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HomeMy WebLinkAboutConract between DOE and KCPHD Amend 10 Kittitas County Public Health Contract/Agreement Review Form Kittitas Count Public Health Department Today's Date: 04/13/26 Legal Request #: 12395 Fund/Department: 116-Public Health Agenda Date: LontractjAgree ment inrormation Contract/Agreement Agency: Department of Ecology Contract/Agreement Title: State of Wa Dept of Ecology and KCPHD Amendment 1 Begin Date: 07.01.25 1 1 End Date: 06.30.27 Total $ Amount: Decrease of6,649.33for anew total of$116,959.51 I Contract/Agreement #: C2500178 Contract/Agreement Summary: The purpose of this agreement is for the contractor to provide Pollution Prevention Assistance (PPA) Specialist who will provide technical assistance and education outreach to small quantity generators in an effort to prevent pollution of waters of the state as part of the Pollution Prevention Assistance Partnership. The attached amendment decreases funding in the amount of $8649.33 for a new maximum of $116,959.51. Kittitas County Prosecutor and Auditor Review and Comment: Budget Information Revenue Code(s): 116 - 615.08.05.334.03.10 Expense Code(s): PH5500-102 Agency is not suspended/disbarred Not Checked (reason) Pass Through Information Agency to Pass Through Amount to Pass Through Expense Code: Sub -Contract Approved Date: ADMIN I Version: 0 1 Supersedes: 0 1 Date Adopted: 12/01/2024 1 Modified By: Katie Odiaga Approval By: Chelsey Loeffers 4/22/26, 4:06 PM SAM.gov Entity Information STATE OF WAS H I N OTO N Active Registration Unique Entity ID CAGE/NCAGE N48GCZ2FJA47 OWP75 Physical Address Mailing Address 300 Desmond DR SE PO Box 47615 Lacey, Washington Olympia, Washington 98503-1274, United States 98504-7615, United States Purpose of Registration All Awards Version Current Record BUSINESS INFORMATION Expiration Date Doing Business As URL Registration Dates Department of https://ecology.wa.g Ecology ov/ Division Name Division Number Activation Date (blank) (blank) Mar 5, 2026 Congressional State/Country of Submission District Incorporation Date Washington 10 (blank), (blank) Mar 4, 2026 Initial Registration Owner CAGE Legal Business Date Name Jan 3, 2002 Immediate (blank)(blank) Owner Highest Level (blank)(blank) Entity Dates Owner Mar 4, 2027 https://sam.gov/entities/view/N48 GCZ2FJA47/core Data ?status=Active&emrKeyValue=2016622-1768488882701 534&reg Id=16934982 1 /2 4/22/26, 4:06 PM SAM.gov Entity Start Date Jul 1, 1970 Fiscal Year End Close Date Jun 30 Executive Compensation Registrants in the System for Award Management (SAM) respond to the Executive Compensation questions in accordance with Section 6202 of P.L. 110-252, amending the Federal Funding Accountability and Transparency Act (P.L. 109-282). This information is not displayed in SAM. It is sent to USAspending.gov for display in association with an eligible award. Maintaining an active registration in SAM demonstrates the registrant responded to the questions. SAM SEARCH AUTHORIZATION authorize my entity's non -sensitive information to be displayed in SAM public search results: Yes ENTITY TYPES Business Types Entity Structure U.S. Government Entity Entity Type US State Government Profit Structure (blank) Organization (blank) Factors Socio-Economic Types Check the registrant's Reps & Certs, if present, under FAR 52.212-3 or FAR 52.219-1 to determine if the entity is an SBA -certified HUBZone small business concern. Additional small business information may be found in the SBA's Dynamic Small Business Search if the entity completed the SBA supplemental pages during registration. https://sam.gov/entities/view/N48GCZ2FJA47/coreData?status=Active&emrKeyVaIue=2016622-1768488882701534&regld=16934982 2/2 Docusign Envelope ID: A5542800-F076-88E3-82CC-131 C8A3BDE84C DEPARTMENT OF ECOLOGY State of Washington AMENDMENT NO.01 TO Contract NO. C2500178 BETWEEN THE STATE OF WASHINGTON DEPARTMENT OF ECOLOGY AND Kittitas County Public Health District PROJECT TITLE: Pollution Prevention Assistance PURPOSE: To amend the Agreement between the state of Washington, Department of Ecology, hereinafter referred to as "ECOLOGY," and Kittitas County Public Health District, hereinafter referred to as or "Contractor." WHEREAS: the negative balance in the Model Toxics Control Act (MTCA) Operating Account has resulted in the Hazardous Waste and Toxics Reduction (HWTR) Program, reducing funds originally provided in agreements with our Pollution Prevention Assistance Partnership (PPA) partners. The amendment will reflect the modified budget. IT IS MUTUALLY AGREED the Agreement is amended as follows: 1) Section 3: COMPENSATION of the agreement is amended as follows: New text is indicated with underlined (sample). The source of funds for this IAA is Model Toxics Control Opgrating Account 23P and Model Toxics Control Capital Account (23N). Both parties agree to comply with all applicable rules and regulations associated with these funds. 