HomeMy WebLinkAboutCONSENT Consolidated Contracts No 10Nom
615 5Iioridon Streot
Port Townsend, WA 98368desOwnwww:JoftorsonCountyPudlioboolth,org
Public HetConsent Agendalt
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Josh D. Peters, County Administrator
FROM: Apple Martine, JCPH Director
Veronica Shaw, JCPH Deputy Director
DATE: olkerd t 2 ' 2a2-4
SUBJECT: Agenda Item - Consolidated Contracts Amendment #10 with the Department
of Health; January 1, 2025 - December 31, 2027; $119,788 additional
STATEMENT OF ISSUE:
Jefferson County Public Health (JCPH) requests Board approval of Consolidated Contract Amendment #10
between JCPH and State of Washington Department of Health (DOH); January 1, 2025 - December 31, 2027;
additional funding of $119,788 for a total to date of $6,120,484.
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 one statement of work (SOW) and funding for the following program:
FY24 OD2A Funding: this program provides support for Syndemic (occurring when two or more
infectious diseases or health conditions cluster and interact within a population) Prevention Services for
infectious diseases; this revision provides new funds for FFY25 and adds unspent funds from FFY24
additional funding of $119,788).
FISCAL IMPACT/COST BENEFIT ANALYSIS:
Total consideration for this Contract Amendment is $119,788. The Consolidated Contract is funded by DOH,
and comprises both Federal and State funds.
RECOMMENDATION:
JCPH Management recommends BoCC approval of Consolidated Contract Amendment #10 between JCPH and
DOH; January 1, 2025 - December 31, 2027; additional funding of $119,788.
REVIEWED BY:
Josh D. Peters, County Administrator Date
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CC-25-001-A10
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11/18/2025
CONTRACT REVIEW FORM I Clear Form
INSTRUCTIONS ARE ON THE NEXT PAGE)
CONTRACT WITH: State of WA Dept of Health Contract No: CC-25-001-A10
Contract For: Consolidated Contracts, Amendment 10 Term: 1/1/2025 - 12/31/2027
COUNTY DEPARTMENT: Public Health
Contact Person: Apple Martine
Contact Phone: x 443
Contact email: amartine@co.jefferson.wa.us
AMOUNT: $119,788 additional, fora total of$6,120,484 PROCESS:
Exempt from Bid Process
Revenue: $119,788 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 CO L C C 155.080 AND CHAPTER 42.23 RCW.
e
CERTIFIED: L N/A:I " f 40" Nov. 18, 2025
Signature Date
STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE
COUNTY (CONTRACTOR) HAS NOT BEEN DEBAR D BY ANY FEDERAL, STATE, OR LOCAL
AGENCY.
CERTIFIED: N/A:Nov. 18, 2025
Signature Date
STEP 3: RISK MANAGEMENT REVIEW (will be added electronically through Laserfiche):
Electronically approved by Risk Management on 11/18/2025.
STEP 4: PROSECUTING ATTORNEY REVIEW (will be added electronically through Laserfiche):
Electronically approved as to form by PAO on 11/18/2025.
Amendment No. 10 amending statement of work and increasing contract
price. All prior amendments and original attached.
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
Page 1 of 15
JEFFERSON COUNTY PUBLIC HEALTH
2025-2027 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH32053 AMENDMENT NUMBER: 10
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:
httns://stateofwa.share rnt.corn/sites/doh-ofsfundingresourcesisitepagesthome.aspx'? .e1:9a94688da2d94d3ea80ac74b4:32e4d7c
Adds Statements of Work for the following programs:
Amends Statements of Work for the following programs:
Infectious Disease Syndemic Prevention Services-SSP- Effective July 1, 2025
Deletes Statements of Work for the following programs:
2. Exhibit B-10 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-9 Allocations
as follows:
Increase of S119,788 for a revised maximum consideration of$6,120.484.
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
APPRO E .: 0 FORM ONLY APPROVED AS TO FORM ONLY
77 // , Assistant Attorney General
r - for 11/18/2025
Philip C.Hunsucker, Date
Chief Civil Deputy Prosecuting Attorney
Cc-25-ool-A10 Page 1 of 1
EXHIBIT B-10
Page 2 of 15
Jefferson County Public Health ALLOCATIONS Contract Number: CLH32053
Contract Term:2025-2027 Date: November 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 Brstfdg Peer Cn Pr Mgmt USDA 7WA700WA1 Amd 9 10.557 333.10.55 01/01/25 09/30/27 10/01/24 09/30/27 722)21,455 27,516
FFY25 Brstfdg Peer Cn Pr Mgmt USDA 7WA700WA1 Amd 8 10.557 333.10.55 01/01/25 09/30/27 10/01/24 09/30/27 6,061)
FFY25 Brstfdg Peer Cn Pr Mgmt USDA 7WA700WA1 Amd 4,8 10.557 333.10.55 01/01/25 09/30/27 10/01/24 09/30/27 $28,238
FFY24 Brstfdg Peer Cn Pr Mgmt USDA 7WA700WA1 Amd 8 10.557 333.10.55 01/01/25 09/30/26 10/01/23 09/30/26 6,061 6,061
FFY24 Brstfdg Peer Cn Pr Mgmt USDA 7WA700WA1 Amd 4 10.557 333.10.55 01/01/25 09/30/26 10/01/23 09/30/26 ($28,238) 0
FFY24 Brstfdg Peer Cn Pr Mgmt USDA 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 8 10.557 333.10.55 01/01/25 09/30/25 10/01/24 09/30/25 3,448) $144,669 144,669
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
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
FFY26 WIC Client Svs Contracts USDA 7WA700WA7 Amd 9 10.557 333.10.55 10/01/25 09/30/26 10/01/25 09/30/27 $14,563 14,563 14,563
FFY25 Farm Mkt Ntr Prog Mgmt USDA 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
FFY25 PHEP BP2-CDC-LHJ Partners NU9OTU000055 Amd 9 93.069 333.93.06 07/01/25 06/30/26 07/01/25 06/30/26 $14,857 34,384 48,138
FFY25 PHEP BP2-CDC-LHJ Partners NU9OTU000055 Amd 7 93.069 333.93.06 07/01/25 06/30/26 07/01/25 06/30/26 $19,527
FFY24 PHEP BP1-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
FFY25 OD2A OID CDC Prevent NU17CE010218 Amd 10 93.136 333.93.13 09/01/25 06/30/26 09/01/25 08/31/26 $98,000 98,000 217,677
FFY24 OD2A OLD CDC Prevent NU17CE010218 Amd 10 93.136 333.93.13 07/01/25 08/31/25 09/01/24 08/31/25 S21,788 38,121
FFY24 OD2A OID CDC Prevent NU17CE010218 Amd6 93.136 333.93.13 07/01/25 08/31/25 09/01/24 08/31/25 $16,333
FFY24 OD2A OID CDC Prevent NUI7CE010218 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 9 93.217 333.93.21 04/01/25 03/31/26 04/01/25 03/31/26 $21,049 38,072 55,038
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
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 1 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 NU5OCK000515 Amd 1,7 93.323 333.93.32 01/01/25 12/31/25 01/15/21 07/31/26 $15,580 15,580 15,580
FFY19 ELC ED Immunizations CDC NU50CK000515 Amd 9 93.323 333.93.32 07/01/25 06/30/26 07/01/25 07/30/26 $10,000 10,000 10,000
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
PH Infrastructure Comp Al-LHJ NE110E000053 Amd 9 93.967 333.93.96 01/01/25 11/30/27 12/01/22 11/30/27 $200,000 350,300 350,300
PH Infrastructure Comp Al-LHJ NE11OE000053 Amd 3 93.967 333.93.96 01/01/25 11/30/27 12/01/22 11/30/27 $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
Page 1 of 3
EXHIBIT B-10
Jefferson County Public Health ALLOCATIONS
Page 3 of 15
Contract Number: CLH32053
Contract Term:2025-2027 Date: November 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 MCHBG Special Pr HRSA 2 B04MC54583 Amd 9 93.994 333.93.99 10/01/25 09/30/26 10/01/25 09/30/26 3,376 3,376 3,376
FFY26 MCHBG LHJ Contracts HRSA YR1 NGA Not Received Amd 9 93.994 333.93.99 10/01/25 09/30/26 10/01/25 09/30/26 ($36,700) 0 0
FFY26 MCHBG LHJ Contracts HRSA YR1 NGA Not Received Amd 7 93.994 333.93.99 10/01/25 09/30/26 10/01/25 09/30/26 $36,700
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
SFY26 Sch Based Hlth Cent 1225 Proviso Amd 7 N/A 334.04.90 07/01/25 06/30/26 07/01/25 06/30/26 $140,000 140,000 140,000
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
SFY26 Sexual&Rep Hlth Cost Share Amd 9 N/A 334.04.91 01/01/26 06/30/26 07/01/25 06/30/26 $41,664 41,664 137,061
SFY26 Sexual&Rep Hlth Cost Share Amd 7 N/A 334.04.91 07/01/25 12/31/25 07/01/25 06/30/26 $47,404 47,404
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
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 07/01/24 06/30/25 $31,500
Rec ShellfishBiotoxin 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 8 N/A 334.04.93 07/01/26 06/30/27 07/01/25 06/30/27 6,571 6,571 68,200
Small Onsite Management(ALEA)Amd 8 N/A 334.04.93 07/01/25 06/30/26 07/01/25 06/30/27 $36,611 36,611
Small Onsite Management(ALEA)Amd 8 N/A 334.04.93 01/01/25 06/30/25 07/01/23 06/30/25 8,763)25,018
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
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
SFY27 Wastewater Management-GFS Amd 8 N/A 334.04.93 07/01/26 06/30/27 07/01/26 06/30/27 $31,822 31,822 49,824
SFY25 Wastewater Management-GFS Amd 8 N/A 334.04.93 01/01/25 06/30/25 07/01/24 06/30/25 8,763 18,002
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)
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
SFY26 FPHS-LHJ Funds-GFS Amd 9 N/A 336.04.25 07/01/25 06/30/26 07/01/25 06/30/26 ($75,000) $2,128,000 4,461,000
SFY26 FPHS-LHJ Funds-GFS Amd 7 N/A 336.04.25 07/01/25 06/30/26 07/01/25 06/30/26 $2,203,000
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
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
Page 2 of 3
EXHIBIT B-10 Page 4 of 15
Jefferson County Public Health ALLOCATIONS Contract Number: CLH32053
Contract Term:2025-2027 Date: November 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
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%of15%)TA Amd6 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
YR27 SRF-Local Asst(15%)TA Amd1 N/A 346.26.66 01/01/25 06/30/25 07/01/23 06/30/25 1,000
TOTAL 6,120,484 S6,120,484
Total consideration: S6,000,696 GRAND TOTAL 6,120,484
119,788
GRAND TOTAL S6,120,484 Total Fed 989,849
Total State 5,130,635
Assistance Listing Number flea Catalog of Federal Domestic Assistance
Federal revenue codes begin with"333". State revenue codes begin with"334".
Page 3 of 3
Page 5 of 15
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: Revision Revision#(for this SOW) 1 Funding Source Federal Compliance T e of Payment
Federal Subrecipient (check if applicable) Reimbursement
Period of Performance: July 1,2025 through June 30,2026
State FFATA(Transparency Act) 0 Fixed Price
Other 0 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: Add new funds for FFY25 OD2A and add unspent funds from FFY24 that ended 06/30/25 to time period of 07/01/25-08/31/25.
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
SFY26 DRUG USER HEALTH PROGRAM 12405160 N/A 334.04.91 07/01/25 06/30/26 80,500 0 80,500
FFY24 OD2A OID CDC PREVENT 12405241 93.136 333.93.13 _ 07/01/25 08/31/25 16,333 21,788 38,121
FFY25 OD2A OID CDC PREVENT 12405252 93.136 333.93.13 09/01/25 06/30/26 0 98,000 98,000
0 0 0
0 0 0
0 0 0
TOTALS 96,833 119,788 216,621
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 11 Contract Number CLH32053-Amendment 10
Page 6 of 15
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 $4-63333
Provide appropriate referrals to SSP participants; navigation services 15th of each month following 38,121 for
facilitate access to receive health care and medical number of care navigation sessions service. 07/01/25—08/31/25
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 11 Contract Number CLH32053-Amendment 10
Page 7 of 15
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 Reimbursement of
MOUD);housing;and advocacy,including but not and social services actual costs incurred,
limited to criminal legal involvement,medical providers, • number of outreach attempts per not to exceed$98,000
benefits navigation,and family reunification. participant for 09/01/25—06/30/26
NOTE:See Special Requirements,Terms and
Conditions—Section 5 Syringe Services Program,
Harm Reduction Care Navigation Requirement for
additional task information
3 The LHJ will engage in OD2A-S evaluation activities for Quarterly submission of collected data and Enter quarterly data into the
work completed using OD2A-S funds.Evaluation answers to qualitative questions(as it DOH/OID issued template on
activities will involve: applies to your OD2A-S activities)on a the following dates:
As applicable,collecting data on CDC performance DOH-provided template For reporting period
measures to support DOH evaluation plan. 9/1/25-11/30/25
o Total number of harm reduction service December 1,2025
encounters(e.g.,in-person,mail,telephone, For reporting period
online) 12/1/25-2/28/26
o Zip code where harm reduction services
March 1 2025
were provided(list"unknown'when
For reporting periodlocationisunknown)
o Total number of navigators located in a
3/1/26-5/31/26
harm reduction setting or other setting
June 1,2026
o Number of referrals to harm reduction For reporting period
services for each race ethnicity 6/1/26-8/31/26
o If possible,total number of hours spent by September 1,2026
each navigator on linkage to care or referral
efforts
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
Exhibit A,Statement of Work Page 3 of 11 Contract Number CLH32053-Amendment 10
Page 8 of 15
Task
Activity Deliverables/Outcomes Due Date/Time Frame
Payment Information
and/or Amount
o Number of referrals to behavioral health
treatment only(without MOUD)for each
race/ethnicity
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 finance4,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.govby 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.
Exhibit A,Statement of Work Page 4 of 11 Contract Number CLH32053-Amendment 10
Page 9 of 15
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 Al 9 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 31,2026.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.
Exhibit A,Statement of Work Page 5 of 11 Contract Number CLH32053-Amendment 10
Page 10 of 15
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,LC SW).
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:
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:
Exhibit A,Statement of Work Page 6 of 11 Contract Number CLH32053-Amendment 10
Page 11 of 15
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.
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:
Exhibit A,Statement of Work Page 7 of 11 Contract Number CLH32053-Amendment 10
Page 12 of 15
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.
