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Home My WebLink AboutCON CON 2022-2024 Amendment 2Kittitas County Review Form Grants & Contract Agreement Contract/G rant lnformation Recommendation for Board won Verification the Contracting Agency is not Suspended/Disbarred: Agency is not suspended/disbarred I Not Checked (reason) Today's Date 03/oLl2022 PA Camas Request #:53756 Fund/Department 116-Public Health Agenda Date: 03/15 /2022 s Contract /Grant Agency: Consolidated Contract2022-2024 Amendment 2 Period Begin Date: January t,2O22 Period Ehd Date: December 3L,2024 Total Grant/Contract Amount: lncrease of 5813,467.00 for new total of 52,619,312.00 Grant/Contract Number: C1H31015 Contract/G ra nt Su m m ary: Adds Statements of Work for the following programsl o DCHS-ELC COVID-19 Response - Effective January L,2022 o ELC COVID-19 - Effective January I,2O2Z o Emergency Preparedness, Resilience & Response-PHEP - Effective January 7,2022 o Ol-Promotion of lmmunizations to lmprove Vaccination Rates - Effective January t,2022 Amends Statements of Work for the following programs: r Climate & Health Wildfire Smoke lndoor Air Quality Project - Effective January 1,2022 Department Head Sign Director Date of Health Review and Comment: z>? k C**)Pr"r \--t,,* Signature ?\ Signature of Auditor's Office Date itor, Date ?3 & Prosecutor's Office APPROVED AS TO FORM: Kittitas County Prosec Grant/Contract Review Page 1 KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT ?,022 -202 4 CONS OLIDATE D CONTRA.CT CONTRACT NUMBER: CLH31015 AMENDMENT NUMBER: 2 PURPOSE OF CIIANGE: To amend this contract between the DEPARTMENT OF F{EALTH hereinafter referred to as "DOH", and KITTITAS COLINTY 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: Exhibit A Statements of Work, includes the following statements of work, which are incorporated by this reference and located on the DOH Finance SharePoint site in the Upload Center at the following URL: httos://stateofwa.sharepoint.com/sites/doh-ofsfundingresources/sitepages/home.aspx?:e 1 :9a94688da2d94d3ea80ac7fbc32e4d7c X Adds Statements of Work for the following programs: DCHS-ELC COVID-I9 Response - Effective January 1,2022 ELC COVID-I9 - Effective January 1,2022 Emergency Preparedness, Resilience & Response-PHEP - Effective January 1,2022 Ol-Promotion of Immunizations to Improve Vaccination Rates - Effective January 1,2022 X Amends Statements of Work for the following programs: Climate & Health Wildfire Smoke Indoor Air Quality Project - Effective January 1,2022 n Deletes Statements of Work for the following programs: 2. Exhibit B-2 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-1 Allocations as follows: X Increase of $813.467 for a revised maximum consideration of $2.619.312. I Decrease of - for a revised maximum consideration of -.n No change in the maximum consideration of -. Exhibit B Allocations are attached only for informational purposes. Unless designated otherwise herein, the effective date of this amendment is the date of execution. ALL U I HtlK I l,l(M5 ANU UUNUI I IUI\b OI Ine Onglnal COnlraOI an(l any SUDSCq UCIrt i4rlltrIrullrellls rsllalll lll ruu ruruti 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 Fratrla f/anrikro4 C''r,7' r' Brenda Henrikson, Contracts Speciaiist (11a t 2I,2022 13124 PDtl APPROVED AS TO FORM ONLY Assistant Attomey General Date Page I of I Date Kittitas County Public Health Department Indirect Rate as ofJanuary 1,2022:25.2s%o Public Heatth Dept & 12.75%o county central Svcs EXHIBIT B2 ALLOCATIONS Contract Term: 2 022-2024 Assist List #* DOH Use Only BARS Statement of Work Chart of Accounts Revenue LHJ Funding Period f\ading Period Code** Start Date End Date Start Date End Date