 $3 4 , 0 4 0 FF Y l 8 MC H B G LH J Co n t r a c t s BO 4 M C 3 1 5 2 4 N/ A 93 . 9 9 4 33 3 . 9 3 . 9 9 01 / 0 1 / 1 8 09 / 3 0 / 1 8 10 / 0 1 / 1 7 09 / 3 0 / 1 8 53 3 , 1 4 7 FE M A - 7 5 CO V I D LH J Al l o c a t i o n NG A No t Re c e i v e d Am d 18 97 . 0 3 6 33 3 . 9 7 . 0 3 07 / 0 1 / 2 0 12 / 3 0 / 2 0 07 / 0 1 / 2 0 12 / 3 0 / 2 0 ($ 1 8 9 , 0 2 7 ) 50 50 FE M A - 7 5 CO V I D LH J Al l o c a t i o n NG A No t Re c e i v e d Am d 16 97 . 0 3 6 33 3 . 9 7 . 0 3 07 / 0 1 / 2 0 12 / 3 0 / 2 0 07 / 0 1 / 2 0 12 / 3 0 / 2 0 51 8 9 , 0 2 7 GF S - G r o u p B (F O - E ) Am d 10 N/ A 33 4 04 . 9 0 07 / 0 1 / 2 0 12 / 3 1 / 2 0 07 / 0 1 / 1 9 06 / 3 0 / 2 1 $2 0 , 0 0 0 $2 0 , 0 0 0 52 5 , 0 0 0 GF S - Gr o u p B (F O - E ) N/ A N/ A 33 4 . 0 4 . 9 0 01 / 0 1 / 1 8 06 / 3 0 / 1 8 07 / 0 1 / 1 7 06 / 3 0 / 1 9 55 , 0 0 0 $5 , 0 0 0 FY 2 Gr o u p B Pr o g r a m s fo r DW (F O - E ) Am d 3 N/ A 33 4 . 0 4 . 9 0 07 / 0 1 / 1 8 06 / 3 0 / 1 9 07 / 0 1 / 1 7 06 / 3 0 / 1 9 $1 0 , 0 0 0 51 0 , 0 0 0 51 0 , 0 0 0 Zo o n o t i c s - G F S Am d 9 N/ A 33 4 . 0 4 . 9 1 07 / 0 1 / 1 9 06 / 3 0 / 2 0 07 / 0 1 / 1 9 06 / 3 0 / 2 1 54 , 0 2 9 $4 , 0 2 9 $5 , 0 0 0 Zo o n o t i c s - G F S Am d 9 N/ A 33 4 . 0 4 . 9 1 06 / 0 1 / 1 9 06 / 3 0 / 1 9 07 / 0 1 / 1 7 06 / 3 0 / 1 9 59 7 1 59 7 1 FY 2 0 / 2 1 CO V I D - 1 9 Di s a s t e r Re s p o n s e Ac c t Am d 13 , 18 N/ A 33 4 . 0 4 . 9 2 01 / 2 0 / 2 0 06 / 3 0 / 2 1 01 / 0 1 / 2 0 06 / 3 0 / 2 1 $7 1 , 4 7 8 57 1 , 4 7 8 $7 1 , 4 7 8 Pa g e 2 of 4 EX H I B I T B- 2 2 Ki t t i t a s Co u n t y Pu b l i c He a l t h De p a r t m e n t AL L O C A T I O N S Co n t r a c t Nu m b e r : CL H 1 8 2 4 9 Co n t r a c t Te r m : 20 1 8 - 2 0 2 1 Da t e : Ju l y 15 , 20 2 1 In d i r e c t Ra t e as of Ja n u a r y 20 1 8 : 29 . 5 0 % Pu b l i c He a l t h De p t & 12 . 5 0 % Co u n t y Ce n t r a l Sv e s In d i r e c t Ra t e as of Ja n u a r y 20 1 9 : 28 . 2 5 % Pu b l i c He a l t h De p t & 12 . 7 5 % Co u n t y Ce n t r a l Sv e s DO H Us e On l y BA R S St a t e m e n t of Wo r k Ch a r t of Ac c o u n t s Fu n d i n g Ch a r t of Fe d e r a l Aw a r d Re v e n u e Fu n d i n g Pe r i o d Fu n d i n g Pe r i o d Pe r i o d Ac c o u n t s Ch a r t of Ac c o u n t s Pr o g r a m Ti t l e Id e n t i f i c a t i o n # Am e n d # CF D A * Co d e * * St a r t Da t e En d Da t e St a r t Da t e En d Da t e Am o u n t Su b To t a l To t a l SF Y 2 Le a d En v i r o n m e n t s of Ch i l d r e n Am d 8 N/ A 33 4 . 0 4 . 9 3 07 / 0 1 / 1 8 06 / 3 0 / 1 9 07 / 0 1 / 1 8 06 / 3 0 / 1 9 ($ 1 , 5 0 0 ) 50 52 , 0 0 0 SF Y 2 Le a d En v i r o n m e n t s of Ch i l d r e n Am d 4 N/ A 33 4 . 0 4 . 9 3 07 / 0 1 / 1 8 06 / 3 0 / 1 9 07 / 0 1 / 1 8 06 / 3 0 / 1 9 $1 , 5 0 0 SF Y l Le a d En v i r o n m e n t s of Ch i l d r e n Am d 1 N/ A 33 4 . 0 4 93 01 / 0 1 / 1 8 06 / 3 0 / 1 8 07 / 0 1 / 1 7 06 / 3 0 / 1 8 $2 , 0 0 0 $2 , 0 0 0 FP H S - L H J - P r o v i s o (Y R I ) Am d 22 N/ A 33 6 . 0 4 . 2 5 07 / 0 1 / 2 1 12 / 3 1 / 2 1 07 / 0 1 / 2 1 06 / 3 0 / 2 3 $1 0 0 , 0 0 0 $1 0 0 , 0 0 0 53 4 2 , 0 0 0 FP H S Fu n d i n g fo r LH J s Am d l6 , 18 N/ A 33 6 . 0 4 . 2 5 07 / 0 1 / 2 0 06 / 3 0 / 2 1 07 / 0 1 / 1 9 06 / 3 0 / 2 1 $5 8 , 0 0 0 $1 0 0 , 0 0 0 FP H S Fu n d i n g fo r LH J s Am d 10 , 18 N/ A 33 6 . 0 4 . 2 5 07 / 0 1 / 2 0 06 / 3 0 / 2 1 07 / 0 1 / 1 9 06 / 3 0 / 2 1 $4 2 , 0 0 0 FP H S Fu n d i n g fo r LH J s Am d 16 N/ A 33 6 04 . 