HomeMy WebLinkAboutCONSENT Consolidated contract Amend 6 615 Sheridan Street
Port Townsend, WA 98368
9 Orson www.JeffersonCountyPublicHealth.org
Consent Agenda
Public Healt
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Josh Peters, County Administrator
FROM: Apple Martine, JCPH Director
Veronica Shaw, JCPH Deputy Director
DATE: �WS� �, 2�JZ).r
SUBJECT: Agenda Item — Consolidated Contracts Amendment #6 with the Department
of Health; January 1, 2025 — December 31, 2027; $103,533 additional
STATEMENT OF ISSUE:
Jefferson County Public Health (JCPH) requests Board approval of Consolidated Contract Amendment #6
between JCPH and State of Washington Department of Health (DOH); January 1, 2025 — December 31, 2027;
additional funding of $103,533 for a total to date of $3,289,422.
ANALYSIS/STRATEGIC GOALS/PROS and CONS:
The purpose of this agreement is to provide public health services to the people of Washington State. This
Amendment adds and/or amends statements of work (SOW) and funding for the following programs:
• Infectious Disease-Syndemic Prevention Services-SSP: this revision adds a Statement of Work providing
Syndemic (occurring when two or more infectious diseases or health conditions cluster and interact
within a population) Prevention Services for infectious diseases (additional funding of $96,833)
• Recreational Shellfish Activities: continues the program with no changes (adds $7,500 for the next
funding cycle)
• Office of Drinking Water Group A Program provides funding to the local health jurisdiction (LHJ) for
conducting sanitary surveys and providing technical assistance to small community water systems: this
amendment extends funding period, and changes MI code for Sanitary Survey Fees (decrease of$800)
FISCAL IMPACT/COST BENEFIT ANALYSIS:
Total consideration for this Contract Amendment is $103,533. The Consolidated Contract is funded by DOH,
and comprises both Federal and State funds.
Community Health
Developmental Disabilities Environmental Public Health
360-385-9400 360-385-9444
360-385-9401 (f) (f) 360-379-4487
Always working for a safer and healthier community
CC-25-001-A6
RECOMMENDATION:
JCPH Management recommends BoCC approval of Consolidated Contract Amendment #6 between JCPH and
DOH; January 1, 2025 — December 31, 2027; additional funding of $103,533.
REVIEWED BY:
Josh 7ters, County Administrator Date
Community Health Environmental Public Health
Developmental Disabilities 360-385-9444
360-385-9400 Always working for a safer and healthier community (f) 360-379-4487
360-385-9401 (f)
CONTRACT REVIEW FORM Clear Form
(INSTRUCTIONS ARE ON THE NEXT PAGE)
CONTRACT WITH: State of WA Dept of Health Contract No: CC-25-001-A6
Contract For: Consolidated Contracts, Amendment 6 Term: 1/1/2025 - 12/31/2027
COUNTY DEPARTMENT: Public Health
Contact Person: Veronica Shaw
Contact Phone: x 409
Contact email: veronica@co.jefferson.wa.us
/
AMOUNT: $103,533 additional,for a total of$3,289,422 PROCESS: Y Exempt from Bid Process
Revenue: $103,533 Cooperative Purchase
Expenditure: Competitive Sealed Bid
Matching Funds Required: Small Works Roster
Sources(s) of Matching Funds Vendor List Bid
Fund # 127 RFP or RFQ
Munis Org/Obj 12756220 Other:
APPROVAL STEPS:
STEP 1: DEPARTMENT CERTIFIES COMP CE WG 'F .55.080 AND CHAPTER 42.23 RCW.
CERTIFIED: N/A: ■ � July 18, 2025
Sig re Date
STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE
COUNTY (CONTRACTOR) HAS NOT:, DEBAR. D : ANY FEDERAL, STATE, OR LOCAL
AGENCY. I
CERTIFIED: N/A: `1 C� /00/ July 18, 2025
Signature Date
STEP 3: RISK MANAGEMENT REVIEW (will be added electronically through Laserfiche):
Electronically approved by Risk Management on 7/24/2025.
STEP 4: PROSECUTING ATTORNEY REVIEW (will be added electronically through Laserfiche):
Electronically approved as to form by PAO on 7/24/2025.
Glenn thanks for letting us know why the prior amendment was not
included--very helpful.
STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND
PROSECUTING ATTORNEY(IF REQUIRED).
STEP 6: CONTRACTOR SIGNS
STEP 7: SUBMIT TO BOCC FOR APPROVAL
1
Page 1 of 19
JEFFERSON COUNTY PUBLIC HEALTH
2025-2027 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH32053 AMENDMENT NUMBER: 6
PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as
"DOH", and JEFFERSON 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:
https://stateofwa.sharcpoint.com/sitcs/doh-ofsfundingresources/sitepages/home.aspx?=c 1:9a94688da2d94d3ea80ac7fbc32c4d7c
® Adds Statements of Work for the following programs:
Infectious Disease Syndemic Prevention Services-SSP-Effective July 1,2025
Recreational Shellfish Activities-Effective July 1,2025
® Amends Statements of Work for the following programs:
Office of Drinking Water Group A Program-Effective January 1,2025
O Deletes Statements of Work for the following programs:
2. Exhibit B-6 Allocations,attached and incorporated by this reference,amends and replaces Exhibit B-5 Allocations as
follows:
® Increase of$103,533 for a revised maximum consideration of$3,289,422,
El 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.
JEFFERSON COUNTY WASHINGTON STATE OF WASHINGTON
BOARD OF COUNTY COMMISSIONERS DEPARTMENT OF HEALTH
Heidi Eisenhour,Chair Date Date
APPROVED AS TO FORM ONLY APPROVED AS TO FORM ONLY
Assistant Attorney General
am, ..n. July 24, 2025
Philip C.Hunsucker, Date
Chief Civil Deputy Prosecuting Attorney Page 1 of 1
CC-25-00I-A6
EXHIBIT B-6 Page 2 of 19
Jefferson County Public Health ALLOCATIONS Contract Number: CLH32053
Contract Term:2025-2027 Date: July 1,2025
Indirect Rate January 1,2025 through December 31,2025:27.38%Public Health
DOH Use Only
BARS Statement of Work Chart of Accounts Funding Chart of
Federal Award Assist Revenue LHJ Funding Period Funding Period Period Accounts
Chart of Accounts Program Title Identification# Amend# List#* Code** Start Date End Date Start Date End Date Amount SubTotal Total
FFY25 USDA BFPC Prog Mgmt 7WA700WA1 Amd 4 10.557 333.10.55 01/01/25 09/30/26 10/01/24 09/30/26 $28,238 $28,238 $28,238
FFY24 USDA BFPC Prog Mgmt 7WA700WA1 Amd 4 10.557 333.10.55 01/01/25 09/30/26 10/01/23 09/30/26 ($28,238) $0
FFY24 USDA BFPC Prog Mgmt 7WA700WA1 Amd 2 10.557 333.10.55 01/01/25 09/30/26 10/01/23 09/30/26 $28,238
FFY25 USDA WIC Client Svs Contracts 7WA700WA7 Amd 4 10.557 333.10.55 01/01/25 09/30/25 10/01/24 09/30/25 $3,975 $148,117 $148,117
FFY25 USDA WIC Client Svs Contracts 7WA700WA7 Amd 2 10.557 333.10.55 01/01/25 09/30/25 10/01/24 09/30/25 $144,142
FFY25 USDA FMNP Mgmt 7WA810WA7 Amd 4 10.572 333.10.57 01/01/25 09/30/25 10/01/24 09/30/25 $637 $637 $637
FFY25 SWIMMING BEACH ACT IAR(ECY) 01J74301 Amd 2 66.472 333.66.47 03/01/25 10/31/25 01/01/25 11/30/25 $13,500 $13,500 $13,500
FFY24 PHEP BPI-CDC-LHJ Partners NU9OT0000055 Amd 1 93.069 333.93.06 01/01/25 06/30/25 07/01/24 06/30/25 $13,754 $13,754 $13,754
FFY24 OD2A OID CDC Prevent NU17CE010218 Amd 6 93.136 333.93.13 07/01/25 08/31/25 09/01/24 08/31/25 $16,333 $16,333 $97,889
FFY24 OD2A OID CDC Prevent NU17CE010218 Amd 2 93.136 333.93.13 01/01/25 06/30/25 09/01/24 08/31/25 $32,556 $81,556
FFY24 OD2A OID CDC Prevent NU17CE010218 Amd 1 93.136 333.93.13 01/01/25 06/30/25 09/01/24 08/31/25 $49,000
FFY25 FPHPA Title X Family Plan FPHPA006560 Amd 5 93.217 333.93.21 04/01/25 03/31/26 04/01/25 03/31/26 $17,023 $17,023 $33,989
FFY24 FPHPA Title X Family Plan FPHPA006560 Amd 3 93.217 333.93.21 01/01/25 03/31/25 04/01/24 03/31/25 $8,345 $16,966
FFY24 FPHPA Title X Family Plan FPHPA006560 Amd 21 93.217 333.93.21 01/01/25 03/31/25 04/01/24 03/31/25 $8,621
FFY24 CDC PPHF Ops NH23IP922619 Amd I 93.268 333.93.26 01/01/25 06/30/25 07/01/23 06/30/25 $10,000 $10,000 $10,000
FFY20 ELC EDE LHJs CDC NU50CK000515 Amd 1 93.323 333.93.32 01/01/25 06/30/25 01/15/21 07/31/25 $15,580 $15,580 $15,580
FFY21 CDC COVID-19 PHWFD-LHJ NU90TP922181 Amd 3 93.354 333.93.35 01/01/25 06/30/25 07/01/23 06/30/25 $51,330 $51,330 $51,330
FFY22 PH Infrastructure Comp Al-LHJ NE110E000053 Amd 3 93.967 333.93.96 01/01/25 11/30/27 12/01/22 11/30/27 $150,300 $150,300 $150,300
FFY25 HRSA MCHBG LHJ Contracts B04MC54583 Amd 1 93.994 333.93.99 01/01/25 09/30/25 10/01/24 09/30/25 $27,525 $27,525 $27,525
SFY25 SBHC Proviso Amd 1 N/A 334.04.90 01/01/25 06/30/25 07/01/24 06/30/25 $59,000 $59,000 $59,000
SFY25 DUH Naloxone DDO HCA IAR Amd 4 N/A 334.04.91 03/01/25 06/30/25 12/10/24 06/30/25 $15,000 $15,000 $15,000
SFY26 Drug User Health Program Amd 6 N/A 334.04.91 07/01/25 06/30/26 07/01/25 06/30/26 $80,500 $80,500 $120,750
SFY25 Drug User Health Program Amd I N/A 334.04.91 01/01/25 06/30/25 07/01/24 06/30/25 $40,250 $40,250
SFY25 Sexual&Rep Hlth Cost Share Amd 1 N/A 334.04.91 01/01/25 06/30/25 07/01/24 06/30/25 $47,993 $47,993 $47,993
SFY25 SSPS Opiod Harm Red Proviso Amd 2 N/A 334.04.91 01/01/25 06/30/25 07/01/24 06/30/25 $8,000 $8,000 $8,000
Page 1 of 2
EXHIBIT B-6 Page 3 of 19
Jefferson County Public Health ALLOCATIONS Contract Number: CLH32053
Contract Term:2025-2027 Date: July 1,2025
Indirect Rate January 1,2025 through December 31,2025:27.38%Public Health
DOH Use Only
BARS Statement of Work Chart of Accounts Funding Chart of
Federal Award Assist Revenue LHJ Funding Period Funding Period Period Accounts
Chart of Accounts Program Title Identification# Amend# List#* Code** Start Date End Date Start Date End Date Amount SubTotal Total
SFY25 LHJ Opioid Campaign Proviso Amd 3 N/A 334.04.93 01/01/25 06/30/25 07/01/24 06/30/25 $24,500 $56,000 $56,000
SFY25 LHJ Opioid Campaign Proviso Amd 1 N/A 334.04.93 01/01/25 06/30/25 07/01/24 06/30/25 $31,500
Rec Shellfish/Biotoxin Amd 6 N/A 334.04.93 07/01/25 06/30/26 07/01/25 06/30/26 $7,500 $7,500 $11,200
Rec Shellfish/Biotoxin Amd 1 N/A 334.04.93 01/01/25 06/30/25 07/01/23 06/30/25 $3,700 $3,700
Small Onsite Management(ALEA) Amd 4 N/A 334.04.93 01/01/25 06/30/25 07/01/23 06/30/25 $1,363 $33,781 $33,781
Small Onsite Management(ALEA) Amd 3 N/A 334.04.93 01/01/25 06/30/25 07/01/23 06/30/25 $32,418
SFY25 Wastewater Management-GFS Amd 4 N/A 334.04.93 01/01/25 06/30/25 07/01/24 06/30/25 ($1,363) $9,239 $9,239
SFY25 Wastewater Management-GFS Amd 3 N/A 334.04.93 01/01/25 06/30/25 07/01/24 06/30/25 $10,602
SFY25 FPHS-LHJ Funds-GFS Amd 1 N/A 336.04.25 01/01/25 06/30/25 07/01/24 06/30/25 $2,333,000 $2,333,000 $2,333,000
YR1 Stimulus-Local Asst(10%of 15%)SS Amd 6 N/A 346.26.64 01/01/25 12/31/27 07/01/23 06/30/28 $1,800 $1,800 $1,800
YR 28 SRF-Local Asst(15%)SS Amd 6 N/A 346.26.64 01/01/25 12/31/27 07/01/24 06/30/29 ($2,200) $0 $0
YR 28 SRF-Local Asst(15%)SS Amd 4 N/A 346.26.64 01/01/25 12/31/27 07/01/24 06/30/29 $2,200
YR 27 SRF-Local Asst(15%)SS Amd 4 N/A 346.26.64 01/01/25 06/30/25 07/01/23 06/30/25 ($2,200) $0
YR 27 SRF-Local Asst(15%)SS Amd 1 N/A 346.26.64 01/01/25 06/30/25 07/01/23 06/30/25 $2,200
Sanitary Survey Fees SS-State Amd 6 N/A 346.26.65 01/01/25 12/31/27 07/01/23 12/31/27 ($400) $1,800 $1,800
Sanitary Survey Fees SS-State Amd 1,6 N/A 346.26.65 01/01/25 12/31/27 07/01/23 12/31/27 $2,200
YR1 Stimulus-Local Asst(10%of 15%)TA Amd 6 N/A 346.26.66 01/01/25 12/31/27 07/01/23 06/30/28 $1,000 $1,000 $1,000
YR 28 SRF-Local Asst(15%)TA Amd 6 N/A 346.26.66 01/01/25 12/31/27 07/01/24 06/30/29 ($1,000) $0 $0
YR 28 SRF-Local Asst(15%)TA Amd 4 N/A 346.26.66 01/01/25 12/31/27 07/01/24 06/30/29 $1,000
YR 27 SRF-Local Asst(15%)TA Amd 4 N/A 346.26.66 01/01/25 06/30/25 07/01/23 06/30/25 ($1,000) $0
YR 27 SRF-Local Asst(15%)TA Amd 1 N/A 346.26.66 01/01/25 06/30/25 07/01/23 06/30/25 $1,000
TOTAL $3,289,422 S3,289,422
Total consideration: $3,185,889 GRAND TOTAL $3,289,422
$103,533
GRAND TOTAL $3,289,422 Total Fed $590,859
Total State $2,698,563
*Assistance Listing Number fka Catalog of Federal Domestic Assistance
**Federal revenue codes begin with"333". State revenue codes begin with"334".
Page 2 of 2
Page 4 of 19
Exhibit A
Statement of Work
Contract Term: 2025-2027
DOH Program Name or Title: Infectious Disease Syndemic Prevention Services- Local Health Jurisdiction Name: Jefferson County Public Health
SSP-Effective July 1,2025
Contract Number: CLH32053
SOW Type: Original Revision#(for this SOW) Funding Source Federal Compliance Type of Payment
® Federal Subrecipient (check if applicable) ® Reimbursement
Period of Performance: July 1,2025 through June 30,2026 ® State El FFATA(Transparency Act) El Fixed Price
El Other El Research&Development
Statement of Work Purpose: The purpose of this statement of work(SOW)is to provide Syndemic Prevention Services for infectious diseases(HIV, STI,and Adult Viral
Hepatitis),supporting the Office of Infectious Disease(OID)within Department of Health(DOH)
Revision Purpose: N/A
Master Assistance BARS Allocation
LHJ Funding Period Change
Index Listing Revenue CurrentTotal
DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation Increase(+) Allocation
SFY26 DRUG USER HEALTH PROGRAM 12405160 N/A 334.04.91 07/01/25 06/30/26 0 80,500 80,500
FFY24 OD2A OID CDC PREVENT 12405241 93.136 333.93.13 07/01/25 08/31/25 0 16,333 16,333
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 0 96,833 96,833
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
# and/or Amount
1 Syringe Services Programs: Support for Operations: SSP operations outcomes include delivering Enter deliverable data into the Reimbursement of
services and tracking: DOH/OID issued database for actual costs incurred,
Provide comprehensive Syringe Services Programs(SSP) • number of sterile syringes distributed tracking SSP activities by the not to exceed S80,500
to people who use drugs(PWUD). This plan of action is • number of naloxone kits distributed 15th of each month following for 07/01/25—06/30/26
directed to distribute syringes to communities that use • number of participant encounters service.
drugs to prevent transmission of infectious disease. SSPs • number of referrals to health and social
will operate during scheduled hours to provide all services
required harm reduction supplies,naloxone,and syringes
to prevent transmission of disease and overdose. SSPs Submit Performance Objectives&Work
will offer referrals to address social determinants of Plan within the first six months of contract
health. period that will include:
• Outcomes aligned with program
strategies and activities.
Exhibit A,Statement of Work Page 1 of 10 Contract Number CLH32053-Amendment 6
Page 5 of 19
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
Priority populations for Syringe Services Programs • SMART objectives aligned with
include people who use drugs,with a focus on: performance targets
• People systemically marginalized and • Activities aligned with program
underserved due to racism—Black/African outcomes
American,Latino/Latina/Latine/Latinx, • Timeline for implementation(including
American Indian/Alaska Native people and staffing of the proposed program,
other communities for whom there are training,etc.)
documented health disparities in your region. • Anticipated capacity building or
• People who are unhoused or unstably housed. technical assistance needs.
• People engaged in sex work.
• People involved in the criminal legal system. NOTE:See Special Requirements,Terms
• Gender expansive/transgender individuals. and Conditions—Section 7 Performance
• Gay,bi,and other men who have sex with men. Objectives&Workplans for additional
deliverable information
NOTE: See Special Requirements,Terms and
Conditions—Section 4 Syringe Services Programs:
Support for Operations Program Requirements for
additional task information.
Syringe Services Programs:Clinical Services SSP Clinical services outcomes may
include,but are not limited to,delivering
Provide direct access to clinical services to improve the services and tracking:
health and well-being of people who use drugs.At • Number of wound care sessions
minimum,services must include onsite,low-barrier • Number of infectious disease tests
access to wound care,infectious disease testing,STI and conducted(hepatitis C,HIV,
hepatitis C treatment,and medications for opioid use gonorrhea-chlamydia,syphilis)
disorder.Additional services can include mental health • %positive of infectious disease tests
services,sexual and reproductive health care,and other (hepatitis C,HIV,gonorrhea-
primary care and psychosocial support services. chlamydia,syphilis)
• Number of participants started on
NOTE: See Special Requirements,Terms and hepatitis C treatment
Conditions—Section 6 Syringe Services Program, • Number of participants inducted on
Clinical Services Requirements for additional task medications for opioid use disorder
information.
2 Syringe Services Programs:Harm Reduction Service Harm reduction care navigation outcomes Enter deliverable data into the Reimbursement of
Navigation include delivering services and tracking: DOH/OID issued database for actual costs incurred,
• number of participants enrolled in care tracking SSP activities by the not to exceed$16,333
Provide appropriate referrals to SSP participants; navigation services 15th of each month following for 07/01/25—08/31/25
facilitate access to receive health care and medical • number of care navigation sessions service.
services,social services,behavioral health counseling and • number of referrals to health and social
other services including substance use treatment services
Exhibit A,Statement of Work Page 2 of 10 Contract Number CLH32053-Amendment 6
Page 6 of 19
Task Payment Information
Activity Deliverables/Outcomes Due Date/Time Frame and/or Amount
(including medications for opiate use disorder,or • number of linkages to care for health
MOUD);housing;and advocacy,including but not and social services
limited to criminal legal involvement,medical providers, • number of outreach attempts per
benefits navigation,and family reunification. participant
NOTE:See Special Requirements,Terms and
Conditions—Section 5 Syringe Services Program,
Harm Reduction Care Navigation Requirement for
additional task information
DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site.Questions related to this SOW,or any other
finance-related inquiry,may be sent to finance(nldoh.wa.gov.