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
Exhibit A,Statement of Work Page 8 of 11 Contract Number CLH32053-Amendment 10
Page 13 of 15
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 fmancial 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
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 I 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 U,p
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.
Exhibit A,Statement of Work Page 9 of 11 Contract Number CLH32053-Amendment 10
Page 14 of 15
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
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:
Exhibit A,Statement of Work Page 10 of 11 Contract Number CLH32053-Amendment 10
Page 15 of 15
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-costprinciples-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 defmition 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 11 of 11 Contract Number CLH32053-Amendment 10
Page 1 of 50
JEFFERSON COUNTY PUBLIC HEALTH
2025-2027 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH32053 AMENDMENT NUMBER: 9
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:
httrs.vsttneofwasshartooint.corn<sNtesidoh-ofs€und neresources s tcp `I rna.also+:'-Ci,9a94billda2d94d3caVac 111c:,32e4d74
Adds Statements of Work for the following programs:
Office of immunizations-ELC-Effective July 1,2025
Amends Statements of Work for the following programs:
Foundational Public Health Services-Effective July 1,2025
Maternal&Child Health Block Grant-Effective January 1,2025
Office of People Services-HR-Public Health Infrastructure Grant-Effective January 1,2025
Office of Resiliency&Health Security-PHEP-Effective July 1,2025
OSS LMP Implementation-Effective July 1,2025
Sexual&Reproductive Health Program-Effective January I,2025
WIC Nutrition Program-Effective January 1,2025
Deletes Statements of Work for the following programs:
2. Exhibit B-9 Allocations,attached and incorporated by this reference,amends and replaces Exhibit B-8 Allocations as follows:
Increase of$I93.087 for a revised maximum consideration of$6,000,696.
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.
JE RSON COUNTY WASHINGTON STATE OF WASHINGTON
OA D OF COUNTY COMMISSIONERS DEPARTMENT OF HEALTH
I 7(0/2- az atef—t
4t-z.-SJ^) 11/12/2025
Heidi Eisenhour,Chair Date Date
APPROVED,AS O FORM ONLY APPROVED AS TO FORM ONLY
Assistant Attorney General
i
for 11/04/2025
hilip C Win—sucker, Date
Chief Civil Deputy Prosecuting Attorney Page I of 1
CC-25-OOI-A9
EXHIBIT B-9
Page 2 of 50
Jefferson County Public Health ALLOCATIONS Contract Number: CLH32053
Contract Term:2025-2027 Date: October 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 Brstfdg Peer Cn Pr Mgmt USDA 7WA700WAI Amd 9 10.557 333.10.55 01/01/25 09/30/27 10/01/24 09/30/27 722)21,455 27,516
FFY25 Brstfdg Peer Cn Pr Mgmt USDA 7WA700WA1 Amd 8 10.557 333.10.55 01/01/25 09/30/27 10/01/24 09/30/27 ($6,061)
FFY25 Brstfdg Peer Cn Pr Mgmt USDA 7WA700WA1 Amd 4,8 10.557 333.10.55 01/01/25 09/30/27 10/01/24 09/30/27 $28,238
FFY24 Brstfdg Peer Cn Pr Mgmt USDA 7WA700WAI Amd 8 10.557 333.10.55 01/01/25 09/30/26 10/01/23 09/30/26 6,061 6,061
FFY24 Brstfdg Peer Cn Pr Mgmt USDA 7WA700WA1 Amd 4 10.557 333.10.55 01/01/25 09/30/26 10/01/23 09/30/26 ($28,238) 0
FFY24 Brstfdg Peer Cn Pr Mgmt USDA 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 8 10.557 333.10.55 01/01/25 09/30/25 10/01/24 09/30/25' ($3,448) $144,669 144,669
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
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
FFY26 WIC Client Svs Contracts USDA 7WA700WA7 1md 9 10.557 333.10.55 10/01/25 09/30/26 10/01/25 09/30/27` S14.563 514,563 14,563
FFY25 Farm Mkt Ntr Prog Mgmt USDA 7WA81OWA7 Amd 4 10.572 333.10.57 01/01/25 09/30/25 10/01/24 09/30/25 637 637 637 IFFY25SWIMMINGBEACHACTIAR(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
FFY25 PHEP BP2-CDC-LHJ Partners NU9OTU000055 Amd 9 93.069 333.93.06 07/01/25 06/30/26 07/01/25 06/30/26 $14,857 S34.384 48,138
FFY25 PHEP BP2-CDC-LHJ Partners NU9OTU000055 Amd 7 93.069 333.93.06 07/01/25 06/30/26 07/01/25 06/30/26 $19,527
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 S13,754
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 S16,333 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'=! S32,556 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 1md 9 93.217 333.93.21 04/01/25 03/31/26 04/01/25 03/31/26'i'i S21.049 38.072 555.038
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
FFY24 FPHPA Title X Family Plan FPI-1PA006560 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 1 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 NU5OCK000515 Amd 1,7 93.323 333.93.32 01/01/25 12/31/25 01/15/21 07/31/26 $15,580 15,580 15,580
FFY19 ELC ED Immunizations CDC NU50CK000515 Auld 9 93.323 333.93.32 07/01/25 06/30/26 07/01/25 07/30/26 $10,000 10.000 10,000
FFY21 CDC COVID-19 PHWFD-LHJ NU901P922181 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
PH Infrastructure Comp Al-LHJ NE110E000053 Amd 9 93.967 333.93.96 01/01/25 11/30/27 12/01/22 11/30/27 S200,000 S350.300 S350,300
PH Infrastructure Comp Al-LHJ NE11OE000053 Amd 3 93.967 333.93.96 01/01/25 11/30/27 12/01/22 11/30/27 $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 S27,525 27,525
Page 1 of 3
EXHIBIT B-9
Page 3 of 50
Jefferson County Public Health ALLOCATIONS Contract Number: CLH32053
Contract Term:2025-2027 Date: October 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
hart of Accounts Program Title Identification# Amend#List#* Code** Start Date End Date Start Date End Date Amount SubTotal Total
FFY25 MCHBG Special Pr HRSA 2 B04MC54583 Amd 9 93.994 333.93.99 10/01/25 09/30/26 10/01/25 09/30/26 3,376 3,376 3,376
FFY26 MCHBG LHJ Contracts HRSA YRI NGA Not Received Amd 9 93.994 333.93.99 10/01/25 09/30/26 10/01/25 09/30/26 ($36,700) 0 0
FFY26 MCHBG LHJ Contracts HRSA YRI NGA Not Received Amd 7 93.994 333.93.99 10/01/25 09/30/26 10/01/25 09/30/26 $36,700
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
SFY26 Sch Based Hlth Cent 1225 Proviso Amd 7 N/A 334.04.90 07/01/25 06/30/26 07/01/25 06/30/26 $140,000 140,000 140,000
SFY25 DUHNaloxone 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 1 N/A 334.04.91 01/01/25 06/30/25 07/01/24 06/30/25 $40,250 40,250
SFY26 Sexual&Rep Hlth Cost Share Amd 9 N/A 334.04.91 01/01/26 06/30/26 07/01/25 06/30/26 $41,664 41,664 137,061
SFY26 Sexual&Rep Hlth Cost Share Amd 7 N/A 334.04.91 07/01/25 12/31/25 07/01/25 06/30/26 $47,404 47,404
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
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
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 8 N/A 334.04.93 07/01/26 06/30/27 07/01/25 06/30/27 6,571 6,571 68,200
Small Onsite Management(ALEA) Amd 8 N/A 334.04.93 07/01/25 06/30/26 07/01/25 06/30/27 $36,611 36,611
Small Onsite Management(ALEA) Amd 8 N/A 334.04.93 01/01/25 06/30/25 07/01/23 06/30/25 8,763)25,018
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
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
SFY27 Wastewater Management-GFS Amd 8 N/A 334.04.93 07/01/26 06/30/27 07/01/26 06/30/27 $31,822 31,822 49,824
SFY25 Wastewater Management-GFS Amd 8 N/A 334.04.93 01/01/25 06/30/25 07/01/24 06/30/25 8,763 18,002
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)
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
SFY26 FPIIS-LHJ Funds-GFS Anal 9 N/A 336.04.25 07/01/25 06/30/26 07/01/25 06/30/26 ($75,000) $2,128,000 4,461,000
SFY26 FPHS-LHJ Funds-GFS Amd 7 N/A 336.04.25 07/01/25 06/30/26 07/01/25 06/30/26 $2,203,000
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
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
Page 2 of 3
EXHIBIT B-9
Page 4 of 50
Jefferson County Public Health ALLOCATIONS Contract Number: CL1132053
Contract Term:2025-2027 Date: October 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 LIIJ 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
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 I N/A 346.26.64 01/0l/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
YRl 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 06/30/24 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 6,000,696 $6,000,696
Total consideration: S5,807,609 GRAND TOTAL 6,000,696
193,087
GRAND TOTAL 6,000,696 Total Fed 870,061
Total State 5,130,635
Assistance Listing Number fka Catalog of Federal Domestic Assistance
Federal revenue codes begin with"333". State revenue codes begin with"334".
Page 3 of 3
Page 5 of 50
Exhibit A
Statement of Work
Contract Term: 2025-2027
DO El Program Name or Title: Foundational Public Health Services- Local Health Jurisdiction Name: Jefferson County Public Health
Effective July 1,2025
Contract Number: CLH32053
SOW Type: Revision Revision#(for this SOW) 1 Funding Source Federal Compliance Type of Payment
El Federal<Select One> (check if applicable) Reimbursement
Period of Performance: July 1,2025 through June 30,2026
State El FFATA(Transparency Act) ®Periodic Distribution
El Other El Research&Development
Statement of Work Purpose: Per RCW 43.70.512,Foundational Public Health Services(FPHS)funds are for the governmental public health system:local health jurisdictions,
Department of Health,state Board of Health,sovereign tribal nations and Indian health programs. These funds are to build the system's capacity and increase the availability of
FPHS services statewide.
Revision Purpose: Correct allocation,remove task 11,add task 12 and edit language in EPH Core Teams section.
Master Assistance BARS Allocation
LHJ Funding Period ChangeIndexListingRevenueCurrentTotal
DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation Decrease(—) Allocation
SFY26 FPHS-LHJ FUNDS-GFS 99210860 N/A 336.04.25 07/01/25 06/30/26 2,203,000 75,000 2,128,000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 2,203,000 75,000 2,128,000
Task Payment
Activity Deliverables/Outcomes Due Date/Time Frame Information and/or
Amount
FPHS funds to each LHJ—See below in Program Specific Requirements See below in Program Specific
See below in Program
I
Activity Special Instructions for details Requirements-Deliverables
Specific Requirements- $520.000
Deliverables
Assessment Reinforcing Capacity—See below in Program Specific See below in Program Specific
See below in Program
2 Specific Requirements- $60.000Requirements—Activity Special Instructions for details Requirements-Deliverables
Deliverables
Assessment—CHA/CHIP—See below in Program Specific Requirements See below in Program Specific
See below in Program
3 Specific Requirements- $30,000ActivitySpecialInstructionsfordetailsRequirements-Deliverables
Deliverables
Lifecourse-NEW SFY 24 Full Lifecourse Workforce Capacity—See See below in Program
See below in Program Specific
4 below in Program Specific Requirements—Activity Special Instructions for
Requirements-Deliverables
Specific Requirements- $353,000
details Deliverables
Exhibit A,Statement of Work Page 1 of 7 Contract Number CLH32053-Amendment 9
Page 6 of 50
Task Payment
Activity Deliverables/Outcomes Due Date/Time Frame Information and/or
Amount
CD-NEW SFY 24 Immunization Outreach,Education& Response— See below in Program
See below in Program Specific
5 See below in Program Specific Requirements—Activity Special
Requirements-Deliverables
Specific Requirements- $75,000
Instructions for details Deliverables
EPH -NEW SFY 24 Fully fund Environmental Public Health Policy& See below in Program
See below in Program Specific
6 Leadership Capacity—See below in Program Specific Requirements—Specific Requirements- $150,000
Activity Special Instructions for details
Requirements-Deliverables
Deliverables
FC-NEW SFY 24 Strengthening Local Finance Capacity—See below See below in Program Specific
See below in Program
7
in Program Specific Requirements—Activity Special Instructions for details Requirements-Deliverables
Specific Requirements- $62,000
Deliverables
FC-NEW SFY 24 Public Health Communications—See below in See below in Program Specific
See below in Program
8
Program Specific Requirements—Activity Special Instructions for details Requirements-Deliverables
Specific Requirements- $200,000
Deliverables
Lifecourse-NEW SFY 24 Illicit Substance Use and Overdose Response
See below in Program Specific
See below in Program
9 —See below in Program Specific Requirements—Activity Special
Requirements-Deliverables
Specific Requirements- $150.000
Instructions for details Deliverables
EPR-NEW SFY 24 Emergency Preparedness& Response—Capacity See below in Program
10 and Capability—See below in Program Specific Requirements—Activity
See below in Program Specific
Specific Requirements- $178.000
Special Instructions for details
Requirements-Deliverables
Deliverables
I-1 (4ssessrrteflt/ eillr.+tee C I-1 r P) See, ...: o_ .. c i fi c 150,000
Requirements 1ctiv itv Special Instructions for details Deliverables
EPH-NEW SFY 24 Social Work Support—See below in Program See below in Program Specific
See below in Program
11
Specific Requirements—Activity Special Instructions for details Requirements-Deliverables
Specific Requirements- $85,000
Deliverables
Assessment—Localized Epidemiology Capacity—General—See below in See below in Program Specific
See below in Program
12 Specific Requirements- $75,000ProQrarnSpecificRequirements—:!ctivity Special Instructions/or details Requirements-Deliverables
Deliverables
EPH Core Team—Safe and Healthy Communities—See below in See below in Program Specific
See below in Program
13
Program Specific Requirements—Activity Special Instructions for details Requirements-Deliverables
Specific Requirements 47,000
Deliverables
EPH Core Team—Climate Change Response—See below in Program See below in Program Specific
See below in Program
I4
Specific Requirements—Activity Special Instructions for details Requirements-Deliverables
Specific Requirements- $80,000
Deliverables
EPH Core Team—System-Wide Data Management Improvement_—See See below in Program
15 below in Program Specific Requirements—Activity Special Instructions for
See below in Program Specific
Specific Requirements- $63.000
details
Requirements-Deliverables
Deliverables
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 tin,uuc a doh.wa.gov.
FPHS staff from DOH and the Washington State Association of Local Public Health Officials(WSALPHO)will coordinate and communicate together to build and assure common
systemwide approaches per FPHS Steering Committee direction and the FPHS framework intent.