Amount Contract Numben Date: Funding Priod SubTotal cLH3101s February 1,2022 Chart of Accounts Totd $30,818 s29,492 $83,000 $35,719 $3s9,803 st74 $14,s88 $754,494 $34,000 $33,147 925"877 $ 1,210,000 $3,600 $3,600 s1,000 $2,619$12 $1,375,235 sl,244,077 Chart of Accounts Progrrm Title Federal Award Identification # FFY22 IAR SNAP Ed Prog Mgnt-Region 2 207WAWA5e3903 FFY21 PHEP BP3 LHJ Funding NU90TP922043 FFY22 CDC EHC EHR Supplemental NGA Not Received FFY20 Envir Health Capacity-C (CDC) NCE NUEIEH00I445 FFY20 Envir Health Capacity-C (CDC) NCE NLJE1EHO01445 COVID19 Vaccines R4 NI123IP9Z26|9 FF"rl9 COVID CAR_ES NUs0cK000s1s FFY19 ELC COVID Ed LHJ Allocation NUS0CK000S15 FFY20 ELC EDE LHJ Allocation NU50CK000S15 FFY21 Phys Ach/ty & Nutrition Prog NU58DP006504 FFY22 MCHBG L}IJ CONAACTS 80445251 GFS-Group B (FGE) FPHS-LHJ-Provi so (\fR2) FPHS-LHJ-Proviso (YR 1 ) YR24 SRF - Local Asst (15%) (FO-E) SS Sanitary Suwey Fees (FO-E) SS-Stare YR24 SRF - Local Asst (15%) (FO-E) TA TOTAL Total consideration: $1,805,845 $813,467 GRAN'D TOTAL 52,619,312 +Catalog of Federal Domestic Assistance a*Federal revenue codes begin with "333''. State revenue codes begin with "334". Amend # Amd I Amd 2 Amd I Amd 2 Amd I Amd 1 Amd 2 Amd 2 Amd 2 Amd 1 Amd 1 Amd 1 Amd i Amd I Amd 1 Amd I tund I 10.561 93.069 93.070 93.070 93.070 93.268 93.323 93.323 93323 93.439 93.994 N/A N/A N/A N/A N/A N/A 333. i0.56 333.93.06 333.93.07 333.93.07 333.93.07 333.93.26 333.93.32 333.93.32 333.9332 333.93.43 333.93.99 334.04.90 336.04.25 336.04.25 346.26.64 346.26.65 346.26.6s 0t/01/22 0t/01n2 0U07/22 0U0'/22 01/01./22 01/01t22 0u0u22 ou0tn2 0u01/22 01/01/22 01t01/22 01/07/22 07/07/22 0U01t22 01/01/22 01/0U22 0110),t22 09/30n2 0680n2 08/31/22 088u22 08/31t22 06/30/24 04122D2 t0n8/22 t2t3u22 09/29/22 09130/22 06/30/22 06/30t23 06130t22 12/31/22 12/3t/22 12/31/22 t0/01/21 o7lun7 09/0u20 09/07r20 09/0r/20 07/01t20 04t23t20 05/79t20 01n5l2l 09/30/21 t0/01,t2r 07/01/21 07/0il21 07/01t21 07/0r/21 07/0I/2r 07/0t/21 09/30/22 06BAn2 08/31122 o88tn2 08/31/22 06/30t24 078u24 70fl8tT2 01Btn4 09/29/22 09t30/22 06/30/22 06130/23 06/30/23 06130/23 06/30/23 06t30123 $30,8 I 8 s29,492 $83,000 s14,719 $21,000 $359,803 s174 $14,s88 s754,494 $34,000 s33"147 925,877 s60s,000 $605,000 $3,600 s3,600 $r,000 82,619p12 $30,818 s29,492 $83,000 $35,719 $359,803 sl14 $r4,588 s754,494 $34,000 933,147 s2s"877 $605,000 $605,000 $3"600 $3,600 $1,000 s2,619312 GRAND TOTAL Total Fed Total State Page I of 1 Period of Performance: January 1. 2022 through Decen rcr 3I.2022 Exhibit A Statement of Work Contract Term: 2022-2024 DOH Program Name or Title: DCHS - ELC COVID- 9 Response - Effective January 1.20 2 Local Health Jurisdiction Name: Kittitas Counfy Public Health Deparknent Contract Number: CLH3l015 SOW Type: Original Revision # (for this SOW)Type of Payment X Reimbursement f] Fixed Price Federal Compliance (check if appticable) Xn FFATA (Transparency Act) Research & Development Funding Source X Federal Subrecipient I state I othet Statement of Work Purpose: The purpose of this staten :nt of work (SOW) is to provide supplemental funding for the LHJ to ensure adequate culturally and lingquistically responsive testing, investigation and contract tracing resol rces to limit the spread of COWD-19. This fuqding is the actual carryforward amount. Revision Purpose: N/A DOFI Chart of Accounts Master Index Title FFYI9 ELC COVID ED ALLOCATION FFY2O ELC EDE LHJ ALLOCATION TOTALS Activity mitigation, communications and or other preparedness ar l response activities for COVID-l9. Examples of key activities include: o Incident management for the response r Testing r Caselnvestigation/ContactTracing o Sustainable isolation and quarantine r Care coordination . Surge management r Data reporting Total Allocation 14,588 754.494 0 0 0 0 769.082 Allocation Change Increase (+) 14,588 754.494 0 0 0 0 769.082 0 0 0 Current Allocation 0 0 0 0 t0/r8122 12/31122 LHJ Funding Period Start Date End Date 01/0t/22 01/01/22 BARS Revenue Code 333.93.32 333.9332 Assistance Listing Numtrer 93.323 93.323 Master Index Code t897129G I 897120E # Task Payment Information and/or AmountDue Date/Time F'rameDeliverables/Outcomes Exhibit A, Statement of Work Page 1 of7 Contract Number CLH31015 Due Date/Time FrameD eliverables/Outcomes Enter all case investigation data in WDRS following guidance from-DOH. Activity contact tacing and case investigations activities meet DOH case and Contact Tracing Mehics. (Metrics to be determined collaboratively by DOH, LHJs and Tribes.) Work with DOH to develop a corrective action plan if unable to meet metrics.6. Perform daily monitoring for symptoms during quarantine period of contacts ii. Case investigation l. Stive to maintain the capacity to surge a minimum of five (5) case investigators and contact tracers for every 100,000 people in the jurisdiction, as needed, based on disease rates. DOH centralized investigation will court toward this minimum. 2. Enter all case investigation and outbreak data in WDRS following DOH guidance. a) Strive to enter all case investigation and outbreak data into CREST as directed by DOH- b) Ensure all staffdesignated to utilize WDRS have access and are trained in the system. c) Include ifnew positive cases are tied to a known existing positive case or indicate community spread. d) Conduct case investigation and monitor outbreaks. e) Coordinate with Tribal par0rers in conducting case investigations for tribal members. 3. Ensure contact tracing and case investigation activities meet DOH Case and Contact Tracing Metrics. (Metrics to be determined collaboratively by DOH, LHJs, and Tribes.) Work with DOH to develop a corrective action plan if unable to meet meftics. b. Testing i. Work with parfirers and Tribes to ensure testing is available to every person within the jurisdiction meeting current DOH criteria for testing and 5 Ensure needs.other local # Task Payment Information and/or Amount Exhibit A, Statement of Work Page3 of7 Contract Number CLH3 1015 # Task Activity ii. Congregate care facilities: In col the state licensing agency (DSHS infection prevention assessments. Infection control and isolation an protocols in congregate care facil iii. High risk businesses or communi operations. In collaboration with agencies and Labor and Industrie food processing and manufacturir ensure adequate practices to prev exposrue, conduct testing and res outbreaks" iv. Healthcare: Support infection pre control assessments, testing, coht isolation procedrxes. Provide edu resources to a variety of healthca (e.g., nwsing homes, hospitals, d v. Non-healthcare settings that hous populations: In collaboration witl corrections agency (DOC) and ot partners, support testing, infectio. isolation and quarantine and socir wraparound supports for individr temporarily residing in congregal including detention centers, priso transition housing, homeless shel vulnerable populations. vi. Schools: In collaboration with OI health jurisdictions, support infec and control and outbreak respons university school settings. eboration with , support lesting. . quarantine ties. y-based state licensing , partner with g businesses to nt COVID-I9 rond to ,ention and ling, and ntional r setting types ntal, dialysis). 