Federal Funding Accountability and Transparency Act(FFATA)(Applies to federal grant awards.)
This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act(FFATA or the Transparency Act).
The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent.
To comply with this act and be eligible to perform the activities in this statement of work,the LHJ must have a Unique Entity Identifier(UEI)generated by SAM.gov.
Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. 109-282.
Program Specific Requirements
Special Requirements,Terms and Conditions
1. Definitions
a. ANONYMOUS SERVICES-HIV Prevention services including condom distribution,outreach and light touch.
b. CAPACITY BUILDING-The process by which individuals and organizations obtain,improve,and retain the skills,knowledge,tools,equipment,and
other resources needed to do their jobs competently.
c. CONTRACTOR—For the purposes of this Statement of Work Only,the entity receiving funds directly from Washington State Department of Health
(DOH)for client services to prevent or treat conditions named in the statement of work will be referred to as contractor.
d. HARM REDUCTION-Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.
e. INTEGRATED TESTING-For the purpose of this Statement of Work,Integrated Testing includes Human Immunodeficiency Virus(HIV),Gonorrhea
(GC),Chlamydia(CT),Syphilis,Hepatitis C(HCV)and Hepatitis B(HBV).
f. SOCIAL DETERMINANTS OF HEALTH-Social determinants of health(SDOH)are the conditions in the environments where people are born,live,
learn,work,play,worship,and age that affect a wide range of health,functioning,and quality-of-life outcomes and risks.
g. YOUTH-For purposes of this agreement,the term"youth"applies to persons under the age of 18.
2. Submission of Invoice Vouchers—
a. On a monthly basis,the CONTRACTOR shall submit complete and correct A19 invoice vouchers with amounts billable to DOH under this statement of work
and the corresponding OID Expense Summary backup form.All A19 invoice vouchers must be submitted by the 25th of the following month.Prior approval is
required for a different frequency of billing.
Exhibit A,Statement of Work Page 3 of 10 Contract Number CLH32053-Amendment 6
Page 7 of 19
i. The CONTRACTOR must provide all backup documentation as required based on the assigned risk level and/or as identified by DOH program staff
to determine allowability of billed expenses. Risk assessments are completed at the beginning of a new contract for all sub-recipient contracts.
Contact your contract manager if you are unaware of your assigned risk level.
ii. DOH may ask for additional backup information to pay invoices based on the needs of the funding sources supporting the work.
b. The CONTRACTOR shall submit all final claims for payment for costs due and payable under this statement of work by July 31,2026.DOH will pay belated
claims at its discretion,contingent upon the availability of funds.
3. Program Organization—CONTRACTOR must
a. The CONTRACTOR must provide a full updated organizational chart,including Board of Directors with contact information if applicable,and staffing plan
referencing positions described in the budget narrative.
b. The CONTRACTOR must provide job descriptions for any new or changed positions in the updated organizational chart.
i. Any new positions funded through the original contract funds,must have prior DOH approval.
c. The CONTRACTOR must notify their DOH contract manager within 30 days of any staff vacancies related to contracted positions and provide an updated
budget.
i. Any new fiscal staff responsible for invoicing on this contract will need to meet with the assigned OID Contract Manager within 60 days for DOH
invoice overview and training.
4. Syringe Services Program:Support for Operations Program Requirements
a. Operate for a minimum of 8 hours per week and 2 days per week.
b. Provide mobile and/or street outreach(note:programs must have a vehicle for mobile outreach.)
c. Offer safer injection supplies(see list of required safer injection supplies below).
d. Submit monthly SSP data in accordance with DOH standards.
e. Attend required capacity building/training opportunities provided by DOH.
f. Participate in annual site visits with DOH staff.
g. Demonstrate structure for receiving and incorporating participant feedback about services.
h. Partner with relevant local agencies to ensure effective outreach and service provision.(See Scope of Work narrative below for details on MOUs required.)
i. Develop and maintain a Universal Precautions and Sharps Handling policy and procedure,including clear,written policies on handling biohazardous waste,
avoiding unnecessary handling of sharps,and potential needle stick injuries to staff,volunteers,and participants.Programs should follow the universal precaution
guidelines established by the CDC and OSHA. SSPs may need to adapt those precautions to accommodate the circumstances of their work(e.g.,mobile and
outreach settings).Programs should also anticipate the potential of needlestick injury and have a"post-exposure-prophylaxis"protocol included in this document.
j. All staff and volunteers working directly with participants/clients must complete CPR certification within the first 3 months after contract start date(if not
already complete).
5. Syringe Services Program,Harm Reduction Care Navigation Requirements
a. Includes all requirements for Syringe Service Program operations(see above)
b. Attend Harm Reduction Care Navigation training provided by DOH.
c. Support participant transportation(e.g.,through the provision of bus passes,cab vouchers,or direct transportation).
d. Accompany participants to appointments or provide"warm hand-offs."
e. Full-time care navigators(1.0 FTE)shall not exceed a case load greater than 25 individuals.
f. Submit monthly outcome data in accordance with DOH standards.
6. Syringe Services Program,Clinical Services Requirements
a. Includes all requirements for Syringe Service Program operations(see above)
b. Must have clinical staff licensed to practice in the state of Washington to provide clinical services(e.g.,RN,PA,ARNP,LCSW).
c. If providing advanced level clinical services(e.g.,PA,ARNP,CNM),programs must have appropriate clinical oversight.
Exhibit A,Statement of Work Page 4 of 10 Contract Number CLH32053-Amendment 6
Page 8 of 19
Note: Clinical services can be provided through sub-contractor arrangement or MOU with a Federally Qualified Health Center or other clinical
partner if there is a justification the relationship will support efforts to reach people who use drugs and provide onsite and/or mobile clinical services.
Clinical services can also be provided using telemedicine services with appropriate description of why in-person services cannot be provided and who
the telemedicine partner(s)will be.
NOTE: Funds from this contract may not be used to purchase basic safer injection supplies(listed below)—Instead,DOH will provide Contractors with supplies.
Below is the list of required supplies for SSP to be provided to Contractors by DOH:
a. Syringes(1 cc 27 gauge 1/2",28 gauge 1/2",and 29 gauge 1/2"; 1 cc 30 gauge 5/16";3 cc 25G 1"and 1.5")
b. Alcohol pads
c. Non-latex tourniquets
d. Sterile water
e. Sterile saline
f. Cookers
g. Cottons and/or cellulose filters
h. Bandages/gauze
i. Sharps containers(1 quart and 2 gallon for distribution, 8 gallon for program use)
j. Naloxone
k. Amber bags
The exceptions to these supplies are vendor or manufacturer supply shortages. If a program expects to run out of one of these items,please contact DOH immediately.
7. Performance Objectives&Work Plan:
a. Funded Syndemic Prevention Services agencies are required to submit Performance Objectives and Work Plan that provides both a high-level overview of the
period of performance and a detailed description of the first year of the contract period.The work plan should incorporate related program strategies and
activities.Applicants should propose specific,measurable,achievable,realistic,and time-based(SMART)process and/or outcome objectives for each activity
aligned with performance outcomes.The work plan should include training,capacity building,and TA needs to support the implementation of the funded
services.Proposed work plan activities may be adjusted in collaboration with OID staff to better address the overarching goals of the funded services.OID will
provide a template that must be used in developing the work plan.
b. The applicant should address the following outline in their work plan:
i. Contract Year 2 Detailed Work Plan(For each funded service category)
ii. Program strategies and activities
iii. Outcomes aligned with program strategies and activities
iv. SMART objectives aligned with performance targets
v. Activities aligned with program outcomes
vi. Timeline for implementation(including staffing of the proposed program,training,etc.)
vii. Anticipated capacity building or technical assistance needs.
c. Performance Objectives&Work Plans should be submitted by December 31,2025.
d. OID staff are available to support in developing Performance Objectives&Work Plans in collaboration with funded agencies.
e. Performance Objectives&Work Plans will be reviewed between OID staff and funded agencies at least quarterly.Performance Objectives&Work Plans can be
adjusted throughout the period of performance.
8. Participation in program evaluation activities—The Contractor is expected to participate in program evaluation activities,including evaluation planning,and collecting
and reporting qualitative and quantitative program data,as deemed necessary by OID staff.
Exhibit A,Statement of Work Page 5 of 10 Contract Number CLH32053-Amendment 6
Page 9 of 19
9. Participation in Capacity Building and Technical Assistance Activities designed to increase efficacy of Syndemic Services
a. Opportunities for capacity building and technical assistance for contractor will be offered throughout the contract year by WA DOH and other regional or
national capacity building organizations.
b. Contractors will be expected to meet with WA DOH OID staff on an annual basis to discuss training and will work with DOH to track shared completion of
Capacity Building Needs
c. All contracted staff will be required to complete training in respect to their role.DOH staff and contracted staff will work together to track completion of required
trainings.
10. CLAS Standards—The CONTRACTOR will comply with the National Standards for Culturally and Linguistically Appropriate Services(CLAS)standards(1,5-9).
National Standards for Culturally and Linguistically Appropriate Services(CLAS)in Health and Health Care(allianceforclas.org)
11. Participation in Program Monitoring Activities—
a. DOH will conduct semi-annual or annual performance site visits in the following areas:
i. Integrated testing
ii. Syndemic service navigation
iii. PrEP Housing
iv. Syringe Service Programs
v. Mail-order naloxone distribution program
vi. Fiscal Monitoring—To be scheduled by the DOH Fiscal Monitoring Unit
b. Corrective Action Plans—DOH may exercise the following options if the CONTRACTOR does not come into compliance or resolution with programmatic
and/or fiscal monitoring corrective action plan by the due date(s)identified in the CAP.i.§200.339 Remedies for noncompliance.
If a non-Federal entity fails to comply with the U.S.Constitution,Federal statutes,regulations or the terms and conditions of a Federal award,the Federal
awarding agency or pass-through entity may impose additional conditions,as described in§200.208.If the Federal awarding agency or pass-through entity
determines that noncompliance cannot be remedied by imposing additional conditions,the Federal awarding agency or pass-through entity may take one or more
of the following actions,as appropriate in the circumstances:
(a)Temporarily withhold cash payments pending correction of the deficiency by the non-Federal entity or more severe enforcement action by the Federal
awarding agency or pass-through entity.
(b)Disallow(that is,deny both use of funds and any applicable matching credit for)all or part of the cost of the activity or action not in compliance.
(c)Wholly or partly suspend or terminate the Federal award.
(d)Initiate suspension or debarment proceedings as authorized under 2 CFR part 180 and Federal awarding agency regulations(or in the case of a pass-through
entity,recommend such a proceeding be initiated by a Federal awarding agency).
(e)Withhold further Federal awards for the project or program.
(f)Take other remedies that may be legally available
12. Contract Management—
a. Fiscal Guidance
I Indirect-If charging indirect costs,the CONTRACTOR must have a current federally negotiated rate or De Minimis certification of file with DOH.
DOH is not able to reimburse indirect costs without an approved indirect cost rate or De Minimis certification of file.
Exhibit A,Statement of Work Page 6 of 10 Contract Number CLH32053-Amendment 6
Page 10 of 19
ii. Advance Payments Prohibited—DOH funds are"cost reimbursement"funds. DOH will not make payment in advance or in anticipation of services
or supplies provided.This includes payments of"one-twelfth"of the current fiscal year's funding.
iii. Duplication of EIP Services—The CONTRACTOR shall not use contract funds to provide a parallel medication service to EIP. CONTRACTOR'S
providing case management services shall make every effort to enroll clients in EIP.
iv. Payment of Cash or Checks to Clients Not Allowed—Where direct provision of service is not possible or effective,vouchers or similar programs,
which may only be exchanged for a specific service(e.g.,transportation),shall be used to meet the need for such services. CONTRACTOR shall
administer gift cards voucher programs to assure that recipients cannot readily convert vouchers into cash.
1. Store gift cards that can be redeemed at one merchant or an affiliated group of merchants for specific goods or services are allowable as
incentives for eligible program participants.
2. General-use prepaid cards are considered"cash equivalent"and are therefore unallowable. Such cards generally bear the logo of a payment
network,such as Visa,MasterCard,or American Express,and are accepted by any merchant that accepts those credit or debit cards as payment.
Gift cards that are cobranded with the logo of a payment network and the logo of a merchant or affiliated group of merchants are general-use
prepaid cards,not store gift cards,and therefore are unallowable.
3. The CONTRACTOR must ensure that a policy for managing gift cards with strong internal controls is in place.
v. Funds for Needle Exchange Programs Not Allowed with Federal Funding—CONTRACTOR shall not expend contract federal funds to support
needle exchange programs using funds from HIV Community Services Tasks.
vi. Travel—Out of staff travel requires prior approval from DOH and must follow GSA guidelines and reimbursement rates.
vii. Supervision,under DOH Community Programs contracts,will be understood as the delivery of a set of interrelated functions encompassing
administrative,educational and supportive roles that work collectively to ensure clinical staff(i.e.case managers,navigators,coordinators,assistants,
coaches)are equipped with the skills necessary to deliver competent and ethical services to clients that adhere to best practices within applicable
fields as well as all relevant Statewide Standards. Supervisors must meet the criteria set forth within the WA State HIV Case Management Standards
and provide the level of interaction and review detailed in that document.
It is the understanding of DOH that Supervision funded under the direct program portion of this contract include at minimum the provision of at least
two of the three functions detailed here:administrative,educational or supportive supervision. Supervision that encompasses only administrative
functions will not be considered billable under Direct Program.To that end,it is the expectation of DOH that those personnel identified as Supervisors
have no more than one degree of separation from direct client care.Exceptions to this rule can be presented and considered to and by DOH Contract
Management.It will fall to the requesting organization to satisfactorily demonstrate that any Supervisory positions falling within the scope of Direct
Program are meeting the expectation of provision of educational or supportive supervision with the aim of directly impacting client experiences,
quality of services,and adherence to best practices and Statewide Standards.
viii. Small and Attractive items—Each Contractor shall perform a risk assessment(both financial and operational)on the agency's assets to identify
those assets that are particularly at risk or vulnerable to loss.Operational risks include risks associated with data security on mobile or portable
computing devices that store or have access to state data.Assets so identified that fall below the state's capitalization policy are considered small and
attractive assets.The Contractor shall develop written internal policies for managing small and attractive assets. Internal policies should take into
consideration the WaTech IT Security Standard SEC-04,which includes SEC-04-06-S Mobile Device Security Standard and SEC-04-01-G Media
Handling and Data Disposal Best Practices-https://watech.wa.gov/policies.
Exhibit A,Statement of Work Page 7 of 10 Contract Number CLH32053-Amendment 6
Page 11 of 19
The Contractor shall implement specific measures to control small and attractive assets in order to minimize identified risks.Periodically,the
Contractor should perform a follow up risk assessment to determine if the additional controls implemented are effective in managing the identified
risks.
Contractor must include,at a minimum,the following assets with unit costs of$300 or more:
1. Laptops and Notebook Computers
2. Tablets and Smart Phones
Agencies must also include the following assets with unit costs of$1,000 or more:
1. Optical Devices,Binoculars,Telescopes,Infrared Viewers,and Rangefinders
2. Cameras and Photographic Projection Equipment
3. Desktop Computers(PCs)
4. Television Sets,DVD Players,Blu-ray Players,and Video Cameras(home type)
ix. Food and Refreshments—Food and refreshments are not allowable direct costs,unless provided in conjunction with allowable meetings,whose
primary purpose is the dissemination of technical information.Pre-approval is required when food and refreshments are purchased for these
meetings.A sign in sheet with the clients'ID number from the DOH approved data system as well as an agenda is required to receive reimbursement
for these charges.
1. The CONTRACTOR shall follow Healthy Nutrition Guidelines for Meetings and Events]Washington State Department of Health
when purchasing food and refreshments for approved meetings.
2. Food for staff meetings/training is unallowable.
PLEASE NOTE: If meals/refreshments are purchased for allowable meetings,food can only be
purchased for clients at the per diem rate.Any expenses over per diem will be denied. U.S. General Services Administration Per Diem
Look Up
x. Reimbursement of disallowed costs—The CONTRACTOR agrees to reimburse DOH for expenditures billed to the DOH for costs that are later
determined through audit or monitoring to be disallowed under the requirements of 2 CFR Part 200—Uniform Administrative Requirements,Cost
Principles,and Audit Requirements for Federal Audits.
b. Contract Modifications
i. Notice of Change in Services—The CONTRACTOR shall notify DOH program staff,within 45 days,if any situations arise that may impede
implementation of the services contained in the statement of work.DOH and the CONTRACTOR will agree to strategies for resolving any shortfalls.
DOH retains the right to withhold funds in the event of substantial noncompliance.
ii. Contract Amendments—Effective Date—The CONTRACTOR shall not begin providing services authorized by a contract amendment until the
CONTRACTOR has received a signed and fully executed copy of the contract amendment from DOH.
1. Local Health Jurisdiction(LHJ)Contractors—Request for contract amendments must be received no less than 60 days prior to the Draft Due
Date identified by the CON CON SOW Schedule on the CON CON Dashboard.
2. Non-LHJ Contractors—Request for contract amendments must be received no later than 60 days prior to the end of the Federal Fiscal Year
(FFY)and 90 days prior to end of the State Fiscal Year(SFY).
a. Amendments must be signed prior to the end of the FFY or SFY end date.
EX.FFY end date is 12/31,contract amendment request due to contract manager by 11/1
Exhibit A,Statement of Work Page 8 of 10 Contract Number CLH32053-Amendment 6
Page 12 of 19
13. Content Review and Website Disclaimer Notice
In accordance with all federal guidance,contractors receiving funds through DOH will submit all proposed written materials requiring review for HIV-related scientific or
medical accuracy including written materials,audio visual materials,and pictorials, including social marketing and advertising materials,educational materials,social
media communications(e.g.,Facebook,twitter)and other electronic communications,such as internet/webpages to the OID Content Review Committee.CONTRACTOR
shall submit all materials to be reviewed for scientific or medical accuracy to:
Michael Barnes,Washington State Department of Health
PO Box 47841
Olympia,WA 98504-7841
Phone: 360-810-1880
Email: Michael.Barnes®doh.wa.gov
For social marketing campaigns and media strategies,please adhere to the program guidance on the review of HIV-related educational and informational materials for
CDC assistance programs https://www.cdc.gov/hiv/pdf/funding/announcements/ps12-1201/cdc-hiv-ps12-1201-content-review-guidance.pdf
14. Youth and Peer Outreach Workers
All programs,including CONTRACTORS,using youth(either paid or volunteer)in program activities will use caution and judgment in the venues/situations where
youth workers are placed. Agencies will give careful consideration to the age appropriateness of the activity or venue.Agencies will also ensure that organizational staff
and youth comply with all relevant laws and regulations regarding entrance into adult establishments and environments.Agencies will also maintain and implement
appropriate safety protocols that include clear explanation of the appropriate laws and curfews and clearly delineate safe and appropriate participation of youth in program
outreach activities.
15. Whistleblower
a. Whistleblower statue,41 U.S.C.&4712,applies to all employees working for CONTRACTOR,subcontractors,and subgrantees on federal grants and contracts.
The statue(41 U.S.C.&4712)states that an"employee of a CONTRACTOR,subcontractor,grantee,or subgrantee,may not be discharged,demoted,or
otherwise discriminated against as a reprisal for"whistleblowing."In addition,whistleblower protections cannot be waived by an agreement,policy,form,or
condition of employment.
b. The National Defense Authorization Act(NDAA)for Fiscal Year 2013(Pub.L. 112-239,enacted January 2,2013)mandates a pilot program entitled"Pilot
Program for Enhancement of Contractor Employee Whistleblower Protections."This program requires all grantees,their subgrantees,and subcontractors to:
i. Inform their employees working on any federal award they are subject to the whistleblower rights and remedies of the pilot program
ii. Inform their employees in writing of employee whistleblower protections under 41 U.S.C. &4712 in the predominant native language of the
workforce;and,
iii. CONTRACTOR and grantees will include such requirements in any agreement made with a subcontractor or subgrantee.
16. Allowable Costs
All expenditures incurred and reimbursements made for performance under this statement of work shall be based on actual allowable costs.Costs can include direct labor,
direct material,and other direct costs specific to the performance of activities or achievement of deliverables under this statement of work.
For information in determining allowable costs,please reference OMB Circulars:
2 CFR200(State,Local and Indian Tribal governments)at:https://www.federalregister.gov/documents/2013/12/26/2013-30465/uniform-administrative-
requirements-cost-principles-and-audit-requirements-for-federal-awards.
Exhibit A,Statement of Work Page 9 of 10 Contract Number CLH32053-Amendment 6
Page 13 of 19
**Disclosure of information is governed by the Washington Administrative Code(WAC)246-101-120,520 and 635,and the Revised Code of Washington(RCW)
70.24.080,70.24.084,and 70.24.105 regarding the exchange of medical information among health care providers related to HIV/AIDS or STI diagnosis and treatment.