Exhibit A,Statement of Work Page 2 of 7 Contract Number CLH32053-Amendment 9
Page 7 of 50
For LHJ questions about the use of funds:
o Chris Goodwin,FPHS Policy Advisor,WSALPHO—cgoodwinna,wsac.org, 564-200-3166
o Brianna Steere,FPHS Policy Advisor,WSALPHO—bsteere a,wsac.org,564-200-3171
The intent of FPHS funding is outlined in RCW 43.70.512.
Foundational Public Health Services Definitions and related information can be found here: www.doh.wa.gov/fphs.
Stable funding and an iterative decision-making process—The FPHS Steering Committee's roles and responsibilities are outlined in the FPHS Committee&Workgroup
Charter The Steering Committee is the decision making body for FPHS and operates under a consensus-based decision making model,outlined here.The Steering Committee use
an iterative approach to decision making meaning additional tasks and/or funds may be added to a local health jurisdiction's(LHJ)FPHS Statement of Work(SOW)as funding
decisions are made.
Spending of FPHS funds—FPHS funds do not require pre-approval or pre-authorization to spend. FPHS funds are to assure FPHS services are available in each jurisdiction based
on the FPHS Definitions(link)and as reflected in the SOW.Assurance includes providing FPHS as part of your jurisdiction's program operations,contracting with another
governmental public health system partner to provide the service,or receiving the service through a new service delivery model such as crossjurisdictional sharing or regional
staff.FPHS funds are eligible starting at the beginning of each state fiscal year(July 1)regardless of when funds are received by the LHJ,even if the expenditure
occurred before the LHJ's contract was signed.
These funds are not intended for fee-based services such as select environmental public health services.As state funding for FPHS increases,other funds sources(local revenue,
grants, federal block grants)should be directed to the implementation of additional important services and local/state priorities as determined by each agency/jurisdiction.
Annual Allocations—The legislature appropriates FPHS funding on an annual basis and the FPHS Steering Committee allocates funds annually through the FPHS Concurrence
Process for the State Fiscal Year(SFY):July-June.
The Legislature appropriates FPHS funding amounts for each fiscal year of the biennium. This means that funds must be spent within that fiscal year and cannot be carried
forward. Any funds not spent by June 30"'each year must be returned to the State Treasury. Funding allocations reset and begin again at the start of the next fiscal year(July 1).
This Statement of Work is for the period of July 1,2025-June 30,2026 and may be included in multiple Consolidated Contracts(ConCons)which are based on the calendar year
and renewed every three years.
Disbursement of FPHS funds to LHJs—Unlike other ConCon grants,FPHS bill-back to DOH is NOT required. Half of the annual FPHS funds allocated by the Steering
Committee to each LHJ are disbursed each July and January. The July payments to LHJs and access to FPHS allocation for all other parts of the governmental public health
system occur upon completion of the FPHS Annual Assessment.
Deliverables—FPHS funds are to be used to assure FPHS services statewide. The FPHS accountability process measures how funds are spent,along with changes in system
capacity through the FPHS Annual Assessment,system performance indicators,and other data. DOH,SBOH and local health jurisdictions have agreed to complete:
1. Reporting of spending and spending projections. Process timelines and reporting template are provided by the FPHS Steering Committee via FPHS Support Staff.
2. FPHS Annual Assessment is due each July to report on the previous state fiscal year.Process and reporting template are provided by the FPHS Steering Committee via
FPHS Support Staff. System results are published in the annual FPHS Investment Report available at www.doh.wa.gov/fphs.
BARS Revenue Code:336.04.25
Exhibit A, Statement of Work Page 3 of 7 Contract Number CLH32053-Amendment 9
Page 8 of 50
BARS Expenditure Coding—provided for your reference
562.xx BARS Expenditure Codes for FPHS activities:see below
10 FPHS Epidemiology&Surveillance
11 FPHS Community Health Assessment
12 FPHS Emergency Preparedness&Response
13 FPHS Communication
14 FPHS Policy Development
15 FPHS Community Partnership Development
16 FPHS Business Competencies
17 FPHS Technology
20 FPHS CD Data&Planning
21 FPHS Promote Immunizations
23 FPHS Disease Investigation—Tuberculosis(TB)
24 FPHS Disease Investigation—Hepatitis C
25 FPHS Disease Investigation—Syphilis,Gonorrhea&HIV
26 FPHS Disease Investigation—STD(other)
27 FPHS Disease Investigation—VPD
28 FPHS Disease Investigation—Enteric
29 FPHS Disease Investigation—General CD
40 FPHS EPH Data&Planning
41 FPHS Food
42 FPHS Recreational Water
43 FPHS Drinking Water Quality
44 FPHS On-site Wastewater
45 FPHS Solid&Hazardous Waste
46 FPHS Schools
47 FPHS Temporary Worker Housing
48 FPHS Transient Accommodations
49 FPHS Smoking in Public Places
50 FPHS Other EPH Outbreak Investigations
51 FPHS Zoonotics(includes vectors)
52 FPHS Radiation
53 FPHS Land Use Planning
60 FPHS MCH Data&Planning
70 FPHS Chronic Disease,Injury&Violence Prevention Data&Planning
80 FPHS Access/Linkage with Medical,Oral and Behavioral Health Care Services Data&Planning
90 FPHS Vital Records
91 FPHS Laboratory—Centralized(PHSKC Only)
92 FPHS Laboratory
Special References(i.e.,RCWs,WACs,etc.):
FPHS Intent-RCW 43.70.512
FPHS Funding—RCW 43.70.515
FPHS Committee&Workgroup Charter
Exhibit A,Statement of Work Page 4 of 7 Contract Number CLH32053-Amendment 9
Page 9 of 50
FPHS Steering Committee Consensus Decision Making Model
Activity Special Instructions:
Investments to Each LHJ:
1. FPHS Funds to Each LHJ
These funds are allocated to be used to provide any programs and services within all of the FPHS Definitions.Each LHJ is empowered to prioritize where and how to use
these funds to maximize equitable,effective and efficient delivery of FPHS to every community in Washington.
Use BARS expenditure codes from the list above that most closely align with expenditure made.
Targeted Investments to Each LHJ:
2. Assessment Reinforcing Capacity(FPHS definition G.2)
Support LHJ assessment capacity with flexible funds to meet locally identified needs.BARS expenditure codes: 562.10 or 11
3. Assessment—CHA/CHIP(FPHS definitions G.3)
Support any CHA/CHIP activity or service(e.g.,data analysis,focus groups,report writing,process facilitation)and may be used to contract with other agencies for staff
time or services. Use BARS expenditure codes:562.11
4. Lifecourse-NEW SFY 24 Full Lifecourse Workforce Capacity(FPHS definitions D,E,F)
Infrastructure and workforce investments to each LHJ to meet fundamental needs in three areas:Maternal/Child/Family Health; Access/Linkage with Medical,Oral and
Behavioral Health Services;and Chronic Disease,Injury and Violence Prevention. Use BARS expenditure codes:562.60,562.70,and/or 562.80
5. CD-NEW SFY 24 Immunization Outreach,Education& Response(FPHS definition C.3)
Promote immunization education and use of the statewide immunization registry through evidence-based strategies.Funding can also be used to support vaccine-
preventable disease response.BARS expenditure codes:562.21 and/or 562.27
6. EPH-NEW SFY 24 Fully fund Environmental Public Health Policy& Leadership Capacity(FPHS definitions B.2,A.C,J.1-3,K.1-2,L.1)
These funds are to be used for staffing costs for environmental health responsibilities and functions(that are not directly fee-based)within leadership,policy development,
foundational public health services implementation,evaluation,or administration,including(but not limited to)Environmental Health Directors.Examples of funded
roles include work relating to general policy,statewide and/or system-wide,and/or cross-jurisdictional work,legislation,and rulemaking, SBOH engagement,leadership
support and/or development,workforce development,leadership within health equity,climate,and environmental justice.Use BARS expenditure codes: 562.14,562.40—
562.53
7. FC-NEW SFY 24 Strengthening Local Finance Capacity(FPHS definitions L.2-4,L.6,L.8)
Capacity and infrastructure to assure fiscal management and contract and procurement policies and procedures are effectively implemented to support programs and
services.Use BARS expenditure codes:562.16
8. FC-NEW SFY 24 Public Health Communications(FPHS definitions 1.1-2)
Capacity to enhance the frequency,accuracy,and accessibility of public health communications to diverse populations via various media to support programs and
services.Use BARS expenditure codes: 562.13
Exhibit A, Statement of Work Page 5 of 7 Contract Number CLH32053-Amendment 9
Page 10 of 50
9. Lifecourse-NEW SFY 24 Illicit Substance Use and Overdose Response(FPHS definitions D.1-2,D.4,F.1-3,G.1-3,I.1-2,J.1-J.3,K.1-2)
Capacity and infrastructure related to addressing overdose crisis.This includes but is not limited to:Overdose response trainings,convening stakeholders or coordination
groups,data analysis,and community education.Use BARS expenditure codes: 562.13, 562.14,562.15,562.60,562.70,562.80
10. EPR-NEW SFY 24 Emergency Preparedness& Response—Capacity and Capability(FPHS definitions H. 1-4)
Capacity and infrastructure to support and enhance the local delivery of FPHS Emergency Preparedness and Response services and activities across critical subject matter
areas.Use BARS expenditure codes: 562.12
Increase assessment and epidemiology capacity via regional/shared epidemiologist model to meet locally identified needs. Use BARS expenditure codes: 562.10 or 11
Targeted Investments to Select LHJs—Assuring FPHS Available in Own Jurisdiction
12. EPH-NEW SFY 24 Social Work Support(FPHS definitions B.1-3,B.6-7, D.1,D.2,D.4.E.2,E.4,F.2-3,J.1-2,K.1-2,L.3,L.5)
This investment is intended to support non-traditional responses to environmental health complaints and challenges in the context of social work support and care
coordination with social service providers.Activities include:assessment of complaints and challenges;identifying cases and circumstances for engaging in social work
support and care coordination;and engagement with social service providers.Funds may be used to support these activities,as well as related staffing and training
expenses.Use BARS expenditure codes:562.14,562.15,562.40,562.47,562.48
13. Assessment—Localized Epidemiology Capacity—General(Assessment/Surveillance,CHA/CHIP)(FPHS definitions G.1,2)
Provide general assessment epidemiology focused on local public health assessment needs. Use BARS expenditure codes: 562.10 or 11
1-1211
approaches specific to each sub topic area.
Recipients of these Core Team FPHS funds are required to participate in the associated Cere Team for each investment. Recipients may spend these funds towards
c
investment is distinctive from all other Core Team FPHS investments.
Core Teams exist outside the FPHS structure,in partnership between LHJs and WA DOH.with one co lead from each. Model programs developed through Core Team
r
There arc currently six EPH Core Teams.They arc listed below,with their sub topic area(s),as applicable.
System Wide Data Management Improvement
Climate Change Response
Lead Exposure
Water System Capacity
Homelessness Response
Safe&Healthy Communities
Exhibit A,Statement of Work Page 6 of 7 Contract Number CLH32053-Amendment 9
Page 11 of 50
EPH--Core Teams(Applies to all EPH Core Team FPHS Investments)(FPHS definition B.1-7)
Each EPH Core Team investment is for LHJ staff to participate in a cross jurisdictional topic-specific Core Team.The Core Teams are each tasked with developing one or
more model program(s),intended to offer guidance for scalable environmental public health responses relating to their specific sub-topic area(s). Where it makes sense to
do so,the Core Teams may also work on implementation of these model programs.The content and output of these model programs will vary depending on the needs and
approaches specific to each sub-topic area.
Recipients of these Core Team FPHS funds are required to participate in the associated Core Team for each investment.Recipients may spend these funds towards
staffing time necessary to participate and on FPHS-qualifying activities for the specific sub-topic area(s)attached to its associated investment.Each Core Team FPHS
investment is distinctive from all other Core Team FPHS investments.
Core Teams exist outside the FPHS structure,in partnership between LHJs and WA DOH,with one co-lead from each.Model programs developed through Core Team
work will be made available to all Washington public health agencies.
There are currently sip four EPH Core Teams.They are listed below,with their sub-topic area(s),as applicable.
System-Wide Data Management Improvement
Climate-Change Response
Lead Exposure
Water System Capacity
Safe&Healthy Communities
Jefferson is receiving funds to participate in these EPH Core Teams:
14. EPH Core Team—Safe& Healthy Communities
This Core Team develops system capacity to advance EPH perspectives into planning processes such as State Environmental Policy Act(SEPA)work,Health Impact
Assessments,Comprehensive Plans,and related environmental review opportunities.The Core Team will develop one or more model program(s)to provide scalable
approaches to healthy community planning,which may include wastewater planning and treatment,seawater intrusion in drinking water,ventilation in public buildings,
PFAS contamination,climate change challenges,and other emerging topics identified by the Core Team.
Use BARS expenditure code:562.40
15. EPH Core Team—Climate-Change Response
This Core Team will address environmental health concerns related to climate and the effects of climate change.
Model program development will start with Wildfire Smoke and Harmful Algal Blooms,and may include other priorities and topics.
16. EPH Core Team—System-Wide Data Management Improvement
This Core Team will identify and employ a strategy for data sharing,storage and consistency across the state.
Use BARS expenditure code:562.40.
Exhibit A,Statement of Work Page 7 of 7 Contract Number CLH32053-Amendment 9
Page 12 of 50
Exhibit A
Statement of Work
Contract Term: 2025-2027
DOH Program Name or Title: Maternal&Child Health Block Grant—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
0 Federal Subrecipient (check if applicable) Reimbursement
Period of Performance: January 1,2025 through September 30,2026
State El FFATA(Transparency Act) El Fixed Price
Other Research&Development
Statement of Work Purpose: The purpose of this statement of work(SOW)is to support local interventions that impact the target population of the Maternal and Child Health
Block Grant.
Revision Purpose: The purpose of this revision is to remove FFY26 MCHBG LHJ CONTRACTS HRSA YR1 funding as the Department of Health has not received the FFY26
funding,add FFY25 MCHBG SPECIAL PR HRSA 2 funds and change language in task 3f.