2 5 07 / 0 1 / 1 9 06 / 3 0 / 2 0 07 / 0 1 / 1 9 06 / 3 0 / 2 1 55 8 , 0 0 0 51 0 0 , 0 0 0 FP H S Fu n d i r i g fo r LH J s Am d 10 N/ A 33 6 . 0 4 . 2 5 07 / 0 1 / 1 9 06 / 3 0 / 2 0 07 / 0 1 / 1 9 06 / 3 0 / 2 1 54 2 , 0 0 0 FP H S Fu n d i n g fo r LH J s Di r Am d 3 N/ A 33 6 . 0 4 . 2 5 07 / 0 1 / 1 8 06 / 3 0 / 1 9 07 / 0 1 / 1 7 06 / 3 0 / 1 9 $4 2 , 0 0 0 $4 2 , 0 0 0 YR 20 SR F - Lo c a l As s t (1 5 % ) (F S ) SS Am d 3 N/ A 34 6 . 2 6 . 6 4 01 / 0 1 / 1 8 12 / 3 1 / 1 8 07 / 0 1 / 1 5 12 / 3 1 / 1 8 ($ 2 , 4 0 0 ) 50 $0 YR 20 SR F - Lo c a l As s t (1 5 % ) (F S ) SS N/ A , Am d 3 N/ A 34 6 . 2 6 . 6 4 01 / 0 1 / 1 8 12 / 3 1 / 1 8 07 / 0 1 / 1 5 12 / 3 1 / 1 8 $2 , 4 0 0 YR 21 SR F - Lo c a l As s t (1 5 % ) (F S ) SS Am d 10 N/ A 34 6 . 2 6 64 01 / 0 1 / 1 8 06 / 3 0 / 1 9 07 / 0 1 / 1 7 06 / 3 0 / 1 9 ($ 3 , 2 0 0 ) 52 , 4 0 0 $2 , 4 0 0 YR 21 SR F - Lo c a l As s t (1 5 % ) (F S ) SS Am d 9, 10 N/ A 34 6 . 2 6 . 6 4 01 / 0 1 / 1 8 06 / 3 0 / 1 9 07 / 0 1 / 1 7 06 / 3 0 / 1 9 $4 0 0 YR 21 SR F - Lo c a l As s t (1 5 % ) (F S ) SS Am d 7, 10 N/ A 34 6 . 2 6 . 6 4 01 / 0 1 / 1 8 06 / 3 0 / 1 9 07 / 0 1 / 1 7 06 / 3 0 / 1 9 $2 , 8 0 0 YR 21 SR F - Lo c a l As s t (1 5 % ) (F S ) SS Am d 3, 7, 10 N/ A 34 6 . 2 6 . 6 4 01 / 0 1 / 1 8 06 / 3 0 / 1 9 07 / 0 1 / 1 7 06 / 3 0 / 1 9 $2 , 4 0 0 YR 22 SR F - Lo c a l As s t (1 5 % ) (F O - E ) SS Am d 21 N/ A 34 6 . 2 6 . 6 4 01 / 0 1 / 1 9 12 / 3 1 / 2 0 01 / 0 1 / 1 9 06 / 3 0 / 2 1 ($ 2 , 2 0 0 ) $4 , 4 0 0 $4 , 4 0 0 YR 22 SR F - Lo c a l As s t (1 5 % ) (F O - E ) SS Am d 14 N/ A 34 6 . 2 6 . 6 4 01 / 0 1 / 1 9 12 / 3 1 / 2 0 01 / 0 1 / 1 9 06 / 3 0 / 2 1 ($ 4 0 0 ) YR 22 SR F - Lo c a l As s t (1 5 % ) (F O - E ) SS Am d 12 N/ A 34 6 . 2 6 . 6 4 01 / 0 1 / 1 9 12 / 3 1 / 2 0 01 / 0 1 / 1 9 06 / 3 0 / 2 1 $3 , 8 0 0 YR 22 SR F - Lo c a l As s t (1 5 % ) (F O - E ) SS Am d 10 , 12 N/ A 34 6 . 2 6 . 6 4 01 / 0 1 / 1 9 12 / 3 1 / 2 0 01 / 0 1 / 1 9 06 / 3 0 / 2 1 53 , 2 0 0 YR 23 SR F - Lo c a l As s t (1 5 % ) (F O - E ) SS Am d 22 N/ A 34 6 . 2 6 . 6 4 01 / 0 1 / 2 1 12 / 3 1 / 2 1 09 / 0 1 / 2 0 12 / 3 1 / 2 1 ($ 7 , 8 0 0 ) $4 , 8 0 0 $4 , 8 0 0 YR 23 SR F - Lo c a l As s t (1 5 % ) (F O - E ) SS Am d 21 N/ A 34 6 . 2 6 . 6 4 01 / 0 1 / 2 1 12 / 3 1 / 2 1 09 / 0 1 / 2 0 12 / 3 1 / 2 1 $2 , 2 0 0 YR 23 SR F - Lo c a l As s t (1 5 % ) (F O - E ) SS Am d l9 N/ A 34 6 . 2 6 . 6 4 01 / 0 1 / 2 1 12 / 3 1 / 2 1 09 / 0 1 / 2 0 12 / 3 1 / 2 1 $1 0 , 4 0 0 Sa n i t a r y Su r v e y Fe e s (F O - E ) SS - S t a t e Am d 22 N/ A 34 6 . 2 6 . 6 5 01 / 0 1 / 1 8 12 / 3 1 / 2 1 07 / 0 1 / 1 7 12 / 3 1 / 2 1 ($ 7 , 8 0 0 ) $1 1 , 6 0 0 $1 1 , 6 0 0 Sa n i t a r y Su r v e y Fe e s (F O - E ) SS - S t a t e Am d 21 N/ A 34 6 26 . 6 5 01 / 0 1 / 1 8 12 / 3 1 / 2 1 07 / 0 1 / 1 7 12 / 3 1 / 2 1 51 0 , 4 0 0 Sa n i t a r y Su r v e y Fe e s (F O - E ) SS - S t a t e Am d 14 , 21 N/ A 34 6 . 2 6 . 6 5 01 / 0 1 / 1 8 12 / 3 1 / 2 1 07 / 0 1 / 1 7 12 / 3 1 / 2 1 ($ 4 0 0 ) Sa n i t a r y Su r v e y Fe e s (F O - E ) SS - S t a t e Am d 12 , 21 N/ A 34 6 . 2 6 . 6 5 01 / 0 1 / 1 8 12 / 3 1 / 2 1 07 / 0 1 / 1 7 12 / 3 1 / 2 1 53 , 8 0 0 Sa n i t a r y Su r v e y Fe e s (F O - E ) SS - S t a t e Am d 9, 12 , 21 N/ A 34 6 26 . 6 5 01 / 0 1 / 1 8 12 / 3 1 / 2 1 07 / 0 1 / 1 7 12 / 3 1 / 2 1 54 0 0 Sa n i t a r y Su r v e y Fe e s (F O - E ) SS - S t a t e Am d 7, 12 , 21 N/ A 34 6 . 