'vulnerable state rer state control, I services and rls living or r living settings, Ls, jails, :rs, and other FI and local ion prevention in K-I2 and D eliverablesi 0utcomes Payment Information and/or Amount f. Ensure adequate resources are directed lowards H2A housing facilities within communities, ishing industries and long-term care facilities o prevent and control disease transmission. Funds cat be used to hire support staf{ provide incentives or fac .ity-based funding for onsite infection prevention :fforts, etc. C. Community education. Work with Tri es and partners to provide culturally and linguistically esponsive community outreach and education rel led to COVID- 19. Due Date/Time Frame Exhibit A, Statement of Work Page 5 of7 Contract Number CLH3 I 01 5 'l All workwill be perfornned in aceordance wlth the revised and approved project plans to be submitted to DOIL Special BiIIing Requirements the budget will not be accepted or approved. wrlr *vwrwu' u'ruB! submission of rnvoice vouchers: The LHJ shall submit correct monthly Al9-1A invoice vouchers for amounts billable under this statement of work to DoH by the 25th of thefollowing month or on a frequency no less often th n quarterly 'vr uv*@ vruqr Other: Exhibit A, Statement of Work PageT of7 Contract Number CLH3 I 01 5 DOH ProgramName or Title: Emersencv Preparednr ;s. Resilience & Resoonse - PHEP - Effective Janu ry 1.2022 Period of Performance: January 1.2022 through June 3 J.2022 Exhibit A Statement of Work Conhact Term: 2022:2024 Local Health Jurisdiction Name: Kittitas Countv Public Health Department Contract Number: CLH3 10 I 5 SOW Type: Orieinal Revision # (for this SOW)Type of Payment X Reimbunement E Fixed Price Federal Compliance (check if appticable) X nf'efn (Transparency Act) I Research & Develooment Funding Source El Federal Subrecipient E state E othet Statement of Work Purpose: The purpose of this stater ent of work is to establish funding and tasks to support and sustain LHJ public health emergency preparedness as part of statewide public hea lth emergency preparedness, resilien c and response. Revision Purpose: NA DOH Chart of Accounts Masten Index Title FFY21 PHEP BP3 LHJ TOTALS Acti 'itX Across a Complete repoding templates as requested by D( H to comply with program and federalgrant requirem ents, in cludin g m id-yea r and end-of-ye r rep orts. Across Domains and Capabilities Exhibit A, Statement of Work Template September202 I Total Allocation 29,492 0 0 0 0 0 0 29,492 0 29.492 Allocation Change Increase (+) 29.492 0 0 0 0 0 Current Allocation 0 0 0 0 0 0 0 0 06/30122 LHJ Funding Period Start Date End Date 01/0U22 BARS Revenue Code 333.93.06 Assistance T-isting Number 93.069 Master Index Code 3 I 102380 4 Task I 2 Payment Information and/or Amount Reimbursement for actualcosts notto exceed totalfunding consideration amount. Due Date/Time Frame June30,2022 Within 30 days ofthe change. Deliverables/Outco mes End-of-yearreport on template provided byDOH. Additiona I reporting may be required if federal requirernents change. Submit any changes to contact information (submitted in 2 02 I ) within 30 daysofthe change. Page I of6 Contract Number CLH3 1 01 5 Payment Information and/or Amount Due Date/Time Frame June30,2022 June30,2022 As requested byDOH. June30,2022 Deliverables/Outco mes End-of-yearreport on templa te provided byDOH. Briefly describe connections, lessons leamed, and any changes made. End-of-yearreport on template provided byDOH. Participation in IPPW unless cancelled. provided by DOH. Indicate that this was done or that no response incident occurred. 