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Home My WebLink AboutAGENDA PACKET 051126 UPDATED 1 AGENDA Jefferson County Board of Commissioners Regular Meeting – Monday, May 11, 2026 at 9:00 a.m. This is a Hybrid meeting: Virtual and In-Person Attendance at Jefferson County Courthouse – Commissioners’ Chambers 1820 Jefferson Street, Port Townsend, WA Heather Dudley-Nollette, District 1 | Heidi Eisenhour, District 2 | Greg Brotherton, District 3 – Chair To view Agenda items, meeting materials and comments received, click here: www.co.jefferson.wa.us – Services – Laserfiche Web Portal (username and password is: public)– Board of Commissioners – BOCC Agenda Packets – 2026 Weekly Agenda Items – Month of the meeting – Day of the meeting You can join this meeting by using the following methods: In the event of technical difficulties, at least one of the methods above will be accessible to the public. Please try all methods first before calling 360-385-9100 to report any issues. Individuals may provide Public Comment using the following methods: • Video: Refer to meeting instructions above • Audio-only: Refer to meeting instructions above • Email: You may submit comments/correspondence to us at: jeffbocc@co.jefferson.wa.us up through 11:59 p.m. the day before the meeting. Public Comment Periods are dedicated to listening to the public. Each person may address the Board one time during these periods. To ensure equal opportunity for the public to comment, all comments shall be limited to 2 or 3 minutes per person, depending on the volume of public in attendance. Some Agenda items may have additional Public Comment Periods – these comment periods are for listening to comments specific to that Agenda item. The Chair may add additional Public Comment Periods throughout the meeting. 9:00 a.m. CALL TO ORDER 9:01 a.m. PUBLIC COMMENT PERIOD – ALL TOPICS • Zoom Meeting: https://zoom.us/j/93777841705 This option will allow you to join the meeting live. You will need to enter an email address. If you wish to provide public comment, click on the hand icon at the bottom of the screen to “raise your hand.” Participation will be up to the Chair and Clerk • Audio-only: Dial: 1-253-215-8782 and use Webinar ID: 937-7784-1705# This option will allow you to listen to the meeting live. If you wish to provide public comment, press *9 to “raise your hand.” Participation will be up to the Chair and Clerk Access for the hearing impaired can be accommodated using Washington Relay Service at 1-800-833-6384. If you need special accommodations, please contact our office 24 hours in advance. • In-person: You are welcome to join this meeting in-person. Agenda: May 11, 2026 2 No set time APPROVAL AND ADOPTION OF THE CONSENT AGENDA: (Items listed below have been distributed to the Commissioners in advance for study and will be enacted by one motion. If separate discussion is desired on an item, that item may be removed from the Consent Agenda and placed on the Regular Agenda, at the request of any of the Commissioners). 1. AGREEMENT re: Thriving Communities Small Grants Program; Community Opportunity Fair; $500; Port Ludlow Village Council (PLVC) 2. AGREEMENT, Amendment No. 1 re: Landes Terrace Project; Change in scope; County Administrator’s Office; Habitat for Humanity of East Jefferson County 3. AGREEMENT, Amendment No. 13 re: Consolidated Contracts; Additional $101,206 for a total of $6,280,284; Public Health; Washington State Department of Health 4. AGREEMENT, Change Order No. 16 re: Phase 2 Water Reclamation Plant for the PHUGA, Project No. 405-2114-0, Commerce Project No. 22-96515-026; Increase of $10,712,377.70 to $10,733,767.64; Public Works; Washington State Department of Commerce 5. APPROVAL OF REPORT re: 2025 Transportation Benefit District Annual Report 6. APPROVAL OF LICENSE re: Public Right-of-Way along Upper Hoh Road; Public Works; Washington Coast Sustainable Salmon Foundation 7. ADVISORY BOARD APPOINTMENT re: Law Enforcement Officers and Firefighters (LEOFF)-I Disability Retirement Board; Law enforcement representative – Sheriff Andy Pernsteiner 8. ADVISORY BOARD APPOINTMENT (3) re: Jefferson County Tourism Coordinating Council (TCC); Diane Smeland, Port Ludlow Representative; Marsha Massey, Regional Marketing DMO Representative; Amy Neil, West End Representative 9. ADVISORY COMMITTEE RESIGNATION re: Jefferson County Marine Resources Committee; District 2 NWSC Representative – Jeff Taylor 10. APPROVAL OF PAYROLL WARRANTS: Dated May 5, 2026 and totaling $2,565,959.05, Dated May 5, 2026 and totaling $186,889.20 (Sound Health), Dated May 7, 2026 and totaling $285.44 11. APPROVAL OF ACCOUNTS PAYABLE WARRANTS: Dated