2) Section 3: COMPENSATION of the agreement is amended as follows: Total compensation is decreased by $8,649.33, from $125,608.84 to new total contract value of $116,959.51. Version 411412025 Docusign Envelope ID: A5542800-F07B-88E3-82CC-B1C8A3BDE84C State of Washington Department of Ecology Contract no. C2500178, Amendment 01 Kittitas County Public Health District 3) Appendix B, Budget Detail is amended as follows: Deleted text is indicated with strikethrough (san+*) and new text is underlined sam le . * 0 Applied to Salaries Only Table A: Goods & Services _ Goods & Services over $1,000 must be listed here or approved by Estimated Cost ECOLOGY PRIOR to reimbursement. Table B: Equipment — - --- Equipment over $1,000 must be listed here or approved by Estimated Cost ECOLOGY PRIOR to reimbursement. _ — — Pg 2 Version 411412025 Docusign Envelope ID: A5542800-1`0713-88E3-82CC-131 C8A3BDE84C State of Washington Department of Ecology Contract no. C2500178, Amendment 01 Kittitas County Public Health District All other terms and conditions of the original Agreement including any other amendments remain in full force and effect, except as expressly provided by this Amendment. This Amendment is signed by persons who represent that they have the authority to execute this Amendment and bind their respective organizations to this Amendment. This Amendment is effective on the Ecology signature date. IN WITNESS WHEREOF, the parties below, having read this Amendment in its entirety, including any attachments, do agree in each and every particular as indicated by their below signatures. State of Washington Kittitas County Public Health Department of Ecology By: By: Signature Date Signature Date Katrina Lassiter Chelsey Loeffers Print Name Print Name Hazardous Waste & Toxic Reduction Program Public Health Director Manager Title Title Pg 3 Version 411412025 Docusign Envelope ID: A55428D0-F07B-88E3-82CC-B1 CBA3BDE84C CONTRACT FACE SHEET For Internal Routing Use of ran 'm4f w (Instructions on Instructions Tab) ECOLOGY Type: Contract CGP System #: 21938 Contract #• C2500178 Amendment #: 1 Work Assignment #: Contractor Statewide Vendor- SWV #: 'SWV 0010475-07 EIN: Contractor Name: Kittitas County Public Health Contract Title / Description / Bid #: Pollution Prevention Assistance (PPA) - technical assistance and education outreach to small businesses. Program: MOO-HWTR Project Officer: Andrew Maher Phone: 509-329-3612 Secondary Project Officer (i.e., Budget Analyst): Ellen Hafer Phone: 564-233-8638 Staff completed DES Contract Training Yes (check all that apply) ❑ Goods/Services RCW 39.26 ❑ Decision to Contract El Interagency RCW 39.34 ❑ DES State Contract # ❑ IT RCW 39.26 ❑ Competitive Bid # ❑ Public Works RCW 39.04 ❑ Sole Source # ❑ Arch./Eng. RCW 39.80 ❑ Direct Buy ❑ Other: OMWBE: (check all that apply) LJ OMWBE 1 71 WA Small Bus. Ll WA Veteran Bus. Subcontractor: ❑ Uses Sub Contractor AMENDMENT: (check all that apply) ❑ Time Extension Increase ❑ Decrease Amount of Amendment: $8,649.33 LJ Other: Deliverable Reduction Total of Contract after Amendments: $116,959.51 TERM: Start Date: 7/1/2025 End Date: 6/30/2027 How To Encumber and Disburse: Program Budget Manager Completes Contract Cost: $116,959.51 Sales Tax (PW only): $ - Total Eligible Cost: $ 116,959.51 Required information: MIC (8 char) Fund/EAI Project - Sub -Prof M72311HO 23P/1-Ho 9M997D10 23N/D10 (Required for Single -year Operating Appropriations & contracts extending beyond current biennium) Prior Bien's Current BI FY: 2026 Current BI FY: 2027 Totals 38,921.94 38,921.93 77,843.87 39,115.64 19,557.82 19,557.82 (Fiscal Staff: IGL: Subsidiary: Misc: Budget Total $ 116,959.51 Budget Total must equal Total Eligible Cost