2 6 . 6 5 01 / 0 1 / 1 8 12 / 3 1 / 2 1 07 / 0 1 / 1 7 12 / 3 1 / 2 1 $2 , 8 0 0 Sa n i t a r y Su r v e y Fe e s (F O - E ) SS - S t a t e N/ A , Am d 3, 7, 12 , 21 N/ A 34 6 26 . 6 5 01 / 0 1 / 1 8 12 / 3 1 / 2 1 07 / 0 1 / 1 7 12 / 3 1 / 2 1 $2 , 4 0 0 YR 20 SR F - Lo c a l As s t (1 5 % ) (F S ) TA Am d 3 N/ A 34 6 . 2 6 . 6 6 01 / 0 1 / 1 8 12 / 3 1 / 1 8 07 / 0 1 / 1 5 12 / 3 1 / 1 8 ($ 2 , 0 0 0 ) $0 $0 YR 20 SR F - Lo c a l As s t (1 5 % ) (F S ) TA N/ A , Am d 3 N/ A 34 6 . 2 6 . 6 6 01 / 0 1 / 1 8 12 / 3 1 / 1 8 07 / 0 1 / 1 5 12 / 3 1 / 1 8 $2 , 0 0 0 Pa g e 3 of 4 EX H I B I T B- 2 2 Ki t t i t a s Co u n t y Pu b l i c He a l t h De p a r t m e n t AL L O C A T I O N S Co n t r a c t Nu m b e r : CL H 1 8 2 4 9 Co n t r a c t Te r m : 20 1 8 - 2 0 2 1 Da t e : Ju l y 15 , 20 2 1 In d i r e c t Ra t e as of Ja n u a r y 20 1 8 : 29 . 5 0 % Pu b l i c He a l t h De p t & 12 . 5 0 % Co u n t y Ce n t r a l Sv e s In d i r e c t Ra t e as of Ja n u a r y 20 1 9 : 28 . 2 5 % Pu b l i c He a l t h De p t & 12 . 7 5 % Co u n t y Ce n t r a l Sv c s DO H Us e On l y BA R S St a t e m e n t of Wo r k Ch a r t of Ac c o u n t s Fu n d i n g Ch a r t of Fe d e r a l Aw a n ! Re v e n u e Fu n d i n g Pe r i o d Fu n d i n g Pe r i o d Pe r i o d Ac c o u n t s Ch a r t of Ac c o u n t s Pr o g r a m Ti t l e Id e n t i f i c a t i o n # Am e n d # CF D A * Co d e * * St a r t Da t e En d Da t e St a r t Da t e En d Da t e Am o u n t Su b To t a l To t a l YR 21 SR F - Lo c a l As s t (1 5 % ) (F S ) TA Am d 10 N/ A 34 6 . 2 6 . 6 6 01 / 0 1 / 1 8 06 / 3 0 / 1 9 07 / 0 1 / 1 7 06 / 3 0 / 1 9 (5 4 , 0 0 0 ) 50 50 YR 21 SR F - Lo c a l As s t (1 5 % ) (F S ) TA Am d 7, 10 N/ A 34 6 . 2 6 . 6 6 01 / 0 1 / 1 8 06 / 3 0 / 1 9 07 / 0 1 / 1 7 06 / 3 0 / 1 9 $2 , 0 0 0 YR 21 SR F - Lo c a l As s t (1 5 % ) (F S ) TA Am d 3, 7, 10 N/ A 34 6 . 2 6 . 6 6 01 / 0 1 / 1 8 06 / 3 0 / 1 9 07 / 0 1 / 1 7 06 / 3 0 / 1 9 $2 , 0 0 0 YR 22 SR F - Lo c a l As s t (1 5 % ) (F O - E ) TA Am d 14 N/ A 34 6 . 2 6 . 6 6 01 / 0 1 / 1 9 12 / 3 1 / 2 0 01 / 0 1 / 1 9 06 / 3 0 / 2 1 ($ 2 , 0 0 0 ) $2 , 0 0 0 $2 , 0 0 0 YR 22 SR F - Lo c a l As s t (1 5 % ) (F O - E ) TA Am d 12 N/ A 34 6 . 2 6 . 6 6 01 / 0 1 / 1 9 12 / 3 1 / 2 0 01 / 0 1 / 1 9 06 / 3 0 / 2 1 $2 , 0 0 0 YR 22 SR F - Lo c a l As s t (1 5 % ) (F O - E ) TA Am d 10 , 12 N/ A 34 6 . 2 6 . 6 6 01 / 0 1 / 1 9 12 / 3 1 / 2 0 01 / 0 1 / 1 9 06 / 3 0 / 2 1 $2 , 0 0 0 YR 23 SR F - Lo c a l As s t (1 5 % ) (F O - E ) TA Am d 22 N/ A 34 6 . 2 6 . 6 6 01 / 0 1 / 2 1 12 / 3 1 / 2 1 09 / 0 1 / 2 0 12 / 3 1 / 2 1 ($ 2 , 0 0 0 ) 54 , 0 0 0 54 , 0 0 0 YR 23 SR F - Lo c a l As s t (1 5 % ) (F O - E ) TA Am d 21 N/ A 34 6 . 2 6 . 6 6 01 / 0 1 / 2 1 12 / 3 1 / 2 1 09 / 0 1 / 2 0 12 / 3 1 / 2 1 $4 , 0 0 0 YR 23 SR F - Lo c a l As s t (1 5 % ) (F O - E ) TA Am d 19 N/ A 34 6 . 2 6 . 