May 5, 2026 and totaling $6,500 REGULAR AGENDA: No set time UPDATE re: Moderate Fire Risk Declaration Jeremy Williammee, DCD Director/Fire Marshal Brian Tracer, Deputy Fire Marshal No set time PROCLAMATION re: Proclaiming May 2026 as Building Safety Month Chelsea Pronovost, DCD Services Manager No set time PROCLAMATION re: Declaring the Week of May 10-16, 2026 as National Police Week and Observe May 15, 2026 as Peace Officer’s Memorial Day Andy Pernsteiner, Sheriff Thomas Olson, Port Townsend Police Chief Agenda: May 11, 2026 3 10:30 a.m. HEARING re: Additional 2026 Budget Appropriations; Various County Departments Josh Peters, County Administrator Judy Shepherd, Finance Director 11:00 a.m. WORKSHOP re: Connectivity Summit debrief Daniel Milholland, TPA Director No set time WORKSHOP re: Surveys Design and Frequency update Shawn Fredrick, Central Services Director Liz Anderson, Communications Specialist No set time COMMISSIONERS BRIEFING SESSION No set time RECESS 1:30 p.m. AFTERNOON SESSION 1:30 p.m. to 2:00 p.m. EXECUTIVE SESSION with the County Administrator, and Chief Civil Deputy Prosecuting Attorney (DPA) re: Potential/Actual Litigation; Exemption as Outlined in the Open Public Meetings Act, RCW 42.30.110(1)(i) DISCUSSION, POTENTIAL ACTION with PUBLIC COMMENT re: TOPIC OF THE EXECUTIVE SESSION 2:30 p.m. DISCUSSION and POTENTIAL ACTION re: Opportunity Zone Letters of Support (2): 1) Port Townsend Tract; and 2) Brinnon/West End David Ballif, EDC Director Team Jefferson No set time ADDITIONAL DISCUSSION ITEMS No set time ADJOURNMENT (Adjourn by 4:30 p.m.) Agenda: May 11, 2026 4 COMMISSIONERS MEETING SCHEDULE The Week of May 11, 2026 A snapshot of the meetings the Commissioners will be attending this week are notated below, and are subject to change. If you would like to get more information on these meetings, please contact the Commissioners’ Office at 360-385-9100 or send us an email at: jeffbocc@co.jefferson.wa.us Monday, May 11, 2026 9:00 a.m. BOCC Meeting - Board Tuesday, May 12, 2026 No meetings scheduled Wednesday, May 13, 2026 9:00 a.m. Forest Practices Board Regular Quarterly Meeting – Heidi 10:00 a.m. Ferry Advisory Committee Meeting - Heather 10:00 a.m. Olympic Region Clean Air Agency Board of Directors Meeting – Greg 5:30 p.m. Planning Commission Comp Plan Hearing - Heidi Thursday, May 14, 2026 1:30 p.m. Technology Advisory Committee Meeting – Greg 3:00 p.m. Clean Water District Advisory Council Meeting – Heidi 6:00 p.m. Jefferson County Fairgrounds Association Board Meeting - Heather Friday, May 15, 2026 10:00 a.m. Olympic Consortium Board Meeting - Greg 12:30 p.m. KPTZ – Josh The County has various Boards and Committees that are subject to the Open Public Meetings Act (OPMA). Agendas for those meetings will be posted to the Jefferson County website calendar 24 hours prior to the start of the meeting. Agendas will contain information on how to provide public comment, meeting access, and meeting materials (if available). For more information, go to: www.co.jefferson.wa.us and click on the Calendar tab. COMMISSIONERS MAY ADD AND TAKE ACTION ON OTHER ITEMS NOT LISTED ON THIS AGENDA. Americans with Disabilities Act (ADA) Accommodations Provided Upon Request S0 9\S/ I N GAO ACCOUNTS PAYABLE WARRANT REPORT WARRANT DATE: 5/5/2026- Emergency Warrant TOTAL: $6,500 RECORDS OF ALL CLAIMS SUBMITTED FOR PAYMENT ALONG WITH VOUCHERS APPROVED BY THE BOARD OF JEFFERSON COUNTY COMMISSIONERS ARE RETAINED BY THE JEFFERSON COUNTY AUDITOR AND PUBLIC WORKS DEPARTMENT. I THE UNDERSIGNED BOARD OF COUNTY COMMISSIONERS DO HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT THE MATERIALS HAVE BEEN FURNISHED, THE SERVICES RENDERED OR THE LABOR PERFORMED AS DESCRIBED HEREIN,THAT ANY ADVANCE PAYMENT IS DUE AND PAYABLE PURSUANT TO A CONTRACT OR IS AVAILABLE AS AN OPTION FOR FULL OR PARTIAL FULFILLMENT OF A CONTRACTUAL OBLIGATION, AND THAT THE CLAIM IS A JUST, DUE AND UNPAID OBLIGATION AGAINST JEFFERSON COUNTY AND THAT I AM AUTHORIZED TO AUTHENTICATE AND CERTIFY TO SAID CLAIM. CHAIRPERSON, COMMISSIONER COMMISSIONER, MEMBER COMMISSIONER, MEMBER CHECK NUMBER CHECK DATE VENDOR NUMBER VENDOR NAME INVOICE ORG OBJECT FUND AMOUNT 100246076 05/05/2026 10661 MARK DANIELS WARRANT 74126 50251478 460103 502 6,500.00 JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS CONSENT AGENDA REQUEST TO: Jefferson County Board of Commissioners FROM: Carolyn Gallaway, Clerk of the Board DATE: May 11, 2026 SUBJECT: AGREEMENT, Amendment No. 1 re: 2026 Affordable Housing/Homelessness Grant Funding; Landes Terrace Project; Habitat for Humanity of East Jefferson County STATEMENT OF ISSUE: On November 17, 2025, the Board of County