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
FFY25 HRSA MCHBG LHJ CONTRACTS 78101251 93.994 333.93.99 01/01/25 09/30/25 27,525 0 27,525
FFY26 MCHBG LHJ CONTRACTS HRSA YR1 78101261 93.994 333.93.99 10/01/25 09/30/26 36,700 36,700 0
FFY25 MCHBG SPECIAL PR HRSA 2 7810125A 93.994 333.93.99 10/01/25 09/30/26 0 3,376 3,376
0 0 0
0 0 0
0 0 0
TOTALS 64,225 33,324 30,901
Task
Activity Deliverables/Outcomes Due Date/Time Frame
Payment Information
and/or Amount
Maternal and Child Health Block Grant(MCHBG)Administration
la Report actual expenditures for the six-month period Submit actual expenditures using the MCHBG May 16,2025 Reimbursement for actual
from October 1,2024 through March 31,2025. Budget Workbook to DOH Community costs,not to exceed total
Consultant. funding consideration.
lb Develop 2025-2026 MCHBG Budget Workbook for Submit MCHBG Budget Workbook to DOH September 5,2025 Monthly Reports must only
October 1,2025 through September 30,2026 using Community Consultant. reflect activities paid for
DOH-provided template. with funds provided in this
lc Participate in DOH-sponsored annual MCHBG meeting. LHJ Contract Lead or designee will attend September 30,2025 statement of work for the
meeting. specified funding period.
Exhibit A, Statement of Work Page I of 5 Contract Number CLH32053-Amendment 9
Page 13 of 50
Task
Activity Deliverables/Outcomes Due Date/Time Frame
Payment Information
and/or Amount
Id Report actual expenditures for October 1,2024 through Submit actual expenditures using the MCHBG December 5,2025
September 30,2025. Budget Workbook to DOH Community See Program Specific
Consultant. Requirements and Special
1e Report actual expenditures for the six-month period Submit actual expenditures using the MCHBG May 15,2026 Billing Requirements.
from October 1,2025 through March 31,2026. Budget Workbook to DOH Community
Consultant.
1 f Report annual FTE billed to MCHBG. Submit FTE information on DOH-provided July 1,2026
template.
lg Develop 2026-2027 MCHBG Budget Workbook for Submit MCHBG Budget Workbook to DOH September 4,2026
October 1,2026 through September 30,2027 using Community Consultant.
DOH-provided template.
lh Participate in DOH-sponsored MCHBG fall regional LHJ Contract Lead or designee will attend September 30,2026
meeting. regional meeting.
Implementation
2a Report 2024-25 MCHBG-funded activities and Submit monthly reports to DOH Community January 15,2025 Reimbursement for actual
outcomes using DOH-provided reporting template.As a Consultant.Describe in your updates within February 15,2025 costs,not to exceed total
foundation of your MCHBG work determine how each activity of the monthly report how you March 15,2025 funding consideration.
processes and programs can close gaps in health are intentionally focused on closing gaps in April 15,2025 Monthly Reports must only
outcomes. health outcomes. May 15,2025 reflect activities paid for
June 15,2025 with funds provided in this
July 15,2025 statement of work for the
August 15,2025 specified funding period.
September 15,2025
2b Develop 2025-26 MCHBG reporting document for Submit MCHBG reporting document to DOH Draft-August 15,2025 See Program Specific
October 1,2025 through September 30,2026 using Community Consultant. Final-September 12,2025 Requirements and Special
DOH-provided template. Billing Requirements.
2c Report 2025-26 MCHBG-funded activities and Submit monthly reports to DOH Community September report due
outcomes using DOH-provided reporting template.As a Consultant.Describe in your updates within October 15,2025
foundation of your MCHBG work determine how each activity of the monthly report how you November 15,2025
processes and programs can close gaps in health are intentionally focused on closing gaps in December 15,2025
outcomes. health outcomes. January 15,2026
February 15,2026
March 15,2026
April 15,2026
May 15,2026
June 15,2026
July 15,2026
August 15,2026
September 15,2026
Exhibit A, Statement of Work Page 2 of 5 Contract Number CLH32053-Amendment 9
Page 14 of 50
Task
Activity Deliverables/Outcomes Due Date/Time Frame
Payment Information
and/or Amount
2d Develop 2026-27 MCHBG Monthly Reporting Submit MCHBG reporting document to DOH Draft—August 14,2026
Template for October 1,2026 through September 30, Community Consultant. Final—September 11,2026
2027 using DOH-provided template.
Children and Youth with Special Health Care Needs(CYSHCN)
3a Complete intake and renewal,per reporting guidance Submit data to DOH per CYSHCN Program January 15,2025 Reimbursement for actual
supplied by DOH,on all infants and children served by guidance. April 15,2025 costs,not to exceed total
the CYSHCN Program as referenced in CYSHCN July 15,2025 funding consideration.
Program guidance.If no CYSHCN care coordination Monthly Reports must only
enabling service)is provided in a given quarter,email reflect activities paid for
the CHIF administrator at DOH-CHIFa,doh.wa.gov and with funds provided in this
indicate that zero clients were served during the quarter. statement of work for the
No spreadsheet is necessary when zero clients are specified funding period.
served.
3b Identify unmet needs for CYSHCN on Medicaid and Submit completed Health Services 30 days after forms are See Program Specific
refer to DOH CYSHCN Program for approval to access Authorization forms and Central Treatment completed. Requirements and Special
Diagnostic and Treatment funds as needed. Fund requests directly to the CYSHCN Through September 30,Billing Requirements.
Program as needed.2025
3c Review your program's entry on ParentHelpl23.org Document in the Administrative box on your September 30,2025
annually for accuracy. MCHBG report that you have updated
information on your local CYSHCN program
with WithinReach/Help Me Grow.
3d Support improvements to the local system of care Submit updates as part of monthly reporting January 15,2025
public health services and systems/policy,systems,and document. February 15,2025
environment)for CYSHCN.Refer to the Focus of Work March 15,2025
document for example activities and priority areas. April 15,2025
May 15,2025
June 15,2025
July 15,2025
August 15,2025
September 15,2025
3e Complete intake and renewal,per reporting guidance Submit data to DOH per CYSHCN Program October 15,2025
supplied by DOH,on all infants and children served by guidance. January 15,2026
the CYSHCN Program as referenced in CYSHCN April 15,2026
Program guidance.If no CYSHCN care coordination July 15,2026
enabling service)is provided in a given quarter,email
the CHIF administrator at DOH-CHIFC doh.wa.gov and
indicate that zero clients were served during the quarter.
No spreadsheet is necessary when zero clients are
served.
Exhibit A,Statement of Work Page 3 of 5 Contract Number CLH32053-Amendment 9
Page 15 of 50
Task
Activity Deliverables/Outcomes Due Date/Time Frame
Payment Information
and/or Amount
3f Review your program's entry on ParentHelpl 2 or_Document in the Administrative box on your September 30,2026
Ile/p Ale Grow's ParentHelp123 Resource l inder MCHBG report that you have updated
annually for accuracy. information on your local CYSHCN program
with WithinReach/Help Me Grow.
3g Support improvements to the local system of care Submit updates as part of monthly reporting September report due
public health services and systems/policy,systems,and document. October 15,2025
environment)for CYSHCN.Refer to the Focus of Work
document for example activities and priority areas. November 15,2025
December 15,2025
January 15,2026
February 15,2026
March 15,2026
April 15,2026
May 15,2026
June 15,2026
July 15,2026
August 15,2026
September 15,2026
MCHBG Assessment and Evaluation
4a As part of the ongoing 5-year MCHBG Needs Submit documentation as requested by DOH. September 30,2025 Reimbursement for actual
Assessment,participate in activities developed and costs,not to exceed total
coordinated by DOH using DOH-provided reporting funding consideration.
template. Monthly Reports must only
4b Provide summary of outcomes of MCHBG-funded work Submit documentation as requested by DOH. November 21,2025 reflect activities paid for
completed from October 1,2024 through September 30, with funds provided in this
2025 using DOH-provided reporting template. statement of work for the
4c As part of the ongoing 5-year MCHBG Needs Submit documentation as requested by DOH. September 30,2026 specified funding period.
Assessment,participate in activities developed and
coordinated by DOH using DOH-provided reporting See Program Specific
template. Requirements and Special
Billing 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(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.
Exhibit A,Statement of Work Page 4 of 5 Contract Number CLH32053-Amendment 9
Page 16 of 50
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:
All training costs and all travel expenses for such training(for example:per diem,hotel,registration fees)must be pre-approved,unless identified in pre-approved Budget
Workbook.Submit a paragraph to your Community Consultant explaining why the training is necessary to implement a strategy in the approved work plan. Details should also
include total cost of the training and a link to or brochure of the training.Retain a copy of the Community Consultant's approval in your records.
Program Manual,Handbook,Policy References:
CYSHCN Information and Resources:
Children and Youth with Special Health Care Needs Website(wa.gov)
Restrictions on Funds(i.e.,disallowed expenses or activities,indirect costs,etc.):
1. At least 30%of federal Title V funds must be used for preventive and primary care services for children and at least 30%must be used for services for children with
special health care needs. [Social Security Law,Sec.505(a)(3)].
2. Funds may not be used for:
a. Inpatient services,other than inpatient services for children with special health care needs or high-risk pregnant women and infants,and other patient services approved by
Health Resources and Services Administration(HRSA).
b. Cash payments to intended recipients of health services.
c. The purchase or improvement of land,the purchase,construction,or permanent improvement of any building or other facility, or the purchase of major medical
equipment.
d. Meeting other federal matching funds requirements.
e. Providing funds for research or training to any entity other than a public or nonprofit private entity.
f. Payment for any services furnished by a provider or entity who has been excluded under Title XVIII(Medicare),Title XIX(Medicaid),or Title XX(social services block
grant).[Social Security Law,Sec 504(b)].
3. If any charges are imposed for the provision of health services using Title V(MCH Block Grant)funds,such charges will be pursuant to a public schedule of charges;will not
be imposed with respect to services provided to low-income mothers or children;and will be adjusted to reflect the income,resources,and family size of the individual
provided the services. [Social Security Law,Sec.505(1)(D)].
Monitoring Visits(i.e.,frequency,type,etc.):
Check-ins with DOH Community Consultant as needed.
Billing Requirements:
Payment is contingent upon DOH receipt and approval of all deliverables and an acceptable A19-IA invoice voucher.Payment to completely expend the"Total Consideration"for
a specific funding period will not be processed until all deliverables are accepted and approved by DOH. Invoices must be submitted monthly by the 30th of each month following
the month in which the expenditures were incurred and must be based on actual allowable program costs.Billing for services on a monthly fraction of the"Total Consideration"
will not be accepted or approved.
Special Instructions:
Contact DOH Community Consultant for approval of expenses not reflected in pre-approved Budget Workbook.
Exhibit A, Statement of Work Page 5 of 5 Contract Number CLH32053-Amendment 9
Page 17 of 50
Exhibit A
Statement of Work
Contract Term: 2025-2027
D011 Program Name or Title: Office of Immunizations—ELC-Effective July 1,2025 Local Health Jurisdiction Name: Jefferson County Public Health
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
El 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 conduct activities related to health education and promotion of COVID-19,
long COVID and other vaccine-preventable diseases for at-risk populations,including strengthening bi-directional relationships with health care providers and increasing access to
care.
Revision Purpose: N/A
Master Assistance BARS Allocation
LHJ Funding Period ChangeIndexListingRevenueCurrentg Total
DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation Increase(+) Allocation
FFY19 ELC ED IMMUNIZATIONS CDC 7431025E 93.323 333.93.32 07/01/25 06/30/26 0 10,000 10,000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 0 10,000 10,000
Task Payment
Activity Deliverables/Outcomes Due Date/Time Frame Information and/or
Amount
1. Implement communication,health education and other strategies or Written report describing Within 30 days of execution Reimbursement for
other activities,working with health care providers,community- activity/activities expected to be of contract amendment. actual costs incurred,
based organizations or other partners to reach the locally identified implemented on provided document. not to exceed total
population. funding consideration
Implementation plan of activities to be Within 30 days of execution amount.
conducted as part of activity on DOH of contract amendment.
provided document.
Forecast of expected spending of funds Within 30 days of execution
through remainder period of of contract amendment.
performance(June 2025)on provided
document.
Exhibit A, Statement of Work Page 1 of 3 Contract Number CLH32053-Amendment 9
Page 18 of 50
Task
Payment
Activity Deliverables/Outcomes Due Date/Time Frame Information and/or
Amount
2. Catalog activities and conduct an evaluation of the strategies used Written report,showing the strategies June 30,2026
to increase access to services. used and the final progress of the reach
template to be provided)
3. Co-sponsor one mobile health event with Care-a-Van in their Plan to incorporate to be added to June 30,2026
jurisdiction including planning,outreach,and logistics to reach the implementation plan.
locally identified population.
Written report describing the mobile
health event including date,location,
services offered,partners,and number of
attendees.
4. Provide culturally and linguistically appropriate information about Written report describing outreach and June 30,2026
vaccine-preventable diseases and Long COVID to reach locally education strategies.
identified populations.
Copies of any developed materials.
5. Other activities to consider,with support provided by DOH: Written report,showing the strategies June 30,2026
used and the final progress of the reach
Consider adding activities that assess the need for Long (template to be provided)
COVID screening and treatment,distribute Long COVID
clinical education resources to providers in each
jurisdiction,and support linkages between social care and
clinical care.
Consider hosting Mental Health First Aid training for the
public health and health care workforce to increase skill
and response capability.
Contact Jennifer Robinson at:ienirobinson'2 wsu.edu
Website:https://w N1.1k.mentalhealthfirstaid.org/
Consider hosting a virtual or in-person training for health
care leaders to support the workforce and reduce burnout.
o Example:Leading in Healthcare:Contributing to
more health within the system
o Description:This workshop focuses on simple
and accessible best-practices for supervisors and
managers on leading through crisis and
developing healthy team/work group culture.
We will cover communication tactics and
strategies during times of adversity or high-
intensity,crisis recovery,and grief and loss.We
will focus on actionable steps that those in
leadership positions can take to improve the
wellness and functionality of their teams from a
behavioral health lens,and the specific strategies
used by highly successful teams during and after
recovery from adverse events.
Exhibit A,Statement of Work Page 2 of 3 Contract Number CLH32053-Amendment 9
Page 19 of 50
Task
Payment
Activity Deliverables/Outcomes Due Date/Time Frame Information and/or
Amount
Distribute and promote provider behavioral health and wellbeing
resources from DOH.
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 USASpending.gov by DOH as required by P.L. 109-282.
Program Specific Requirements
Invoicing:
Invoices must be submitted monthly to include the previous month's reimbursements/costs to DOH using a Contract A19-IA invoice voucher form and required back-up
documentation.Final invoices are due within 45 days of the end of the contract.
Unallowable Costs:
There are limitations from the funding source on allowable costs for this statement of work.If the LHJ is unsure if a cost is allowable,they should contact the DOH contract
manager for approval of the cost prior to making the purchase or charge.