11.1 Notificationto DOH Duty Officer within 60 minutes of activation. I 1.2 Sitreps submittedto DOH Duty Officer rreport on templateEnd-of-yea Activity any$ reqNote: Prior approvalfrom vel.trate Capability I Community Preparedness Connect with new and/orexisting partners in order to develop working relationships thatpromotecapabilities,capacityandcommunityresilience,inciuding butnotlimitedto:. Local and/orregional Emergency Manage(s).o Local andlorregional hospitals.r Local and/orregional elected officials. Domain I Community Resilience tions that work with vulnerable tions.r Localand/ capability 3 Emergency operations coordination - Training & Exercise Based on availability of training participate in at least one Foundationalpublic Hea lth Emergency Preparedness Training provided byregion, DOH, DOH-contractedpartner,or DOH-approved hainerin person or via webinar. Notes: r This is one ormore specific trainings coordinatedby DOH. DOH will work with LHJ to implement. ' Participation in an activation, exercise or real-world event may be considered additional training, but does not take the place of the requirement to participate in at ieast one training as descnlbed above. Domain 2 Incident Management capability 3 Emergency operations coordination - Training & Exercise Thencelled.caunless(rPP\V)orkshopwPlanning 2.022Jan Preparedness for tedIntegrarn ls teParticipa Domain 2 Incident Management Ca p ab ility 3 Em ergency Op era tions Co ordina tion I 1.1 Provide immediatenotificationto DoH Duty officer at360-ggg-0g3g or hanalert@doh.wa.gov forallresponse incidents involving use of emergency response plans and/or incident comma nd structures. I 1.2 Produce andprovide situation reports (sitreps) documentinglHJ activity during alt incidents. Sitrep may be developed by the LHJ or anotherjurisdiction that iniludes iiput from LHJ. Domain 2 Incident Management Task # 8 9 l0 1l Exhibit A, Statement of Work Template September202 I Page 3 of6 Contract Number CLH3 I 0 I 5 a. Task 15 t6 t7 Aat yity 14.4 Identifyingand implementing communicat )n stra ln world incident will satisfy need to participate in drill. Conduct a hot wash c - After Action Review (AAR) evaluatinglHJ participation in communication strategies durinp the incident. If, the real-world event response is ongoing, LH. may opt to conduct a hot wash or AAR evaluatingcommunication strategiesto date OR nclude a summary of communication activities in mid-yearand/orend-of yearreports 4(one s .mple of communication Note tion in a real-world event ma m etthe for 14 14.3 and14.4 Domain 3 Information Management Capability 6 Inforrnation Sharing 15.1 Maintain Washington Secure Electronic Cc nmunications, Urgent Response and Exchange System (WASECURES) a s primary notification lystem. 1 5 .2 P articrp ate in DOH Jed notifica tion drills. I 5.3 Conduct at least one LHJ drill using LHJ-p :ferred staff notification system. Notes: . Registered usen mustlog in quarter$atami Limum. o DOH will providetechnicalassistancetoLH, I onusing WASECTIRES. . LHJ may choose to use anothernotification s 'stem in addition to WASECURES to alert staff incidents. Domain 3 Inforrnation Management Capability 6 Information Sharing hovide Essential Elements of Information @F,Ir l during incident response upon request from DOH. Note: DOH will request specific data elements f rm the LHJ during an incident response, as neededto informdecision makingbyDOH and lateleaders,aswell as federalpartnerswhen Domain 4 Countermeasures and Mitigation Capability 8 Medical Countermeasures Dispensi g Cap ab ility 9 M edica I Counterm ea sures Manager r ent a nd Distribution Update andmaintain MedicalCountermeasure ( {CM)Plans for LHJ and/orRegion. Notes: Exhibit A, Statement of Work Template September202 I Payment Information and/or Amount Due Date/Time Frame June 30,2022 Upon request. June 30,2022 June 30,2022 Deliverables/0utco mes End-of-yearreport on template provided byDOH. Provide EEIs uponrequest. Note in end-of-yearreport that EEIs were provided or none were requested. End-of-year