Commissioners (BOCC) approved the Housing Fund Board's 2026 funding recommendations for Affordable Housing Fund 148, Homeless Housing Fund 149, 1590 Funds. One of the recommendations was for Habitat for Humanity to receive $90,000 for the Landes Terrace Project. Habitat for Humanity contacted Jefferson County in March and requested to change the scope of their work, after receiving additional grants for the Landes Terrace project. ANALYSIS: The Housing Fund Board met on March 25, 2026 and approved a motion to recommend that the BOCC accept the changes to the contract as presented by Habit for Humanity. On April 20, 2026, the BOCC approved the recommendation and authorized staff to update their contract. FISCAL IMPACT: N/A RECOMMENDATION: Approve the attached Grant Agreement amendment with Habitat for Humanity of East Jefferson County for the Landes Terrace Project. REVIEWED BY: ç,Ø) Jo . Peters, County Administrator Date CONTRACT REVIEW FORM Clear Form INSTRUCTIONS ARE ON THE NEXT PAGE) CONTRACT WITH: HABITAT FOR HUMANITY OF JEFFERSON COUNTY Contract No: HAB-LANDES-AMEND1 Contract For: AMENDMENT NO.1 re LANDES TERRACE NEW CONSTRUCTION Term: 01/01/26-12/31/26 COUNTY DEPARTMENT: COUNTY ADMINISTRATOR'S OFFICE Contact Person: CAROLYN GALLAWAY Contact Phone: 360-385-9122 Contact entail: CAROLYN@CO.JEFFERSON.WA.US AMOUNT: NO CHANGE IN AMOUNT PROCESS: Exempt from Bid Process Revenue: Cooperative Purchase Expenditure: Competitive Scaled Bid Matching Funds Required: Small Works Roster Sources(s) of Matching Funds Vendor List Bid Fund #RFP or RFQ Munis Org/Obj Other: APPROVAL STEPS: STEP I: DEPARTMENT CERTIFIES COMPLI NCE WI i,ICC 3.55.080 ANI)CHANTER 42.23 RCW. 1 CERTIFIED: N/A: 1. 4h/6c-va4 ,.1 (L C' ignature U Date STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE COUNTY (CONTRACTOR) HAS NOT BEEN DEBARRED BY ANY FEDERAL, STATE, OR LOCAL AGENCY. I Z{CERTIFIED: FIT N/A: ifo, An., Signature 0 Date STEP 3: RISK MANAGEMENT REVIEW (will be added electronically through Laserfiche): Electronically approved by Risk Management on 5/6/2026. STEP 4: PROSECUTING ATTORNEY REVIEW (will be added electronically through Laserfiche): Electronically approved as to form by PAO on 5/6/2026. Revised Exhibit D, once executed, will change scope of original contract. Reviewed and approved by DPA Luther on 5/6/26. 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 Amendment No. 1 to the Grant Agreement by and Between Jefferson County and Habitat for Humanity of East Jefferson County for the Landes Street Project This Amendment No. 1 to the Grant Agreement is made and entered into by and between Habitat for Humanity of East Jefferson County ("Grantee") and Jefferson County, a political subdivision under the laws of the State of Washington ("County"), (collectively Parties"). WHEREAS,the Parties want to amend the Grant Agreement entered into between them; NOW, THEREFORE, the Parties agree to Amend the original contract by adding the following: 1. Exhibit D—AMENDED SCOPE OF WORK: which shall have the force and effect of changing the scope of work of the original contract, referenced therein at Exhibits A, C, and elsewhere in the contract. 2. All other terms remain the same, including those terms and obligations appearing in Exhibits A, C, and elsewhere, but which are not altered by the addition of Exhibit D. SIGNATURES FOLLOW ON NEXT PAGE) 1 Jefferson County Habitat fo 1 anity of East Jcffco Board of Commissioners 240,G--- 4SignatureDto r Greg Brotherton, Chair Date SEAL: ATTEST: Carolyn Gallaway, CMC Date Clerk of the Board Approved as to form only: 05/06/2026 Jer h B. ther Date Civil Deputy Prosecuting Attorney 2 Exhibit D AMENDED SCOPE OF WORK Original Terms and Conditions of the Scope of Work Subject to This Amendment: Habitat for Humanity of East Jefferson County will sell five homes in their Landes Terrace Project to homebuyers earning 60%AMI or below. Each homebuyer will receive $18,000 subsidy per home from the $90,000 received from Jefferson County. Amended Scope of Work: The Scope of Work is amended to the following: Habitat for Humanity of East Jefferson County will sell three homes in their Landes Terrace Project to homebuyers earning 60%AMI or below. Each homebuyer will receive a subsidy from Jefferson County,totaling $54,000 for all three homes. In addition, one homebuyer who earns 60%AMI will receive an $18,000 subsidy for a newly constructed 3-bedroom home at 2358 Cliff Street, and one homebuyer earning 60%AMI will receive an$18,000 subsidy for a Habitat for Humanity home located at 1215 Rosecrans Street. ORIGINAL AGREEMENT FOR 2026 AFFORDABLE HOUSING/HOMELESSNESS SERVICES FUNDING FOR HABITAT FOR HUMANITY—LANDES