Please note that CONTRACTORs fit under the definition of"health care providers"and"individuals with knowledge of a person with a reportable disease or condition"
in the WAC and RCW.
DOH statutory authority to have access to the confidential information or limited Dataset(s)identified in this agreement to the Information Recipient: RCW 43.70.050
Information Recipient's statutory authority to receive the confidential information or limited Dataset(s)identified in this Agreement: RCW 70.02.220(7)
Exhibit A,Statement of Work Page 10 of 10 Contract Number CLH32053-Amendment 6
Page 14 of 19
Exhibit A
Statement of Work
Contract Term: 2025-2027
DOH Program Name or Title: Office of Drinking Water Group A Program- Local Health Jurisdiction Name: Jefferson County Public Health
Effective January 1,2025
Contract Number: CLH32053
SOW Type: Revision Revision#(for this SOW) 2 Funding Source Federal Compliance Type of Payment
® Federal Contractor (check if applicable) ❑ Reimbursement
Period of Performance: January 1,2025 through December 31,2027 ® State Z FFATA(Transparency Act) ® Fixed Price
❑ Other ❑ Research&Development
Statement of Work Purpose: The purpose of this statement of work is to provide funding to the LHJ for conducting sanitary surveys and providing technical assistance to small
community and non-community Group A water systems
Revision Purpose: To change the MI code for Sanitary Survey Fees SS-State from 24232522 to 24112522 and extend the funding period end date from 06/30/25 to 12/31/27,
remove I Sanitary Survey for 3 or more connections($800),and change the Chart of Accounts Master Index Title from YR 28 SRF-LOCAL ASST(15%)to YRI STIMULUS-
LOCAL ASST(10%OF 15%)for SS and TA.
Master Assistance BARS Allocation
Index Listing Revenue LHJ Funding Period Current Change Total
DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation Decrease(—) Allocation
SANITARY SURVEY FEES SS-STATE 24112522 N/A 346.26.65 01/01/25 12/31/27 2,200 -400 1,800
YR 27 SRF-LOCAL ASST(15%)SS 24119227 N/A 346.26.64 01/01/25 12/31/25 0 0 0
YR 27 SRF-LOCAL ASST(15%)TA 24119227 N/A 346.26.66 01/01/25 12/31/25 0 0 0
YR 28 SRF-LOCAL ASST(15%)SS 24119228 N/A 346.26.64 01/01/25 12/31/27 2,200 -2,200 0
YR1 STIMULUS-LOCAL ASST(10%OF 15%)SS 24144240 N/A 346.26.64 01/01/25 12/31/27 0 1,800 1,800
YR 28 SRF-LOCAL ASST(15%)TA 24119228 N/A 346.26.66 01/01/25 12/31/27 1,000 -1,000 0
YR1 STIMULUS-LOCAL ASST(10%OF 15%)TA 24144240 N/A 346.26.66 01/01/25 12/31/27 0 1,000 1,000
0 0 0
0 0 0
TOTALS 5,400 -800 4,600
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount
1 Trained LHJ staff will conduct sanitary surveys of Provide Final* Sanitary Survey Reports Final Sanitary Survey Upon ODW acceptance of the Final
small community and non-community Group A to ODW Regional Office. Complete Reports must be Sanitary Survey Report,the LW shall be
water systems identified by the DOH Office of Sanitary Survey Reports shall include: received by the ODW paid$400 for each sanitary survey of a non-
Drinking Water(ODW)Regional Office. 1. Cover letter identifying significant Regional Office within community system with three or fewer
deficiencies, significant findings, 30 calendar days of connections.
See Special Instructions for task activity. observations,recommendations,and conducting the sanitary
referrals for further ODW follow- survey. Upon ODW acceptance of the Final
up. Sanitary Survey Report,the LW shall be
Exhibit A,Statement of Work Page 1 of 4 Contract Number CLH32053-Amendment 6
Page 15 of 19
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount
The purpose of this statement of work is to provide 2. Completed Small Water System paid$800 for each sanitary survey of a non-
funding to the LHJ for conducting sanitary surveys checklist. community system with four or more
and providing technical assistance to small 3. Updated Water Facilities Inventory connections and each community system.
community and non-community Group A water (WFI).
systems. 4. Photos of water system with text Payment is inclusive of all associated costs
identifying features such as travel,lodging,per diem.
5. Any other supporting documents.
Payment is authorized upon receipt and
*Final Reports reviewed and accepted by acceptance of the Final Sanitary Survey
the ODW Regional Office. Report within the 30-day deadline.
Late or incomplete reports may not be
accepted for payment.
2 Trained LHJ staff will conduct Special Purpose Provide completed SPI Report and any Completed SPI Reports Upon acceptance of the completed SPI
Investigations(SPI)of small community and non- supporting documents and photos to must be received by the Report,the LW shall be paid$800 for each
community Group A water systems identified by ODW Regional Office. ODW Regional Office SPI.
the ODW Regional Office. within 2 working days
of the service request. Payment is inclusive of all associated costs
See Special Instructions for task activity. such as travel,lodging,per diem.
Payment is authorized upon receipt and
acceptance of completed SPI Report within
the 2-working day deadline.
Late or incomplete reports may not be
accepted for payment.
3 Trained LHJ staff will provide direct technical Provide completed TA Report and any Completed TA Report Upon acceptance of the completed TA
assistance(TA)to small community and non- supporting documents and photos to must be received by the Report,the LHJ shall be paid for each
community Group A water systems identified by ODW Regional Office. ODW Regional Office technical assistance activity as follows:
the ODW Regional Office. within 30 calendar • Up to 3 hours of work:$250
days of providing • 3-6 hours of work:$500
See Special Instructions for task activity. technical assistance. • More than 6 hours of work: $750
Payment is inclusive of all associated costs
such as consulting fee,travel,lodging,per
diem.
Payment is authorized upon receipt and
acceptance of completed TA Report within
the 30-day deadline.
Late or incomplete reports may not be
accepted for payment.
Exhibit A,Statement of Work Page 2 of 4 Contract Number CLH32053-Amendment 6
Page 16 of 19
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount
4 LHJ staff performing the activities under tasks 1,2 For training attended in person,prior to Annually For training attended in person,LHJ shall
and 3 attend periodic required survey training as attending the training,submit an be paid mileage,per diem,lodging,and
directed by DOH. "Authorization for Travel(Non- registration costs as approved on the pre-
Employee)"DOH Form 710-013 to the authorization form in accordance with the
See Special Instructions for task activity. ODW Program Contact for approval(to current rates listed on the OFM Website
ensure enough funds are available). http://www.ofm.wa.gov/resources/travel.asp
DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site.Questions related to this SOW,or any other
finance-related inquiry,may be sent to finance(a)doh.wa.gov.
Federal Funding Accountability and Transparency Act(FFATA)(Applies to federal grant awards.)
This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act(FFATA or the Transparency Act).
The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent.
To comply with this act and be eligible to perform the activities in this statement of work,the LHJ must have a Unique Entity Identifier(UEI)generated by SAM.gov.
Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. 109-282.
Program Specific Requirements
Data Sharing
The Office of Drinking Water will share water system information and files with the local health jurisdiction to support the work identified in this statement of work. To request
water system data please contact the regional office with the name of the water system,water system ID#,specific information being requested and any timeline requirements.If
allowable,please give administrative staff 3 to 5 business days to provide records.
Program Manual,Handbook,Policy References: Field Guide(DOH Publication 331-486).
Special References:
Chapter 246-290 WAC is the set of rules that regulate Group A water systems. By this statement of work,ODW contracts with the LHJ to conduct sanitary surveys(and SPIs and
provide technical assistance)for small community and non-community water systems with groundwater sources. ODW retains responsibility for conducting sanitary surveys(and
SPIs and provide technical assistance)for small community and non-community water systems with surface water sources, large water systems,and systems with complex
treatment.
LHJ staff assigned to perform activities under tasks 1,2,and 3 must be trained and approved by ODW prior to performing work. See special instructions under Task 4,below.
Special Billing Requirements
The LHJ shall submit quarterly invoices within 30 days following the end of the quarter in which work was completed,noting on the invoice the quarter and year being billed for.
Payment cannot exceed a maximum accumulative fee of$4,,400-$3,600-for Task I,and$1,000 for Task 2,Task 3 and Task 4 combined during the contracting period,to be paid
at the rates specified in the Payment Method/Amount section above. When invoicing for sanitary surveys,bill half to BARS Revenue Code 346.26.64 and half to BARS Revenue
Code 346.26.65.
Exhibit A,Statement of Work Page 3 of 4 Contract Number CLH32053-Amendment 6
Page 17 of 19
When invoicing for Task 1,submit the list of WS Name,ID#,Amount Billed,Survey Date and Letter Date for which you are requesting payment.
When invoicing for Task 2-3,submit the list of WS Name,ID#,TA Date and description of TA work performed,and Amount Billed.
When invoicing for Task 4,submit receipts and the signed pre-authorization form for non-employee travel to the ODW Program Contact below and a signed A19-lA Invoice
Voucher to DOH Grants Management,billing to BARS Revenue Code 346.26.66 under Technical Assistance(TA).
Special Instructions
Task 1
Trained LHJ staff will evaluate the water system for physical and operational deficiencies and prepare a Final Sanitary Survey Report which has been accepted by ODW.Detailed
guidance is provided in the Field Guide for Sanitary Surveys,Special Purpose Investigations and Technical Assistance(Field Guide).The sanitary survey will include an
evaluation of the following eight elements:source;treatment;distribution system;finished water storage;pumps,pump facilities and controls;monitoring,reporting and data
verification;system management and operation;and certified operator compliance. If a system is more complex than anticipated or other significant issues arise,the LW may
request ODW assistance.
• No more than 3 surveys of non-community systems with three or fewer connections be completed between January 1,2025,and December 31,2025.
• No more than 4 3 surveys of non-community systems with four or more connections and all community systems to be completed between January 1,2025 and
December 31,2025.
The process for assignment of surveys to the LHJ,notification of the water system,and ODW follow-up with unresponsive water systems;and other roles and responsibilities of
the LHJ are described in the Field Guide.
Task 2
Trained LHJ staff will perform Special Purpose Investigations(SPIs)as assigned by ODW. SPIs are inspections to determine the cause of positive coliform samples or the cause of
other emergency conditions. SPIs may also include sanitary surveys of newly discovered Group A water systems.Additional detail about conducting SPIs is described in the Field
Guide.The ODW Regional Office must authorize in advance any SPI conducted by LW staff.
Task 3
Trained LHJ staff will conduct Technical Assistance as assigned by ODW.Technical Assistance includes assisting water system personnel in completing work or verifying work
has been addressed as required,requested,or advised by the ODW to meet applicable drinking water regulations. Examples of technical assistance activities are described in the
Field Guide.The ODW Regional Office must authorize in advance any technical assistance provided by the LHJ to a water system.
Task 4
LHJ staff assigned to perform activities under tasks 1,2,and 3 must be trained and approved by ODW prior to performing work.
If required trainings,workshops or meetings are not available,not scheduled,or if the LW staff person is unable to attend these activities prior to conducting assigned tasks,the
LHJ staff person may,with ODW approval,substitute other training activities to be determined by ODW. Such substitute activities may include one-on-one training with ODW
staff,co-surveys with ODW staff,or other activities as arranged and pre-approved by ODW.LW staff may not perform the activities under tasks 1,2,and 3 without completing
the training that has been arranged and approved by ODW.
Exhibit A,Statement of Work Page 4 of 4 Contract Number CLH32053-Amendment 6
Page 18 of 19
Exhibit A
Statement of Work
Contract Term: 2025-2027
DOH Program Name or Title: Recreational Shellfish Activities- Local Health Jurisdiction Name: Jefferson County Public Health
Effective July 1,2025
Contract Number: CLH32053
SOW Type: Original Revision#(for this SOW) Funding Source Federal Compliance Type of Payment
❑ Federal<Select One> (check if applicable) ® Reimbursement
Period of Performance: July 1,2025 through June 30,2026 ® State ❑ FFATA(Transparency Act) ❑ Fixed Price
❑ Other ❑ Research&Development
Statement of Work Purpose: The purpose of this statement of work(SOW)is to provide funds for shellfish harvesting safety.
Revision Purpose: N/A
Master Assistance BARS Allocation
Index Listing Revenue LHJ Funding Period Current Change Total
DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation Increase(+) Allocation
REC. SHELLFISH/BIOTOXIN 26402600 N/A 334.04.93 07/01/25 06/30/26 0 7,500 7,500
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 0 7,500 7,500
Task Payment Information
Activity Deliverables/Outcomes Due Date/Time Frame and/or Amount
1 Biotoxin Monitoring Submit annual report on DOH approved Email Report to DOH by $7,000
• Collect monitoring samples on schedule according to format of activities for the year,including the February 15,2026
Department of Health(DOH)Biotoxin Monitoring Plan, number of sites monitored and samples
coordinate deviations from the schedule with DOH,notify collected,and number and names of beaches (See Special Instructions
DOH in advance if samples cannot be collected. posted with signs. below.)
• Conduct emergency biotoxin sampling when needed.
• Post/remove recreational shellfish warning and/or
classification signs on beaches and restock cages as -
needed.
• Issue biotoxin news releases during biotoxin closures in
Jefferson County.
• This task may also include recruiting,training,and
coordination of volunteers,and fuel reimbursement funds
for volunteer biotoxin monitoring.
Exhibit A,Statement of Work Page 1 of 2 Contract Number CLH32053-Amendment 6
Page 19 of 19
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
# and/or Amount
2 Outreach Submit annual report including the number Email Report to DOH by $500
• Staff educational booths at local events. of events staffed and amount of educational February 15,2026
• Distribute safe shellfish harvesting information. materials distributed.
(See Special Instructions
below.)
DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site.Questions related to this SOW,or any other
finance-related inquiry,may be sent to finance(a doh.wa.gov.
Program Specific Requirements
Program Manual,Handbook,Policy References:
Department of Health's Biotoxin Monitoring Plan
Special References(i.e.,RCWs,WACs,etc.):
Chapter 246-280 WAC
https://doh.wa.gov/community-and-environment/shellfish/recreational-shellfish
hops://doh.wa.gov/about-us/programs-and-services/environmental-public-health/environmental-health-and-safety/about-shellfish-program/about-biotoxins-and-illness-prevention-
program
Special Instructions:
Report for work performed in 2025 must be submitted via email to Liz Maier(liz.maier(idoh.wa.gov)by February 15,2026.
The report format will be provided by DOH and may be modified throughout the period of performance via email announcement.
Exhibit A,Statement of Work Page 2 of 2 Contract Number CLH32053-Amendment 6
Page 1 of 11
JEFFERSON COUNTY PUBLIC HEALTH
2025-2027 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH32053 AMENDMENT NUMBER: 5
PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as
"DOH",and JEFFERSON 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:
l. 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:
hops://stateof'wa.sharenoint.corn/sitesidoh-ofsfundinaresources/sitenattes!home.aspx? eI:9a94688da2d94d3ea8Gac7tbc32e4d7c
❑ Adds Statements of Work for the following programs:
❑ Amends Statements of Work for the following programs:
Sexual&Reproductive Health Program-Effective January 1,2025
❑ Deletes Statements of Work for the following programs:
2. Exhibit B-5 Allocations,attached and incorporated by this reference,amends and replaces Exhibit B-4 Allocations as
follows:
Increase of$17,023 for a revised maximum consideration of$3,185,889.
❑ 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.
JEFFERSON COUNTY WASHINGTON STATE OF WASHINGTON
BOARD OF COUNTY COMMISSIONERS DEPARTMENT OF HEALTH
Heidi Eisenhour.Chair !Mc Date
APPROVED AS TO FORM ONLY APPROVED AS TO FORM ONLY
Assistant Attorney General
Philip C.Hunsucker. Date
Chief Civil Deputy Prosecuting Attorney
CC-2S-001-A5 Page 1 of I
EXHIBIT B-5 Page 2 of 11
Jefferson County Public Health ALLOCATIONS Contract Number: CLH32053
Contract Term:2025-2027 Date: June 1,2025
Indirect Rate January 1,2025 through December 31,2025:27.38%Public Health
DOH Use Only
BARS Statement of Work Chart of Accounts Funding Chart of
Federal Award Assist Revenue LH.I Funding Period Funding Period Period Accounts
Chart of Accounts Program Title Identification# Amend# List#* code** Start Date End Dale Start Date End Date Amount SubTotal Total
FFY25 USDA BFPC Prog Mgmt 7WA700WA1 Amd4 10.557 333.10.55 01/01/25 09/30/26 10/01/24 09/30/26 $28,238 $28,238 $28,238
FFY24 USDA BFPC Frog Mgmt 7WA700WA1 Amd 4 10.557 333.10.55 01/01/25 09130126 10/01/23 09/30/26 ($28,238) $0
FFY24 USDA BFPC Frog Mgmt 7WA700WA1 Amd 2 10.557 333.10.55 01/01/25 09/30/26 10/01/23 09/30/26 $28,238
FFY25 USDA WIC Client Svs Contracts 7WA700WA7 Amd 4 10.557 333.10.55 01/01/25 09/30/25 10/01/24 09/30/25 $3,975 $148.117 $148,117
FFY25 USDA WIC Client Svs Contracts 7WA700WA7 Amd 2 10.557 333.10.55 01/01/25 09/30/25 10/01/24 09/30/25 $144,142
FFY25 USDA FMNP Mgmt 7WA810WA7 Amd 4 10.572 333.10 57 01/01/25 09/30/25 10/01/24 09/30/25 $637 $637 $637
FFY25 SWIMMING BEACH ACT IAR(ECY) 01.174301 Amd 2 66.472 333.66.47 03/01/25 10/31/25 01/01/25 11/30/25 $13,500 $13,500 $13,500
FFY24 PHEP BPI-CDC-LHJ Partners NU9i)TU000055 Amd 1 93.069 333.93.06 01/01/25 06/30/25 07/01/24 06/30/25 $13,754 S13,754 $13,754
FFY24 OD2A OID CDC Prevent NU I7CE010218 Amd 2 93.136 333.93.13 01/01/25 06/30/25 09/01/24 08/31/25 $32,556 $81.556 $81,556
FFY24 0132A OLD CDC Prevent NU l 7CE010218 Amd 1 93.136 333.93.13 01/01/25 06/30/25 09/01/24 08/31/25 $49,000
FFY25 FPHPA Title X.Family Plan FPHPA006560 Amd 5 93.217 333.93.21 04/01/25 03/31/26 04/01/25 03/31/26 S17,023 $17,023 $33,989
FFY24 FPHPA Title X Family Plan FPHPA006560 Amd 3 93.217 333.93.21 01/01/25 03/31/25 04/01/24 03/31/25 $8,345 $16,966
FFY24 FPHPA Title X Family Plan FPHPA006560 Amd 21 93.217 333.93.21 01/01/25 03/31/25 04/01/24 03/31/25 $8,621
FFY24 CDC PPHF Ops N11231P922619 Amd I 93.268 333.93.26 01/01/25 06/30/25 07/01/23 06/30/25 $10,000 $10,000 $10,000
FFY20 ELC EDE LHJs CDC NU50CK000515 Amd I 93.323 333.93.32 01/01/25 06/30/25 01/15/21 07/31/25 $15,580 $15,580 $15,580
FFY21 CDC COVID-I9 PHWFD-LHJ NU90TP922181 Amd 3 93.354 333.93.35 01/01/25 06/30.25 07/01/23 06/30/25 $51,330 $51,330 $51,330
FFY22 PH Infrastructure Comp AI-LHJ NE110E000053 Amd 3 93.967 333.93.96 01/01/25 11/30/27 12/01/22 11/30/27 $150,300 $150,300 $150,300
FFY25 HRSA MCHBG LHJ Contracts B04MC54583 Amd 1 93.994 333.93.99 01/01/25 09/30/25 10/01/24 09/30/25 $27,525 $27.525 $27,525
SFY25 SBHC Proviso Amd I N/A 334.04.90 01/01/25 06/30/25 07/01/24 06130/25 $59,000 $59,000 $59.000
SFY25 DUH Naloxone DDO HCA FAR Amd 4 N/A 334.04 91 03/01/25 06/30/25 12/10/24 06/30/25 $15,000 S15.000 $15,000
SFY25 Drug User Health Program Amd I N/A 334.04.91 01/01/25 06/30/25 07/01/24 06/30/25, $40,250 $40,250 S40,250
SFY25 Sexual&Rep Hlth Cost Share Amd 1 N/A 334.04.91 01/01/25 06/30/25 07/0124 06/30/25 $47,993 S47,993 $47,993
SFY25 SSPS Opiod Harm Red Proviso Amd 2 N/A 334.04.91 01/01/25 06/30/25 07/01/24 06/30/25 $8,000 $8,000 $8,000
SFY25 LHJ Opioid Campaign Proviso Amd 3 N/A 334.04.93 01/01/25 06/30/25 07/01/24 06/30/25 $24,500 $56,000 $56,000
SFY25 LHJ Opioid Campaign Proviso Amd I N/A 334.04.93.01/01/25 06/30/25 07/01/24 06/30/25 $31,500
Page 1 of 2
EXHIBIT B-5 Page 3 of 11
Jefferson County Public Health ALLOCATIONS Contract Number: CLH32053
Contract Term:2025-2027 Date: June I,2025
Indirect Rate January 1,2025 through December 31,2025:27.38%Public Health
DO11 Use Only
BARS Statement of Work Chart of Accounts Funding Chart of
Federal Award Assist Revenue L.HJ Funding Period Funding Period Period Accounts
Chart of Accounts Program Title Identification# %mend# List#* Code** Start Date End Date Start Date End Date Amount SubTotal Total
RecShelltish/Biotoxin Amd 1 N/A 334.04.93 01/01/25 06/30/25 07/01/23 06/30/25 $3,700 $3,700 $3,700
Small Onsite Management(ALEA) Amd 4 N/A 334.04.93 0I/01/25 06/30/25 07/01/23 06/30/25 $1,363 $33,781 $33,781
Small Onsite Management(ALEA) Amd 3 N/A 334.04.93 01/01/25 06/30/25 07/01/23 06/30/25 $32,418
SFY25 Wastewater Management-GFS Amd 4 N/A 334.04.93 01/01/25 06/30/25 07/01/24 06/30/25 ($1,363) $9,239 $9.239
SFY25 Wastewater Management-GFS Amd 3 N/A 334.04-93 01/01/25 06/30/25 07/01/24 06/30/25 $10,602
SFY25 FPHS-LH.1 Funds-GFS Amd I N/A 336.04.25 01/0I/25 06/30/25 07/01/24 06/30/25 $2,333,000 $2,333,000 $2.333,000
YR 28 SRF-Local Asst(15%)SS Amd 4 N/A 346.26 64 01/01/25 12/31/27 07/01/24 06/30/29 $2,200 $2,200 $2,200
YR 27 SRF-Local Asst(15%)SS Amd 4 N/A 346.26.64 01/01/25 06/30/25 07/01/23 06/30/25 ($2,200) $0
YR 27 SRF-Local Asst(15%)SS Amd 1 N/A 346.26.64 01/01/25 06/30/25 07/01/23 06/30/25 $2,200
Sanitary Survey Fees SS-State Amd I N/A 346.26 65 01/01/25 06/30/25 07/01/23 12/31/27 $2,200 $2,200 $2,200
YR 28 SRF-Local Asst(15%)TA Amd 4 N/A 346.26.66• 01/01/25 12/31/27 07/01/24 06/30/29 $1,000 $1,000 $1,000
YR 27 SRF-Local Asst(15%)TA Amd 4 N/A 346.26.66 01/01/25 06/30/25 07/01/23 06/30/25 ($1,000) $0
YR 27 SRF-Local Asst(15%)TA Amd 1 N/A 346.26.66 01/01/25 06/30/25 07/01/23 06/30/25 $1,000 -
