HomeMy WebLinkAboutCON CON AMENDMENT 16Today's Date
10/31/2023 _
Fund/Department
116-Public Health
Kittitas County
Review Form
Grants & Contract Agreement
PBK#
Agenda Date:
Contract/Grant Information
Contract /Grant Agency: Consolidated Contract Amendment 16
Period Begin Date: 01.01.2022
Period End Date: 12.31.2024
. SIT...:'L1 T•, �
NI S C11'.lti rill-'ry
Total Grant/Contract Amount: Increase of $238,815.00 for a new revised maximum of $5,926,202.00
Grant/Contract Number: CLH31015
Contract/Grant Summary:
The Consolidated Contract Amendment 16 Amends the following:
Amends Statements of Work for the following programs:
• COVID-19 Gap Funding- Effective July 1, 2023
• Executive Office of Resiliency and Health Security- Effective January 1, 2022
• Office of Drinking Water Group A Program- Effective January 1, 2022
• Office of Immunization COVID-19 Vaccine- Effective January 1, 2022
■ Supplemental Nutrition Assistance Program- Education -Effective January 1, 2022
Exhibit B-16 Allocations, attached and incorporated by this reference, amends, and replaces Exhibit B-15
Allocations as follows:
• Increase of $238,815 for a revised maximum consideration of $5,926,202.00
Recommendation for Board of Health Review on
I
Department Head Signature: , Director Date:
I
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APPROVED AS TO FORM:
Signature of Prosecutor's Office Date
Signature of Auditor's Office
Date
Verification the Contracting Agency is not Suspended/Disbarred:
Agency is not suspended/disbarred Not Checked (reason)
Grant/Contract Review Page 1
Financial Information
Total Amount $ State Funds $ Federal Funds $
Percentage County Funds Matching Funds $ CFDA#
In -Kind $
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 ❑ attach budget form No ® why not
New Division Created?
Budgeted, & not using some funds till 2024)
will be in budget
612.39.29.333.210.27
— COVID GAP Funding
Revenue Code 611.17.333.93.35
— Workforce Development
612.02.02.346.264/265
— Group A Water Sanitary Surveys
_612.94.333.10.56
—SNAP Ed
[Expense Code 51001
/ 52001 / 50098 / 54199 / 54101 / 53115
Pass Through Information
Agency to Pass Through
Amount to Pass Through
Sub -Contract Approved
Prosecutor Review
Date:
Has the Prosecutor reviewed this agreement?
County Departments Impacted
Auditor
Information Services
Prosecutor
BOCC Approval Needed?
Yes
Staff Member Presenting:
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Expense Code:
Yes ❑ No u
Facilities Maintenance
Human Resource
Treasurer
Reviewer � Date
Grant/Contract Review Page 2
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2022-2024 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH31015 AMENDMENT NUMBER: 16
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, 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:
https://stateofwa.sharepoint.com/sitesldah-afsfu din resource site a es/homa.as x?=e1:9a94.688da2d94d3ea80ac7fbc32cLd7c
❑ Adds Statements of Work for the following programs:
® Amends Statements of Work for the following programs:
COVID-19 LHJ Gap Funding - Effective July 1, 2023
Executive Office of Resiliency & Health Security-WFD LHJ - Effective July 1, 2023
Office of Drinking Water Group A Program - Effective January 1, 2022
Office of Immunization COVID-19 Vaccine - Effective January 1, 2022
Supplemental Nutrition Assistance Program -Education - Effective January 1, 2022
❑ Deletes Statements of Work for the following programs:
2. Exhibit B-16 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-15 Allocations
as follows:
® Increase of $238,815 for a revised maximum consideration of $5,926,202.
❑ Decrease of for a revised maximum consideration of
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 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
Signature: Signature:
Date: Date:
APPROVED AS TO FORM ONLY
Assistant Attorney General
Page I of 1
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