TERRACE NEW CONSTRUCTION This Agreement is by and between Jefferson COUNTY, Washington (the COUNTY) and HABITAT FOR HUMANITY OF EAST JEFFERSON COUNTY("RECIPIENT"). WHEREAS, RECIPIENT is a non-profit corporation registered with the Secretary of State of the State of Washington under UBI number 601 850 143; and WHEREAS, the COUNTY desires to support affordable housing and reduce or eliminate homelessness in unincorporated Jefferson COUNTY, as authorized by Chapter 36.22 RCW, Chapter 82.14 RCW, and Chapter 3.33 Jefferson COUNTY Code; and WHEREAS, the COUNTY appointed the Jefferson COUNTY Housing Fund Board HFB") to review and recommend Affordable and Supportive Housing Fund (1590 FUNDS) and/or Homeless Housing and Assistance Fund (5386 FUNDS) proposals submitted to the COUNTY, as authorized by RCW 82.14.530, RCW 82.14.540 and Chapter 3.33 Jefferson COUNTY Code;and WHEREAS, RECIPIENT submitted a qualified Affordable and Supportive Housing Fund 1590 FUNDS) and/or Homeless Housing and Assistance Fund (5386 FUNDS) proposal to the HFB; WHEREAS, the HFB reviewed and recommended funding all or part of RECIPIENT's qualified Affordable and Supportive Housing Fund (1590 FUNDS) and/or Homeless Housing and Assistance Fund(5386 FUNDS)proposal to the Jefferson County Board of Commissioners; WHEREAS, the Jefferson County Board of Commissioners reviewed the HFB recommendation for funding all or part of RECIPIENT's qualified Affordable and Supportive Housing Fund (1590 FUNDS) and/or Homeless Housing and Assistance Fund (5386 FUNDS) proposal and finalized an award of$90,000 from Fund 148 for the purposes recommended by the HFB ("Final HFB Award"); IN CONSIDERATION of the mutual covenants and agreements herein it is agreed by the parties as follows: 1.SERVICES TO BE PERFORMED USING THE HFB AWARD a. RECIPIENT shall use its capabilities and utilize up to the total amount of Final HFB Award for the approved scope of work for the Project described in RECIPIENT's proposal for the 2026 fiscal year,a copy of which is attached as Exhibit A. b. The budget for the Project is described in Exhibit B, attached. 2.RESPONSIBILITIES OF RECIPIENT a. Reports. RECIPIENT shall submit a progress report no later than July 1, 2026, midway through the grant cycle period. An annual report form will be due no later than January 31, 2027. The report form will be distributed before the end of the year. Non-compliance HFB Grant Award Agreement for Habitat for Humanity — Landes Terrace Page 1 may result in no funds awarded in the future. Reports shall include a comparison of outcomes to date with those initially proposed, and the total number of individuals served during the Agreement term. b. Payment. Expenses incurred on the Project, as described in Section 1.b., by the Project's consultants, contractors, suppliers, or RECIPIENT's staff shall be submitted to the COUNTY Administrator's Office by RECIPIENT using a detailed invoice that includes all of the following: i. Each detailed invoice shall show individual items followed by the total amount incurred and the amount eligible for reimbursement under this grant. RECIPIENT may submit such invoices to the COUNTY once per month during the course of the Project for work completed. All invoices shall be submitted no later than 30 days after project completion; and, ii. The COUNTY shall review and approve invoice payments. Payments will be limited to the monies that are available under the grant as described in Section 1. Such invoices, once approved, will be paid using the COUNTY's normal bill paying process and cycle. c. For a minimum of six (6) years, maintain documented proof of payments made, contracts executed, and other expenditures authorized under this Agreement. Upon reasonable notice, provide access to COUNTY or State representatives to audit those records. d. Funding provided by this Agreement may only be expended on the services described in Section 1 of this Agreement. Any monies used for other services or purposes shall be refunded to Jefferson COUNTY. Any monies under-expended of the total funding allocated under this Agreement shall be refunded to Jefferson COUNTY by January 31, 2027. 3. RESPONSIBILITY OF JEFFERSON COUNTY a. The COUNTY shall provide RECIPIENT funding from the Affordable and Supportive Housing Fund (1590 FUNDS) and/or Homeless Housing and Assistance Fund (5386 FUNDS) to be used in support of their responsibilities as defined under this Agreement. b. Said funding is in the amount of the Final HFB Award for the 2026 fiscal year. Payment is conditioned on full compliance with this Agreement, including but not limited to, the submittal of the reports required by Section 2. c. Payment shall be made by the COUNTY upon receipt of an invoice on the next available billing cycle. 