Advertising costs(e.g.,conventions,displays,exhibits,meetings,memorabilia,gifts,souvenirs)
Alcoholic beverages
Building,purchases,construction,capital improvements
Clinical care(non-immunization services)
Entertainment costs
Fundraising Cost
Goods and services for personal use
Honoraria
Independent Research
Land acquisition
Legislative/lobbying activities
Interest on loans for the acquisition and/or modernization of an existing building
Payment of a bad debt,collection of improper payments
Promotional and/or incentive materials(e.g.plaques,clothing,and commemorative items such as pens,mugs/cups,folders/folios,lanyards,magnets,conference bags)
Purchase of food/meals(unless part of required travel per diem costs)
Vehicle Purchase
Vaccine Purchase
Exhibit A,Statement of Work Page 3 of 3 Contract Number CLH32053-Amendment 9
Page 20 of 50
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) 2 Funding Source Federal Compliance Type of Payment
El Federal Subrecipient (check if applicable) El Reimbursement
Period of Performance: January 1,2025 through November 30,2027
State FFATA(Transparency Act) Fixed Price
0 Other 0 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: Purpose of revision is to add second allocation of funding and update Task 2 and 3 due dates.
Master Assistance BARS Allocation
LHJ Funding Period ChangeIndexListingRevenueCurrentg Total
DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation Increase(+) Allocation
PH INFRASTRUCTURE COMP AI-LHJ 92321223 93.967 333.93.96 01/01/25 11/30/27 150,300 200,000 350,300
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 150,300 200,000 350,300
Task
Activity Deliverables/Outcomes Due Date/Time Frame
Payment Information
and/or Amount
I 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
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. DOH Program Contact 45 days of the close of the
Funding is intended to establish,expand,train,and sustain before using funds. month in which services
public health staff to support LHJ prevention,preparedness, were provided.
response,and recovery initiatives.These include the
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 9
Page 21 of 50
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 of 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. except for the,final year of
of public health services. Ultimately,these workforce the grant:
investments will support accelerated prevention, January 10,2026
preparedness,and response to emerging threats,and January 10.2027
improved other public health outcomes. January 10,202S
November 30, 2027
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$5,000 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 1,2022),as of the end of May 31,2026
the reporting period.
Exhibit A,Statement of Work Page 2 of 4 Contract Number CLH32053-Amendment 9
Page 22 of 50
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 except for the final
o Describe any data limitations, reporting period:
including reasons unable to report, • July 10,2025
and steps taken to obtain data January 10,2026
and/or improve data quality in the • July 10,2026
future.If you reported on these
January 10,2027
data using a definition that was
July 10,2027differentthanprovidedinCDC's •
January' 10,2028guidance,please describe.
o Provide any additional context or
November 3ii. '02'
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 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 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 eCFR::2 CFR Part 200--Uniform Administrative Requirements.Cost Principles,and Audit Requirements 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 9
Page 23 of 50
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)
Capital 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$5,000 or more.)
Disposition of equipment with a current value of$5,000 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 A l9 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 A19 with backup documentation appropriate for risk level.DOH will provide A19 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 9
Page 24 of 50
Exhibit A
Statement of Work
Contract Term: 2025-2027
DOH Program Name or Title: Office of Resiliency&Health Security-PHEP- Local Health Jurisdiction Name: Jefferson County Public Health
Effective July 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: 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 is to establish funding and tasks for LHJs to strengthen their capacity and capability around the Public
Health Response Readiness Framework(CDC)to prepare for,respond to,and recover from public health threats and emergencies through a continuous cycle of planning,
organizing,training,equipping,exercising,evaluating,and implementing corrective actions as described in the Public Health Emergency Preparedness(PHEP)Cooperative
Agreement.Many LHJs support a position responsible for public health emergency preparedness and response. LHJs use different titles for these positions.DOH wants to be
respectful of this diversity and refers to the people who fill these important roles as Public Health Emergency Response Coordinators.
This statement of work includes a partial allocation of PHEP funds because DOH has received a partial allocation from the CDC.DOH will add the remaining funds to the
statement of work when they are received.If they are not received,DOH will review the statement of work and adjust actvities as needed.
Guidance Documents-LHJs are strongly encouraged to use the Guidance Documents listed in the Program Specific Requirements in the bottom section of this Statement of Work.
Revision Purpose: The purpose of this revision is to add the remaining PHEP BP2 funds.
Master Assistance BARS Allocation
LHJ Funding Period ChangeIndexListingRevenueCurrentg Total
DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation Increase(+) Allocation
FFY25 PHEP BP2-CDC-LHJ PARTNERS 31602254 93.069 333.93.06 07/01/25 06/30/26 19,527 14,857 34,384
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 19,527 14,857 34,384
Task
Payment
Activity Deliverables/Outcomes Due Date/Time Frame Information and/or
Amount
1 Maintain accurate and up-to-date contact information.This includes Submit information by September 1, September 1,2025 Reimbursement for
names,position titles,email addresses,and phone numbers of key LHJ 2025,and any changes within 30 days of Within 30 days of the actual costs not to
staff responsible for this statement of work,including management, the change. change. exceed total funding
Emergency Response Coordinator(s),and accounting and/or financial allocation amount.
staff. Mid-and end-of-year reports on template December 31,2025
provided by DOH.Note any changes or June 30,2026
no changes.
Exhibit A,Statement of Work Page 1 of 10 Contract Number CLH32053-Amendment 9
Page 25 of 50
Task
Payment
Activity Deliverables/Outcomes Due Date/Time Frame Information and/or
Amount
2 As requested,submit additional information to DOH to comply with Information requested by DOH. Upon request from
federal grant requirements and/or DOH requirements. DOH.
3 Participate with DOH in a site visit(virtual or in person)to develop Participation in site visit. As requested by DOH.
stronger relationships,enhance collaboration,and promote a unified
approach to public health preparedness and response efforts. Preparation and follow-up activities as
requested by DOH.
4 Jurisdictional Risk Assessment
Implementing the preparedness cycle in any organization or jurisdiction is dependent on information about jurisdictional hazards.DOH is
providing every local health jurisdiction with access to the H2azaRDS tool that was developed by the University of Washington.This
Jurisdictional Risk Assessment(JRA)identifies,analyzes,and prioritizes potential public health and medical threats and hazards within the
jurisdiction.
4.1 Participate in the public health disaster risk assessment tool/report Participation in training. December 31,2025
H2azaRDs tool)training.This training will provide a foundational
understanding of the tool and the rollout of it. Mid-year reports on template provided by
DOH(note participation in training).
Note: LHJs will be notified at least 30 days in advance of the training
date.
4.2 Complete a jurisdictional risk assessment tool/report during the PHEP Risk Assessment December 31,2025
FFY24 BPI grant period or between July 1 and December 31,2025,to
inform the 2026 Integrated Preparedness Planning Workshop(IPPW).
OR
Participate in a jurisdictional risk assessment tool/report during the
PHEP FFY24 BPI grant period or between July 1 and December 31,
2025,to inform the 2026 IPPW.
The completed risk assessment report will include:
Documented risk profiles,capability gaps,and
recommendations to inform planning and resource allocation.
Preparedness strategies in alignment with local,state,and
federal emergency management frameworks.
A list of identified risks within the jurisdiction.
A prioritized ranking of the top five risks.
A summary of how these risks impact the most affected
populations.
Exhibit A,Statement of Work Page 2 of 10 Contract Number CLH32053-Amendment 9
Page 26 of 50
Task
Payment
Activity Deliverables/Outcomes Due Date/Time Frame Information and/or
Amount
5 Training
Maintaining baseline training competency is essential for a coordinated and effective public health emergency response.Ensuring staff complete
the appropriate Incident Command System(ICS)training enables them to operate within standardized response structures and communicate
effectively during emergencies.Requiring sub-awardees to verify completion through a DOH-approved training plan promotes accountability
and consistency across jurisdictions.
5.1 Ensure baseline NIMS compliant training competency is maintained as Mid-and end-of-year reports on December 31,2025
determined by the LHJ. templates provided by DOH,including June 30,2026
titles,dates,and sponsor of trainings.
PHEP funding may be used to support additional public health
emergency response trainings identified by the LHJ.
6 Exercising
Both state and local health departments follow the Homeland Security Exercise and Evaluation Program(HSEEP)principles.Assessing the
effectiveness of our emergency response plans and the training of those who might respond to the public health impacts of disasters,is a core
component of the preparedness cycle.The act of exercising combined with the learning as demonstrated by an After-Action Report(AAR)
drives future planning and training. It is DOH's responsibility to meet the exercise requirements under our CDC PHEP Cooperative Agreement.
DOH uses the Multi-Year Preparedness Activities Calendar(MYPAC)to demonstrate that sub-recipients of the PHEP funding are participating
in,or leading exercises.Local Jurisdictions and Tribes may use PHEP funding for any exercise that furthers their preparedness.
6.1 If DOH participation is requested,complete the WA DOH Exercise Exercise Notification Form As soon as the LHJ is
Notification Form prior to conducting an exercise that was not aware of the exercise
previously identified in the LHJ's MYPAC or led by DOH. date and details.
6.2 Conduct,or participate in,at least one emergency response exercise by Submit a Completed After-Action For AARs that the LHJ
June 30,2026. Report/Improvement Plan(AAR/IP) are responsible for,90
days after exercise
LHJs should coordinate preparedness exercises with local partners, completion.For others,
including Tribes,emergency management,healthcare facilities,and when the AAR is
first responder agencies.Participation in exercises hosted by other publicly available.
organizations within the jurisdiction or geographic region is also
strongly encouraged to support regional coordination and strengthen
multi-agency response capabilities.
Note:A real-world response would meet this deliverable.
7 Public Health Emergency Response Planning
A core component of every public health preparedness and response program is maintaining an up-to-date and complete emergency response
plan that describes how the jurisdiction will respond to the public health impacts of the most likely threats faced by the jurisdiction.
7.1 Update or develop LHJ identified sections of the Comprehensive Describe progress to date in the mid-year December 31,2025
Emergency Response Plan addressing gaps/needs identified from an report on template provided by DOH.June 30,2026
After Action Report from an exercise or a real world response
Exhibit A,Statement of Work Page 3 of 10 Contract Number CLH32053-Amendment 9
Page 27 of 50
Payment
I ask
Activity Deliverables/Outcomes Due Date/Time Frame Information and/or
Amount
Emergency Response Plan by June 30,
Align the Plan with National Incident Management System/Incident 2026.
Command System(NIMS/ICS)standards and coordinate with
community-based organizations,healthcare,and local emergency
response agencies.
8 Integrated Preparedness Planning
Washington values the strengths of a decentralized public health system while recognizing that PHEP resources are limited.The Integrated
Preparedness Planning(IPP)process is intended to promote inter jurisdictional efficiency by aligning planning,training,and exercise efforts
across the many public health jurisdictions in the state.
8.1 To inform IPPW,develop a Multi-Year Preparedness Activities MYPAC January 5,2026
Calendar(MYPAC).
Bring(or have available)your MYPAC January 13-14,2026
Use the following to inform development of your MYPAC:exercise to the IPPW(digital or on paper).
plans,emergency response plans,AAR/IPs,IPPs,and response Highlight activities that are new since
training plans. January 2025.
8.2 Participate in both days of DOH Integrated Preparedness Planning Participation in IPPW(DOH will be January 13-14,2026
Workshop(IPPW),with at least one representative(virtually or in looking at sign in documents).
person).
End-of-year report on template provided June 30,2026
The IPPW is scheduled for January 13-14,2026(location TBD). by DOH.
8.3 Develop or update a multi-year-integrated preparedness plan with Multiyear integrated preparedness plan June 30,2026
critical response and recovery partners using the whole community that is aligned with HSEEP principles,
approach. developed or updated between February 1
and June 30,2026(after the IPPW).
Use the information gathered in tasks 8.1.and 8.2 to inform the
development of this plan
9 Emergency Information Sharing
Effective emergency communication and notification are critical for ensuring a timely,coordinated response to public health incidents.
Immediate notification and accurate situation reporting enable rapid decision-making,resource deployment,and situational awareness at the
state,tribal,and local levels.Maintaining reliable communication systems and conducting regular drills help verify readiness,strengthen
coordination,and ensure that response protocols function as intended during real-world emergencies.
9.1 Notification Requirement:Notify the Washington State Department of Mid-and end-of-year reports on template December 31,2025
Health(DOH)Duty Officer at 360-888-0838 or via email at provided by DOH. June 30,2026
hanalerE doh.wa.gov for any incident that involves the activation of
emergency response plans and/or the implementation of an incident
command structure.
Exhibit A,Statement of Work Page 4 of 10 Contract Number CLH32053-Amendment 9
Page 28 of 50
Task
Payment
Activity Deliverables/Outcomes Due Date/Time Frame Information and/or
Amount
9.2 Situation Reporting:Develop situation reports(sitreps)documenting Mid-and end-of-year reports on template December 31,2025
jurisdictional activities during all response incidents that extend provided by DOH.Note whether June 30,2026
beyond two operational periods and require a written Incident Action Situation Reports were submitted,or
Plan. there was no need to submit them.
Situation reports may be prepared directly by the LHJ or by another
jurisdiction,provided they include input from the LHJ to ensure
accuracy and completeness.
Submit Situation Reports to DOH Duty Office(hanalert@doh.wa.gov)
during LHJ response as soon as they are available.
9.3 Maintain the Washington Secure Electronic Communications,Urgent Mid-and end-of-year reports on template December 31,2025
Response,and Exchange System(WASECURES)as the primary provided by DOH. June 30,2026
platform for emergency notifications.
Participate in DOH-led notification drills.
Notes:
Registered users must log in(or respond to an alert)quarterly
at a minimum.
DOH will provide technical assistance to LHJs on using
WASECURES.
LHJ may choose to use another notification system in
addition to WASECURES to alert staff during incidents.
9.4 Participate in quarterly WASECURES notification drills coordinated Mid-and end-of-year reports on template December 31,2025
by DOH to support statewide communication readiness. provided by DOH. June 30,2026
9.5 Conduct at least one Local Health Jurisdiction(LHJ)-led drill using the Submit results of the drill on the mid-OR December 31,2025 OR
jurisdiction's preferred staff notification system to ensure operational end-of-year reports on template provided June 30,2026
effectiveness. by DOH.
10 Medical Materiel and Volunteer Management
Effective medical materiel and volunteer management are essential for ensuring timely access to critical supplies and skilled personnel during
public health emergencies,enabling local health jurisdictions to respond quickly,coordinate resources efficiently,and maintain continuity of
operations under surge conditions.While LHJs are not expected to sustain these capabilities independently,they must have plans in place to
access and coordinate resources through local,mutual aid,and state systems when needed.