Federolly Funded? No Federal Amount $ (Remarks: Amending total and MICs. Spend operating (23P) before capital (23N), Approved Contract Freeze form in Program's contract file. Robyn Crawford - Signed Electronically 3/23/2025 Fiscal / Contracts Approval Date Sub -Object 3/23/2026 Program Budget Manager Approval Date ECY 010-53 Rev 2/2024 Docusign Envelope ID: A5542800-F07B-88E3-82CC-BiC8A3BDE84C Face Sheet CONTRACT INSTRUCTIONS General: Do not use this form for Grant or Loan Agreements. See the EAGL Face Sheet. Project Officer, Program Budget Analyst, or Program Budget Manager familiar with the content of the contract or amendment fills out the Face Sheet. Program Budget Manager provides complete information in the Budget section. Program sends final draft documents for review and approval by Contracts/Fiscal staff. Contracts/Fiscal staff reviews and assigns a Contract number (if new), enters sub -object on Face Sheet and signs their approval, then returns to the Program. Obtain contractor signature and then appropriate Ecology signature. When all parties have signed the contract -or amendment, Program sends the Face Sheet with the signed contract or amendment to Fiscal for filing. Line Specific: Type: Contract - can be an IAA or contract. Master - generally has an RFQQ, Work Assignment - will be related to a convience contract. Total Eligible Cost: This line always shows the total eligible Ecology amount of the Contract. Sales Tax: This line is IF the sales tax is not included in the contract cost but must be paid (usually for public works contracts). Program Budget Manager completes the Fund Information (Master Index Code (MIC), Fund, Expenditure Authority Index (EAI), and Project & Sub -Project). Encumbrance/Disbursement Section: See Examples tab for examples In the fiscal year (FY) columns enter amounts, by MIC, fund/EAI, and project coding (if applicable): Split codes must be split on separate lines on the face sheet A. Original Contract -Enter the total amount for each fiscal year in the FY columns. -OR- B. Amendment - Leave original amounts OR sum pior bien amounts and on new rows enter ONLY the increase decrease amounts for each fiscal year. Sum prior bien amounts paid and enter in the "Prior Bien's" column. Remarks: If descriptions for "other" fields above are too long, then enter here. Enter general comments, note which MIC to pay from first, J code info, etc. Federally Funded: Please select Yes or No and enter the federal dollars for the contract. Docusign Envelope ID: A5542800-F07B-88E3-82CC-B1C8A3BDE84C Definitions: Contract Manager serves as the primary point of contact for the contractor and is key to ensure the agency receives satisfactory performace. See Purchasing Directives for additional responsibilities. DES Contract Training requirements are available at htt awwecolo sites fsi Site Page s I Proc uremenff.20Trainin .as Lx. Program Budget Manager Approves budget coding and signs/approves face sheet. Project Officer is responsible for the planning, management, communication, and execution of a particular project. They are responsible for accomplishing the project objectives. Works with Contract Manager. The same person may be both the project officer and contract manager. Secondary Project Officer is a secondary contact in the program for fiscal to send reports (closeout reports) (i.e., budget analyst). Subcontractor: an individual, firm, or organization, hired and paid by the contractor, to perform all or part of the services identified in the statement of work of the contract with Ecology. Subcontractors are not staff employed by the Contractor. SWV #: Statewide Vendor #, unique to the Contractor and issued by Office of Financial Management, used for processing contractor payments. Required before contract can be NOTE: Terms and definitions listed on the face sheet are being used to match those within CGP. Docusign Envelope ID: A5542800-FO7B-88E3-82CC-B1C8A3BDE84C 1) Complete and preferred: Shows amendment on new line. 831 -I ❑ Q Increase Amount of $ 321,980.00 AMENDMENT: (check all thatapply) Time Extension [:I Decrease Amendment Name Change/add ❑� Total of Contract $ 1,138,372.00 Other. suspension after Amendments- TERM: Start Date: i 2/= End Date: 11/3Q/2022 CcntractCast $ L183,872.00 How To Encumber and Disburse: Sales Tax (PWonlyj-,j 5 Program