4. TERM This Agreement shall be for a term of one year, commencing on January 1, 2026 and ending on December 31,2026,except for the reports required in Section 2,which are due January 31, 2027. 5.ASSIGNMENT A party's interests in this in this Agreement may not be assigned to any other person. HFB Grant Award Agreement for Habitat for Humanity —Landes Terrace Page 2 6. . TERMINATION a. This Agreement may be terminated, in whole or in part, by the COUNTY upon thirty (30) days written notice in the event expected or actual revenue from Fund 148 and/or 149 is reduced or limited in any way, or for non-performance of duties under this Agreement, or for any reason. b. RECIPIENT may terminate this Agreement upon thirty (30) days written notice to the COUNTY. In the event of termination under this clause, the COUNTY shall be liable to pay only for services rendered prior to the effective date of termination. If termination covers a period for which payment has already been made, RECIPIENT shall refund to the COUNTY a pro-rated share of the payment based upon the balance of time remaining in the paid period, unless otherwise negotiated. 7.HOLD HARMLESS a. RECIPIENT shall indemnify and hold the COUNTY, and its officers, employees, agents and volunteers (and their marital communities) harmless from and shall process and defend at its own expense, including all costs, attorney fees and expenses relating thereto, all claims, demands, or suits at law or equity arising in whole or in part, directly or indirectly, from RECIPIENT's negligence or breach of an of its obligations under this Agreement; provided that nothing herein shall require RECIPIENT to indemnify the COUNTY against and hold harmless the COUNTY from claims, demands or suits based solely upon the conduct of the COUNTY, its officers, employees, agents and volunteers and their marital communities), and; provided further that if the claims or suits are caused by or result from the concurrent negligence of: (a) RECIPIENT's agents or employees; and, (b) the COUNTY, its officers, employees agents and volunteers (and their marital communities), this indemnity provision with respect to claims or suits based upon such negligence, and or the costs to the COUNTY of defending such claims and suits, etc., shall be valid and enforceable only to the extent of RECIPIENT's negligence, or the negligence of RECIPIENT's agents or employees. b. RECIPIENT specifically assumes potential liability for actions brought against the COUNTY by RECIPIENT's employees, including all other persons engaged in the performance of any work or service required of RECIPIENT under this Agreement and, solely for the purpose of this indemnification and defense, RECIPIENT specifically waives any immunity under the state industrial insurance law, Title 51 RCW. RECIPIENT recognize that this waiver was specifically entered into pursuant to provisions of RCW 4.24.115 and was subject of mutual negotiation. 8.INSURANCE RECIPIENT shall obtain and keep in force during the term of this Agreement, or as otherwise required, the following insurance: a. Commercial General Liability Insurance. RECIPIENT shall maintain commercial general liability coverage on a form acceptable to Jefferson COUNTY Risk Management for bodily injury, personal injury, and property damage, with a limits of not less than in the amount of at least $1 million per occurrence, for bodily injury, including death, and property damage; and HFB Grant Award Agreement for Habitat for Humanity—Landes Terrace Page 3 b. Worker's Compensation (Industrial Insurance). RECIPIENT shall maintain workers' compensation insurance at its own expense, as required by Title 51 RCW, for the term of this Agreement and shall provide evidence of coverage to Jefferson COUNTY Risk Management,upon request. 9.INDEPENDENT CONTRACTOR a. RECIPIENT and the COUNTY agree that RECIPIENT is an independent contractor with respect to the services provided pursuant to this Agreement. b. Nothing in this Agreement shall be considered to create the relationship of employer and employee between the parties hereto. c. Neither RECIPIENT nor any employee of RECIPIENT shall be entitled to any benefits accorded COUNTY employees by virtue of the services provided under this Agreement. d. The COUNTY shall not be responsible for withholding or otherwise deducting federal income tax or social security or for contributing to the state industrial insurance program, otherwise assuming the duties of an employer with respect to RECIPIENT, or any employee, representative, agent or