10.1 Maintain and update the LHJ's medical materiel management plan Mid-and end-of-year reports on template December 31,2025
components,operational guide,or process document by verifying that provided by DOH that describe progress June 30,2026
the local agency's preferred large parcel delivery sites are accurate and on this task.
operational and jointly confirmed with DOH,confirming that
Exhibit A,Statement of Work Page 5 of 10 Contract Number CLH32053-Amendment 9
Page 29 of 50
Task
Payment
Activity Deliverables/Outcomes Due Date/Time Frame Information and/or
Amount
inventory tracking systems work as intended,and ensuring the LHJ can Summary of medical materiel December 31,2025 OR
procure,store,manage,and distribute palletized and bulk medical management plan components, June 30,2026
supplies during a public health emergency when necessary.operational guide,or process document.
You may submit the whole plan,guide,
or document if you prefer.)
10.2 Develop process/procedure to integrate clinical volunteers into your Mid-and end-of-year reports on December 31. 2025
emergency response plan(s)including the process for management of template provided by DOH,including
volunteers during a public health emergency.This could be in identified volunteer management point June 30,2026
partnership with other response partners(EM,Hospitals,Local of contact.
Volunteer agencies,etc.).
Volunteer management process,procedure, June 30,2026
This plan must identify a point of contact to collaborate with state or plan,including the point of contact.
volunteer registries and support volunteer vetting,credentialing,and
response readiness.
Updated volunteer management point of As changes occur.
If a Medical Reserve Corps(MRC)is housed within the Local Health contact,as needed.
Jurisdiction(LHJ),confirm a Point of Contact(POC).
For LHJs without an MRC,identify a POC to liaise with external
volunteer management organizations,including the State Emergency
Medical Reserve Corps.
11 Public Health Information and Warning
Effectively communicating with the public about health risks during emergencies is essential for reducing morbidity and mortality. When
people understand the nature of a threat and what actions they can take to stay safe,they are better equipped to protect themselves and others.
Timely,clear,and culturally appropriate messaging helps minimize confusion, supports informed decision-making,and ultimately saves lives
during public health emergencies.
11.1 Incorporate communication strategies into exercises to strengthen your Mid-and end-of-year reports on template December 31,2025
jurisdiction's capacity to manage and disseminate accurate information provided by DOH. June 30,2026
during emergencies to populations disproportionately affected by top
public health hazards within jurisdiction.
12 Healthcare Coalition Partnerships
Collaboration between local PHEP recipients and healthcare coalitions is essential to align public health and healthcare system preparedness
capabilities,enhance interoperable response plans,and ensure efficient allocation of critical resources during emergencies.
12.1 Participate in the Northwest Healthcare Response Network(NWHRN) Mid-and end-of-year reports on template December 31,2025
monthly or the Healthcare Alliance(HCA)bi-monthly meetings,at provided by DOH. June 30,2026
least once during each contract reporting period.
Exhibit A, Statement of Work Page 6 of 10 Contract Number CLH32053-Amendment 9
Page 30 of 50
Task
Payment
Activity Deliverables/Outcomes Due Date/Time Frame Information and/or
Amount
The contract reporting periods are July 1 —December 31,2025,and
January I —June 30,2026.
12.2 Participate in the following additional activities with the Northwest Mid-and end-of-year reports on template December 31,2025
Healthcare Response Network(NWHRN)or the Healthcare Alliance provided by DOH. June 30,2026
HCA):
Communications
Planning
Training, and/or exercises.
13 Coordination with Tribes
Tribes bring valuable cultural knowledge,governance structures,and community networks,essential for effective preparedness,response,and
recovery. Partnering with tribes enhances trust,optimizes resource use,and ensures equitable support during crises.
13.1 Seek to engage and coordinate with local tribes on preparedness Mid-and end-of-year reports on template December 31,2025
activities,if you have federally recognized tribes within your LHJ.provided by DOH. June 30,2026
Note:The jurisdictional risk assessment might be an opportunity to
work with tribes(Task#4).
14 Administrative Preparedness Plans/Procedures
Administrative preparedness is essential for LHJs to effectively fulfill their obligation to respond to public health emergencies in their
jurisdiction.Having established administrative procedures that allow your organization to implement appropriate flexibility during declared
emergencies—even in the absence of a formal plan—helps ensure rapid access to resources,contracts, staffing,and operational support during
public health emergencies.
14.1 Based on the unique structure and administrative procedures,review Mid-and end-of-year reports on template December 31,2025
and have an understanding of the following areas: provided by DOH. June 30,2026
Conditions under which expedited processes can be activated.
Identification of those authorized to implement emergency Plan and/or procedures available upon
administrative processes and procedures. request
Streamlined processes for securing emergency funding from
federal,state,or both levels of government(recognizing that
state and federal funding is contingent on availability).
Accelerated procedures for procuring resources,including
additional staff(temporary or permanent).
Criteria for deactivating emergency processes and
transitioning back to normal operations.
Exhibit A,Statement of Work Page 7 of 10 Contract Number CLH32053-Amendment 9
Page 31 of 50
Task
Payment
Activity Deliverables/Outcomes Due Date/Time Frame Information and/or
Amount
15 Build Highly Qualified PHEP Workforce
Maintaining a qualified PHEP workforce is essential for ensuring operational readiness and effective emergency response.Ongoing
participation in communities of practice fosters shared learning,supports the dissemination of best practices,and strengthens workforce
competencies needed to execute critical public health preparedness functions.
15.1 Engage in at least one community of practice(CoP)group that Mid-and end-of-year reports on template December 31,2025
identifies problems,solutions,and best practices in public health provided by DOH.
emergency preparedness.This can be a community of practice led by June 30,2026
DOH,CDC,or Northwest Center for Evidence-Based Public Health
Emergency Preparedness and Response.
Note:Attending the MCM CoP(Task 16.2)meets this activity also.
I6 Medical Countermeasures—All LHJs,including non-Cities Readiness Initiative(CRI)* LHJs,must be able to meet medical countermeasure
MCM)capabilities to ensure timely protection of their communities during public health emergencies. Building and maintaining this capability
supports equitable access to life-saving interventions and strengthens the overall statewide response system.
Non-CRI LHJs are LHJs that do not receive Cities Readiness Initiative(CRI)funding. In Washington State,the LHJs that receive CRI funding
are Clark County Public Health,Public Health—Seattle&King County,Snohomish County Health Department,and Tacoma—Pierce County
Health Department.
16.1 Update MCM plan between July 1. 2025,and June 30, 2026,to reflect Updated MCM plan(submit once by December 31.2025
current capabilities,procedures,and resources,to demonstrate ongoing June 30,2026,or sooner). June 30,2026
medical countermeasure(MCM)readiness.
If the Plan is not submitted by
If the MCM plan does not include jurisdiction's ability to receive, December 31,2025,describe progress to
stage,store,and distribute MCM,provide a comprehensive date in the mid-year report on template
supplemental report on these capabilities.This report should include: provided by DOH.
The process for receiving,staging,storing,and distributing
MCM.End-of-year report on template provided
by DOH.
16.2 Attend one of the MCM quarterly meetings for the non-CRI LHJs and Mid-and end-of-year reports on template December 31,2025
one MCM community of practice meeting throughout the performance provided by DOH.
period. June 30,2026
Note:Participation in the MCM community of practice also meets the
requirement of Task 15.1.
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.
Exhibit A,Statement of Work Page 8 of 10 Contract Number CLH32053-Amendment 9
Page 32 of 50
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:
Guidance Documents-LHJs are strongly encouraged to use the following documents to inform the implementation of activities in this statement of work.
DOH will provide copies of the documents.
New Statement of Work Guidance Document(under development)
Washington State Doctrine for Enhancing Resiliency, Health Security,Response, and Recovery.
Public Health Response Readiness Framework(CDC) --2024-2028 PHEP Program Priorities—Defines Excellence in Response Operations
Public Health Emergency Preparedness and Response Capabilities:National Standards for State, Local, Tribal,and Territorial Public Health
Public Health Emergency Preparedness(PHEP) Cooperative Agreement(2024—2029 Guidance Document)
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
CFR :: 2 CFR Part 200--Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Awards
Recipients may only use funds for reasonable program purposes,including personnel,travel,supplies,and services."PHEP Notice of Funding Opportunity: Funding Limitations
Supplemental Guidance—February 2024
The following expenses are not allowable with these funds:
Clothing(except for vests to be worn during exercises or responses).
Salaries at a rate above Federal Executive Schedule Level II.
Vehicles(with preapproval,funds may be used to lease vehicles).
Pay or reimburse backfilling costs for staff.
Vaccines for seasonal influenza mass vaccination clinics or other routine vaccinations covered by CDC/ACIP schedules.
Influenza vaccines for the public.
Promotional items and memorabilia.
Construction or major renovations.
Preapproval from DOH is required to use these funds for:
Contracting.
Purchasing food or beverages is generally not allowable(unless employees are in travel status,then reimbursement of food and beverages is allowable).
Purchasing equipment(see definition of equipment in 2 CFR 200,link above).
Exhibit A,Statement of Work Page 9 of 10 Contract Number CLH32053-Amendment 9
Page 33 of 50
Disposition of equipment with a current value of(see 2 CFR 200,link above).
Leasing vehicles.
Out of state travel.
Overtime pay for staff directly associated with this statement of work.
Purchase of caches of vaccine for public health responders and their households to ensure the health and safety of the public health workforce.
Purchase of caches of vaccine for select critical workforce groups to ensure their health and safety during an exercise testing response plans.
See also DOH A 19 Documentation Matrix for additional expenses that may require preapproval.
BILLING
Please refer to the Billing Instructions in the 2025—2027 Consolidated Contract.
All expenses on invoices must be related to the Statement of Work Tasks.
Submit invoices monthly on a signed A19-IA invoice voucher form with backup documentation appropriate for risk level. DOH will provide A19 form and risk level.
Submit invoices monthly within 60 days of the end of the month of service(unless the related ConCon amendment has not been executed,in that case submit invoices as
soon as possible after the amendment is executed).
Please do not submit invoices until the ConCon amendment including the funds has been executed.
If invoices include indirect costs,there must be a DOH-approved indirect rate cost agreement.
If there are no expenses related to this Statement of Work for a month,let the DOH Contact via email.
If you are submitting a supplemental,revised,corrected,or any additional invoice for a month,please clarify your intentions in the email with the invoice.
Submit final billing within 60 days of the end of the funding period.
Exhibit A, Statement of Work Page 10 of 10 Contract Number CLH32053-Amendment 9
Page 34 of 50
Exhibit A
Statement of Work
Contract Term: 2025-2027
DOH Program Name or Title: OSS LMP Implementation- Effective July 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: July 1,2025 through June 30,2027
State FFATA(Transparency Act) El Fixed Price
Other 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
for the 2025-2027 biennium.
Revision Purpose: Add task-level budgets and complete goals and measurable objectives table.
Master Assistance BARS AllocationLHJFundingPeriodChangeTotalIndexListingRevenueCurrent
DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation None Allocation
SMALL ONSITE MANAGEMENT(ALEA) 26705100 N/A 334.04.93 07/01/25 06/30/26 36,611 0 36,611
SFY27 WASTEWATER MANAGEMENT-GFS 26701170 N/A 334.04.93 07/01/26 06/30/27 31,822 0 31,822
SMALL ONSITE MANAGEMENT(ALEA) 26705100 N/A 334.04.93 07/01/26 06/30/27 6,571 0 6,571
0 0 0
0 0 0
0 0 0
TOTALS 75,004 0 75,004
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")
sy
Units Starting Targets
e.g. systems ) Amount
OSS compliant with inspections in Marine Recovery Areas(MRAs)Number of OSS 74/
OSS compliant with inspections countywide Number of OSS 2,52
Number of OSS failures identified/
OSS failures identified/corrected in MRA number of OSS failures with completed 12,2
repairs
Number of OSS failure identified/
OSS failures identified/corrected countywide number of OSS failures with completed 33.,9 33 /-
repairs
Exhibit A,Statement of Work Page 1 of 3 Contract Number CLH32053-Amendment 9
Page 35 of 50
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. $3,754 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.
I 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 X
Control completed and in-progress. progress report in Subtask $18,750 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.Enforcement Protocol a. By first semi-annual
Mail inspection reminders to homeowners as needed. b.Data on the following: progress report due date
Inspection Compliance tracking/mapping. Number of OSS with current
Failure and repair tracking/mapping. inspections b.Report in semi-annual
Compliance enforcement.progress report in Subtask
Complaint response.
1.2•
Exhibit A,Statement of Work Page 2 of 3 Contract Number CLH32053-Amendment 9
Page 36 of 50
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.Provide draft and final process/policy a.Prior to issuing any Reimbursement up to
The LHJ will provide rebates to homeowners for pumping, documents to DOH. rebates. 52,500 based on actual
inspection and minor repairs.Rebates issued will be up to costs.
X. b.Report number of rebates provided for b.By grant closeout.
pumping,monitoring inspections and access
risers.
3.2 Homeowner Inspection Incentives a.Provide draft and final process/policy a.Prior to issuing any
Promote pumping,inspection and minor repairs with rebates documents to DOH. incentives.
to homeowners in priority areas. Rebates issued will be up to
X. 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 finance@doh.wa.gov.
Exhibit A, Statement of Work Page 3 of 3 Contract Number CLH32053-Amendment 9
Page 37 of 50
Exhibit A
Statement of Work
Contract Term: 2025-2027
DOH Program Name or Title: Sexual&Reproductive Health Program - Local Health Jurisdiction Name: Jefferson County Public Health
Effective January 1,2025
Contract Number: CLH32053
SOW Type: Revision Revision#(for this SOW) 4 Funding Source Federal Compliance Type of Payment
Federal Subrecipient (check if applicable) Reimbursement
Period of Performance: January 1,2025 through June 30,2026
State FFATA(Transparency Act) El Fixed Price
El 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 1-5 of the contract,which runs January 1,2022—March 31,2027.
For state funding,due dates after June 30,2026 are for reporting only.LHJs may not bill under this contract for work done after June 30,2026.
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$21,049 in FFY25 FPHPA Title X Family Planning funds for the period of 04/01/25-03/31/26,add$$41,664 in SFY26
Sexual and Reprouctive Health Cost Share funds for the period of 01/01/26-06/30/26,and extend the period of performance through June 30,2026.
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 17,023 21,049 38,072
SFY26 SEXUAL&REP HLTH COST SHARE 78431160 N/A 334.04.91 07/01/25 12/31/25 47,404 0 47,404
SFY26 SEXUAL&REP HLTH COST SHARE 78431160 N/A 334.04.91 01/01/26 06/30/26 0 41,664 41,664
0 0 0
TOTALS 129,386 62,713 192,099
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 As described in Task 6: Billing must be based on
SRHP)&Title X(TX)Services—excluding accompanied by an R&E workbook showing revenue Revenue and Expense a current cost analysis
abortion and other surgical procedures related and expenses for the month billed and any other Reports in the Reporting approved by DOH(see
to SRHP. required back-up documentation per DOH policy.Requirements section Reporting Requirements
below.below).