TOTAL $3,185,889 $3,185,889
Total consideration: $3,168,866 GRAND TOTAL $3,185.889
$17,023
GRAND TOTAL $3,185,889 Total Fed $574,526
Total State S2,611,363
*Assistance Listing Number fka Catalog of Federal Domestic Assistance
**Federal revenue codes begin with"333". State revenue codes begin with"334".
Page 2 of 2
Page 4 of 11
Exhibit A
Statement of Work
Contract Term: 2025-2027
DOH Program Name or Title: Sexual& Reproductive Health Program - Local Health Jurisdiction Name: Jefferson Count\ Public Health
Effective January 1, 2025
Contract Number: CLH32053
SOW Type: Revision Revision#(for this SOW) 2 Funding Source - Federal Compliance Type of Payment
® Federal Subrecipient (check if applicable) ►ZI Reimbursement
Period of Performance: Januar\ I, 2025 through March 31.2026 ® State ® FFATA (Transparency Act) ❑ Fixed Price
0 Other ❑ Research&Development
Statement of Work Purpose: The purpose of this statement of work(SOW)is to provide sexual and reproductive health services(SRH)to Washington State residents.These
services will comply with all state. federal,and DOH SRHP Manual requirements. It highlights specific requirements,but all must be complied with. Budgets are based on an
approved allocation formula with funds available.
This Statement of Work spans Years 1-4 of the contract, which runs January 1,2022—March 31,2026.
For state funding,due dates after June 30,2025 are for reporting only.LHJs may not bill under this contract for work done after June 30.2025.
For federal funding.due dates after March 31.2026 are for reporting only.LHJs may not bill federal funds under this contract for work done after March 31,2026.
Revision Purpose: The purpose of this revision is to add$17.023 in Title X federal funding for the period of 04/01/2025-03/31/2026,extend the SOW period of performance
from 06/30/2025 to 03/31/2026,and revise language in task table and Program Specific Requirements section.
Master Assistance BARS Allocation
Index Listing Revenue LHJ Funding Period Current Change Total
DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation Increase(+) Allocation
FFY24 FPHPA TITLE X FAMILY PLAN 78430240 93.217 333.93.21 01/01/25 03/31/25 16.966 0 16.966
SFY25 SEXUAL&REP HLTH COST SHARE 78430150 N/A 334.04.91 01/01/25 06/30/25 47,993 0 47,993
FFY25 FPHPA TITLE X FAMILY PLAN 78430250 93.217 333.93.21 04/01/25 03 31 '26 0 17.023 17.023
0 0 0
0 0 0
0 0 0
TOTALS 64,959 17,023 81.982
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
# and/or Amount
•
1 Sexual and Reproductive Health Program • .A 19 invoice vouchers submitted in a timely manner No more than monthly Billing must be based
(SRHP)&Title X(TX)Services—excluding accompanied by an R&E workbook showing revenue and no less than on a current cost
abortion and other surgical procedures related to I and expenses for the month billed and any other guarterh. analysis approved by
SRHP. required back up documentation per DOH policy. DOH(see Reporting
i As described in Task 6: Requirements below).
A. Comply with Washington State SRHP Manual. i • All reports described in Reporting Requirements Revenue and Expense
federal Title X requirements and all state and below.
Reports in the
Exhibit A,Statement of Work Page I of 8 Contract Number CLH32053-Amendment 5
Page 5 of 11
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
federal laws.Also see Program Manual. Reporting DOH reserves the right
Handbook,Policy References under Reporting • Other data and documentation in format requested by Requirements cecrrun to withhold payment
Requirements(below). DOH.(Includes copies of program and financial audits below. until:
and reviews including summaries conducted by other • Compliance issues
B. Complete required Agency Information Request entities.) As requested by DOH or a previous SOW
including Title X Assurance of Compliance and are resolved in a
National Provider Identifier(NPI)billing • To facilitate DOH/TX desk reviews—requested way accepted by
numbers documentation available to DOH in requested format. DOH
• Current data is
C. Provide medical services,community education • To facilitate DOH/TX site-visits—appropriate staff submitted to,and
and outreach,and staff training,consistent with and documentation readily available prior to and accepted by,
state requirements: during review. Ahlers.
• A 19 back up
I. LHJ is responsible for making sure all staff DOH performs site visits. Follow-up site visits are documentation
have the knowledge to carry out the performed until identified issues are resolved. required by DOH
requirements of the SOW. has been submitted
and approved.
2. Medical.laboratory,and other services • Other deliverables
related to abortion are not covered by this have been met.
task.
Payment is limited to
3. Community education services must be the maximum funds
based on the needs of the community.LHJ available for funding
must have an Information&Education source.
(l&E)committee with five(5)or more
members that is broadly representative of DOH will reimburse
the population or community for which for:
materials are intended.The committee • Actual allowable
must review a batch of patient-facing costs according to
materials annually(at least 15 products or your approved cost
15%of the total number of materials, analysis(see
whichever is smaller);meet at least Reporting
annually and establish a written record of Requirements
its determination.(42 CFR 59[59.6]) below).
or
4. Outreach is to ensure all populations in • The amount
your community understand the services remaining in the
available. Focus your outreach efforts on SOW divided by
increasing equity. the number of
months remaining
Washington State Sexual and Reproductive in the funding
Health Network priority populations are: source,plus one,
• Teens whichever is less.
Exhibit A,Statement of Work Page 2 of 8 Contract Number CLH32053-Amendment 5
Page 6of11
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
# and/or Amount
• People who are uninsured or
underinsured,and/or low-income Payment will be
(at or below 250%of the federal calculated by R&E
poverty line) provided by DOH(see
• Rural communities
Reporting Requirements• Hispanic below).
• Black, Indigenous,People of
Color All services through the
Extra efforts should be made to provide end of this contract
information and services to people who period must be billed
intersect with multiple priority population within 60 days.
categories.
5. Provide all services in accordance with:
• DOH SRHP&Title X Manual
• Other state and federal
requirements
• Reporting Requirements(see
below)
D. Collect,maintain,and provide data about each CVR data submitted to DOH data contractor(Ahlers&
family planning clinic visit as defined in the
SRH CVR Manual. Associates)electronically in a format compatible with The 15'of the
I. Maintain a computer system that includes Ahlers software. following month.
safety precautions against loss of Within thirty (30)days
information. i • Data for each month
2. Ensure data entry personnel protect of receiving
confidentiality of CVR data. I • Corrected CVR data error/rejection report or
3. Have ability to retrieve all information for request from DOH
Sexual and
auditing and monitoring by DOH or its
designee. Reproductive Health
data manager.
E. Notify DOH contract manager of all:
• Key staff and organizational changes. Email briefly describing change. As needed to keep
information current.
• Proposed clinic site additions.New clinic
sites must be approved by DOH before
offering services supported by SRHP/Title
X funding.
• Expected clinic site closures.Note:DOH
may,at its sole discretion,recalculate
LHJ's funding allocation if it closes a clinic
site.
Exhibit A,Statement of Work Page 3 of 8 Contract Number CLH32053-Amendment 5
Page 7 of 11
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
# and/or Amount
• Any other change that might affect LHJ's
ability to provide the sexual and
reproductive services described in this
SOW.
Reporting Requirements
Agency information Request This information must be reported using the template April 30th during each
or format provided by DOH.All signatures and forms year of this contract.
DOH SRHP requires updated information from all must be completed by April 30t6 during each year of
members of the SRHP Network to ensure accurate this contract.Requested information will include: AND
records of LHJ's organization and the services it
provides. Information about your agency contacts and your As needed or requested
organization's staffing to maintain accuracy of
In addition,elements of this report allow DOH to A. Head of Organization information.
ensure that SRHP&Title X requirements including B. Head of Finance
client fees and required services are met.The C. Medical Director
updated information also assists DOH to manage D. NPI numbers used to bill Medicaid
this SOW and the Sexual& Reproductive Health E. The following(one person might fill more than one
Network as a whole. role)
a. Contract Coordinator
b. Clinical representative
c. Billing contact
d. Outreach and education contact
e. Contact for CVR data
f. Contact for EHR information
Information regarding sexual and reproductive health
related services offered at each clinic site:
A. Cost analysis: How LHJ determines what it costs
to provide services.LHJ uses this to help construct
its fee schedule.A cost analysis must be
performed by LHJ within three years prior to the
start date of this SOW. If contractor cost analysis
was approved by DOH at the beginning of the
contract period.LHJ does not have to resubmit
unless changes are made.LHJ must email DOH
contract manager informing them that no changes
were made.
B. Sliding fee schedule that includes all services
required in the SRH Manual.Additional SRH-
related services as outlined in Task I may also be
included on LHJ's sliding fee schedule.
Exhibit A,Statement of Work Page 4 of 8 Contract Number CLH32053-Amendment 5
Page 8 of 11
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
a. Sliding fee schedule must be based on cost
analysis described above.
b. Fee schedule must be resubmitted for
reapproval anytime there are any significant
changes.which may include changing of
services.fees,etc.
c. LHJ must not implement a revised fee
schedule until it has been approved in writing
by DOH.
d. Income conversion tables must be updated Submit an updated
annually and approved by DOH income conversion
table by March 15 of
Information related to current Community Outreach Plan: each year of the
contract.
LHJ's community outreach plan follows a 5-year cycle.
This process must include the following steps:
A. Utilize the state level priority populations,county
level demographic data,and agency profile to
identify unmet need in the community served.
B. Determine objectives and activities to expand
sexual and reproductive health to reach
populations in need of services in the community
served.
C. Measure completion of the objectives and
activities.
2 Program Updates This information must be reported using the template During quarterly check
or format provided by DOH. It will include information ins and as requested by
Summary of ongoing activities related to the SRH about contractor's work during current and past DOH
Program.This informs quality improvement of the SOWs:
Washington State SRH Network.
A. Community education and outreach strategies and
j activities and a discussion of their effectiveness.
B. Staff training.
4 Family Planning Annual Report(FPAR) Organization-level data on clinical services emailed to Data to be collected
DOH SRH data manager annually through the
Information DOH is requesting to develop trend Number of: end of the grant(2027).
data. All information is for the calendar year A. Pap tests with an ASC or higher result
(January through December).The subsequent B. Pap tests with an HSIL or higher result
agreements sent to the agency will request that these C. HIV Positive confidential tests
data be collected and reported on within the D. HIV Anonymous tests
statement of work period of performance. E. FTE required to provide sexual and reproductive
health services:
• Physicians
Exhibit A,Statement of Work Page 5 of 8 Contract Number CLH32053-Amendment 5
Page 9 of 11
Task Activity • Deliverables/Outcomes I)ue Date/Time Frame Payment Information
and/or Amount
• Physician assistants+nurse practitioners+
certified nurse midwives
• Registered nurses with expanded scope of practice
who are trained and permitted by state specific
regulations to perform all aspects of the physical
assessment.
Financial data emailed to DOH Contract Manager
R&E showing Other Revenue through the end of the grant
as described below.
Subsequent agreements will request that data be collected
and reported on during the appropriate contract period of
performance.(FPAR due 01-31 annually through 2027)
5 Clinic Visit Reports(CVRs) Clinic visit records must include all elements specified The 15th of the
in the Clinic Visit Record(CVR)Manual available at: following month.
hops://ww w.doh.wa.2ov/Portals/1/Documents/Pubs/930-
139-( N R\IanuaI.pdf. Within thirty(30)days
of receiving error or
CVR data must be submitted to DOH data contractor rejection report or
(Ahlers&Associates)electronically in a format compatible request from DOH
with Ahlers software. SRH data manager.
- Each month's CVR data
- Corrected CVR data
6 Revenue and Expense Reports(R&E) Completed R&E for time period that shows all revenue Submitted +yith each-
(including program income)that support Task I SRH invoice(A 19). No
Services and all expenses related to providing those
services. R&E workbook will be provided by DOH. no ler than quarter)}.
A. Expenses must match General Ledger. R&E showing all
B. Other revenue/program income must reflect revenue sources of revenue that
actually received in the reporting month. `trpport services must
All entries on"Other"rows must be accompanied by a days of the budeet
description of the revenue source or expense,including anyperiod. December
calculations uses. , ;,,; , r e
submitted-. Februaw..
Invoices(,119's)and
Rc(•Es that support
Exhibit A,Statement of Work Page 6 of 8 Contract Number CLH32053-Amendment 5
Page 10 of 11
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
through the
end of this contra('1
must he billed
following the required
deadlines:
• 11cu•eh invoices
and R&f.'s are(hie
hi 1/ay /01h
a June Invoices and
R&-Es are due hi
l ugust 10th
• December
Invoices and
RA Es are due by
Iehruary loth
• .111 remaining
months MILS/ he
billed within 60
clays.
DOH Program and Fiscal Contact information for all ConCon SOWs can be found on the DOH Finance SharePoint site. Questions related to this SOW,or any other
finance-related inquiry,may be sent to tinance'ddoh.wa.cov.
Federal Funding Accountability and Transparency Act(FFATA)(Applies to federal grant awards.)
This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act(FFATA or the Transparency Act).
The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent.
To comply with this act and be eligible to perform the activities in this statement of work,the LHJ must have a Unique Entity Identifier(UEI)generated by SAM.gov.
Information about the LHJ and this statement of work will be made available on USASpendine.eov by DOH as required by P.L. 109-282.
Program Specific Requirements
Program Manual,Handbook,Policy References:
LHJ must comply with all state,federal,DOH SRHP,and Title X requirements.policies.and regulations and with their DOH approved Agency information Dashboard.
Reference documents include:
• DOH SRHP Manual(DOH publication 930-122,available at 930-122-FPRHManualComplete.pdf(wa.gov)Some provisions of this manual are highlighted in this SOW.
but all provisions of the manual must be complied with.
• Clinic Visit Record Manual(https: doh.wa.wv/sites/default/tiles/2024-10/930-139-CVRManual.pdt)
• LHJ's approved Agency Information Request.
Exhibit A,Statement of Work Page 7 of 8 Contract Number CLH32053-Amendment 5
Page 11 of 11
Billing Requirements:
See Payment column of Tasks and Deliverables table and R&E report description in Reporting Requirements table
Billing must he based on a current cost analysis approved hi DOII(see Reporting Requirements table).
DOH reserve's the right to withhold payment until:
• Compliance issues or a previous SOH.are resolved in a way accepted by DOl i.
• Current data is submitted to. and accepted by. . filers.
• 119 back up documentation required by DON has been submitted and approved.
• Other deliverables have been met.
Billing invoicing for reimbursement shall happen no more than monthly as costs crre incurred and no lees than quarterly to hest monitor spending plans.
Billings invoices shall include copies of backup documentation for a!i expenses according to the contract's risk level as defined by A19 Backup Documentation Matrix.
Backup documentation can include. but is not limited to; receipts. invoices. pilling records. stork orcrcrs, positive time and attendance records (timesheetsi, travel vouchers
and accounting expense reports.
• Additional backup documentation may be requested if needed.
• Payments will not he made. and invoices will be returned to you if sufficient backup documentation is not provided within 30 days qf our receipt of your request for
reimbursement.
Payment is limited to the' maximum limas available for JUnding source.
D011 will reimburse for:
• .-lctual allowable costs according to your approved cost analysis(see Reporting Requirements table). Or
• the amount remaining in the divided by the number of months remaining in the f tneliag source,pins one, whichever is less.
Payment will he calculated by Rd 1:provided by D011(see Reporting Requirements table,.
Final reimbursement requests Or completed contract activities must be received and approyed.for/bovinely by 1)011 within 45 clays of the end of the .SUIT'period of pe rtormance.
Special Instructions:
Accessibility of Services
• Clients must not be denied services or subjected to variation in quality of services because of inability to pay.
• LHJ must make sure their communities are informed of the services available.
• LHJ must make sure that all services provided are accessible to priority populations.
o Facilities must be geographically accessible to the populations served.
o As much as possible,services will be available at times convenient to those seeking services.
o Clinics must comply with the Americans with Disabilities Act.
o Facilities must meet applicable standards established by the Federal, State,and local governments, including local fire,building,and licensing codes.
o Clinic settings must ensure respect for the privacy and dignity of the individual.
• Clients must be accepted on referral from any source.
• Services must be provided solely on a voluntary basis.Acceptance of SRH services must not be a prerequisite to eligibility for,or receipt-of,services in any non-SRH
programs of the LHJ.
Availability of Emergency Services
The LHJ must have written plans and procedures for the management of on-site medical emergencies, including emergencies that require transport and after-hours management of
contraceptive emergencies.(See DOH SRH Manual)
If LHJ or DOH discontinues this contract:
See SRHP Manual for close out requirements and resources.
Exhibit A,Statement of Work Page 8 of 8 Contract Number CLH32053-Amendment 5
Signature: Signature:
Email: ggilbert@co.jefferson.wa.us Email: Brenda.Henrikson@DOH.WA.GOV
Page 1 of 33
JEFFERSON COUNTY PUBLIC HEALTH
2025-2027 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH320S3 AMENDMENT NUMBER: 4
PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as"DOH",and
JEFFERSON 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:
I. 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://stateofwasCiarepoint.cort Isis stdoh-o€`sfundingresourceslsitcnapsthomc,tray?-c I:9a94685de2dlt94d3ca&0ac7#bc32c4d7c
❑ Adds Statements of Work for the following programs:
® Amends Statements of Work for the following programs:
Infectious Disease-Syndemic Prevention Services-SSP-Effective January 1,2025
Office of Drinking Water Group A Program-Effective January 1,2025
Office of People Services-HR-Public Health Infrastructure Grant-Effective January 1,2025
OSS LMP Implementation-Effective January 1,2025
WIC Nutrition Program-Effective January 1,2025
❑ Deletes Statements of Work for the following programs:
2. Exhibit B-4 Allocations,attached and incorporated by this reference,amends and replaces Exhibit 8-3 Allocations as follows:
mo Increase of S19,612 for a revised maximum consideration of S3,168,866,
❑ Decrease of for a revised maximum consideration of .