6 6 01 / 0 1 / 2 1 12 / 3 1 / 2 1 09 / 0 1 / 2 0 12 / 3 1 / 2 1 $2 , 0 0 0 TO T A L $3 , 7 7 9 , 1 0 1 $3 , 7 7 9 , 1 0 1 To t a l co n s i d e r a t i o n : $3 , 5 9 6 , 1 7 2 GR A N D TO T A L $3 , 7 7 9 , 1 0 1 $1 8 2 , 9 2 9 GR A N D TO T A L $3 , 7 7 9 , 1 0 1 To t a l Fe d 53 , 2 9 4 , 4 2 3 To t a l St a t e 54 8 4 , 6 7 8 *C a t a l o g of Fe d e r a l Do m e s t i c As s i s t a n c e ** F e d e r a l re v e n u e co d e s be g i n wi t h "3 3 3 " . St a t e re v e n u e co d e s be g i n wi t h "3 3 4 " Pa g e 4 o f 4 Ex h i b i t C- 1 9 Sc h e d u l e of Fe d e r a l Aw a r d s AM E N D M E N T #2 2 Da t e : Ju l y 15 , 20 2 1 KI T T I T A S CO U N T Y HE A L T H DE P T - S W V O O 1 0 4 7 5 - 0 7 CO N T R A C T CL H 1 8 2 4 9 - K i t t i t a s Co u n t y Pu b l i c He a l t h De p a r t m e n t CO N T R A C T PE R I O D : 01 / 0 1 / 2 0 1 8 - 1 2 1 3 1 I 2 0 2 1 DO H To t a l Am t Al l o c a t i o n Pe r i o d Fe d e r a l Fe d e r a l St a r t En d Fe d e r a l Aw a r d Ch a r t of Ac c o u n t s Pr o g r a m Ti t l e BA R S Aw a r d Da t e Aw a r d Da t e Da t e Co n t r a c t Am t CF D A CF D A Pr o g r a m Ti t l e Fe d e r a l Ag e n c y Na m e id e n t i f i c a N o n Nu m b e r Fe d e r a l Gr a n t Aw a r d Na m e St a t e Ad m i n i s t r a t i v e Ma t c h i n g 20 1 9 SU P P L E M E N T A L NU T R I T I O N FF Y 2 0 IA R SN A P ED PR O G MG N T - R E G I O N 2 33 3 10 56 09 / 3 0 / 1 9 55 , 3 0 0 , 0 0 0 10 / 0 1 / 1 9 09 / 3 0 / 2 0 52 0 , 6 0 3 10 56 1 Gr a n t s fo r th e Su p p l e m e n t a l pa r t m e o gr i c u l t u r e Fo o d an d 20 7 W A W A 5 Q 3 9 0 3 AS S I S T A N C E PR O G R A M - E D U C A T I O N Nu t r i t i o n As s i s t a n c e Pr o g r a m (S N A P - E D ) St a t e Ad r u n t s i r a l v e Mu l c h i n g FF Y 2 0 IA R SN A P ED PR O G MG M T - R E G I O N 2 33 3 . 1 0 . 5 6 d d 10 / 0 1 / 2 0 09 / 3 0 / 2 1 $2 6 , 0 4 6 10 56 1 Gr a n t s fo r t h e Su p p l e m e n t a l pa r t m e S n f Ag r i c u l t u r e Fo o d an d NG A No t Re c e i v e d NG A No t Re c e i v e d Nu t r i t i o n As s i s t a n c e Pm g r a m St a t e Ad m i n i s t r a t i v e Ma t c h i n g FF Y 1 9 CS S IA R SN A P - E D PR O G MG N T 33 3 10 56 09 / 2 8 / 1 8 $5 , 3 8 6 , 2 6 6 10 / 0 1 / 1 8 09 / 3 0 / 1 9 $2 0 , 1 7 4 10 56 1 Gr a n t s fo r th e Su p p l e m e n t a l pa me S n gr i c u l t u r e Fo o d an d 19 7 W A W A 5 Q 3 9 0 3 SN A P 2Y R NU T R I T I O N ED OB E S I T Y Nu t r i t i o n As s i s t a n c e Pr o g r a m St a t e Ad m i n i s t r a t i v e Ma t c h i n g 20 1 6 SU P P L E M E N T A L NU T R I T I O N FF Y 1 8 CS S IA R SN A P - E D PR O G R A M MG N T CF 33 3 10 56 09 / 3 0 / 1 9 $5 , 3 0 0 , 0 0 0 10 / 0 1 / 1 8 09 / 3 0 / 1 9 $8 5 8 10 56 1 Gr a n t s fo r th e Su p p l e m e n t a l p rn e S n f Ag r i c u l t u r e Fo o d an d 18 7 W A W A 5 Q 3 9 0 3 AS S I S T A N C E PR O G R A M ED U C A T I O N Nu t r i t i o n As s i s t a n c e Po g r a m (S N A P - E D ) St a l e Ad m i n i s t r a h v e Ma t c h i n g 20 1 8 SU P P L E M E N T A L NU T R I T I O N FF Y 1 8 CS S IA R SN A P - E D PR O G R A M MG N T 33 3 . 1 0 56 09 / 2 8 / 1 7 55 , 3 0 0 , 0 0 0 01 / 0 1 / 1 8 09 / 3 0 / 1 8 $2 2 , 8 5 5 10 56 1 Gr a n i s fo r t h e $u p p i a m e n t a l po t m e o gr i c u l t u r e Fo o d an d 18 7 W A W A 5 Q 3 9 0 3 AS S I S T A N C E PR O G R A M ED U C A T I O N Nu t r i t i o n As s i s t a n c e Pr o g r a m (S N A P - E D ) St a t e Ad m i n i s t r a l i v e Ma l c h i n g 20 1 8 SU P P L E M E N T A L NU T R I T I O N FF Y 1 7 CS S lA R SN A P - E D PR O G R A M MG N T CF 33 3 10 56 09 / 1 0 / 1 6 $5 , 7 3 9 , 8 5 6 01 / 0 1 / 1 8 09 / 3 0 / 1 8 $1 , 4 7 2 10 56 1 Gr a n t s fo r tn e su p p e m s n i a l pa r t m e n t Ag r i c u l t u r e Fo o d an d 17 1 7 W A W A 5 Q 3 9 0 AS S l S T A N C E PR O G R A M ED U C A T I O N Nu i r i b u n As s i s t a n c e Pr o g r a m (S N A P - E D ) CO V I D LH J OF M AL L O C A T I O N - C A R E S 33 3 21 01 03 / 0 1 / 2 0 12 / 3 1 / 2 1 $9 0 9 , 4 0 0 21 01 9 Co r o n a m r u s Re l i e f Fu n d De p a r t m e n t of th e Tr e a s u r y NG A No t Re c e i v e d NG A No t Re c e i v e d Br f V - C O V I D ED LH J AL L O C A T I O N - C A R E S 33 3 2 1 01 0 No 07 / 0 1 / 2 0 12 / 3 1 / 2 1 $2 5 2 , 0 3 6 21 . 