subcontractor of RECIPIENT. e. RECIPIENT shall be responsible for all applicable withholdings, deductions, state industrial insurance, tax reports, business licenses, registrations, and all other obligations of an independent organization. HFB Grant Award Agreement for Habitat for Humanity —Landes Terrace Page 4 10. SUBCONTRACTING REQUIREMENTS a. RECIPIENT Owns Contract Performance. RECIPIENT is responsible for meeting all terms and conditions of this Agreement including standards of service, quality of materials and workmanship, costs and schedules. Failure of a subcontractor to perform is no defense to a breach of this Agreement. Recipient assumes responsibility for all liability for the actions and quality of services performed by any subcontractor. b. Subcontractor Disputes. Any dispute arising between RECIPIENT and any subcontractors or between subcontractors must be resolved with involvement of any kind on the part of the COUNTY and without detrimental impact on the delivery of contracted goods and services. 11. LEGAL AND REGULATORY COMPLIANCE While performing under this Agreement, RECIPIENT, subcontractors, and their employees are required to comply with all applicable local, state and federal laws, codes, ordinances and regulations, including but not limited to: a. Applicable regulations of the Washington State Department of Labor and Industries, including WA-DOSH Safety Regulation; and b. State and Federal Anti-Discrimination Laws. 12. COMPLIANCE WITH LAWS RECIPIENT shall comply with all Federal, State, and local laws and ordinances applicable to the work to be done under this Agreement. 13. CHOICE OF LAW The parties agree that this Agreement is entered into in the State of Washington. This Agreement shall be governed by and construed under the laws of the United States, the State of Washington and the County of Jefferson, as if applied to transactions entered into and to be performed wholly within Jefferson County, Washington between Jefferson County residents. No party shall argue or assert that any state law other than Washington law applies to the governance or construction of this Agreement. 14. DISPUTES a. The parties agree to use their best efforts to prevent and resolve disputes before they escalate into claims or legal actions. Any disputed issue not resolved under this Agreement shall be submitted in writing within 10 days to the County Risk Manager, whose decision in the matter shall be final, but shall be subject to judicial review. b. If either party deem it necessary to institute legal action or proceeding to enforce any right or obligation under this Agreement, each party in such action shall pay for its own attorney's fees and court costs. c. Any legal action shall be initiated in the Superior Court of the State of Washington for Jefferson County, subject to the venue provisions for actions against counties in RCW HFB Grant Award Agreement for Habitat for Humanity—Landes Terrace Page 5 36.01.050. The parties agree that the parties have the right of appeal from such decisions of the Superior Court under the laws of the State of Washington. d. RECIPIENT consents to the personal jurisdiction of the courts of the State of Washington. 15. DISCRIMINATION PROHIBITED RECIPIENT with regard to the project to be completed under this Agreement, shall not discriminate on the grounds of age, sex, marital status, sexual orientation, race, creed, color, national origin, honorably discharged veteran or military status, or the presence of any sensory, mental, or physical disability or the use of a trained dog guide or service animal by a person with a disability, unless based upon a bona fide occupational qualification in the selection and retention of employees,materials, supplies, or subcontractors. 16. INTEGRATED AGREEMENT This agreement together with attachments or addenda represents the entire and integrated agreement between the COUNTY and RECIPIENT and supersedes all prior negotiations, representations, or agreements written or oral. 17. PUBLIC RECORDS ACT This Agreement and any reports submitted by RECIPIENT are subject to disclosure as a public record under the Public Records Act, RCW Chapter 42.56. 18. RECORDS RETENTION AND AUDIT AUTHORIZATION a. A minimum of six years, RECIPIENT shall maintain documented proof of payments made, contracts executed and other expenditures authorized under your Agreement with Jefferson COUNTY. b. Upon reasonable notice, RECIPIENT shall provide access to COUNTY or State representatives to audit records related to the funds provided to RECIPIENT under this Agreement. 