Budget ManalZer Completes Total Eligible Cost: r,$ 1,188,872 W (Required for Single -year operating Appropriations & Required information: contracts extending beyond current biennium) Prior Bieris CurtentBl CurrentBi MIC (3 char) Fund/EW Project -Sub -Prof FY: 2Q FY: 21 Totais /1—XJ28-02 866,892.00 866,892.00 0009J23N 0009/831 23N/A13 X128-02 Fiscal Staff: GL: Subsidiary: Misc: 321,990.00 Budget Tota11 $ 1,1W,872.0 Budget Total must equal Total Eligible Cost 2) Complete and preferred: Shows prior paid amounts in Previous MIC ❑� Increase Amount of 50 825 00 AMENDMENT: (check all thatapply) Time Extension ❑ Decrease Amendment -- Add deliverab les for ❑� Total of Contract $ 248,010.00 other: -Z4 after Amendments: TEAM: Start Date: 10/14/2019 End Date: 10/37./"24 Contract Cost: $ 248,010.00 How To Encumber and Disburse: Sales Tax tPWonly)- $ Program Budget Manager Completes Total Eligible Cost $ 248,010.00 (Required for Single -year operating Appropriations & Required information: contracts extending beyond current biennium) Prior Bien's Currerrt BI Cuareat Bf MIC (8 char) Fund/EAI Project-sub-Proj_ FY: 23 FY: Totals Prior-BN 197,185.00 1.97,185.00 E61PLOAO 23P/GAO 9WG&EM 38,]18.75 ,706.5 E6NTROAO 23P/OAO 9WD2-MN �• 12'66.25 12 (Fiscal Staff: GL I Subsidiary: Misc: SUdgetTotall 248,010.00 Budget Total must equal Total Eligible Cost 3) NOT COMPLETE/INCORRECT - only lists amendment amount. ` `I` 0 Increase Amount of 8,630.00 AMENDMENT: (check all that apply)( ❑� Time Extension I © ®ecrease Amendment $ Docusign Envelope ID: A5542800-F07B-88E3-82CC-B1C8A3BDE84C Total of Contract $ ❑ Other. a#tetAmendme!—A TERM: Start Date: 3fI/202D End Date: Contract Cost: $ How To Encumber and Disburse: Sales Tax (PW Only}; $ Program Budget Manager Completes Total Ellgibie Cost: $ (Required for Single -year Operating Appropriations& equired information: contracts extending beyond current biennium) Prior Bien's Current BI Current BI MIC (8 char) Fund/EAi Pro e� rt•S�_ FY' 20 DSG27OA0 23P/OAO 9DG9-07 8•00-00 220,775.00 220, 775.00 Fiscal Staff: GU Subsidiary: Misr: Budget TotalmustequalTotalEligible Cost Docusign Envelope ID: A5542800-1`0713-88E3-82CC-131 C8A3BDE84C Contracts Unit Freeze Exemption Tracking Form for r� qvvp� Contract/IAA/Amendments DEPARTMENT OF Instructions: This form must be submitted with all Contract/IAA/Amendment packets ECOLOGY State of`Nashington to the Fiscal Contracts Unit. If the Program is seeking an exemption/exception that requires Deputy Direct approval (see section 2 and guidance page), the Freeze Exemption/Exception Request Form for Service Contracts must also be filled out, approved, and included in the packet submitted to the Fiscal Contracts Unit. Request Information Date: 1 /30/26 To Program Budget Manager: Ellen Hafer From Approving Manager: Elaine Snouwaert Program/Office/Division: HWTR / ERO / PPA Contract/IAA/Amendment Information New Service Contract: Yes 7 No New IAA: Yes No New Work Assignment: Yes F✓ No New DES Work Order: Yes W No Amendment No. (if applicable): 01 Contract No. (if applicable): C2500178 Contractor/IAA Agency: Kittitas County Public Health District Exemption Information This form affirms that the attached contract/amendment meets a freeze exemption or has been approved by the Deputy Director as outlined in Ecology's Directive 24-19 Freeze Guidance and Forms page. Section 1 — Contracts and Amendments that DO NOT required Deputy Director approval and exempt from the OFM Freeze: ❑ Service Contract or Amendment costing less than $10.000. Note: This also includes Interagency and Intergovernmental Agreements (IAAs), Tier 2 Work Orders under DES Master Contracts, and Work Assignments under Ecology's Convenience Contracts (Prime). ECY Internal Form — Contracts Unit Freeze Exemption Tracking Form Rev. 1/14/25 Docusign Envelope ID: A5542800-F07B-88E3-82CC-B1 C8A3BDE84C ❑ Funded entirely by private OR ❑ federal funding sources, Note: Any Service Contracts with state match, or a combination of state, federal/private local funds, are subject to the freeze. Zero -cost amendments. Note: Such as time extensions that don't add funds, administrative amendments (e.g., changing the contract manager, or redistributing existing contract funds between tasks). Per additional OFM direction received 12/6/2024 and updates received on 12/12/2024, the contracts below are