❑ No change in the maximum consideration of �;
Exhibit 8 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.
JEFFERSON COUNTY WASHINGTON STATE OF WASHINGTON
BOARD OF COUNTY COMMISSIONERS DEPARTMENT OF HEALTH
1 ;
cidi Eisenhour,Chair Date Date
APPROVE1 £O FORM ONLY APPROVED AS TO FORM ONLY
d/h/' } , f Assistant Attorney General
or Q5/Q5/2Q25
'Philip C.Hunsucker, Date
Chief Civil Deputy Prosecuting Attorney
Page 1 of 1
CC•25.00l-A4
EXHIBIT B-4 Page 2 of 33
Jefferson County Public Health ALLOCATIONS Contract Number: CLH32053
Contract Term:2025-2027 Date: April I,2025
Indirect Rate January 1,2025 through December 31,2025:27.38%Public Health
DOH Use Only
BARS Statement of Work Chart of Accounts Funding Chart of
Federal Award Assist Revenue LHJ Funding Period Funding Period Period Accounts
Chart of Accounts Program Title Identification# Amend# List#" code+' Start Date End Date Start Date End Date Amount SubTotal Total
GI,\25 USDA[WPC Prog Mgmt NGA Not Received Amd 4 10.557 333.10,55 01/01/25 09/30/26 10/01/24 09/30/26 S28,238 528.238 528,238
FF1 24 USDA BFPC Prog Mgmt 7WA700WAI Amd 4 10.557 333.10.55 01/01/25 09/30/26 10/01/23 09/30/26 (S28,238) S0
FFY24 USDA BFPC Prog Mgmt 7WA700WA1 Amd 2 10.557 333.10,55 01/01/25 09/3026 10/01/23 09/3026 $28,238
FFY25 USDA WIC Client Svs Contracts 7WA700WA7 Amd 4 10.557 333.10.55 01/01/25 09/30/25 10/01/24 09/30/25 $3,975 S148,117 5148,117
FFY25 USDA WIC Client Svs Contracts 7WA700WA7 Amd 2 10.557 333.10.55 01/01/25 09/30/25 10/01/24 09/30/25 $144,142
FFY25 USDA FMNP Mgml 7W4810WA7 Amd 4 10.572 333.10.57 01/01/25 09/30/25 10/01/24 09/30/25 $637 S637 S637
FFY25 SWIMMING BEACHACTIAR(ECY) 01/74301 Amd2 66.472 333.66,47 03/01/25 10/31/25 01/0125 11/3025 $13,500 $13,500 $13,500
FFY24 PHEP BPI-CDC-LHJ Partners NU9OTU000055 Amd 1 93.069 333.93,06 01/01/25 06/30/25 07/01/24 06/30/25 $13,754 $13,754 $13,754
FFY24 OD2A OlD CDC Prevent NU17CE010218 Amd 2 93.136 333.93,13 01/01/25 06/3025 09/01/24 08/3125 $32,556 $81,556 $81,556
FFY24 OD2A OM CDC Prevent NU17CE010218 Amd I 93.136 333.93.13 01/01/25 06/30/25 09/0124 08/31/25 $49,000
FFY24 FPHPA Title X Family Plan FPHPA006560 Amd 3 93,217 333.93.21 01/01/25 03/31/25 04/0124 03/3125 $8,345 $16,966 $16,966
FFY24 FPHPA Title X Family Plan FPHPA006560 Amd 21 93217 333.9321 01/01/25 03/31/25 04/01/24 03/3125 $8,621
FFY24 CDC PPHF Ops NH231P922619 Amd 1 93.268 333.93.26 01/0125 06/30/25 07/01/23 06/30/25 $10,000 $10,000 $10,000
FFY20 ELC EDE LIUs CDC NU50CK000515 Amd 1 93.323 333.93.32 01/0125 06/30/25 01/15/21 07/31/25 $15,580 $15,580 $15,580
FFY2I CDC COVID-19 PHWFD-LHJ NU90TP922181 Amd 3 93.354 333.93,35 01/01/25 06/30/25 07/01/23 06/30/25 $51,330 $51,330 $51,330
FFY22 PH Infrastructure Comp Al-LHJ NE110E000053 Amd 3 93.967 333.93.96 01/0125 11/3027 12/01/22 11/30/27 $150,300 $150,300 $150,300
FFY25 HRSA MCHBG LHJ Contracts B04MC54583 Amd 1 93.994 333.93,99 01/01/25 09/30/25 10/0124 09/30/25 $27,525 $27,525 $27,525
SFY25 SBHC Proviso Amd I N/A 334.04 90 01/01/25 06/30/25 07/01/24 06/30/25 $59,000 $59,000 $59,000
SFY25 DUH Naloxonc DDO HCA IAR kind 4 N/A 334.04.91 03/01/25 06,30125 12/10/24 06/30/25 $15,000 $15,000 S15,000
SFY25 Drug User Health Program Amd 1 N/A 334,04.91 01/0125 06/30/25 07/01/24 06/30/25 $40,250 $40,250 $40,250
SFY25 Sexual&Rep Hlth Cost Share Amd 1 N/A 334.04.91 01/01/25 06/30/25 07/01/24 06/30/25 $47,993 $47,993 $47,993
SFY25 SSPS Opiod Hann Red Proviso Amd 2 N/A 334.04,91 01/01/25 06/30/25 07/01/24 06/30/25 $8,000 $8,000 $8,000
SFY25 LHJ Opioid Campaign Proviso Amd 3 N/A 334.04.93 01/01/25 06/30/25 07/01/24 06/30/25 $24,500 $56,000 $56,000
SFY25 LHJ Opioid Campaign Proviso Amd 1 N/A 334.04,93 01/01,25 06/30/25 07/0124 06/30/25 $31,500
Page 1 of 2
EXHIBIT B-4 Page 3 of 33
Jefferson County Public Health ALLOCATIONS Contract Number: CLH32053
Contract Term:2025-2027 Date: April 1,2025
Indirect Rate January 1,2025 through December 31,2025:27.38%Public Health
DOH Use Only
BARS Statement of Work Chart of Accounts Funding Chart of
Federal Award Assist Revenue LHJ Funding Period Funding Period Period Accounts
Chart of Accounts Program Title Identification# Amend# List#• Code,* Start Date End Date Start Date End Date Amount SubTotal Total
Rec Shellfish/Biotoxin Amd 1 N/A 334.04.93 01/01/25 06/30/25 07/01/23 06/30/25 $3,700 $3,700 $3,700
Small Onsite Management(AI.,LA) Amd 4 N/A 334.04.93 01/01/25 06/30/25 07/01/23 06/30/25 $1,363 533,781 S33:8I
Small Onsite Management(ALEA) Amd 3 N/A 334.04.93 01/01/25 06/30/25 07/01/23 06/3025 $32,418
SFY25 Wastewater Management-GFS Amd 4 N/A 334.04.93 01/01/25 06/30/25 07/01/24 06/30/25 ($1,363) $9,239 59.239
SFY25 Wastewater Management-GFS Amd 3 NIA 334.04.93 01/0125 06/30/25 07/0124 06/3025 $10,602
SFY25 FPHS-L1-JJ Funds-GFS Amd 1 N/A 336.04.25 01/01/25 06/3025 07/0124 06/3025 $2,333,000 $2,333,000 $2,333,000
YR 28 SRF-Local Asst(15%)SS Amd 4 N/A 346.26.64 01/01/25 12/31/27 07101/24 06/30/29 S2,200 S2,200 $2,200
YR 27 SRF-Local Asst(15%)SS Mod 4 N/A 346.26.64 01/01/25 0630/25 07101/23 06/30/25 (52.200) SO
YR 27 SRF-Local Asst(15%)SS Amd 1 N/A 346.26.64 01/0125 06/30125 07/123 06/3025 $2,200
Sanitary Survey Fees SS-State Amd 1 N/A 346.26.65 01/01/25 06/30/25 07/01/23 06/3025 $2,200 $2,200 $2,200
YR 28 SRF-Local Asst(15%)TA Amd 4 N/A 346.26.66 01/01/25 12/31/27 07/01124 06/30/29 `1,000 S1,000 S1,000
YR 27 SRF-Local Asst(15%)TA Amd 4 NIA 346.26.66 01/01/25 06/30/25 07101/23 06/30/25 ($1,000) SO
YR 27 SRF-I.ocal Asst(15%)TA Amd I N/A 346.26.66 01/01/25 06/30/25 07/01/23 06/30/25 $1,000
TOTAL $3,168,866 $3,168,866
Total consideration: $3,149,254 GRAND TOTAL $3,168,866
519,612
GRAND TOTAL S3,168,866 Total Fed $557,503
Total State S2,611,363
'Assistance Listing Number Ika Catalog of Federal Domestic Assistance
**Federal revenue codes begin with"333". State revenue codes begin with"334",
Page 2 of 2
Page 4 of 33
Exhibit A
Statement of Work
Contract Term: 2025-2027
DOH Program Name or Title: Infectious Disease-Syndemic Prevention Services- Local Health Jurisdiction Name: Jefferson County Public Health
SSP-Effective January I,2025
Contract Number: CLH32053
SOW Type: Revision Revision#(for this SOW) 2 Funding Source Federal Compliance Type of Payment
►2 Federal Subrecipient (check if applicable) ®Reimbursement
Period of Performance: January 1,2025 through June 30,2025 ►� State ❑FFATA(Transparency Act) El Fixed Price
❑ Other El Research&Development
I
Statement of Work Purpose: The purpose of this statement of work(SOW)is to provide Syndemic Prevention Services for infectious diseases(HIV,STI,and Adult Viral
Hepatitis), supporting the Office of Infectious Disease(OID)within Department of Health(DOH). Awarded through OID's 2024 Syndemic RFA.
Revision Purpose: The purpose of this revision is to add new task for 3/1/25-6/30/25 and funding in the amount of$15,000 for Syringe Services Programs:Public Health Supply
Vending Machines Task.
Master Assistance BARS Allocation
Index Listing Revenue LHJ Funding Period Current Change Total
DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation Increase(+) Allocation
SFY25 DRUG USER HEALTH PROGRAM 12405150 N/A 334.04.91 01/01/25 06/30/25 40,250 0 40,250
FFY24 OD2A OID CDC PREVENT 12405241 93.136 333.93.13 01/01/25 06/30/25 81,556 0 81,556
SFY25 SSPS OPIOID HARM RED PROVISO 12405851 N/A 334.04.91 01/01/25 06/30/25 8,000 0 8,000
SFY25 DUH NALOXONE DDO HCA IAR 12405952 N/A 334.04.91 03/01/25 06/30/25 0 15,000 15,000
0 0 0
0 0 0
TOTALS 129,806 15,000 144,806
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
# and/or Amount
Syri.ng Service Programs: Support for Operations
l..-i Syringe Services Programs(SSP): Support for Operations SSP operations outcomes include delivering Enter deliverable data into TASK TOTAL$48,250
services and tracking: the DOH/OID issued SPLIT BY FUNDING
Provide comprehensive SSP to people who use drugs • number of sterile syringes distributed database for tracking SSP SOURCE BELOW
(PWUD). This plan of action is directed to distribute • number of naloxone kits distributed activities by the 15th of
syringes to communities that use drugs to prevent • number of participant encounters each month following Reimbursement of
transmission of infectious disease. SSPs will operate during • number of referrals to health and social service. actual costs incurred,
scheduled hours to provide all required harm reduction services not to exceed$40,250
supplies,naloxone,and syringes to prevent transmission of MI 12405150 SFY25
DRUG USER HEALTH
PROGRAM
Exhibit A,Statement of Work Page 1 of 12 Contract Number CLH32053-Amendment 4
Pages of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
disease and overdose. SSPs will offer referrals to address Submit Performance Objectives&Work Submit Performance
social determinants of health. Plan within the first six months of contract Objectives&Work Plan Reimbursement of
period that will include: by June 30, 2025. actual costs incurred,
Priority populations for Syringe Services Programs include • Outcomes aligned with program not to exceed$8,000—
people who use drugs,with a focus on: strategies and activities. MI 12405851 SFY25
People systemically marginalized and underserved •• SMART objectives aligned with SSPS OPIOID HARM
• RED PROVISO
due to racism—Black/African American, performance targets
Latino/Latina/Latine/Latinx,American • Activities aligned with program
Indian/Alaska Native people and other communities outcomes
for whom there are documented health disparities in • Timeline for implementation(including
your region. staffing of the proposed program,
• People who are unhoused or unstably housed. training,etc.)
• People engaged in sex work. • Anticipated capacity building or
• People involved in the criminal legal system. technical assistance needs.
• Gender expansive/transgender individuals.
• Gay,bi,and other men who have sex with men. NOTE: See Special Requirements,Terms
and Conditions—Section 7 Performance
Objectives&Workplans for additional
NOTE: See Special Requirements,Terms and Conditions deliverable information.
—Section 4 Syringe Services Programs: Support for
Operations Program Requirements for additional task
information.
Syringe Services Programs:Clinical Services
Provide direct access to clinical services to improve the
health and well-being of people who use drugs.At
minimum,services must include onsite,low-barrier access to
wound care, infectious disease testing,STI and hepatitis C
treatment,and medications for opioid use disorder.
Additional services can include mental health services,
sexual and reproductive health care,and other primary care
and psychosocial support services.
NOTE: See Special Requirements,Terms and Conditions
—Section 6 Syringe Services Program,Clinical Services
Requirements for additional task information.
Exhibit A, Statement of Work Page 2 of 12 Contract Number CLH32053-Amendment 4
Pale 6 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
# and/or Amount
Syringe Services Programs:Public Health Supply Vending • Increase access to naloxone,fentanvl Enter deliverable data into Reimbursement of actual
Machines test strips, and other public health the DOIFOID issued costs incurred,not to
supplies by implementing public health database for tracking exceed S15,000
Implement and maintain dispensing machines for dispensing machines naloxone distribution by
distribution of naloxone,fentanyl test strips, and other public • Site and support public health the 15th of each month ,1.1I 12405952 SFY25
health supplies dispensing machines in high-impact following service. DUII NALO,YONF.DDO
settings that serve communities HCA JAR
disproportionately impacted by fatal By June 30, 2025,submit a S15,000 for 3/1/25-
opioid overdose final report that provides 6/30/2025
• Submit monthly naloxone distribution locations of public health
reports dispensing machines and
• Prepare final report that provides rationale for
locations of public health dispensing sites/locations.
machines and rationale for
sites/locations
Syringe Service Programs:Harm Reduction Services-Overdose Data to Action(OD2A)
2 Syringe Services Programs:Harm Reduction Service Harm reduction care navigation outcomes Enter deliverable data into Reimbursement of
Navigation include delivering services and tracking: the DOH/OID issued actual costs incurred,
• number of participants enrolled in care database for tracking SSP not to exceed$81,556
Provide appropriate referrals to SSP participants; facilitate navigation services activities by the 15th of
access to receive health care and medical services,social • number of care navigation sessions each month following Unspent funds may be
services,behavioral health counseling and other services • number of referrals to health and social service. carried forward to
including substance use treatment(including medications for services 7/1/25-8/31/25 contract
opioid use disorder,or MOUD);housing;and advocacy, • number of linkages to care for health and period.
including but not limited to criminal legal involvement, social services
medical providers,benefits navigation,and family number of outreach attempts per participant
reunification.
Submit Performance Objectives&Work
NOTE: See Special Requirements,Terms and Conditions Plan within the first six months of contract Submit Performance
—Section 5 Syringe Services Program,Harm Reduction period that will include: Objectives&Work Plan
Care Navigation Requirement for additional task •" Outcomes aligned with program by June 30, 2025
information. strategies and activities.
• SMART objectives aligned with
performance targets
• Activities aligned with program
outcomes
• Timeline for implementation(including
staffing of the proposed program,
training,etc.)
Exhibit A,Statement of Work Page 3 of 12 Contract Number CLH32053-Amendment 4
Page 7 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment information
and/or Amount
• Anticipated capacity building or
technical assistance needs.
NOTE: See Special Requirements,Terms
and Conditions—Section 7 Performance
Objectives&Workplans for additional
deliverable information.
3 The LHJ will engage in OD2A-S evaluation activities for Quarterly submission of collected data and Enter quarterly data into
work completed using OD2A-S funds.Evaluation activities answers to qualitative questions(as it applies the DOH/OID issued
will involve: to your OD2A-S activities)on a DOH- template on the following
• As applicable,collecting data on CDC performance provided template dates:
measures to support DOH evaluation plan. • For reporting
o Total number of harm reduction service period 1/1/25-
encounters(e.g., in-person,mail,telephone, 3/31/25
online) April 1,2025
o Zip code where harm reduction services were •
For reporting
provided(list"unknown"when location is
unknown) period 4/1/25-
o Total number of navigators located in a harm 6/30/25
reduction setting or other setting July 1,2025
o Number of referrals to harm reduction services • For reporting
for each race ethnicity period 7/1/25-
o If possible,total number of hours spent by each 8/31/25
navigator on linkage to care or referral efforts October 1,2025
o Type of organization where naloxone was
distributed(SSP,faith-based organizations,
schools,etc.)
o Zip code where naloxone was distributed(list
"unknown"when unknown)
o Number of naloxone doses distributed at each
type of organization
o Number of service encounters involving drug
checking
o Zip code for drug checking encounters(list
"unknown"when unknown)
o Number of referrals to MOUD for each
race/ethnicity
o Number of referrals to behavioral health
treatment only(without MOUD)for each
race/ethnicity
Exhibit A,Statement of Work Page 4 of 12 Contract Number CLH32053-Amendment 4
Page 8 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
o Number of other referrals,if not to MOUD and
behavioral health,with a description of the type
of referral
• Providing answers to contextual performance measures
questions.
o How has access to care or treatment has been
improved,and what new/existing community
assets were leveraged?
o What are the barriers for people accessing harm
reduction services in your jurisdiction?
o What are barriers to accessing or receiving
naloxone?
o Describe what types of navigators are included
in the data reported
o Describe methods to support navigators
• Collaborating with the DOH evaluator on a Targeted
Evaluation Project(TEP)that will provide a greater
understanding of navigation activities.
• Supporting other evaluation tasks as requested,to meet
overall CDC evaluation requirements.
DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site.Questions related to this SOW,or any other
finance-related inquiry,may be sent to finance('IIdoh.wa.gov.
Federal Funding Accountability and Transparency Act(FFATA)(Applies to federal grant awards.)
This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act(FFATA or the Transparency Act).
The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent.
To comply with this act and be eligible to perform the activities in this statement of work,the LHJ must have a Unique Entity Identifier(UEI)generated by SAM.gov.
Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. 109-282.
Program Specific Requirements
Special Requirements,Terms and Conditions
1. Definitions
a. ANONYMOUS SERVICES-HIV Prevention services including condom distribution,outreach and light touch.
b. CAPACITY BUILDING-The process by which individuals and organizations obtain,improve,and retain the skills,knowledge,tools,equipment,and other
resources needed to do their jobs competently.
c. CONTRACTOR—For the purposes of this Statement of Work Only,the entity receiving funds directly from Washington State Department of Health(DOH)for
client services to prevent or treat conditions named in the statement of work will be referred to as contractor.
d. HARM REDUCTION-Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.
Exhibit A, Statement of Work Page 5 of 12 Contract Number CLH32053-Amendment 4
Page 9 of 33
e. INTEGRATED TESTING-For the purpose of this Statement of Work,Integrated Testing includes Human Immunodeficiency Virus(HIV),Gonorrhea(GC),
Chlamydia(CT),Syphilis,Hepatitis C(HCV)and Hepatitis B(HBV).
f. SOCIAL DETERMINANTS OF HEALTH-Social determinants of health(SDOH)are the conditions in the environments where people are born,live, learn,
work,play,worship,and age that affect a wide range of health,functioning,and quality-of-life outcomes and risks.
g. YOUTH-For purposes of this agreement,the term"youth"applies to persons under the age of 18.
2. Submission of Invoice Vouchers
a. On a monthly basis,the CONTRACTOR shall submit complete and correct A19 invoice vouchers with amounts billable to DOH under this statement of work and the
corresponding OID Expense Summary backup form.All A19 invoice vouchers must be submitted by the 25th of the following month.Prior approval is required for a
different frequency of billing.
i. The CONTRACTOR must provide all backup documentation as required based on the assigned risk level and/or as identified by DOH program staff to determine
allowability of billed expenses. Risk assessments are completed at the beginning of a new contract for all sub-recipient contracts.Contact your contract manager
if you are unaware of your assigned risk level.
ii. DOH may ask for additional backup information to pay invoices based on the needs of the funding sources supporting the work.
b. The CONTRACTOR shall submit all final claims for payment for costs due and payable under this statement of work by July 31,2025. DOH will pay belated claims at its
discretion,contingent upon the availability of funds.