19. NO SEVERABILITY The terms of this Agreement are not severable. If any provision of this Agreement or the application of this Agreement to any person or circumstance shall be invalid, illegal, or unenforceable to any extent, the remainder of this Agreement and the application this Agreement shall not be enforceable. 20. SURVIVAL Those provisions of this Agreement that by their sense and purpose should survive the term of this Agreement shall survive the term of this Agreement for a period equal to any and all relevant statutes of limitation, plus the time necessary to fully resolve any claims, matters or actions begun within that period.. Without limiting the generality of the preceding sentence, and for the avoidance of doubt, the provisions that survive the term of this agreement include: (a)controlling law; (b) insurance; and, (c) indemnification. HFB Grant Award Agreement for Habitat for Humanity— Landes Terrace Page 6 21. AMENDMENT, MODIFICATION AND WAIVER a. This Agreement may be not be amended or modified to change the approved scope of services in the Final HFB Award. b. Only the Jefferson County Board of Commissioners or their delegate by writing delegation to be made prior to action) shall have the expressed, implied, or apparent authority to sign, alter, amend, modify, or waive any clause or condition of this Agreement. c. Any alteration, amendment, modification, or waiver of any clause or condition of this Agreement is not effective or binding unless made in writing and signed by the Jefferson County Board of Commissioners or their delegate. SIGNATURES ARE ON THE FOLLOWING PAGE HFB Grant Award Agreement for Habitat for Humanity —Landes Terrace Page 7 IEFFERSON COUNTY WASHINGTON HABITAT FOR HUMANITY of East JetTco Board of COUNTY Commissioners Jefferson COUNTY. Washington By:irtc/r2S— eid ise•hour.Chair ate Bv: Sid Lure 111.los,gala B : k2f1_ Greg rotherton. Member Date Name: Jaw\;e MQc;c3_ews.( _ tTitle: £ Xfc.jive Dfg-Ltdley•Nollette. Mer Date Date: 1/12IZDL,10__`,___________ SEAL: a• FFERSo'"• r.•' ;GpMMt1j C0 14 01:Zi: ATTEST: 0' v'•0. g iI C au,... c/2 arolyn G lia«ay. CMC / Date Clerk of the Board Approved as to form only for 12/12/2025 hilip C. Hunsucker. Date Chief Civil Depute Prosecuting Attorney 11FB Grant A‘card Agreement for Habitat for Humanity - Landes Terrace Page 8 EXHIBIT A - SCOPE OF WORK RECIPIENT has been awarded $90,000 (the "Final HFB Award"), after recommendation by the Housing Fund Board ("HFB"). Recipient shall use the Final HFB Award consistently with its response to the request for proposal submitted to the HFB during the 2026 cycle. A true and correct copy of the RECIPIENT's response to the request for proposal is attached as Exhibit C. HFB Grant Award Agreement for Habitat for Humanity— Landes Terrace Page 9 F.X11IR1"1. B —BUDGET RECIPIENT has been awarded $90,000(the "Final HFB Award"), after recommendation by the Housing Fund Board("HFB"). Recipient shall use the Final HFB Award consistently with its response to the request for proposal submitted to the HFB during the 2026 cycle. A true and correct copy of the RECIPIENT's response to the request for proposal is attached as Exhibit C. Applicant: Habitat for Humanity of East Jefferson County Contact: Liesl Slabaugh, Director of Development Address: P.O. Box 658, Port Townsend, WA 98368 Phone: 360-379-2827 Email: l slabaughcn,habitatej c.org HFB Grant Award Agreement for Habitat for Humanity— Landes Terrace Page 10 Exhibit C RECIPIENT'S PROPOSAL Request for Proposal (RFP) starts after this page HFB Grant Award Agreement for Habitat for Humanity— Landes Terrace Page 11 Application Affordable and supportive Housing & Homeless Housing and Assistance Funds For use from January 1, 2026 to December 31, 2026 GENERAL INFORMATION —It is understood that if awarded funding for this period, there is no guarantee of future funding beyond this award. We estimate the available funding for this period to be approximately $160,000 for 5386 Homeless Housing and Assistance(operating) funds; $780,000 for 1590 Affordable and Supportive Housing development funds; and first year operating funds; and $520,000 for 1590 Affordable and Supportive Housing operating funds. Note that 1590 operating funds may be used for all housing-related services. Name of Project or Program: Landes Terrace New Construction Requested total amount for this application: $100,000 Area of the County to be served: East Jefferson County Name of Applicant/Agency: Habitat for Humanity of East Federal Tax ID#: 91-1885667 Jefferson County Contact Person: Lies! Slabaugh Title: Director of Development Address: PO Box 658 City: Port Townsend State: WA Zip: 98368 Phone Number: (360) 379-2827 Fax Number: E-mail: lslabaugh@habitatejc.org CERTIFICATION by