HomeMy WebLinkAboutCon Con Amendment 11■
Kittitas County Public Health
Contract/Agreement Review Form
Public Health
Today's Date: 06/24/26
Fund/Department: I 116-Public Health
Legal Request #:
12604
I
Agenda Date:
Contract/Agreement Information
Contract/Agreement Agency: WA State Department of Health
Contract/Agreement Title: Consolidated Contract Amendment 11
Begin Date: 01/01/2025 End Date: 12/31/2027
Total $ Amount: Increase $1,507,160.00 New max $6,262.951.00 Contract/Agreement #: CLH32055
Contract/Agreement Summary:
The Consolidated Contract Amendment 11 is amended by the following
Exhibit A Statements of Work, includes the following statements of work
Adds Statements of Work for the following programs:
Foundational Public Health Services - Effective July 1, 2026
Infectious Disease Syndemic Prevention Services-SSP - Effective July 1, 2026
Amends Statements of Work for the following programs:
Office of Drinking Water Group B Program - Effective July 1, 2025
Exhibit B-11 Allocations, attached and incorporated by this reference, amends and replaces Exhibit
B-10 Allocations as follows:
Increase of $1,507,160 for a revised maximum consideration of $6,262,951.
Kittitas County Prosecuti
APPROVE A FORM:
Signs u e of rosecutor's
Signature of Auditor's dfl
and Auditor Review and Comment:
J U L o 2" 2026
-
Date
1. -& -z(,
! �rI Date
Budget Information
Revenue Code(s): 336.04.24 / 334.04.912 / 334.04.91
Expense Code(s): PH1600-101 / PH3000-102 / PH3000-103 / PH4300-113
✓❑ 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 Ddiaga I Approval By: Chelsey Loeffers 1
6/26/26, 10:40 AM
SAM.gov
Entity Information
HEALTH, WAS H I N C TO N Active Registration
STATE DEPARTMENT OF
Unique Entity ID CAGE/NCAGE
C16SP2HBR123 1 FSD1
Physical Address Mailing Address
101 Israel RD SE 101 Israel RD SE
Tumwater, Washington Tumwater, Washington
98501-5570, United States 98501-5570, United States
Purpose of Registration
All Awards
Version
Current Record —�
BUSINESS INFORMATION
Doing Business As
URL
(blank)
doh.wa.gov
Registration Dates
Division Name
Division Number
(blank)
(blank)
Activation Date
Congressional
State/Country of
Sep 3, 2025
District
Incorporation
Submission
Washington 10
(blank), (blank)
Date
Sep 3, 2025
Owner
CAGE Legal Business
Initial Registration
Name
Date
Apr 2, 2002
Immediate
(blank)(blank)
Owner
Expiration Date
Sep 3, 2026
Highest Level (blank)(blank)
Owner
https://sam.gov/entities/view/C 16S P2HB R 123/core Data?status=Active&emrKeyValue=2164854-1755894257626050®ld=16317582 1 /2
6/26/26, 10:40 AM SAM.gov
Entity Dates
Entity Start
Date
Jul 1, 1989
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:
L 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/Cl6SP2HBR123/coreData?status=Active&emrKeyValue=2164854-1755894257626050®ld=16317582 2/2
KITTITAS COUNTY PUBLIC HEALTH
2025-2027 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH32055 AMENDMENT NUMBER: 11
PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as
"DOH", and KITTITAS COUNTY PUBLIC HEALTH, 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:
litt s.1/slateofwa.share inL.com/siLesidul7-olsfundin resourceslsite eslhome.as x7=el 9a94688<aZd94d3ea80ac7fbc32e4d7c
® Adds Statements of Work for the following programs:
Foundational Public Health Services - Effective July 1, 2026
Infectious Disease Syndemic Prevention Services-SSP - Effective July 1, 2026
® Amends Statements of Work for the following programs:
Office of Drinking Water Group B Program - Effective July 1, 2025
❑ Deletes Statements of Work for the following programs:
2. Exhibit B-11 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-10 Allocations
as follows:
® Increase of $1,507,160 for a revised maximum consideration of $6,262,951.
❑ Decrease of for a revised maximum consideration of
❑ No change in the maximum consideration of
Exhibit B Allocations are attached only for informational purposes.
3. Exhibit C Federal Grant Awards Index, incorporated by this reference, and located in the ConCon, Funding & BARS
library at the URL provided above.
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 STATE OF WASHINGTON
DEPARTMENT OF HEALTH
Signature: Signature:
Date: I Date:
APPROVED AS TO FORM ONLY
Assistant Attorney General
Page 1 of 1
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