3. Program Organization—CONTRACTOR must
a. The CONTRACTOR must provide a full updated organizational chart,including Board of Directors with contact information if applicable,and staffing plan referencing
positions described in the budget narrative.
b. The CONTRACTOR must provide job descriptions for any new or changed positions in the updated organizational chart.
i. Any new positions funded through the original contract funds,must have prior DOH approval.
c. The CONTRACTOR must notify their DOH contract manager within 30 days of any staff vacancies related to contracted positions and provide an updated budget.
i. Any new fiscal staff responsible for invoicing on this contract will need to meet with the assigned OID Contract Manager within 60 days for DOH invoice
overview and training.
4. Syringe Services Program:Support for Operations Program Requirements
a. Operate for a minimum of 8 hours per week and 2 days per week.
b. Provide mobile and/or street outreach(note: programs must have a vehicle for mobile outreach.)
c. Offer safer injection supplies(see list of required safer injection supplies below).
d. Submit monthly SSP data in accordance with DOH standards.
e. Attend required capacity building/training opportunities provided by DOH.
f. Participate in annual site visits with DOH staff.
g. Demonstrate structure for receiving and incorporating participant feedback about services.
h. Partner with relevant local agencies to ensure effective outreach and service provision.(See Scope of Work narrative below for details on MOUs required.)
i. Develop and maintain a Universal Precautions and Sharps Handling policy and procedure,including clear,written policies on handling biohazardous waste,avoiding
unnecessary handling of sharps,and potential needle stick injuries to staff,volunteers,and participants.Programs should follow the universal precaution guidelines
established by the CDC and OSHA. SSPs may need to adapt those precautions to accommodate the circumstances of their work(e.g.,mobile and outreach settings).
Programs should also anticipate the potential of needlestick injury and have a"post-exposure-prophylaxis"protocol included in this document.
j. All staff and volunteers working directly with participants/clients must complete CPR certification within the first 3 months after contract start date(if not already
complete).
5. Syringe Services Program,Harm Reduction Care Navigation Requirements
a. Includes all requirements for Syringe Service Program operations(see above)
b. Attend Harm Reduction Care Navigation training provided by DOH.
Exhibit A, Statement of Work Page 6 of 12 Contract Number CLH32053-Amendment 4
Page 10 of 33
c. Support participant transportation(e.g.,through the provision of bus passes,cab vouchers,or direct transportation).
d. Accompany participants to appointments or provide"warm hand-offs."
e. Full-time care navigators(1.0 FTE)shall not exceed a case load greater than 25 individuals.
f. Submit monthly outcome data in accordance with DOH standards.
OD2A-S September 1,2024-August 31,2025 Budget Funds
Salaries $30,618.13
Benefits $12,247.25
Other $660.00
Supplies $33,073
Indirect rate $21,401.59
TOTAL $98,000
* The LHJ must receive written approval from DOH before making any changes to the OD2A-S SOW activities or OD2A-S itemized budget
6. Syringe Services Program,Clinical Services Requirements
a. Includes all requirements for Syringe Service Program operations(see above)
b. Must have clinical staff licensed to practice in the state of Washington to provide clinical services(e.g.,RN,PA,ARNP,LCSW).
c. If providing advanced level clinical services(e.g.,PA,ARNP,CNM),programs must have appropriate clinical oversight.
Note:Clinical services can be provided through sub-contractor arrangement or MOU with a Federally Qualified Health Center or other clinical partner if there
is a justification the relationship will support efforts to reach people who use drugs and provide onsite and/or mobile clinical services.Clinical services can also
be provided using telemedicine services with appropriate description of why in-person services cannot be provided and who the telemedicine partner(s)will be.
NOTE:Funds from this contract may not be used to purchase basic safer injection supplies(listed below)—Instead,DOH will provide Contractors with supplies.
Below is the list of required supplies for SSP to be provided to Contractors by DOH:
1) Syringes(1 cc 27 gauge 1/2",28 gauge 1/2",and 29 gauge 1/2"; 1 cc 30 gauge 5/16";3 cc 25G 1"and 1.5")
2) Alcohol pads
3) Non-latex tourniquets
4) Sterile water
5) Sterile saline
6) Cookers
7) Cottons and/or cellulose filters
8) Bandages/gauze
9) Sharps containers(1 quart and 2 gallon for distribution, 8 gallon for program use)
10) Naloxone
11) Amber bags
The exceptions to these supplies are vendor or manufacturer supply shortages.If a program expects to run out of one of these items,please contact DOH immediately.
7. Performance Objectives&Work Plan:
a. Funded Syndemic Prevention Services agencies are required to submit Performance Objectives and Work Plan that provides both a high-level overview of the period of
performance and a detailed description of the second year of the contract period.The work plan should incorporate related program strategies and activities. Contractors
should propose specific,measurable,achievable,realistic,and time-based(SMART)process and/or outcome objectives for each activity aligned with performance
outcomes. The work plan should include training,capacity building,and TA needs to support the implementation of the funded services.Proposed work plan activities
Exhibit A, Statement of Work Page 7 of 12 Contract Number CLH32053-Amendment 4
Page 11 of 33
may be adjusted in collaboration with OID staff to better address the overarching goals of the funded services.OID will provide a template that must be used in
developing the work plan.Note:Syndemic Contract Year 2 is anticipated to be established for July 1,2025 to June 30,2026 dependent on funding allocation.
b. The contractor should address the following outline in their work plan:
i. Contract Year 2 Detailed Work Plan(For each funded service category)
ii. Program strategies and activities
iii. Outcomes aligned with program strategies and activities
iv. SMART objectives aligned with performance targets
v. Activities aligned with program outcomes
vi. Timeline for implementation(including staffmg of the proposed program,training,etc.)
vii. Anticipated capacity building or technical assistance needs.
c. Performance Objectives&Work Plans should be submitted by June 30,2025.
d. OID staff are available to support in developing Performance Objectives&Work Plans in collaboration with funded agencies.
e. Performance Objectives&Work Plans will be reviewed between OID staff and funded agencies at least quarterly.Performance Objectives&Work Plans can be adjusted
throughout the period of performance.
8. Participation in program evaluation activities—The Contractor is expected to participate in program evaluation activities,including evaluation planning,and collecting and
reporting qualitative and quantitative program data,as deemed necessary by OID staff.
9. Participation in Capacity Building and Technical Assistance Activities designed to increase efficacy of Syndemic Services
a. Opportunities for capacity building and technical assistance for contractor will be offered throughout the contract year by WA DOH and other regional or national
capacity building organizations.
b. Contractors will be expected to meet with WA DOH OID staff on an annual basis to discuss training and will work with DOH to track shared completion of Capacity
Building Needs
c. All contracted staff will be required to complete training in respect to their role.DOH staff and contracted staff will work together to track completion of required
trainings.
10. CLAS Standards—The CONTRACTOR will comply with the National Standards for Culturally and Linguistically Appropriate Services(CLAS)standards(1,5-9).National
Stand aRLk 6,11 t'E_It lit till\ and L..inguisticalL Appropriate Services(CLAS)in I and I lealth Care a aIIianeefo3cias.or rt
11. Participation in Program Monitoring Activities—
a. DOH will conduct semi-annual or annual performance site visits in the following areas:
i. Integrated testing
ii. Syndemic service navigation
iii. PrEP Housing
iv. Syringe Service Programs
v. Mail-order naloxone distribution programs
vi. Fiscal Monitoring—To be scheduled by the DOH Fiscal Monitoring Unit
b. Corrective Action Plans—DOH may exercise the following options if the CONTRACTOR does not come into compliance or resolution with programmatic and/or fiscal
monitoring corrective action plan by the due date(s)identified in the CAP.i. §200.339 Remedies for noncompliance.
If a non-Federal entity fails to comply with the U.S. Constitution,Federal statutes,regulations or the terms and conditions of a Federal award,the Federal awarding
agency or pass-through entity may impose additional conditions,as described in§200.208.If the Federal awarding agency or pass-through entity determines that
Exhibit A, Statement of Work Page 8 of 12 Contract Number CLH32053-Amendment 4
Page 12 of 33
noncompliance cannot be remedied by imposing additional conditions,the Federal awarding agency or pass-through entity may take one or more of the following actions,
as appropriate in the circumstances:
(a)Temporarily withhold cash payments pending correction of the deficiency by the non-Federal entity or more severe enforcement action by the Federal
awarding agency or pass-through entity.
(b)Disallow(that is,deny both use of funds and any applicable matching credit for)all or part of the cost of the activity or action not in compliance.
(c)Wholly or partly suspend or terminate the Federal award.
(d)Initiate suspension or debarment proceedings as authorized under 2 CFR part 180 and Federal awarding agency regulations(or in the case of a pass-through
entity,recommend such a proceeding be initiated by a Federal awarding agency).
(e)Withhold further Federal awards for the project or program.
(f)Take other remedies that may be legally available
12. Contract Management—
a. Fiscal Guidance
i. Indirect—If charging indirect costs,the CONTRACTOR must have a current federally negotiated rate or 10%De Minimus certification of file with DOH.DOH
is not able reimburse indirect costs without an approved indirect cost rate or 10%De Minimus certification on file.
ii. Advance Payments Prohibited—DOH funds are"cost reimbursement"funds.DOH will not make payment in advance or in anticipation of services or supplies
provided.This includes payments of"one-twelfth"of the current fiscal year's funding.
iii. Duplication of Early Intervention Program (EIP)Services—The CONTRACTOR shall not use contract funds to provide a parallel medication service to EIP.
CONTRACTOR's providing case management services shall make every effort to enroll clients in EIP.
iv. Payment of Cash or Checks to Clients Not Allowed—Where direct provision of service is not possible or effective,vouchers or similar programs,which may
only be exchanged for a specific service(e.g.,transportation),shall be used to meet the need for such services. CONTRACTOR shall administer gift cards
voucher programs to assure that recipients cannot readily convert vouchers into cash.
1) Store gift cards that can be redeemed at one merchant or an affiliated group of merchants for specific goods or services are allowable as incentives for
eligible program participants.
2) General-use prepaid cards are considered"cash equivalent"and are therefore unallowable. Such cards generally bear the logo of a payment network,such
as Visa,MasterCard,or American Express,and are accepted by any merchant that accepts those credit or debit cards as payment.Gift cards that are
cobranded with the logo of a payment network and the logo of a merchant or affiliated group of merchants are general-use prepaid cards,not store gift
cards,and therefore are unallowable.
3) The CONTRACTOR must ensure that a policy for managing gift cards with strong internal controls is in place.
v. Funds for Needle Exchange Programs Not Allowed with Federal Funding—CONTRACTOR shall not expend contract federal funds to support needle
exchange programs using funds from HIV Community Services Tasks.
vi. Restriction on OD2A-S Funds:The purchase of naloxone cannot be reimbursed using OD2A-S funds. Please refer to the guidance on allowable and
unallowable expenses using OD2A-S funds for a comprehensive list of allowable and unallowable spending.
vii. Travel—Out of staff travel requires prior approval from DOH and must follow GSA guidelines and reimbursement rates.
viii. Supervision, under DOH Community Programs contracts,will be understood as the delivery of a set of interrelated functions encompassing administrative,
educational and supportive roles that work collectively to ensure clinical staff(i.e.,case managers,navigators, coordinators,assistants,coaches)are equipped
with the skills necessary to deliver competent and ethical services to clients that adhere to best practices within applicable fields as well as all relevant Statewide
Exhibit A,Statement of Work Page 9 of 12 Contract Number CLH32053-Amendment 4
Page 13 of 33
Standards. Supervisors must meet the criteria set forth within the WA State HIV Case Management Standards and provide the level of interaction and review
detailed in that document.
It is the understanding of DOH that Supervision funded under the direct program portion of this contract include at minimum,the provision of at least two of the
three functions detailed here: administrative,educational or supportive supervision. Supervision that encompasses only administrative functions will not be
considered billable under Direct Program.To that end,it is the expectation of DOH that those personnel identified as Supervisors have no more than one degree
of separation from direct client care.Exceptions to this rule can be presented and considered to and by DOH Contract Management. It will fall to the requesting
organization to satisfactorily demonstrate that any Supervisory positions falling within the scope of Direct Program are meeting the expectation of provision of
educational or supportive supervision with the aim of directly impacting client experiences,quality of services,and adherence to best practices and Statewide
Standards.
ix. Small and Attractive items—Each Contractor shall perform a risk assessment(both financial and operational)on the agency's assets to identify those assets that
are particularly at risk or vulnerable to loss.Operational risks include risks associated with data security on mobile or portable computing devices that store or
have access to state data.Assets so identified that fall below the state's capitalization policy are considered small and attractive assets.The Contractor shall
develop written internal policies for managing small and attractive assets.Internal policies should take into consideration the Office of the Chief Information
Officer(OCIO)IT Security Standard 141 Section 5.8 Mobile Computing and Section 8.3 Media Handling and Disposal at hops://ocio.wa.govipolicies.
The Contractor shall implement specific measures to control small and attractive assets in order to minimize identified risks.Periodically,the Contractor should
perform a follow-up risk assessment to determine if the additional controls implemented are effective in managing the identified risks.
Contractor must include,at a minimum,the following assets with unit costs of$300 or more:
1) Laptops and Notebook Computers
2) Tablets and Smart Phones
Agencies must also include the following assets with unit costs of$1,000 or more:
1) Optical Devices,Binoculars,Telescopes,Infrared Viewers,and Rangefinders
2) Cameras and Photographic Projection Equipment
3) Desktop Computers(PCs)
4) Television Sets,DVD Players,Blu-ray Players,and Video Cameras(home type)
x. Food and Refreshments—Food and refreshments are not allowable direct costs,unless provided in conjunction with allowable meetings,whose primary
purpose is the dissemination of technical information. Pre-approval is required when food and refreshments are purchased for these meetings.A sign in sheet
with the clients' ID number from the DOH approved data system as well as an agenda is required to receive reimbursement for these charges.
1) The CONTRACTOR shall follow Elealtha Nutrition Guulelines for\t=eettn ,and I ent4 W ,sf iington State Department of health when purchasing
food and refreshments for approved meetings.
2) Food for staff meetings/training is unallowable.
PLEASE NOTE: If meals/refreshments are purchased for allowable meetings,food can only be purchased for clients at the per diem rate.Any expenses over
per diem will be denied. U.S.General Services Administration Per Diem IookUp
xi. Reimbursement of disallowed costs—The CONTRACTOR agrees to reimburse DOH for expenditures billed to the DOH for costs that are Iater determined
through audit or monitoring to be disallowed under the requirements of 2 CFR Part 200—Uniform Administrative Requirements,Cost Principles,and Audit
Requirements for Federal Audits.
Exhibit A,Statement of Work Page 10 of 12 Contract Number CLH32053-Amendment 4
Page 14 of 33
b. Contract Modifications
i. Notice of Change in Services—The CONTRACTOR shall notify DOH program staff,within 45 days, if any situations arise that may impede implementation of
the services contained in the statement of work. DOH and the CONTRACTOR will agree to strategies for resolving any shortfalls.DOH retains the right to
withhold funds in the event of substantial noncompliance.
ii. Contract Amendments—Effective Date—The CONTRACTOR shall not begin providing services authorized by a contract amendment until the
CONTRACTOR has received a signed and fully executed copy of the contract amendment from DOH.
1) Local Health Jurisdiction(LHJ)Contractors—Request for contract amendments must be received no less than 60 days prior to the Draft Due Date
identified by the CON CON SOW Schedule on the CON CON Dashboard.
2) Non-LHJ Contractors—Request for contract amendments must be received no later than 60 days prior to the end of the Federal Fiscal Year(FFY)and
90 days prior to end of the State Fiscal Year(SFY).
• Amendments must be signed prior to the end of the FFY or SFY end date.
EX.FFY end date is 12/31,contract amendment request due to contract manager by 11/1
13. Content Review and Website Disclaimer Notice
In accordance with all federal guidance,contractors receiving funds through DOH will submit all proposed written materials requiring review for HIV-related scientific or
medical accuracy including written materials,audio visual materials,and pictorials, including social marketing and advertising materials,educational materials, social media
communications(e.g.,Facebook,twitter)and other electronic communications,such as internet/webpages to the OID Content Review Committee. CONTRACTOR shall
submit all materials to be reviewed for scientific or medical accuracy to:
Michael Barnes,Washington State Department of Health
PO Box 47841
Olympia,WA 98504-7841
Phone: 360-810-1880
Email: Michael.Barnes@doh.wa.gov
For social marketing campaigns and media strategies,please adhere to the program guidance on the review of HIV-related educational and informational materials for CDC
assistance programs Mips:'wuv cde.sn3v h14,pill"1l ndin an€nouncc.nini,,jpsI 1'120Iicdc-hiv-p;I3 1201-cant:nt-rev`ictw-gui ancc.pdf
14. Youth and Peer Outreach Workers
All programs,including CONTRACTORS,using youth(either paid or volunteer)in program activities will use caution and judgment in the venues/situations where youth
workers are placed. Agencies will give careful consideration to the age appropriateness of the activity or venue.Agencies will also ensure that organizational staff and youth
comply with all relevant laws and regulations regarding entrance into adult establishments and environments.Agencies will also maintain and implement appropriate safety
protocols that include clear explanation of the appropriate laws and curfews and clearly delineate safe and appropriate participation of youth in program outreach activities.
15. Whistleblower
a. Whistleblower statue,41 U.S.C.&4712,applies to all employees working for CONTRACTOR,subcontractors,and subgrantees on federal grants and contracts.The
statue(41 U.S.C.&4712)states that an"employee of a CONTRACTOR,subcontractor,grantee,or subgrantee,may not be discharged,demoted,or otherwise
discriminated against as a reprisal for"whistleblowing."In addition,whistleblower protections cannot be waived by an agreement,policy,form,or condition of
employment.
b. The National Defense Authorization Act(NDAA)for Fiscal Year 2013(Pub.L. 112-239,enacted January 2,2013)mandates a pilot program entitled"Pilot Program for
Enhancement of Contractor Employee Whistleblower Protections."This program requires all grantees,their subgrantees,and subcontractors to:
i. Inform their employees working on any federal award they are subject to the whistleblower rights and remedies of the pilot program
Exhibit A,Statement of Work Page 11 of 12 Contract Number CLH32053-Amendment 4
Page 15 of 33
ii. Inform their employees in writing of employee whistleblower protections under 41 U.S.C.&4712 in the predominant native language of the workforce;and,
iii. CONTRACTOR and grantees will include such requirements in any agreement made with a subcontractor or subgrantee.
16. Allowable Costs
All expenditures incurred and reimbursements made for performance under this statement of work shall be based on actual allowable costs.Costs can include direct labor,
direct material,and other direct costs specific to the performance of activities or achievement of deliverables under this statement of work.
For information in determining allowable costs,please reference OMB Circulars:
2 CFR200(State,Local and Indian Tribal governments)at:https://www.federalregister.gov/documents/2013/12/26/2013-30465/uniform-administrative-requirements-cost-
principles-and-audit-requirements-for-federal-awards
**Disclosure of information is governed by the Washington Administrative Code(WAC)246-101-120,520 and 635,and the Revised Code of Washington(RCW)70.24.080,
70.24.084,and 70.24.105 regarding the exchange of medical information among health care providers related to HIV/AIDS or STI diagnosis and treatment.Please note that
CONTRACTORS fit under the definition of"health care providers"and"individuals with knowledge of a person with a reportable disease or condition"in the WAC and
RCW.
DOH statutory authority to have access to the confidential information or limited Dataset(s)identified in this agreement to the Information Recipient: RCW 43.70.050
Information Recipient's statutory authority to receive the confidential information or limited Dataset(s)identified in this Agreement:RCW 70.02.220(7)
Exhibit A, Statement of Work Page 12 of 12 Contract Number CLH32053-Amendment 4
Page 16 of 33
Exhibit A
Statement of Work
Contract Term: 2025-2027
DOH Program Name or Title: Office of Drinking Water Group A Program - Local Health Jurisdiction Name: Jefferson County Public Health
Effective January 1,2025
Contract Number: CLH32053
SOW Type: Revision Revision#(for this SOW) 1 Funding Source Federal Compliance Type of Payment
®Federal<Select One> (check if applicable) ❑ Reimbursement
Period of Performance: January 1,2025 through December 31,2027 ® State ►.�1 FFATA(Transparency Act) ®Fixed Price
El Other ❑Research&Development
Statement of Work Purpose: The purpose of this statement of work is to provide funding to the LHJ for conducting sanitary surveys and providing technical assistance to small
community and non-community Group A water systems
Revision Purpose: To move funding from YR 27 SRF-Local Asst(15%)SS and TA to YR 28 SRF-Local Asst(15%)SS and TA.