repoft on template provided by DOH. Ifthere is a regional plan, provide input to theRERC. UodatedMCMnlan Page 5 of6 Contract NumberCLH3 1 01 5 DOH Program Name or Title: Climate & Health Wildfire Smoke Indoor Air Ouality Project - Effective January l. 2022 SOW Type: Revision Revision # (for this SOIV) Period of Performance: January I.2022 through August 31, 2022 Exhibit A Statement of Work Contract Term: 2022-2024 Local Health Jurisdiction Name: Kittitas countv public Health Deparrnent Contract Number: CLH3l0l5 Type of Payment [l Reimbursement ! nixed frice Federal Compliance (check if applicable) X f'fefa (Transparency Act) f-l Research & Development Funding Source X Federal Subrecipient I state ! other Statement of work Purpose: The purpose of this statement of work is two-fold and is being done as part of the Center of Disease Contol and prevention s original and approaches" initially awarded to DOH on September 1,2020. i) The frst is to respond to declared wildfre disasters in washington state by identiSing the most vulnerable populations, assessing ambient wildfre smoke infltration into of work provides KCPHD $21,00 to continue this work of the original grant. residential cleaner air room project from the original grant with improvements and incorporation of heat. This statement of work provides KCpHD $g3,000 to perform theseactivities of the supplemental grantthat was awarded to DoH on september 1,2021. Revision Purpose: The purpose of this revision is to add the unspent funding from the 21l1-21conftact for task 12. TotaI Allocation 719.J 00083 0 0 0 0 719 Allocation Change Increase (+) 7191 0 0 0 0 0 7191 Current Allocation 00021 83 0 0 0 0 1 0813U22 0813t/22 LHJ Funding Period Start Date End Date 0ll0t/22 0U0t/22 BARS Revenue Code 333.93.07 333.93.07 Assistance Listing Number 93.O70 93.070 Master Index Code 25440r00 25450222 DOH Chart of Accounts Master Index Title NCEACITY-CFFY2O ENVIRO HEALTH CAP SUPPLEMENTALFFY22 CDC EHC EHR TOTALS Exhibit A, Statement of Work Page I of4 Contract Number CLH3 l0l5 Task # 8 9 l0 l1 Activity . Purchasing HEPA portable air cleaners r Distributing HEPA portable air cleanerr (target 100) o Collect demographics of recipients witl developed method r Developing summary report of interven ion distribution Collaborate with DOH to identifu residences for nrticipation in a repetition ofresidential cleaner air room project r include: r Identifying vulnerable population baser on health risk and county need o Establishing selection criteria for partic ration r Identiffing individuals for intervention Lnd enrolling participants in project . Project staff taking human subjects rese rrch training r Summarizing recruitment process Collaborate with DOH to develop training and p ofresidential cleaner air room project to include r Updating communication resource to train I cleaner air rooms . Updating protocol for applying interventior project in residences heat intervention intoa rtocol for repetition :sidences on creating and implementing strategy for ry serving as main idences, such as rtifuing participants rticipants x throughout project, nrdinating visits, isment for repetition tool Collaborate with DOH to implement interventior repetition ofresidential cleaner air room project point ofcontact for participants to include: r Implementing intervention shategy in ten re establishing the intervention in homes and n when to implement it r Purchasing HEPA portable air cleaners for trr Managing and communicating with residenr including addressing technical difficulties, c etc., as needed of interventioa Collaborate with DOH as lead of qualitative asst ofresidential cleaner air room project to include o Updatingqualitativeinterventionassessmen