0 1 9 Co r o n a v i r u s Re l i e f Fu n d De p a r t m e n t of th e Tr e a s u r y NG A No t Re c e i v e d NG A No t Re c e i v e d De p a r t m e n t of He a l t h an d Hu m a n PU B L I C HE A L T H EM E R G E N C Y FF Y 2 1 PH E P BP 2 LH J FU N D I N G 33 3 93 06 05 / 2 7 / 2 1 51 1 , 5 7 4 , 2 9 8 07 / 0 1 / 2 1 12 / 3 1 / 2 1 52 9 , 4 8 0 93 06 9 Pu b l i c He a l t h Em e r g e n c y Se r v i c e s Ce n t e r s fo r Di s e a s e Co n t r o l NU 9 0 T P 9 2 2 0 4 3 PR E P A R E D N E S S (P H E P ) Pr e p a r e d n e s s an d P r e v e n t i o n CO O P E R A T i v E A G R E E M E N T De p a r t m e n t o f He a l t h an d Hu m a n PU B L I C ME A L T H EM E R G E N C Y FF Y 2 0 PH E P BP 2 LH J FU N D I N G 33 3 93 . 0 6 06 / 1 2 / 2 0 $1 1 , 3 6 5 , 7 9 7 07 / 0 1 / 2 0 06 / 3 0 / 2 1 $4 9 , 1 3 3 93 06 9 Pu b l i c He a l t h Em e r g e n c y Se r v i c e s Ce n t e r s fo r Di s e a s e Co n t r o l NU 9 0 T P 9 2 2 0 4 3 PR E P A R E D N E S S (P H E P ) Pr e p a r e d n e s s an d Pr e v e n t i o n CO O P E R A T I V E AG R E E M E N T De p a r t m e n t of He a l t h an d Hu m a n PU B L I C ME A L T H EM E R G E N C Y FF Y 1 9 PH E P BP 1 LH J FU N D I N G 33 3 93 06 06 / 2 9 / 1 9 $1 1 , 3 0 7 , 9 0 4 07 / 0 1 / 1 9 06 / 3 0 / 2 0 $4 9 , 1 3 3 93 06 9 Pu b l i c He a l t h Em e r g e n c y Se r v i c e s Ce n t e r s fo r Di s e a s e Co n t r o l NU S O T P B 2 2 0 4 3 PR E P A R E D N E S S (P H E P ) Pr e p a r e d n e s s an d Pr e v e n t i o n CO O P E R A T I V E AG R E E M E N T FF Y 1 8 EP R PH E P BP 1 SU P P LH J FU N D I N G 33 3 93 . 0 6 08 / 0 1 / 1 8 $1 1 , 0 6 2 , 7 8 2 07 / 0 1 / 1 8 06 / 3 0 / 1 9 $4 9 , 1 3 4 93 06 9 e rH e a Em e r g e n c y nt e se f rh D a nt r o l NU 9 0 T P 9 2 1 5 5 9 - 0 1 AN E D PU B L EH E LT H an d Pr e v e n l i o n CO O P E R A T I V E AG R E E M E N T FF Y 1 7 EP R PH E P BP 1 LH J FU N D I N G 33 3 93 . 0 6 07 / 1 8 / 1 7 51 1 , 0 6 2 , 7 8 2 01 / 0 1 / 1 8 06 / 3 0 / 1 8 $2 0 , 3 9 8 93 06 9 re ac r H e a l t h Em e r g e n c y Hrs or h D sn e d a on t r o l NU 9 0 T P 9 2 1 8 8 9 - 0 1 P AE N D PN H E P CO O P E R A T I V E FF Y 2 0 EN V I R HE A L T H CA P C I T Y - C (C D C ) 33 3 93 07 04 / 0 2 / 0 0 54 8 9 , 0 9 3 09 / 0 1 / 2 0 11 / 3 0 / 2 1 $1 1 1 , 0 0 0 93 . 0 7 0 En w o n m e n t Pu b l i c He a l t h an d te s or n D su on t r o l NU E 1 E H O O 1 4 4 5 E TN H C TY (E H ) TN M an d P ev e n on EN V I R O N M E N T A L HE A L T H HA Z A R D S FF Y 2 1 VF C OP S 33 3 . 