Master Assistance BARS Allocation
Index Listing Revenue LHJ Funding Period Current Change Total
DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation None Allocation
SANITARY SURVEY FEES SS-STATE 24232522 N/A 346.26.65 01/01/25 06/30/25 2,200 0 2,200
YR 27 SRF-LOCAL ASST(15%)SS 24119227 N/A 346.26.64 01/01/25 12/31/25 2,200 -2,200 0
YR 27 SRF-LOCAL ASST(15%)TA 24119227 N/A 346.26.66 01/01/25 12/31/25 1,000 -1,000 0
YR 28 SRF-LOCAL ASST(15%)SS 24119228 N/A 346.26.64 01/01/25 12/31/27 0 2,200 2,200
YR 28 SRF-LOCAL ASST(15%)TA 24119228 N/A 346.26.66 01/01/25 12/31/27 0 1,000 1,000
0 0 0
TOTALS 5,400 0 5,400
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount
1 Trained LHJ staff will conduct sanitary surveys of Provide Final*Sanitary Survey Reports Final Sanitary Survey Upon ODW acceptance of the Final
small community and non-community Group A to ODW Regional Office.Complete Reports must be Sanitary Survey Report,the LHJ shall be
water systems identified by the DOH Office of Sanitary Survey Reports shall include: received by the ODW paid$400 for each sanitary survey of a non-
Drinking Water(ODW)Regional Office. 1. Cover letter identifying significant Regional Office within community system with three or fewer
deficiencies,significant findings, 30 calendar days of connections.
See Special Instructions for task activity. observations,recommendations,and conducting the sanitary
referrals for further ODW follow- survey. Upon ODW acceptance of the Final
The purpose of this statement of work is to provide up. Sanitary Survey Report,the LHJ shall be
funding to the LHJ for conducting sanitary surveys 2. Completed Small Water System paid$800 for each sanitary survey of a non-
and providing technical assistance to small checklist. community system with four or more
community and non-community Group A water 3. Updated Water Facilities Inventory connections and each community system.
systems. (WFI).
4. Photos of water system with text Payment is inclusive of all associated costs
identifying features such as travel,lodging,per diem.
Exhibit A,Statement of Work Page 1 of 4 _ Contract Number CLH32053-Amendment 4
Page 17 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount
5. Any other supporting documents.
Payment is authorized upon receipt and
*Final Reports reviewed and accepted by acceptance of the Final Sanitary Survey
the ODW Regional Office. Report within the 30-day deadline.
Late or incomplete reports may not be
accepted for payment.
2 Trained LHJ staff will conduct Special Purpose Provide completed SPI Report and any Completed SPI Reports Upon acceptance of the completed SPI
Investigations(SPI)of small community and non- supporting documents and photos to must be received by the Report,the LHJ shall be paid$800 for each
community Group A water systems identified by ODW Regional Office. ODW Regional Office SPI.
the ODW Regional Office. within 2 working days
of the service request. Payment is inclusive of all associated costs
See Special Instructions for task activity. such as travel,lodging,per diem.
Payment is authorized upon receipt and
acceptance of completed SPI Report within
the 2-working day deadline.
Late or incomplete reports may not be
accepted for payment.
3 Trained LHJ staff will provide direct technical Provide completed TA Report and any Completed TA Report Upon acceptance of the completed TA
assistance(TA)to small community and non- supporting documents and photos to must be received by the Report,the LHJ shall be paid for each
community Group A water systems identified by ODW Regional Office. ODW Regional Office technical assistance activity as follows:
the ODW Regional Office. within 30 calendar • Up to 3 hours of work: $250
days of providing • 3-6 hours of work:$500
See Special Instructions for task activity. technical assistance. • More than 6 hours of work:$750
Payment is inclusive of all associated costs
such as consulting fee,travel, lodging,per
diem.
Payment is authorized upon receipt and
acceptance of completed TA Report within
the 30-day deadline.
Late or incomplete reports may not be
accepted for payment.
4 LHJ staff performing the activities under tasks 1,2 For training attended in person,prior to Annually For training attended in person,LHJ shall
and 3 attend periodic required survey training as attending the training,submit an be paid mileage,per diem,lodging,and
directed by DOH. "Authorization for Travel(Non- registration costs as approved on the pre-
Employee)"DOH Form 710-013 to the authorization form in accordance with the
See Special Instructions for task activity. ODW Program Contact for approval(to current rates listed on the OFM Website
ensure enough funds are available). :/Iwww.ofm.wa.gov/resources/travel.asp
Exhibit A, Statement of Work Page 2 of 4 Contract Number CLH32053-Amendment 4
Page 18 of 33
DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site.Questions related to this SOW,or any other
finance-related inquiry,may be sent to finance@doh.wa.gov.
Federal Funding Accountability and Transparency Act(FFATA)(Applies to federal grant awards.)
This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act(FFATA or the Transparency Act).
The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent.
To comply with this act and be eligible to perform the activities in this statement of work,the LHJ must have a Unique Entity Identifier(UEI)generated by SAM.gov.
Information about the LHJ and this statement of work will be made available on LSASpending.gov by DOH as required by P.L. 109-282.
Program Specific Requirements
Data Sharing
The Office of Drinking Water will share water system information and files with the local health jurisdiction to support the work identified in this statement of work. To request
water system data please contact the regional office with the name of the water system,water system ID#,specific information being requested and any timeline requirements. If
allowable,please give administrative staff 3 to 5 business days to provide records.
Program Manual,Handbook,Policy References: Field Guide(DOH Publication 331-486).
Special References:
Chapter 246-290 WAC is the set of rules that regulate Group A water systems. By this statement of work,ODW contracts with the LHJ to conduct sanitary surveys(and SPIs and
provide technical assistance)for small community and non-community water systems with groundwater sources. ODW retains responsibility for conducting sanitary surveys(and
SPIs and provide technical assistance)for small community and non-community water systems with surface water sources, large water systems, and systems with complex
treatment.
LHJ staff assigned to perform activities under tasks 1,2,and 3 must be trained and approved by ODW prior to performing work.See special instructions under Task 4,below.
Special Billing Requirements
The LHJ shall submit quarterly invoices within 30 days following the end of the quarter in which work was completed,noting on the invoice the quarter and year being billed for.
Payment cannot exceed a maximum accumulative fee of$4,400 for Task 1,and$1,000 for Task 2,Task 3 and Task 4 combined during the contracting period,to be paid at the
rates specified in the Payment Method/Amount section above. When invoicing for sanitary surveys.bill half to BARS Revenue Code 346.26.64 and half to BARS Revenue Code
346.26.65.
When invoicing for Task 1,submit the list of WS Name,ID#,Amount Billed,Survey Date and Letter Date for which you are requesting payment.
When invoicing for Task 2-3,submit the list of WS Name,ID#,TA Date and description of TA work performed,and Amount Billed.
When invoicing for Task 4,submit receipts and the signed pre-authorization form for non-employee travel to the ODW Program Contact below and a signed A 19-1A Invoice
Voucher to DOH Grants Management,billing to BARS Revenue Code 346.26.66 under Technical Assistance(TA).
Special Instructions
Task 1
Trained LHJ staff will evaluate the water system for physical and operational deficiencies and prepare a Final Sanitary Survey Report which has been accepted by ODW.Detailed
guidance is provided in the Field Guide for Sanitary Surveys, Special Purpose Investigations and Technical Assistance(Field Guide).The sanitary survey will include an
evaluation of the following eight elements: source;treatment;distribution system;finished water storage;pumps,pump facilities and controls;monitoring,reporting and data
verification;system management and operation;and certified operator compliance. If a system is more complex than anticipated or other significant issues arise,the LHJ may
request ODW assistance.
Exhibit A,Statement of Work Page 3 of 4 Contract Number CLH32053-Amendment 4
Page 19 of 33
• No more than 3 surveys of non-community systems with three or fewer connections be completed between January 1,2025,and December 31,2025.
• No more than 4 surveys of non-community systems with four or more connections and all community systems to be completed between January 1,2025 and
December 31,2025.
The process for assignment of surveys to the LHJ,notification of the water system,and ODW follow-up with unresponsive water systems;and other roles and responsibilities of
the LHJ are described in the Field Guide.
Task 2
Trained LHJ staff will perform Special Purpose Investigations(SPIs)as assigned by ODW.SPIs are inspections to determine the cause of positive coliform samples or the cause of
other emergency conditions.SPIs may also include sanitary surveys of newly discovered Group A water systems.Additional detail about conducting SPIs is described in the Field
Guide.The ODW Regional Office must authorize in advance any SPI conducted by LHJ staff.
Task 3
Trained LHJ staff will conduct Technical Assistance as assigned by ODW.Technical Assistance includes assisting water system personnel in completing work or verifying work
has been addressed as required,requested,or advised by the ODW to meet applicable drinking water regulations. Examples of technical assistance activities are described in the
Field Guide.The ODW Regional Office must authorize in advance any technical assistance provided by the LHJ to a water system.
Task 4
LHJ staff assigned to perform activities under tasks 1,2,and 3 must be trained and approved by ODW prior to performing work.
If required trainings,workshops or meetings are not available,not scheduled,or if the LHJ staff person is unable to attend these activities prior to conducting assigned tasks,the
LHJ staff person may,with ODW approval,substitute other training activities to be determined by ODW. Such substitute activities may include one-on-one training with ODW
staff,co-surveys with ODW staff,or other activities as arranged and pre-approved by ODW.LHJ staff may not perform the activities under tasks 1,2,and 3 without completing
the training that has been arranged and approved by ODW.
Exhibit A,Statement of Work Page 4 of 4 Contract Number CLH32053-Amendment 4
Page 20 of 33
Exhibit A
Statement of Work
Contract Term: 2025-2027
DOH Program Name or Title: Office of People Services-HR-Public Health Local Health Jurisdiction Name: Jefferson County Public Health
Infrastructure Grant-Effective January 1,2025
Contract Number: CLH32053
SOW Type: Revision Revision#(for this SOW) 1 Funding Source Federal Compliance Type of Payment
®Federal Subrecipient (check if applicable) ® Reimbursement
Period of Performance: January 1,2025 through November 30.2027 ❑ State ®FFATA(Transparency Act) ❑ Fixed Price
❑Other ❑Research&Development
Statement of Work Purpose: The purpose of this statement of work(SOW)is to provide funding to establish,expand,train,and sustain the LHJ public health workforce in
accordance with the Centers for Disease Control and Prevention(CDC)Public Health Infrastructure Grant(PHIG)_
Revision Purpose: Update Program Specific requirements,task 2 implementation plan deliverables/outcomes anddue date/time frame.
Master Assistance BARS Allocation
Index Listing Revenue LHJ Funding Period Current Change Total
DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation None Allocation
FFY22 PH INFRASTRUCTURE COMP AI-LHJ 92321223 93.967 333.93.96 01/01/25 11/30/27 150,300 0 150,300
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 150,300 0 150,300
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
1 Develop a contact list of staff responsible for the Submit to DOH Program Contact names, Submit by email to DOH Reimbursement for actual
statement of work(SOW). position titles,email addresses and phone Program Contact any staff costs not to exceed total
numbers of key LHJ staff responsible for this change(s)within 30 days funding allocation
statement of work, including management, amount.
program staff,and accounting and/or
financial staff. Invoice Vouchers must be
2 Develop an implementation plan to use these funds for Submit initial implementation plan to the Implementation plans must billed monthly and
one or more of the allowable costs listed below. DOH Program Contact for review and prior be submitted by email to received by DOH within
approval as soon as possible.We--want to he DOH Program Contact 45 days of the close of the
Funding is intended to establish,expand,train,and sustain ,ure a plant .l- taxvstt before using funds. and month in which services
public health staff to support LHJ prevention,preparedness, :< ,1,4, • = ., were provided.
response, and recovery initiatives.These include the expenses-
following short-term outcomes: increased retention of
existing public health staff,and improved workforce systems
Exhibit A,Statement of Work Page 1 of 4 Contract Number CLH32053-Amendment 4
Page 21 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
and processes. Washington will also move toward the Revisions to the implementation plans are Revised implementation
following intermediate outcome measures as part of this not required to be submitted to DOH for plans are due a month and
Workforce initiative:increased size[and capabilities]of the preapproval. Submit updated implementation 10 days after the end qf the
public health workforce,increased job satisfaction,stronger plans at the end of the grant year with an grant year November 30th:
public health foundational capabilities,and increased reach overview of those changes. * January 10, 2026
of public health services.Ultimately,these workforce • January 10, 2027
investments will support accelerated prevention, • January 10, 2028
preparedness,and response to emerging threats,and
improved other public health outcomes.
Funding can be used for permanent full-time and part-time
staff,temporary or term-limited staff,fellows,interns,
contractors,and contracted employees.
Allowable costs include:
• Costs, including wages and benefits,related to
recruiting,hiring,and training of new or existing
public health staff.
• Purchase of supplies and equipment to support the
expanded and/or current workforce and any training
related to the use of supplies and equipment.
• Training and education(and related travel)for new
and existing staff on topics such as incident
management training,working with underserved
populations,cultural competency,disease
investigations,informatics or data management,or
other needs identified by the LHJ.
• Costs of allowed contractors and contracted staff.
Notes:
• Preapproval from DOH is required to contract with
these funds.
• Preapproval is required for the purchase of
equipment.(Equipment is a tangible item with an
original per-unit cost of t 10;000$3 t;ot)or more.)
3 Data collection,as applicable,is based on: Data on form provided by DOH Reporting periods are:
• Hiring and Retention goals for the Public Health • December 1,2024—
Infrastructure Grant(PHIG)period. Data collection includes: May 31,2025
• Hiring and retention activities the LHJ has at the • Number of funded positions filled by • June 1,2025—
end of the reporting period. job classification and program area November 30,2025
since the inception of the grant • December 1,2025—
(December I,2022),as of the end of May 31,2026
the reporting period.
Exhibit A, Statement of Work Page 2 of 4 Contract Number CLH32053-Amendment 4
Page 22 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
# and/or Amount
o Including positions filled with • June 1,2026—
current employees,new hires,and November 30,2026
PHIG funded positions vacated • December 1,2026—
during the reporting period. May 31,2027
• Data Quality and Context • June 1,2027—
o Are the data provided questionable November 30,2027
or low/poor quality?
o Does the data provided adhere to Report due dates are a
the definitions established by CDC month and 10 days after
in the performance measure the end of the reporting
guidance? period:
o Describe any data limitations, • July 10,2025
including reasons unable to report, • January 10,2026
and steps taken to obtain data • July 10,2026
and/or improve data quality in the • January 10,2027
future.If you reported on these • July 10,2027
data using a definition that was • January 10,2028
different than provided in CDC's
guidance,please describe.
o Provide any additional context or
information related to this measure.
Note:6-month Reporting periods see Due
Date/Time Frame
DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site.Questions related to this SOW,or any other
finance-related inquiry,may be sent to Iir1 tt�ic,,lc�h As_, c ..
Federal Funding Accountability and Transparency Act(FFATA)(Applies to federal grant awards.)
This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act(FFATA or the Transparency Act).
The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent.
To comply with this act and be eligible to perform the activities in this statement of work,the LHJ must have a Unique Entity Identifier(UEI)generated by SAM.gov.
Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. 109-282.
Program Specific Requirements
Follow all Federal requirements for use of Federal funds:Code of Federal Regulations(CFR),Title 2,Subtitle A,Chapter II, Part 200 Uniform Administrative Requirements,Cost
Principle,and Audit Requirements for Federal Awards L( R ' ( l RP in ?t)() 41rrtfonn Adnt nistritive Requirements. Cost Prim:pies, and AuditRegt ire nents for Federal
Awards.
The following expenses are not allowable with these funds:
• Clothing(except for vests to be worn during exercises or response)
Exhibit A,Statement of Work Page 3 of 4 Contract Number CLH32053-Amendment 4
Page 23 of 33
• Equipment not primarily used by or for public health employees.
• Food or beverages(unless employee is in travel status)
• Incentives(except for retention incentives)
• Items to be given to community members(members of the public)
• Salaries at a rate more than Executive Level II(Federal Pay Scale)
• Vehicles(with preapproval,funds may be used to lease vehicles)
• Ca }itat expenses
Preapproval from DOH is required to use these funds for:
• Contracting.
• Purchasing equipment.(Equipment is a tangible item with an original per-unit cost of$1€-004j r 4 000 or more.)
• Disposition of equipment with a current value of S1-O.00O 55(010 or more.(Equipment is a tangible item with an original per-unit cost of$5,000 or more.)
• Leasing vehicles.
• Out-of-state travel.
Note: See also DOH Al9 Documentation Matrix for additional expenses that may require preapproval.
Billing Requirements:
All expenses on invoices must be related to statement of work tasks.
Submit invoices monthly on a signed A 19 with backup documentation appropriate for risk level. DOH will provide A 19 and risk level.
• If your invoice includes indirect costs,you must have an indirect rate cost agreement approved by DOH.
• If you have no expenses related to this statement of work for a month,let your DOH Primary Point of Contact know via email.
• Submit final billing within 45 days of the end of the period of performance for this statement of work.
Exhibit A,Statement of Work Page 4 of 4 Contract Number CLH32053-Amendment 4
Page 24 of 33
Exhibit A
Statement of Work
Contract Term: 2025-2027
DOH Program Name or Title: OSS LMP Implementation-Effective January 1,2025 Local Health Jurisdiction Name: Jefferson County Public Health
Contract Number: CLH32053
SOW Type: Revision Revision#(for this SOW) I Funding Source Federal Compliance Type of Payment
❑Federal<Select One> (check if applicable) ®Reimbursement
Period of Performance: January 1,2025 through June 30,2025 ®State ❑FFATA(Transparency Act) ❑ Fixed Price
❑Other El Research&Development
Statement of Work Purpose: The purpose of this statement of work is to fund implemation of the on-site sewage system(OSS)local management plan(LMP).This funding is
what remains of the 2023-2025 biennium and of SFY25 funding allocations.
Revision Purpose: Updating goals&measurable objectives,updating deliverables,updating payment amounts
Master Assistance BARS Allocation
LHJ Funding Period Change Index Listing Revenue Current g Total
DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation None Allocation
SFY25 WASTEWATERMANAGEMENT-GFS 26701150 N/A 334.04.93 01/01/25 06/30/25 10,602 -1,363 9,239
SMALL ONSITE MANAGEMENT(ALEA) 26705100 N/A 334.04.93 01/01/25 06/30/25 32,418 . 1,363 33,781
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 43,020 0 43,020
GOALS& MEASURABLE OBJECTIVES
This table summarizes starting and target metrics achieved by implementing the tasks below. This data is reported on an ongoing basis in the semiannual progress reports.
Description(e.g.,"OSS compliance") Units Starting Targets
(e.g."systems") Amount
OSS compliant with inspections in Marine Recovery Areas(MRAs) Number of OSS 4-86-132 550
OSS compliant with inspections countywide Number of OSS -1 i9-3-I-446 1,900
Number of OSS failures identified/
OSS failures identified/corrected in MRA number of OSS failures with completed 9/2 /0.3 12/6
repairs
Number of OSS failure identified/
OSS failures identified/corrected countywide number of OSS failures with completed 244 26%9 32/16
repairs
Exhibit A, Statement of Work Page 1 of 3 Contract Number CLH32053-Amendment 4
Page 25 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
# and/or Amount
Task 1: Grant Administration This task is to fund the required financial and reporting activities necessary to meet state DOH and Auditor requirements including
administration of LHJ local management plan and OSS LMP grant program.
1.1 Bi-monthly Invoicing and Progress Reports Bimonthly/Monthly invoices Bimonthly/monthly for Reimbursement up to Sx
DOH Consolidated Contracts(ConCon)requires billing duration of contract period. S2,I I based on actual
within 60 days of completing work.Local or County Health costs.
subrecipients will submit invoices through the ConCon
process and will send progress reports and deliverables to the
LMP Contract Manager. Invoices must be submitted at least
bi-monthly(per ConCon requirements)but no more
frequently than monthly. Invoices will be reviewed for
consistency with progress.The LMP Contract Manager may
require monthly invoices.
1.2 Semi-Annual Progress Reports Data about the following: Due July 15 for the
Reporting periods are semiannually from January 1 — • Qualitative: duration of the contract
June 30 and July 1 —December 31. Progress reports include o Summary of work. period.
data described in the outcome column. o Barriers to LMP Implementation.
• Quantitative:
o OSS inventory metrics.
o Enforcement actions.
o Outreach and Education efforts.
Task 2:Local Management Plan Implementation This task includes all work done to implement the county's LMP excluding grant management tasks and inspection
rebates/incentives.