also exempt from the freeze. ❑ All contracts funded by the enacted capital budget and paid for entirely by bonds proceeds (e.g., State Building Construction Account). ❑ All public works contracts (as defined in RCW 39.04) funded by the enacted budgets, regardless of fund source (i.e. account). Section 2 — Service Contract or Amendments that DO required Deputy Director Approval per Directive 24-19 Freeze Guidance and Forms: This also includes Interagency and Intergovernmental Agreements (IAAs), Tier 2 Work Orders under DES Master Contracts, and Work Assignments under Ecology's Convenience Contracts (Prime). ❑ All Service Contracts costing $10,000 or more. (1OK+) ❑ Amendments that increase the contract value by $10,000 or more. (Amd 1 OK+) 1-1 Related to protection of life or public safety. (Safety) Tax collection or other revenue -generating activities. (Tax/Rev) ❑ Approved information technology projects (see OFM FAQ 6 and 7 for definition). (IT) ❑ Emergency Contracts as defined in RCW 39.26.130. (Emergency) ANY contract or amendment deemed essential by the Program/Office that does not meet an exemption listed above. (DD) In accordance with Ecology's Freeze Guidance please move the referenced contract/amendment forward through the normal process, Budget Manager Approval Budget Manager's Signature: Digitally signed by Hafer, Ellen (ECY) Date: 2026 03 23 13:42:54-07'00' Date: 3/23/26 ECY Internal Form — Contracts Unit Freeze Exemption Tracking Form Rev. 1/14/25 Docusign Envelope ID: A5542800-F07B-88E3-82CC-B1C8A3BDE84C Form Instructions and OFM Definitions Form Instructions Contracts/Amendments —Approving Manager is to complete this form and submit it to the Program Budget Manager. Program Budget Manager (or designee) shall submit this form along with the contract packet (Face Sheet and contract/amendment, etc.) as a complete packet via email to the Contracts Unit. Deputy Director Approval — For any item in Section 2 above, include the approved Freeze Exemption/Exception Request Form for Service Contracts Under Directive 24-19 in the email to the Contracts Unit with the contract packet (Contract, Face Sheet, or Amendment, and the Deputy Director Approval, if applicable). In the email to the Contracts Unit the Program Budget Manager shall state: "I electronically approve both the attached Face Sheet and Contracts Unit Freeze Exemption Form for Contract # Amendment # Contractor " OFM Definitions Exemption: the freeze does not apply due to the criteria listed in the instructions (e.g. protection of life or public safety related). However, agencies must document the rationale for their decisions internally and be prepared to provide this documentation, if requested. Exception: An expense (hiring, contract, travel, goods or equipment) that is subject to the freeze but is deemed critical to statutory duties and therefore approved by the director (and reported to OFM). Agencies must use the OFM Freeze log to report their exceptions. ECY Internal Form — Contracts Unit Freeze Exemption Tracking Form Rev. 1/14/25 0 docusign_ Certificate Of Completion Envelope Id: A5542800-F07B-88E3-82CC-B1C8A3BDE84C Status: Sent Subject: C2500178 Kittitas and Dept. of Ecology PPA Contract Amendment FY2025-27 Docusign Source Envelope: Document Pages: 11 Signatures: 0 Envelope Originator: Certificate Pages: 2 Initials: 0 Kristine Ray AutoNav: Enabled P.O. Box 47600 Envelopeld Stamping: Enabled Olympia, WA 98504 Time Zone: (UTC-08:00) Pacific Time (US & Canada) kray461@ecy.wa.gov IP Address: 162 10.9.31 Record Tracking Status: Original Holder: Kristine Ray Location: DocuSign 3/25/2026 10:37:32 AM kray461 @ecy.wa.gov Security Appliance Status: Connected Pool: Statel-ocal Signer Events Signature Timestamp Sent: 3/25/2026 10:40:59 AM Jesse Cox Viewed: 4/6/2026 9:54:22 AM jesse.cox@co.kittitas.wa.us EH Manager Kittitas County Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign Chelsey Loeffers chelsey.loeffers@co.kittitas.wa.us Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign Kristine Ray kray461@ecy.wa.gov Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign Cheryl Blackburn cb1a461 @ecy.wa.gov Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign Katrina Lassiter klas461@ecy.wa.gov Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 3/25/2026 10:40:59 AM Payment Events Status Timestamps