9 3 26 07 / 0 1 / 1 9 $9 , 2 3 4 , 8 3 5 07 / 0 1 / 2 0 06 / 3 0 / 2 1 55 , 6 0 0 93 26 8 Im m u e n ti o n Co o p e r a t i v e te H r s e a K r h D sn e d a on t r o l NH 2 3 | P 9 2 2 6 1 9 AM C C S ON R G C LN D R A E N N D P R O G R A M an d Pr e v e n t i o n Pa g e 1 of 3 Ex h i b i t C- 1 9 Sc h e d u l e of Fe d e r a l Aw a r d S AM E N D M E N T #2 2 Da t e : Ju l y 15 , 20 2 1 KI T T I T A S CO U N T Y HE A L T H DE P T - S W V O O 1 0 4 7 5 - 0 7 CO N T R A C T CL H 1 8 2 4 9 - K i t t i t a s Co u n t y Pu b l i c He a l t h De p a r t m e n t CO N T R A C T PE R I O D : 01 / 0 1 / 2 0 1 8 - 1 2 / 3 1 / 2 0 2 1 DO H To t a l Am t Al l o c a t i o n Pe r i o d Fe d e r a l Fe d e r a l St a r t En d Fe d e r a l Aw a r d Ch a r t of Ac c o u n t s Pr o g r a m Ti t l e . BA R S Aw a r d Da t e Aw a r d Da t e Da t e Co n t r a c t Am t CF D A CF D A Pr o g r a m Ti t l e Fe d e r a l Ag e n c y Na m e id e t ! ! f n c a t i o n Nu m b e r Fe d e r a l Gr a n t Aw a r d Na m e FF Y 2 1 EN H A N C E D IN F L U E N Z A CO V E R A G E CA R E S 33 3 93 26 08 / 1 3 / 2 0 51 2 , 5 4 8 , 9 5 5 07 / 0 1 / 2 0 06 / 3 0 / 2 1 $5 , 6 0 0 93 26 8 im m u n i z a ñ o n Co o p e r a t i v e nt e H e f rh D sn e d a e nt r o l NH 2 3 I P 9 2 2 6 1 9 AM C C I S ON R G C LN D R A E N N D P R O G R A M an d Pr e v e n t i o n FF Y 2 1 CO V I D 1 9 VA C C I N E SE R V I C E S 4 : A R E S 33 3 93 26 01 / 1 5 / 2 1 56 8 , 6 0 7 , 0 5 3 07 / 0 1 / 2 0 12 / 3 1 / 2 1 $1 4 , 5 8 2 93 26 8 mu n i z a t i o n Co o p e r a t i v e c Cn fe H r s e f rh D sn e d a on t r o l NH 2 3 I P 9 2 2 6 1 9 A7 C N S ON R C LN D R A E N N D P R O G R A M FF Y 2 0 VF C OP S 33 3 93 26 07 / 0 1 / 1 9 59 , 2 3 4 , 8 3 5 07 / 0 1 / 1 9 06 / 3 0 / 2 0 $5 , 6 0 0 93 26 8 rn u e n i z a d o n Co o p e r a t i v e s or h D ed a nt r o l NH 2 3 | P 9 2 2 6 1 9 AM C U C S ON R CR H LN D R A E N N D P R O G R A M De p a r t m e n t o f He a l t h an d Hu m a n IM M U N I Z A T I O N GR A N T AN D FF Y 1 7 VF C OP S 33 3 . 9 3 . 2 6 03 / 0 3 / 1 7 51 , 2 0 1 , 6 0 5 01 / 0 1 / 1 8 06 / 3 0 / 1 8 51 , 1 1 4 93 26 8 Im m u n i z a t i o n Co o p e r a t i v e Se r v i c e s Ce n t e r s fo r Di s e a s e Co n t r o l 5N H 2 3 1 P O O O 7 6 2 - 0 5 - 0 0 VA C C I N E S FO R CH I L D R E N ' S Ag r e e m e n t s an d Pr e v e n t i o n PR O G R A M De p a r t m e n t of He a l l h an d Hu m a n IM M U N I Z A T I O N GR A N T AN D FF Y 1 7 IN C R E A S I N G IM M U N I Z A T I O N RA T E S 33 3 93 26 06 / 2 9 / 1 8 $1 , 7 2 2 , 4 4 3 07 / 0 1 / 1 8 06 / 3 0 / 1 9 $5 , 6 0 0 93 26 8 Im m u n i z a t i o n Co o p e r a t i v e Se r v i c e s Ce n t e r s fo r Di s e a s e Co n t r o l NH 2 3 I P O O O 7 6 2 VA C C I N E S FO R CH I L D R E N ' S Ag r e e m e n t s an d Pr e v e n t i o n PR O G R A M De p a r t m e n t o f He a d h an d Hu m a n IM M U N I Z A T I O N GR A N T AN D FF Y 1 7 AF I X 33 3 93 26 03 / 0 3 / 1 7 51 , 6 7 2 , 2 6 9 01 / 0 1 / 1 8 06 / 3 0 / 1 8 $2 , 2 2 6 93 26 8 Im m u n i z a t i o n Co o p e r a t i v e Se r v i c e s Ce n t e r s fo r Di s e a s e Co n t r o l 5N H 2 3 | P O O O 7 6 2 - 0 5 - 0 0 VA C C I N E S FO R CH I L D R E N ' S Ag r e e m e n t s an d Pr e v e n t i o n PR O G R A M De p a r t m e n t o f He a l t h an d Hu m a n IM M U N i f A T I O N GR A N T AN D FF Y 1 7 31 7 OP S 33 3 93 26 03 / 0 3 / 1 7 55 7 5 , 9 6 9 01 / 0 1 / 1 8 06 / 3 0 / 1 8 $6 1 6 93 . 