2.1 Database Maintenance and Quality Assurance/Quality a. Provide narrative of data clean-up tasks a-d.Report in semi-annual Reimbursement up to
Control completed and in-progress. progress report in Subtask $23s,,\12 based on actual
Database maintenance and QA/QC is ongoing to ensure 1.2. costs.
accurate tracking methods for all OSS in the county. Specific b.Provide narrative of progress on
tasks include: configuring Energov database for SOM
• Continue to`clean-up' the existing data post data workflows,reports, automation tasks.
conversion in Energov permitting database
• Configure Energov database for SOM workflows, c.Provide narrative of API development
reports,automation tasks. tasks completed and in-progress.
• Develop Application Program Interface(API)between
database and Online-RME. d.Provide narrative of Homeowner Inspector
• Develop replacement Homeowner Inspector Authorization website tasks completed and
Authorization website in-progress.
2.2 Operations and Maintenance Program Administration a.L leant--Prre4toc 1. a.At contreet-exeeutioft
• Mail inspection reminders to homeowners as needed. b.Data on the following:
• Inspection Compliance tracking/mapping. • Number of OSS with current b. Report in semi-annual
• Failure and repair tracking/mapping. inspections progress report in Subtask
• Compliance enforcement. 1.2.
• Complaint response.
Exhibit A,Statement of Work Page 2 of 3 Contract Number CLH32053-Amendment 4
Page 26 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
• O&M data reports about inventory and deficiencies. • Number of OSS failures and
calculated risk using DOH-provided
risk assessment.
• Number of repairs.
2.3 Education and Outreach a.Track number of social media posts and a-c.Report in semi-annual
Education and outreach is conducted for OSS owners, mailings progress report in Subtask
realtors,etc.Specific tasks include: 1.2.
• Communicate via social media,website,and mailings b.Track attendance of in-person homeowner
• Provide in-person homeowner septic inspector classes septic inspector classes
for property owners
• Provide online homeowner inspector training and c.Track number of homeowner inspectors
authorization for property owners trained and authorized online
2.4 Professional Development and Coordination a.Attendance and contribution at four(4) a-b. Report attendance
• The LHJ will participate in LMP and West Side meetings per year. semi-annually,as
Coordinators Meetings and will network between scheduled in Task 1.2.
counties. b.Conference and Training participation as
• The LHJ will support professional development available.
through
o Attending DOH OSS Program trainings
o Environmental Heath Conferences
• AEC Conference-Two(2)Staff members
• WOSSA Conference-Two(2)Staff members
Task 3:Homeowner Inspection Rebates/Incentives Program Provide low-income rebates to homeowners.Provide inspection compliance incentives to homeowners in
priority areas.
3.1 Low-Income Homeowner Inspection Rebates a-' x i l y a ter-to i tr g y Reimbursement up to U.
The LHJ will provide rebates to homeowners for pumping, doeumentt;-to DOH. relates: ci2,(i.57 based on actual
inspection and minor repairs. Rebates issued will be up to costs.
$350. b.Report number of rebates provided for b.By grant closeout.
pumping,monitoring inspections and access
risers.
3.2 Homeowner Inspection Incentives 'r i les -ana3 liavee s e!i y ,4 =�5, ,=: •._Y
Promote pumping,inspection and minor repairs with rebates documents DOW i aces}tiva
to homeowners in priority areas. Rebates issued will be up to
$350. b.Report number of rebates for pumping, b.By grant closeout.
monitoring inspections and access risers to
grade provided to priority-area homeowners.
DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site.Questions related to this SOW,or any other
finance-related inquiry,may be sent to i ance a doh.wa.gov.
Exhibit A,Statement of Work Page 3 of 3 Contract Number CLH32053-Amendment 4
Page 27 of 33
Exhibit A
Statement of Work
Contract Term: 2025-2027
DOH Program Name or Title: WIC Nutrition Program-Effective January 1,2025 Local Health Jurisdiction Name: Jefferson County Public Health
Contract Number: CLH32053
SOW Type: Revision Revision#(for this SOW) 2 Funding Source Federal Compliance Type of Payment
® Federal Subrecipient (check if applicable) ®Reimbursement
Period of Performance: January 1,2025 through December 31,2027 ❑ State ®FFATA(Transparency Act) El Fixed Price
❑Other ❑Research&Development
Statement of Work Purpose: To provide Women, Infants,and Children(WIC)Nutrition Program services by following WIC federal regulations,WIC state office policies and
procedures,WIC directives,and other rules. Refer to the Program Specific Requirements section of this document.
Revision Purpose: To add funding to FFY25 USDA WIC CLIENT SVS CONTRACTS($3,975),add a task for FMNP and funding in FFY25 FMNP MGMT($637),Change MI
Code for BFPC,shift funding($28,238)from FFY24 USDA BFPC PROG MGMT to FFY25 USDA BFPC PROG MGMT,and increase caseload.
Master Assistance BARS Allocation
LHJ Funding Period Change Index Listing Revenue Current g Total
DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation Increase(+) Allocation
FFY25 USDA WIC CLIENT SVS CONTRACTS 76101251 10.557 333.10.55 01/01/24 09/30/25 144,142 3,975 148,117
FFY24 USDA BFPC PROG MGMT 7621424A 10.557 333.10.55 10/01/23 09/30/26 28,238 -28,238 0
FFY25 USDA BFPC PROG MGMT 76214250 10.557 333.10.55 01/01/25 09/30/26 0 28.238 I 28,238
FFY25 FMNP MGMT 76540251 10.572 333.10.57 01/01/25 09/30/25 0 637 637
0 0 0
0 0 0
TOTALS 172,380 4,612 176,992
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
# and/or Amount
See"Billing
1 WIC Nutrition Program Requirements"below.
1.1 Maintain authorized participating caseload at 100%based on Outcomes based on monthly participation Authorized participating
quarterly average as determined from monthly caseload data from state WIC caseload management caseload for March 2025
management reports generated at state WIC office. reports. through September 2026=
The Department of Health(Department)State WIC Nutrition 280
Program has the option of reducing authorized participating
caseload and corresponding funding when: Authorized participating
1. Unanticipated funding situations occur. caseload jbr March 2025
2. Reallocations are necessary to redistribute caseload through September 2026
statewide. 300
3. Caseload declines.
Exhibit A,Statement of Work Page 1 of 7 Contract Number CLH32053-Amendment 4
Page 28 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
# and/or Amount
1.2 Submit the annual Nutrition Services Plan for each year of Nutrition Services Plan First year due 9/30/25 Payment withheld if not
the contract. Second year due 9/30/26 received by due date.
Third year due 9/30/27
1.3 Submit the annual Nutrition Services Expenditure Report for Nutrition Services Expenditure Report 11/30/25 Payment withheld if not
each year of the contract. 11/30/26 received by due date.
11/30/27
1.4 Tell participants about other health services in the agency. If Documentation must be available for Biennial WIC Monitor
needed,develop written agreements with other health care review by WIC monitor staff.
agencies and refer participants to these services.
1.5 Provide nutrition education services to participants and Documentation must be available for Biennial WIC Monitor
caregivers in accordance with federal and state requirements. review by WIC monitor staff.
1.6 Issue WIC benefits while assuring adequate WIC card Documentation must be available for Biennial WIC Monitor
security and reconciliation. review by WIC monitor staff.
1.7 Collect data,maintain records, and submit reports to Documentation must be available for Biennial WIC Monitor
effectively enforce the non-discrimination laws(Refer to review by WIC monitor staff.
Civil Rights Assurances below).
1.8a Submit entire WIC and Breastfeeding Peer Counseling Budget Workbook First year due 9/30/25
Budget Workbook for each year of the contract Second year due 9/30/26
Third year due 9/30/27
1.8b Submit Rev-Exp Report spreadsheet from the WIC Budget Revenue and Expense Report and A-19 First year due monthly
Workbook monthly with A-19 through September 30,2025
Second year due monthly
through September 30,2026
Third year due monthly
through September 30,2027
See"Billing
2 Breastfeeding Promotion Requirements" below.
2.1 Provide breastfeeding promotion activities in accordance Status report of chosen activities in First year due 11/30/25
with federal and state requirements. Nutrition Services Plan. Second year due 11/30/26
Third year due 11/30/27
Documentation must be available for
review by WIC monitor staff. Biennial WIC Monitor
2.2 Work with community partners to improve practices that Status report of chosen activities in First year due 8/30/25
affect breastfeeding. Choose one or more of the following Nutrition Services Plan. Second year due 8/30/26
projects: Third year due 8/30/27
a Provide staff,health care providers and community Documentation must be available for
partners virtual breastfeeding training resources. + review by WIC monitor staff. Biennial WIC Monitor
Exhibit A, Statement of Work Page 2 of 7 Contract Number CLH32053-Amendment 4
Page 29 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
■ Work with employers who likely employ low-income
people to create worksite environments that support
breastfeeding.
• Work with birthing hospitals to improve maternity care
practices that affect WIC participant breastfeeding rates.
• Provide participants access to lactation consultants.
Other projects will need pre-approval from the State WIC
Office
See"Billing
3 Breastfeeding Peer Counseling Program(BFPO) Requirements"below.
3.1 Provide Breastfeeding Peer Counseling Program activities in Breastfeeding Peer Counseling Annual First year due 12/31/25
accordance with federal and state requirements.The WIC Report and expenditures from the previous Second year due 12/31/26
Breastfeeding Peer Counseling Program is meant to enhance, federal fiscal year. Third year due 12/31/27
not replace,WIC Breastfeeding promotion and support
activities. Documentation must be available for Biennial WIC Monitor
review by WIC monitor staff.
3.2 Track Breastfeeding Peer Counseling Program expenditures Documentation must be available for Biennial WIC Monitor
and bill separately from the WIC grant. review by WIC monitor staff.
4 Farmers Market Nutrition Program(FMNP) See"Billing
Requirements"below.
4.1 Distribute all Farmers Market Nutrition Program checks to Send completed readable copy of FMiVI' Weekly June-Sept. 2025 arid
eligible WIC participants between June and September 30 of check registers to State WIC office on a June-Sept. 2026
current year. weekly basis following FMNP procedures.
All sent by Oct. 1, 2025,
Documentation must be available Jra Oct. 1,2026, and Oct 1, 2027
review by WIC monitor staff
Biennial WIC Monitor
DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site.Questions related to this SOW,or any other
finance-related inquiry,may be sent to finance@doh.wa.gov.
Federal Fundine Accountability and Transparency Act(FFATA)(Applies to federal grant awards.)
This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act(FFATA or the Transparency Act).
The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent.
To comply with this act and be eligible to perform the activities in this statement of work,the LHJ must have a Unique Entity Identifier(UEI)generated by SAM.gov.
Information about the LHJ and this statement of work will be made available on(1.SASpending.wv by DOH as required by P.L. 109-282.
Exhibit A,Statement of Work Page 3 of 7 Contract Number CLH32053-Amendment 4
Page 30 of 33
Program Specific Requirements
Program Manual,Handbook,Policy References:
The local agency shall be responsible for providing services according to rules,regulations and other information contained in the following:
• WIC Federal Regulations,USDA,and FNS 7CFR Part 246.
• Washington State WIC Nutrition Program Policy and Procedure Manual
• Office of Management and Budget,Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Awards,2 CFR 200
• Farmers Market Nutrition Program Federal Regulations,USDA,FNS 7CFR Part 248
• Other directives issued during the term of the contract
Staffing Requirements:
The local agency shall:
• Use Competent Professional Authority staff,as defined by WIC policy,to determine participant eligibility,prescribe an appropriate food package and offer nutrition
education based on the participants'needs.
• Use a Registered Dietitian(RD)or other qualified nutritionist to provide nutrition services to high risk participants,to include development of a high-risk care plan. The
RD is also responsible for quality assurance of WIC nutrition services. See WIC Policy for qualifications for a Registered Dietitian and other qualified nutritionist.
• Assign a qualified person to be the Breastfeeding Coordinator to organize and direct local agency efforts to meet federal and state policies regarding breastfeeding
promotion and support. The Breastfeeding Coordinator must be an International Board Certified Lactation Consultant or attend an intensive lactation management course,
or other state approved training.
Restrictions on Funds(i.e.,disallowed expenses or activities,indirect costs,etc.):
The local agency shall follow the instructions found in the Policy and Procedure Manual under WIC Allowable Costs and 2 CFR Part 200 Uniform Administrative Requirements,
Cost Principles,and Audit Requirements for Federal Awards.
Special References(i.e.,RCWs,WACs,etc.):
What is the WIC program?
1. The WIC program in the state of Washington is administered by the Department of Health.
2. The WIC program is a federally funded program established in 1972 by an amendment to the Child Nutrition Act of 1966. The purpose of the program is to provide nutrition
and health assessment;nutrition education;nutritious food;breastfeeding counseling;and referral services to pregnant,breastfeeding,and postpartum women, infants,and
young children in specific risk categories.
3. Federal regulations governing the WIC program(7 CFR Part 246)require implementation of standards and procedures to guide the state's administration of the WIC program.
These regulations define the rights,responsibilities,and legal procedures of WIC employees,participants,persons acting on behalf of a participant,and retailers.They are
designed to promote:
a. High quality nutrition services;
b. Consistent application of policies and procedures for eligibility determination;
c. Consistent application of policies and procedures for food benefit issuance and delivery;and
d. WIC program compliance.
4. The WIC program implements policies and procedures stated in program manuals,handbooks,contracts,forms,and other program documents approved by the USDA Food
and Nutrition Service.
5. The WIC program may impose sanctions against WIC participants for not following WIC program rules stated on the WIC rights and responsibilities.
6. The WIC program may impose monetary penalties against persons who misuse WIC benefits or WIC food but who are not WIC participants.
Monitoring Visits(i.e.,frequency,type,etc.):
Program and fiscal monitoring are done on a biennial(every two years)basis and are conducted onsite.
The local agency must maintain on file and have available for review,audit and evaluation:
Exhibit A, Statement of Work Page 4 of 7 Contract Number CLH32053-Amendment 4
Page 31 of 33
• All criteria used for certification,including information on income,nutrition risk eligibility and referrals
• Program requirements
• Nutrition education
• All financial records
Assurances/Certifications:
1. Computer Equipment Loaned by the Department of Health WIC Nutrition Program
In order to perform WIC program activities,the Department requires computer equipment,such as computers,signature pads,document scanners, card readers and printers to
be in local WIC clinics or to be transported to mobile clinics. This equipment("Loaned Equipment")is owned by the Department and loaned to the local agency(Contractor).
The Loaned Equipment is supported by the Department. This equipment shall be used for WIC business only or according to WIC Policy and Procedures.
An inventory of Loaned Equipment is kept by the Department. Each time Loaned Equipment is changed,the parties shall complete the Equipment Transfer Form and the
Department updates the inventory. A copy of the Transfer Form will be provided to the contractor. Copies of the updated inventory list may be requested at any time.
The local agency agrees to:
a. Defend,protect and hold harmless the Department or any of its employees from any claims,suits or actions arising from the use of this Loaned Equipment.
b. Assume responsibility for any loss or damage from abnormal wear or use,or from inappropriate storage or transportation. The Department may enforce this by:
I) Requiring reimbursement from the local agency of the value of the Loaned Equipment at the time of the loss or damage.
2) Requiring the local agency to replace the Loaned Equipment with equipment of the same type,manufacturer,and capabilities(as pre-approved by the Department),or
3) Assertion of a lien against the Contractor's property.
c. Notify the Department immediately of any damage to Loaned Equipment.
d. Notify the Department prior to moving or replacing any Loaned Equipment.
The Department recommends Contractors carry insurance against possible loss or theft.
2. Civil Rights Assurance
a. The local agency shall perform all services and duties necessary to comply with federal law in accordance with the following Civil Rights Assurance.
b. "The Program applicant hereby agrees that it will comply with Title VI of the Civil Rights Act of 1964(42 U.S.C.2000d et seq.),Title LX of the Education Amendments
of 1972(20 U.S.C. 1681 et seq.), Section 504 of the Rehabilitation Act of 1973(29 U.S.C.794),Age Discrimination Act of 1975(42 U.S.C.6101 et seq.);all provisions
required by the implementing regulations of the Department of Agriculture;Department of Justice Enforcement Guidelines,28 CFR 50.3 and 42;and FNS directives and
guidelines,to the effect that,no person shall,on the ground of race,color,national origin,sex,age or handicap,be excluded from participation in,be denied benefits of,or
otherwise be subject to discrimination under any program or activity for which the Program applicant receives Federal financial assistance from FNS;and hereby gives
assurance that it will immediately take measures necessary to effectuate this agreement.
c. "By accepting this assurance,the Program applicant agrees to compile data,maintain records and submit reports as required,to permit effective enforcement of the
nondiscrimination laws and permit authorized USDA personnel during normal working hours to review such records,books and accounts as needed to ascertain
compliance with the nondiscrimination laws.If there are any violations of this assurance,the Department of Agriculture,Food and Nutrition Service,shall have the right
to seek judicial enforcement of this assurance. This assurance is binding on the Program applicant, its successors,transferees,and assignees,as long as it receives
assistance or retains possession of any assistance from the Department.The person or persons whose signatures appear on the contract are authorized to sign this
assurance on behalf of the Program applicant."
3. 2CFR 200
The local agency shall comply with all the fiscal and operations requirements prescribed by the state agency as directed by Federal WIC Regulations(7CFR part 246.6),2CFR
part 200,the debarment and suspension requirements of 2CFR part 200.213, if applicable,the lobbying restrictions of 2CFR part 200.245,and FNS guidelines and instructions
and shall provide on a timely basis to the state agency all required information regarding fiscal and program information.
Billing Requirements:
Exhibit A,Statement of Work Page 5 of 7 Contract Number CLH32053-Amendment 4
Page 32 of 33
1. Definitions
Contract Period: January 1,2025—December 31,2027
Contract Budget Periods: The time periods for which the funding is budgeted.
• There are four federal budget periods
January 1,2025,through September 30,2025
October 1,2025,through September 30,2026
October 1,2026,through September 30,2027
October 1,2027,through December 30,2027
2. Billing Information:
a. Billings are submitted on an A-19-1A invoice. These invoices are provided by the Department in the WIC Budget Workbook and include accounting codes for different
budget categories.
b. A-19s are submitted monthly and must be received by the Department within 60 days following the close of each calendar month.Additional A-19s may be submitted at
any time,but must be received within 60 days of the close of the federal budget period.
c. Funds are allocated by budget categories and by federal budget periods(refer to the budget spreadsheet).
d. Funds are encumbered or spent only during the budget period;no carry forward from previous time periods or borrowing from future time periods is allowed.
e. Payments are limited to the amounts allocated for the budget period for each budget category.
f. Billings are based on actual costs for completed activities. Advance payments are not allowed. Back up documentation must be retained by the local agency and available
for inspection by the Department or other appropriate authorities.
g. Payments will be made only for WIC approved expenditures.Refer to the Washington State WIC Nutrition Program Policy and Procedure Manual Volume 2,Chapter 4—
Allowable Costs and 2 CFR Part 200 Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Awards.
h. If billing for indirect costs,a Cost Allocation Plan or Federal Indirect Cost Agreement must be submitted prior to payment.
Special Instructions:
The local agency shall:
1. Maintain complete,accurate,and current accounting of all local,state,and federal program funds received and expended.
2. Provide,as necessary,a single audit in accordance with the provisions of 2 CFR Part 200 Uniform Administrative Requirements,Cost Principles,and Audit Requirements for
Federal Awards. This circular requires all recipients and sub-recipients of federal funds to have a single audit performed should they spend$750,000 or more of federal grants
or awards from all sources. Contractors spending less than$750,000 in federal grants or awards may also be subject to audit.
3. Use Breastfeeding Peer Counseling(BFPC)Program funds only to support the peer counseling program. Once the program is established and peer counselors are trained,the
majority of the salary costs must be paid to peer counselors to provide direct services to WIC participants. For a list of allowable costs see Volume 2,Chapter 4—Allowable
Costs. The priority use of BFPC funds is to hire and train peer counselors to provide breastfeeding peer counseling services to WIC participants.
SPECIAL REQUIREMENTS
Contract Budget Period Time Period special requirement Amount Special Requirement Description
funds are available
January 1,2025—September 30, January 2025—September 2025 2,500 For general training funds.This funding is for all WIC staff to participate in
2025 WIC-related training.Added in the USDA WIC Client Services Contracts
category to cover training registrations,travel expenses,staff time to
participate in training(salary/benefits for part time or contractor),and other
approved training expenses.
Other:
Exhibit A, Statement of Work Page 6 of 7 Contract Number CLH32053-Amendment 4
Page 33 of 33
Any program requirements that are not followed may be subject to corrective action and may result in monetary fines or repayment of funds.
Exhibit A, Statement of Work Page 7 of 7 Contract Number CLH32053-Amendment 4