Payment Information and/or Amount Reimbursement for actual costs not to exceed $25,000 on Master Index Code 25450222 August 31,2022 August 31,2022 August 31,2022 Due Date/Time Frame August 31,2022 Deliverables/Outcomes # of vulnerable individuals receiving intervention # of recipients with reported demographics LHJ presents to DOH summary repod and oresentation LHJ presents to DOH selection of priority alrisk target population and criteria for participation A recruitment plan for participation in residential cleaner air room project LHJ presents a list of selected households for residential cleaner air room project # of people providing informed consent for participation in residential cleaner air room project Certification of completion for human subjects research training A copy of recruitment summary A copy of updated communication resource An updated protocol for applying interventions in residences # of HEPA portable air cleaners purchased # of residences receiving intervention Summary of implementation of intervention Copy of qualitative assessment tool # of residences completing qualitative assessment Exhibit A, Statement of Work Page3 of4 Contract Number CLH3 I 0l 5 Exhibit A Statement of Work Contract Term: 2022-2024 DOH Program Name or Title: SOW Type: Original Revision # (for this SOW) Period of Performa nce: Ianuary | " 2022 through June 30. 2022 Local Health Jurisdiction Name: Kittitas counlv public Health Departrnent Contract Number: CLH3 l0l5 Type ofPayment X Reimbursement ! Fixed Price Federal Compliance (check if applicable) X prere (Transparency Act) Research &Development Funding Source X Federal Subrecipient n stut" I oth.t statement of work Purpose: The purpose of this statement of work is to contact with local health to conduct activities to improve immunization coverage rates. Revision Purpose: N/A ** IMPORTANT: It is inherent on the LHJ to have awareness of their respective llll2}z2carry--forward balance(s) based on expenditures through l2/3ll202lfor continuingstatements of work' The funding for this 2022-2024 contract statement of work (sow) is to be determined (TBD) and cuoently shows ..None,, in the funding table - intended as aplaceholder only' The total allocation was obligated in the 2018-2021contract Sow and wilt be adjusted and added in the nexi 2022-20z4amendment cycle based on the actualamount of unspent funds after closeout of the contract ending l2/3llz0zl. Total Allocation 0 0 0 0 0 0 0 Allocation Change None 0 0 0 0 0 0 0 Current Allocation 0 0 0 0 0 0 0 06130t22 LHJ Funding Period Start Date End Date 0t/01/22 BARS Revenue Code 333.93.26 Assistance Listing Number 93.268 Master Index Code 743t0212 DOH Chart of Accounts Master Index Title FFY22 VFC TOTALS Payment Informafion and/or Amount Reimbursement for actual costs incurred, not to exceed total funding consideration amount. Reimbursement for actual costs incurred, not to exceed total flrnding consideration amount. Due Date/Time Frame March 31 June 30 D eliverables/Outcomes report describing the progress made on reaching milestones for activities identified in the plan (template will be provided) Written Written report describing the progress made on reaching milestones for activities identified in the plan (template will be Activity coverage commumtyby contract1 immunization 202 submitted rncreaseto December proposalsthe July ln activities 'thefrom ongomg ( identifiedAS Conduct rates partners coverage communityby contract)I immunization 202 submitted lncreaseto December proposalsthe July 1n activities the ongomg (from identifiedas Conduct rates partners # Task I 2 Exhibit A, Statement of Work Template September 202 I Page I of2 Contract Number CLH3 1 015 4