A. Comply with Washington State SRHP All reports described in Reporting Requirements
Manual,federal Title X requirements and all below.As requested bry DOH
Exhibit A,Statement of Work Page I of 8 Contract Number CLH32053-Amendment 9
Page 38 of 50
Task
Activity Deliverables/Outcomes Due Date/Time Frame
Payment Information
and/or Amount
state and federal laws.Also see Program DOH will authorize
Manual,Handbook,Policy References under • Other data and documentation in format requested by payment only upon
Reporting Requirements(below). DOH.(Includes copies of program and financial audits satisfactory completion
and reviews including summaries conducted by other and acceptance of
B. Complete required Agency Information entities.) deliverables and for
Request including Title X Assurance of
allowable costs as
Compliance and National Provider Identifier • Site review directed by DOH SRHP. Follow-up site outlined in the statement
NPI)billing numbers visits as needed until identified issues are resolved. of work and/or budget.
SEE INVOICES and
C. Provide medical services,community Submit documentation to DOH SRHP as requested for
PAYMENTS that
education and outreach,and staff training, a desk review prior to site visit.
consistent with state requirements:
follows this table for
details.
Appropriate staff and documentation readily available
1. LHJ is responsible for making sure all to DOH SRHP prior to and during site visit.
staff have the knowledge to carry out Payment is limited to the
the requirements of the SOW. maximum funds
available for funding
2. Medical,laboratory,and other services source. DOH will
related to abortion are not covered by reimburse for actual
this task. allowable costs as
calc3. Community education services must be
k the R&Eok(
seeworkbook
based on the needs of the community.
LHJ must have an Information& Repportingg Requirementsuirements
Education(I&E)committee with five
table)
5)or more members that is broadly
representative of the population or
All services must be
community for which materials are
billed within 40 days of
intended.The committee must review a the budget period,60
batch of patient-facing materials days for all other billing.
annually(at least 15 products or 15%of
Specific dates noted in
Reporting Requirements,the total number of materials,whichever
is smaller);meet at least annually and Activity 5,Revenue and
establish a written record of its
Expense Reports.
determination.(42 CFR 59[59.6])
4. Outreach is to ensure all populations in
your community understand the services
available.Focus your outreach efforts
on increasing equity.
Exhibit A,Statement of Work Page 2 of 8 Contract Number CLH32053-Amendment 9
Page 39 of 50
Task
Activity Deliverables/Outcomes Due Date/Time Frame
Payment Information
and/or Amount
Washington State Sexual and
Reproductive Health Network priority
populations are:
Teens
People who are uninsured or
underinsured,and/or low-
income(at or below 250%of
the federal poverty line)
Rural communities
Hispanic
Black,Indigenous,People of
Color
Extra efforts should be made to provide
information and services to people who
intersect with multiple priority
population 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
CVR data submitted to DOH data contractor(Ahlers&The 15`h of the followingeachfamilyplanningclinicvisitasdefined
Associates)electronically in a format compatible with month.Within thirty(30)in the SRH CVR Manual.
Ahlers software. days of receivingI. Maintain a computer system that
includes safety precautions against loss
error/rejection report or
of information.
Data for each month request from DOH Sexual
2. Ensure data entry personnel protect
and Reproductive Health
confidentiality of CVR data. Corrected CVR data data manager.
3. Have ability to retrieve all information
for auditing and monitoring by DOH or
its designee.
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.
Eshihit A. Statement of Work Page 3 of 8 Contract Number CLH32053-Amendment 9
Page 40 of 50
Task
Activity Deliverables/Outcomes Due Date/Time Frame
Payment Information
and/or Amount
Expected clinic site closures.Note:
DOH may,at its sole discretion,
recalculate LHJ's funding allocation if it
closes a clinic site.
Any other change that might affect
LHJ's ability to provide the sexual and
reproductive services described in this
SOW.
Reporting Requirements
1 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 must be completed by April 30"'during each year of
all members of the SRHP Network to ensure this contract. Requested information will include: AND
accurate records of LHJ's organization and the
services it provides. Information about your agency contacts and your As needed or requested to
organization's staffing maintain accuracy of
In addition,elements of this report allow DOH to A. Head of Organization information.
ensure that SRHP&Title X requirements B. Head of Finance
including client fees and required services are C. Medical Director
met.The updated information also assists DOH D. NPI numbers used to bill Medicaid
to manage this SOW and the Sexual&E. The following(one person might fill more than one
Reproductive Health 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.
Exhibit A, Statement of Work Page 4 of 8 Contract Number CLH32053-Amendment 9
Page 41 of 50
Task
Activity Deliverables/Outcomes Due Date/Time l rame
Payment Information
and/or Amount
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.
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 each year
Information related to current Community Outreach Plan: 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 i
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 SOWs:
the Washington State SRH Network.
A. Community education and outreach strategies and
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 end
Information DOH is requesting to develop trend Number of: 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
Exhibit A,Statement of Work Page 5 of 8 Contract Number CLH32053-Amendment 9
Page 42 of 50
Task
Activity Deliverables/Outcomes Due Date/Time Frame
Payment Information
and/or Amount
agreements sent to the agency will request that C. HIV Positive confidential tests
these 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 reproducti‘e
health services:
Physicians
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 15'h of the following
in the Clinic Visit Record(CVR)Manual available at: month.
https://www.doh.wa.gov/Portals/1/Documents/Pubs/930-
139-CVRManual.ndf. Within thirty(30)days of
receiving error or
CVR data must be submitted to DOH data contractor rejection report or request
Ahlers&Associates)electronically in a format compatible from DOH SRH data
with Ahlers software. 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 Invoices(A19's)and
including program income)that support Task 1 SRH R&Es that support
Services and all expenses related to providing those services through the end
services.R&E workbook will be provided by DOH. of this contract must be
A. Expenses must match General Ledger. billed following the
B. Other revenue/program income must reflect revenue
required deadlines:
March Invoices and
actually received in the reporting month.
R&Es are due byAllentrieson"Other"rows must be accompanied by a
May 10thdescriptionoftherevenuesourceorexpense, including any
calculations uses.
June Invoices and
R&Es are due by
August 10th
December Invoices
and R&Es are due
by February 10th
Exhibit A,Statement of Work Page 6 of 8 Contract Number CLH32053-Amendment 9
Page 43 of 50
Task
Activity Deliverables/Outcomes Due Date/Time Frame
Payment Information
and/or Amount
All remaining
months must be
billed within 60
days.
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 Accountabilit' 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
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.gov/sites/default/files/2024-10/930-I39-CVRManual.pdf)
LHJ's approved Agency Information Request.
Billing Requirements:
See Payment column of Tasks and Deliverables table and R&E report description in Reporting Requirements table
Billing must be based on a current cost analysis approved by DOH(see Reporting Requirements table).
INVOICES AND PAYMENT: Contractor will submit invoices to the DOH Contract Manager for all amounts to be paid within 30 days of the month of service,or the
submission date of deliverables with an associated cost,as specified in the Statement of Work(SOW).Refer to the SOW,Exhibit A,for invoice due dates on any budget/funding
period(s)that end during the contract period of performance. DOH must receive correct and complete FINAL invoices no later than 45 days after the contract expiration date.
Invoices must reference the contract number and provide detailed information as required.All invoices must be approved by DOH prior to payment;approval will not be
unreasonably withheld.
DOH will authorize payment only upon satisfactory completion and acceptance of deliverables and for allowable costs as outlined in the statement of work and/or budget.DOH
will return all incorrect or incomplete invoices and will not pay for services that occur outside the period of performance.The Contractor will not invoice for services if they are
entitled to payment,have been,or will be paid,by any other source for that service.
DOH will issue payment within 30 days of receiving a correct and complete invoice and approving the deliverable(s).Late invoices will be paid at the discretion of DOH and are
contingent upon the availability of funds.Failure to submit a properly completed IRS form W-9 may result in delayed payments.
Exhibit A,Statement of Work Page 7 of 8 Contract Number CLH32053-Amendment 9
Page 44 of 50
DOH reserves the right to withhold payment until:
Compliance issues or a previous SOW are resolved in a way accepted by DOH.
Payment is limited to the maximum funds available for funding source.
DOH will reimburse for:
Actual allowable costs according to your approved cost analysis(see Reporting Requirements table)and as calculated by the R&E workbook.
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 9
Page 45 of 50
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) 4 Funding Source Federal Compliance Type of Payment
Federal Subrecipient (check if applicable) Reimbursement
Period of Performance: January 1,2025 through December 31,2027
El State FFATA(Transparency Act) 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 funds to FFY26 WIC CLIENT SVS CONTRACTS USDA,reduce FFY25 BRSTFDG PEER CN PR MGMT USDA,and revise program specific
requirements.
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
FFY25 USDA WIC CLIENT SVS CONTRACTS 76101251 10.557 333.10.55 01/01/25 09/30/25 144,669 0 144,669
FFY24 BRSTFDG PEER CN PR MGMT USDA 7621424A 10.557 333.10.55 01/01/25 09/30/26 6,061 0 6,061
FFY25 BRSTFDG PEER CN PR MGMT USDA 76214250 10.557 333.10.55 01/01/25 09/30/27 22,177 722 21,455
FFY25 FARM MKT NTR PROG MGMT USDA 76540251 10.572 333.10.57 01/01/25 09/30/25 637 0 637
FFY26 WIC CLIENT SVS CONTRACTS USDA 76101261 10.557 333.10.55 10/01/25 09/30/26 0 14,563 14,563
0 0 0
TOTALS 173,544 13,841 187,385
Task
Activity Deliverables/Outcomes Due Date/Time Frame
Payment Information
and/or Amount
1 WIC Nutrition Program See"Billing
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 caseload for March 2025
management reports generated at state WIC office. management 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 for 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 6 Contract Number CLH32053-Amendment 9
Page 46 of 50
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 the Nutrition Services Plan First year due 9/30/25 Payment withheld if not
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 security Documentation must be available for Biennial WIC Monitor
and reconciliation. review by WIC monitor staff.
1.7 Collect data,maintain records,and submit reports to effectively Documentation must be available for Biennial WIC Monitor
enforce the non-discrimination laws(Refer to Civil Rights review by WIC monitor staff.
Assurances below).
1.8a Submit entire WIC and Breastfeeding Peer Counseling Budget Budget Workbook First year due 9/30/25
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
2 Breastfeeding Promotion See"Billing
Requirements"below.
2.1 Provide breastfeeding promotion activities in accordance with Status report of chosen activities in First year due 11/30/25
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 affect Status report of chosen activities in First year due 8/30/25
breastfeeding. Choose one or more of the following projects: Nutrition Services Plan. Second year due 8/30/26
Provide staff,health care providers and community partners Third year due 8/30/27
virtual breastfeeding training resources. Documentation must be available for
Work with employers who likely employ low-income review by WIC monitor staff. Biennial WIC Monitor
people to create worksite environments that support
breastfeeding.
Exhibit A,Statement of Work Page 2 of 6 Contract Number CLH32053-Amendment 9
Page 47 of 50
Task Payment Information
Activity Deliverables/Outcomes Due Date/Time Frame
and/or Amount
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
3 Breastfeeding Peer Counseling Program(BFPC) See"Billing
Requirements"below.
3.I 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 Second year due 12/31/26
Breastfeeding Peer Counseling Program is meant to enhance, previous 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 and Documentation must be available for Biennial WIC Monitor
bill separately from the WIC grant. review by WIC monitor staff.
4 Farmers Market Nutrition Program(FMNP) See"Billing
Requirements"below.
4.1 Issue FMNP benefits to eligible WIC participants by September Document in a Family Alert that FMNP Biennial WIC Monitor
30 of the current year. benefits were issued. Set the end date to
Participants have until October 31 of the current year to use October 31 of the current year for the
FMNP benefits at authorized farmers markets and farm stores. alert to dismiss at the end of the season.
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 USASpending.gov by DOH as required by P.L. 109-282.
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
Exhibit A,Statement of Work Page 3 of 6 Contract Number CLH32053-Amendment 9
Page 48 of 50
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?
I. 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:
All criteria used for certification,including information on income,nutrition risk eligibility and referrals
Program requirements
Nutrition education
All financial records
Exhibit A, Statement of Work Page 4 of 6 Contract Number CLH32053-Amendment 9
Page 49 of 50
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:
1) 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 IX 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:
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
Exhibit A,Statement of Work Page 5 of 6 Contract Number CLH32053-Amendment 9
Page 50 of 50
October 1,2025,through September 30,2026
October 1,2026,through September 30,2027
October 1,2027,through December 31,2027
2. Billing Information:
a. Billings are submitted on an A19-IA invoice. These invoices are provided by the Department in the WIC Budget Workbook and include accounting codes for different
budget categories.