2 6 8 Im m u n i z a t i o n Co o p e r a t i v e Se r v i c e s Ce n t e r s fo r Di s e a s e Co n t r o l 5N H 2 3 I P O O O 7 6 2 - 0 5 - 0 0 VA C C I N E S FO f t C½ I L D R E f f S Ag r e e m e n t s an d Pr e v e n t i o n PR O G R A M De p a r t m e n t of He a l t h an d Hu m a n CO V I D 1 9 VA C C I N E S 33 3 93 26 No d 07 / 0 1 / 2 0 12 / 3 1 / 2 1 53 5 4 , 8 0 3 93 26 8 Im r n e u n i z a t i o n Co o p e r a t i v e Se r v i c e s Ce n t e r s fo r Di s e a s e Co n t r o l NG A No t Re c e i v e d NG A No t Re c e i v e d an d Pm v e n t i o n EP I D E M I O L O G Y AN D LA B O R A T O R Y Ep i d e m i o l o g y an d La b o r a t o r y De p a r t m e n t o f He a l t h an d Hu m a n CA P A C I T Y FO R IN F E C T I O U S FF Y 2 0 EL C ED E LH J AL L O C A T I O N 33 3 93 32 01 / 1 4 / 2 1 54 3 8 , 3 0 0 , 9 2 8 01 / 1 5 / 2 1 12 / 3 1 / 2 1 $5 3 0 , 1 6 1 93 32 3 Ca p a c i t y fo r In f e c t i o u s Di s e a s e s Se r v i c e s Ce n l e r s fo r Di s e a s e Co n t r o l NU 5 0 C K O O O 5 1 5 DI S E A S E S (E L C ) - B U I L D I N G AN D (E L C ) an d Pr e v e n t i o n ST R E N G T H E N I N G EP I D E M I O L O G Y , EP I D E M I O L O G Y & LA B O R A T O R Y Ep d e m i o l o g y an d La b e r n i g r y De p a r t m e n t o f He a l t h an d Hu m a n CA P A C I T Y FO R IN F E C T I O U S FF Y 1 9 EL C CO V I D ED LH J AL L O C A T I O N 33 3 93 32 01 / 0 1 / 2 1 51 7 7 , 2 3 1 , 5 4 6 01 / 0 1 / 2 1 12 / 3 1 / 2 1 52 3 7 , 0 7 7 93 . 3 2 3 Ca p a c i t y fo r i n f e c u o u s Di s e a s e s Se r v i c e s Ce n t e r s fo r Di s e a s e Co n t r o l NU 5 0 C K O O O S 1 5 DI S E A S E S (E L C ) - B U I L D I N G & (E L C ) an d Pr e v e n t i o n ST R E N G T H E N I N G EP I D E M I O L O G Y , Ep i d e m i o l o g y an d La b o t e l u r y EP I D E M I O L O G Y & LA B O R A T O R Y Ca p a r d l y fo r In f e c t i o u s Di s e a s e s De p a r t m e n t of He a l l h an d Hu m a n CA P A C I T Y FO R IN F E C T I O U S FF Y 1 9 CO V I D CA R E S 33 3 93 . 3 2 04 / 2 3 / 2 0 $2 2 , 5 8 1 , 7 9 9 06 / 0 1 / 2 0 12 / 3 1 / 2 1 $6 1 , 1 7 7 93 32 3 (E L C p B u d d i n g an d Se r v i c e s Ce n t e r s fo r Di s e a s e Co n t r o l NU 5 0 C K O O O 5 1 5 DI S E A S E S (E L C ) - B U I L D I N G & St r e n g U l e n i n g Ep i d e m i o l o g y , an d Pr e v e n t i o n ST R E N G T H E N I N G EP I D E M I O L O G Y , Pu b l i c He a l t i , Em e r g e n c y CD C CO O P E R A T I V E AG R E E M E N T FF Y 2 0 CD C CO V I D - 1 9 CR I S I S RE S P LH J - T R I B E 33 3 93 35 03 / 1 6 / 2 0 51 3 , 2 3 0 , 7 9 9 01 / 2 0 / 2 0 12 / 3 1 / 2 1 57 8 , 5 2 2 93 35 4 nt e H r s on r h D ed a nt r o l NU B O T P S 2 2 0 6 9 LC RE LE N H R S EN S S P NS E Ae s p o n s e Pu b l i c He d u l Cr o i s an d Pr e v e n t i o n CD C - R F A - T P 1 8 - 1 8 0 2 De p a r t m e n t o f He a k h an d Hu m a n FF Y 2 1 PH Y S AC T V 7 Y & NU T R I T l O N PR O G 33 3 93 . 4 3 d 09 / 3 0 / 2 1 12 / 3 1 / 2 1 $6 0 , 0 0 0 93 43 9 St a t e Ph ic a l N A c t i v i t y an d Se r v i c e s (H H S ) Ce n t e r s fo r Di s e a s e NG A No t Re c e i v e d NG A No t Re c e i v e d Co n t r o l an d Pr e v e n t i o n (C D C ) FF Y 2 0 PH Y S AC T V T Y & NU T R I T I O N PR O G 33 3 . 9 3 . 4 3 NG A No t NG A No t 9/ 3 0 . / 2 0 09 / 2 9 / 2 1 $7 2 , 3 4 6 93 43 9 St a t e Ph y s i c a l Ac t i v i t y an d De p a r t m e n t of He a l t h an d Hu m a n NG A No t Re m i v e d NG A No t Re c e i v e d Re c e i v e d Re c a i v e d Nu t r i t i o n (S P A N ) Se n d c e s FF Y 1 9 PH Y S AC T V T Y & NU T R I T I O N PR O G 33 3 . 9 3 . 4 3 07 / 2 4 / 1 9 51 , 8 4 6 , 0 0 0 09 / 3 0 / 1 9 09 / 2 9 / 2 0 56 0 , 0 0 0 93 . 4 3 9 St a Ph ic a l Ac t i v i t y an d p ri m e n t of He a l t h an d Hu m a n NU 5 8 D P O O 6 5 0 4 N RT OH N AA S L H NC G T (S A N A D N W A ) Pa g e 2 of 3 Ex h i b i t C- 1 9 Sc h e d u l e of Fe d e r a l Aw a r d s AM E N D M E N T # 2 2 Da t e : Ju l y 15 , 20 2 1 KI T T I T A S CO U N T Y HE A L T H DE P T - S W V 0 0 1 0 4 7 5 - 0 7 CO N T R A C T CL H 1 8 2 4 9 - K i t t i t a s Co u n t y Pu b l i c He a l t h De p a r t m e n t CO N T R A C T PE R I O D : 01 I O 1 / 2 0 1 8 - 1 2 I 3 1 / 2 0 2 1 DO H To t a l Am t Al l o c a t i o n Pe r i o d Fe d e r a l Fe d e r a l St a r t En d Fe d e r a l Aw a r d Ch a r t of Ac c o u n t s Pr o g r a m T1 t l e BA R S Aw a r d Da t e Aw a r d Da t e Da t e Co n t r a c t Am t CF D A CF D A Pr o g r a m Ti t l e Fe d e r a l Ag e n c y Na m e id o n i t r i c a t i o n Nu m b e r Fe d e r a l Gr a n t Aw a r d Na m e FF Y 1 8 PH Y S AC T V 7 Y & NU T R I T I O N PR O G 33 3 . 9 3 . 4 3 09 / 0 1 / 1 8 $9 2 3 , 0 0 0 02 / 1 9 / 1 9 09 / 2 9 / 2 0 $6 0 , 0 0 0 93 43 9 S Ph i NA c t i v i t y an d nt of He a l t h an d Hu m a n NU 5 8 D P O O 6 5 0 4 RE F T O - H NC T T (S A N A W A ) NG A No t NG A No t Ma t e m a l an d Ch i l d He a l t h De p a r t m e n t of He a R h an d Hu m a n FF Y 2 2 MC H B G LH J CO N T R A C T S 33 3 93 99 10 / 0 1 / 2 1 12 / 3 1 / 2 1 $1 1 , 0 4 9 93 99 4 Se r v i c e s Bl o c k Gr a n t to th e Se r v i c e s He a R h Re s o u r c e s an d NG A No t Re c e i v e d NG A No t Re c e i v e d Re c e i v e d Ae c e i v e d St a t e s Se r v i c e s Ad m i n i s t r a t i o n Ma t e m a l an d Ch i l d He a l t h De p a r t m e n t o f He a K h an d Hu m a n MA T E R N A L AN D CH I L D HE A L T H FF Y 2 1 MC H B G LH J CO N T R A C T S 33 3 93 99 02 / 0 8 / 2 1 $2 , 6 6 2 , 2 0 1 10 / 0 1 / 2 0 09 / 3 0 / 2 1 $4 4 , 1 9 6 93 99 4 Se r v i c e s Bl o c k Gr a n i la th e se r v i c e s He a R h Re s o u r c e s an d BO 4 4 0 1 6 9 SE R V I C E S BL O C K GR A N T St a t e s Se r v i c e s Ad m i n i s t r a t i o n Ma t e m a l an d Ch i l d He a l t h De p a r t m e n t of He a k h an d Hu m a n FF Y 2 0 MC H B G LH J CO N T R A C T S 33 3 . 9 3 . 9 9 11 / 1 4 / 1 8 $2 , 2 2 5 , 9 7 7 10 / 0 1 / 1 9 09 / 3 0 / 2 0 54 4 , 1 9 6 93 99 4 Se r v i c e s Bl o c k Gr a n t to th e Se r v i c e s He a l t h Re s o u r c e s an d BO 4 M C 3 2 5 7 8 S 1R C N A L AL N D CH I L D HE A L T H St a t e s Se r v i c e s Ad m i n i s t r a t i o n Ma t e m a l an d Ch i l d He a l t h De p a r t m e n t o f He a l t h an d Hu m a n MA T E R N A L AN D CH I L D HE A L T H FF Y 1 9 MC H B G LH J CO N T R A C T S 33 3 93 99 11 / 1 4 / 1 8 52 , 2 2 5 , 9 7 7 10 / 0 1 / 1 6 09 / 3 0 / 1 9 $4 4 , 1 9 6 93 99 4 Se r v i c e s Bl o c k Gr a n t to th e Se r v i c e s He a l t h Re s o u r c e s an d BO 4 M C 3 2 5 7 6 SE R V I C E S BL O C K GR A N T St a t e s Se r v i c e s Ad m i n i s t r a t i o n Ma t e m a l an d Ch i l d He a l t h De p a r t m e n t of He a R h an d Hu m a n FF Y 1 6 MC H B G LH J CO N T R A C T S 33 3 93 . 9 9 10 / 2 0 / 1 7 51 , 6 5 0 , 5 2 8 01 / 0 1 / 1 8 09 / 3 0 / 1 8 $3 4 , 0 4 0 93 99 4 Se r v i c e s Bl o c k Gr a n t to th e Se r v i c e s He a K h Re s o u r c e s an d BO 4 M C 3 1 5 2 4 S IR C N A L AN D CH I L D HE A L T H St a t e s se r v i c e s A d r y d n i s t r a l e n TO T A L $3 , 2 9 4 , 4 2 3 Pa g e 3 of 3