b. Al9s are submitted monthly and must be received by the Department within 30 60 days following the close of each calendar month.Additional Al9s may be submitted at
any time but must be received within 45 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:
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 6 of 6 Contract Number CLH32053-Amendment 9
Page 1 of 17
JEFFERSON COUNTY PUBLIC HEALTH
2025-2027 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH32053 AMENDMENT NUMBER: 8
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:
ii94d3eaS0ac7tb 32e4d7c
Adds Statements of Work for the following programs:
OSS LMP Implementation -Effective July 1,2025
Amends Statements of Work for the following programs:
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-8 Allocations,attached and incorporated by this reference,amends and replaces Exhibit B-7 Allocations as
follows:
Increase of$71.556 for a revised maximum consideration of$5,807,609,
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
t:A
10/07/2025
ci .isenhour,Chair Date Date
APPROVED_S'TO FORM ONLY APPROVED AS TO FORM ONLY
Assistant Attorney General
for 09/2912025
Philip C. Hunsucker,Date
Chief Civil Deputy Prosecuting Attorney Page 1 of I
cc-25-c I•ns
EXHIBIT B-8
Page 2 of 17
Jefferson County Public Health ALLOCATIONS Contract Number: CLH32053
Contract Term:2025-2027 Date: September 1,2025
Indirect Rate January 1,2025 through December 31,2025:27.38%Public Health
D011 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 8 10.557 333.10.55 01/01/25 09/30/27 10/01/24 09/30/27 ($6,061)22,177 28,238
FFY25 USDA BFPC Prog Mgmt 7WA700WAI Amd 4,8 10.557 333.10.55 01/01/25 09/30/27 10/01/24 09/30/27 $28,238
FFY24 USDA BFPC Prog Mgmt 7WA700WAI Amd 8 10.557 333.10.55 01/01/25 09/30/26 10/01/23 09/30/26 6.061 6,061
FFY24 USDA BFPC Prog Mgmt 7WA700WAI 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 7WA700WAI 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 8 10.557 333.10.55 01/01/25 09/30/25 10/01/24 09/30/25 ($3,448) $144,669 144,669
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
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 Farm Mkt Mr Prog Mgmt USDA 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
FFY25 PHEP BP2-CDC-LHJ Partners NU9OTU000055 Amd 7 93.069 333.93.06 07/01/25 06/30/26 07/01/25 06/30/26 $19,527 19,527 33,281
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
FFY24OD2AOIDCDCPrevent NU17CE010218 Amd6 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 S32,556 81,556
FFY24 OD2A OID CDC Prevent NU 17CE010218 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 NH231P922619 Amd 1 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 1,7 93.323 333.93.32 01/01/25 12/31/25 01/15/21 07/31/26 $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 NEI10E000053 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
FFY26 MCHBG LHJ Contracts HRSA YR 1 NGA Not Received Amd 7 93.994 333.93.99 10/01/25 09/30/26 10/01/25 09/30/26 $36,700 36,700 36,700
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
SFY26 Sch Based Hlth Cent 1225 Proviso Amd 7 N/A 334.04.90 07/01/25 06/30/26 07/01/25 06/30/26 $140,000 140,000 140,000
Page 1 of 3
EXHIBIT B-8 Page 3 of 17
Jefferson County Public Health ALLOCATIONS Contract Number: CLH32053
Contract Term:2025-2027 Date: September 1,2025
Indirect Rate January 1,2025 through December 31,2025:27.38%Public Health
D011 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 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 1 N/A 334.04.91 01/01/25 06/30/25 07/01/24 06/30/25 $40,250 40,250
SFY26 Sexual&Rep Hlth Cost Share Amd 7 N/A 334.04.91 07/01/25 12/31/25 07/01/25 06/30/26 $47,404 47,404 95,397
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
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 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 8 N/A 334.04.93 07/01/26 06/30/27 07/01/25 06/30/27 6,571 6,571 S68,200
Small Onsite Management(ALEA) Amd 8 N/A 334.04.93 07/01/25 06/30/26 07/01/25 06/30/27 $36,611 36,611
Small Onsite Management(ALEA) Amd 8 N/A 334.04.93 01/01/25 06/30/25 07/01/23 06/30/25 ($8,763)S25,018
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
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
SFY27 Wastewater Management-GFS Amd 8 N/A 334.04.93 07/01/26 06/30/27 07/01/26 06/30/27 $31,822 S31,822 S49,824
SFY25 Wastewater Management-GFS Amd 8 N/A 334.04.93 01/01/25 06/30/25 07/01/24 06/30/25 8,763 S18,002
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)
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
SFY26 FPHS-LHJ Funds-GFS Amd 7 N/A 336.04.25 07/01/25 06/30/26 07/01/25 06/30/26 $2,203,000 $2,203,000 4,536,000
SFY25 FPHS-LHJ Funds-GFS Amd I N/A 336.04.25 01/01/25 06/30/25 07/01/24 06/30/25 $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`i: $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
YRl 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
Page 2 of 3
EXHIBIT B-8 Page 4 of 17
Jefferson County Public Health ALLOCATIONS Contract Number: 1.11321153
Contract Term:2025-2027 Date: September 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
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 5,807,609 $5,807,609
Total consideration: 5,736,053 GRAND TOTAL 5,807,609
71,556
GRAND TOTAL 5,807,609 Total Fed 643,638
Total State 5,163,971
Assistance Listing Number fka Catalog of Federal Domestic Assistance
Federal revenue codes begin with"333". State revenue codes begin with"334".
Page 3 of 3
Page 5 of 17
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) 2 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 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: Remove$8,763 from ALEA and add it to GFS.
Master Assistance BARS Allocation
LHJ Funding Period ChangeIndexListingRevenueCurrentTotal
DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation None Allocation
SFY25 WASTEWATER MANAGEMENT-GFS 26701150 N/A 334.04.93 01/01/25 06/30/25 9,239 8,763 18,002
SMALL ONSITE MANAGEMENT(ALEA) 26705100 N/A 334.04.93 01/01/25 06/30/25 33,781 8,763 25.018
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
ge.g. systems ) Amount
Targets
OSS compliant NA ith inspections in Marine Recovery Areas(MRAs)Number of OSS 432 550
OSS compliant with inspections countywide Number of OSS 1446 1.900
Number of OSS failures identified/
OSS failures identified/corrected in MRA number of OSS failures with completed 10/3 12/6
repairs
Number of OSS failure identified/
OSS failures identified/corrected countywide number of OSS failures with completed 26/9 32/16
repairs
Exhibit A,Statement of Work Page 1 of 3 Contract Number CLH32053-Amendment 8
Page 6 of 17
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
DOH Consolidated Contracts(ConCon)requires billing duration of contract period. $2,151 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 $28,812 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 Data on the following: Report in semi-annual
Mail inspection reminders to homeowners as needed. Number of OSS with current progress report in Subtask
Inspection Compliance tracking/mapping. inspections 1.2.
Failure and repair tracking/mapping. Number of OSS failures and
Compliance enforcement. calculated risk using DOH-provided
Complaint response. risk assessment.
Exhibit A,Statement of Work Page 2 of 3 Contract Number CLH32053-Amendment 8
Page 7 of 17
Task
Activity Deliverables/Outcomes Due Date/Time Frame
Payment Information
and/or Amount
O&M data reports about inventory and deficiencies. 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 Report number of rebates provided for By grant closeout. Reimbursement up to
The LHJ will provide rebates to homeowners for pumping, pumping,monitoring inspections and access 12,057 based on actual
inspection and minor repairs.Rebates issued will be up to risers. costs.
350.
3.2 Homeowner Inspection Incentives Report number of rebates for pumping, By grant closeout.
Promote pumping,inspection and minor repairs with rebates monitoring inspections and access risers to
to homeowners in priority areas. Rebates issued will be up to grade provided to priority-area homeowners.
350.
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 financeadoh.wa.gov.
Exhibit A, Statement of Work Page 3 of 3 Contract Number CLH32053-Amendment 8
Page 8 of 17
Exhibit A
Statement of Work
Contract Term: 2025-2027
DOH Program Name or Title: OSS LMP Implementation-Effective July 1,2025 Local Health Jurisdiction Name: Jefferson County Public Health
Contract Number: CLH32053
SOW Type: Original Revision#(for this SOW) 0 Funding Source Federal Compliance Type of Payment
Federal<Select One> (check if applicable) Reimbursement
Period of Performance: July 1,2025 through June 30,2027
State FFATA(Transparency Act) Fixed Price
Other 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
for the 2025-2027 biennium.
Revision Purpose: N/A
Master Assistance BARS Allocation
LHJ Funding Period ChangeIndexListingRevenueCurrentTotal
DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation Increase(+) Allocation
SMALL ONSITE MANAGEMENT(ALEA) 26705100 N/A 334.04.93 07/01/25 06/30/26 0 36,611 36,611
SFY27 WASTEWATER MANAGEMENT-GFS 26701170 N/A 334.04.93 07/01/26 06/30/27 0 31,822 31,822
SMALL ONSITE MANAGEMENT(ALEA) 26705100 N/A 334.04.93 07/01/26 06/30/27 0 6,571 6,571
0 0 0
0 0 0
0 0 0
TOTALS 0 75,004 75,004
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
OSS compliant with inspections countywide Number of OSS
Number of OSS failures identified/
OSS failures identified/corrected in MRA number of OSS failures with completed
repairs
Number of OSS failure identified/
OSS failures identified/corrected countywide number of OSS failures with completed
repairs
Exhibit A,Statement of Work Page 1 of 3 Contract Number CLH32053-Amendment 8
Page 9 of 17
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$X
DOH Consolidated Contracts(ConCon)requires billing duration of contract period. based on actual costs.
within 60 days of completing work.Local or County Health
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.I Database Maintenance and Quality Assurance/Quality a.Provide narrative of data clean-up tasks a-d.Report in semi-annual Reimbursement up to$X
Control completed and in-progress. progress report in Subtask based on actual costs.
Database maintenance and QA/QC is ongoing to ensure 1.2.
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.Enforcement Protocol a.By first semi-annual
Mail inspection reminders to homeowners as needed. b. Data on the following: progress report due date
Inspection Compliance tracking/mapping. Number of OSS with current
Failure and repair tracking/mapping.inspections b.Report in semi-annual
Compliance enforcement.progress report in Subtask
Complaint response. 1.2.
Exhibit A,Statement of Work Page 2 of 3 Contract Number CLH32053-Amendment 8
Page 10 of 17
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.Provide draft and final process/policy a.Prior to issuing any Reimbursement up to$X
The LHJ will provide rebates to homeowners for pumping, documents to DOH. rebates.based on actual costs.
inspection and minor repairs.Rebates issued will be up to
X. b.Report number of rebates provided for b.By grant closeout.
pumping,monitoring inspections and access
risers.
3.2 Homeowner Inspection Incentives a.Provide draft and final process/policy a.Prior to issuing any
Promote pumping,inspection and minor repairs with rebates documents to DOH. incentives.
to homeowners in priority areas. Rebates issued will be up to
X. 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 finance@doh.wa.gov.
Exhibit A,Statement of Work Page 3 of 3 Contract Number CLH32053-Amendment 8
Page 11 of 17
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) 3 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) D Fixed Price
0 Other 0 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 reduce FFY25 WIC Client Services balance per the negotiated and agreed-upon volunteer recoveries for the remainder of the contract period(-$3,448.36),
exend FFY25 BRSTFDG PEER CN PR MGMT USDA funding period end date from 09/30/26 to 09/30/27 and shift funding($6,061)to FFY24 BRSTFDG PEER CN PR MGMT
USDA,and update the Chart of Accounts(COA)title for FFY25 USDA FMNP MGMT to FFY25 FARM MKT NTR PROG MGMT USDA to match new biennium COA and
revise task language.
Master Assistance BARS Allocation
LHJ Funding Period ChangeIndexListingRevenueCurrentTotal
DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation Decrease(—) Allocation
FFY25 USDA WIC CLIENT SVS CONTRACTS 76101251 10.557 333.10.55 01/01/25 09/30/25 148,117 3,448 144,669
FFY24 BRSTFDG PEER CN PR MGMT USDA 7621424A 10.557 333.10.55 01/01/25 09/30/26 0 6,061 6,061
FFY25 BRSTFDG PEER CN PR MGMT USDA 76214250 10.557 333.10.55 01/01/25 09/30/27 28,238 6,061 22,177
FFY25 FARM MKT NTR PROG MGMT USDA 76540251 10.572 333.10.57 01/01/25 09/30/25 637 0 637
0 0 0
0 0 0
TOTALS 176,992 3,448 173,544
3 ask
Activity Deliverables/Outcomes Due Date/Time Frame
Payment Information
and/or Amount
See"Billing1WICNutritionProgram
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 caseload for March 2025
management reports generated at state WIC office. management 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 for March 2025
Exhibit A,Statement of Work Page 1 of 7 Contract Number CLH32053-Amendment 8
Page 12 of 17
Task
Activity Deliverables/Outcomes Due Date/Time Frame
Payment Information
and/or Amount
2. Reallocations are necessary to redistribute caseload through September 2026=
statewide. 300
3. Caseload declines.
I.2 Submit the annual Nutrition Services Plan for each year of the Nutrition Services Plan First year due 9/30/25 Payment withheld if not
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 security Documentation must be available for Biennial WIC Monitor
and reconciliation. review by WIC monitor staff.
1.7 Collect data,maintain records,and submit reports to effectively Documentation must be available for Biennial WIC Monitor
enforce the non-discrimination laws(Refer to Civil Rights review by WIC monitor staff.
Assurances below).
1.8a Submit entire WIC and Breastfeeding Peer Counseling Budget Budget Workbook First year due 9/30/25
Workbook for each year of the contract Second year due 9/30/26
Third year due 9/30/27
l.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"Billing2BreastfeedingPromotion
Requirements"below.
2.1 Provide breastfeeding promotion activities in accordance with Status report of chosen activities in First year due 11/30/25
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 affect Status report of chosen activities in First year due 8/30/25
breastfeeding. Choose one or more of the following projects: Nutrition Services Plan. Second year due 8/30/26
Provide staff,health care providers and community partners Third year due 8/30/27
virtual breastfeeding training resources.
Exhibit A,Statement of Work Page 2 of 7 Contract Number CLH32053-Amendment 8
Page 13 of 17
Task
Activity Deliverables/Outcomes Due Date/Time Frame
Payment Information
and/or Amount
Work with employers who likely employ low-income Documentation must be available for Biennial WIC Monitor
people to create worksite environments that support review by WIC monitor staff.
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
3 Breastfeeding Peer Counseling Program(BFPC) See"Billing
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 Second year due 12/31/26
Breastfeeding Peer Counseling Program is meant to enhance, previous 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 and Documentation must be available for Biennial WIC Monitor
bill separately from the WIC grant. review by WIC monitor staff.
4 Farmers Market Nutrition Program(FMNP) See"Billing
Requirements"below.
4.1 Issue FA1NP benefits to eligible WIC participants by September Document in a Family Alert that FA./NP
30 of the current year. benefits were issued. Set the end date to June Sept.2026
Participants have until October 31 of the current year to use October 31 of the current year,for the
FAINP benefits at authori_-ed farmers markets and farm stores. alert to dismiss at the end of the season. Ail sent by Oct. 1,2025 and
by Oct. 1.2026
and by Oct. 1.2027
check registers to State WIC office on a
current year. Biennial WIC Monitor
pfeeod,
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.
Exhibit A,Statement of Work Page 3 of 7 Contract Number CLH32053-Amendment 8
Page 14 of 17
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.gov by DOH as required by P.L. 109-282.
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.
Exhibit A,Statement of Work Page 4 of 7 Contract Number CLH32053-Amendment 8
Page 15 of 17
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:
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:
1) 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 IX 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."
Exhibit A,Statement of Work Page 5 of 7 Contract Number CLH32053-Amendment 8
Page 16 of 17
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:
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 A19-1A invoice. These invoices are provided by the Department in the WIC Budget Workbook and include accounting codes for different
budget categories.
b. Al9s are submitted monthly and must be received by the Department within 60 days following the close of each calendar month. Additional Al9s may be submitted at
any time but must be received within 60 45 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.
Exhibit A,Statement of Work Page 6 of 7 Contract Number CLH32053-Amendment 8
Page 17 of 17
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:
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 8