Authorized Agency Representative(Board President, CEO, or another person authorized to bind the agency in a contract). Name of Authorized Agency Representative (print): Jamie Maciejewski Title:Executive Director Applicant certifies that these funds will be used as described in this application unless a change has been mutually agreed upon between Contractor and Jefferson County Board of County Commissioners. Substantive amendment requests will also require the approval of the Housing Fund Board("HFB"). Applicant certifies that the information in this application is true and correct. Applicant certifies that it has no outstanding obligations to the County with respect to housing funds. joet:t. October 15, 2025 Signature of Authorized Agency Representative Date SPECIFIC INFORMATION Please separately tab each section of the application submission as to Project or Program Description,Capacity, Alignment, Approach, Impact of Funds, Budget. PROJECT DESCRIPTION Name of Project or Program (please include HMIS name/nomher it ippIicabic): Landes Terrace New Construction Amount requested: 100,000 Provide a brief description of the Project or Program: (LINT IT 200 11 ORDS) Habitat for Humanity of East Jefferson County (Habitat EJC) brings people together to build homes, communities, and hope. We partner with low-income people(below 80% Area Median Income)to build and repair homes, with a focus on homeownership. Habitat EJC offers an opportunity to hard working community members facing an increasingly unaffordable housing market. Low-income buyers work alongside dozens of volunteers to build their own house, make a small down payment, and assume an affordable mortgage(one- third or less of income). Habitat homeowners are responsible, tax-paying members of the community. The stability of home ownership allows them to invest more time and energy in the well-being of their family, friends, and community. Specify the Project or Program goals and expected outcomes. Specify the measures of success by which the Project or Program will be assessed. (LIMIT 300 WORDS). 299 Habitat EJC is requesting$20,000 for each of five homes in our Landes Terrace project(for a total of S I00,000)as an affordability subsidy. These five homes will be sold to homebuyers earning 60%AMI or below. This affordability subsidy will stay with the land to make these homes permanently affordable to low- income homebuyers. The total cost to build a Habitat home, including land purchase and infrastructure, is typically around$355,000, while the typical mortgage for a Habitat homeowner is $205,000. The $150,000 gap is bridged by philanthropy and grants. Habitat EJC has applied to the Housing Trust Fund for$150,000 per house to cover this gap but only expects to get $130,000 or less. A grant from the Jefferson County Affordable Housing Fund would be applied to any gap remaining after Housing Trust Fund dollars are applied. These five homes are part of a 14-unit development on Landes Terrace in Port Townsend,all permanently affordable. The ownership agreements will require that all future resales of these homes be affordable to homebuyers who qualify for Habitat's program (based on area median income). Homeownership creates stability and financial security for families who can afford it, but the reality is that many cannot. Affordable housing is disappearing at an unprecedented pace. This puts many residents at risk of homelessness and adds stress to families who are cost burdened by their housing(paying more than 1/3 of their income). Homeownership is an excellent permanent housing resource for working households at 60% AMI or below who are at risk of displacement or homelessness due to the high cost of housing. They gain control over their housing costs and situation,no longer subject to rising rents or loss of housing when their rental is converted to a vacation rental or sold. For this reason, homeownership can be a better option than renting for many low- income individuals and families. Specify the number of units of housing to be created or number of individuals who will be served by the Project or Program. Five units of housing which will service five households or an estimated 13 people in the short term, but many more as homes resell at a permanently affordable price in the future. Threshold Requirements: Identify the specific eligible use(s) under 5386 and/or 1590 for which the Project or Program qualifies, as listed on pages two through four of the RFP. If you are submitting for both operating and development funds, please submit separate budgets for each. 1 590 Development Funds: $100,000 A. 1. Constructing affordable housing,which may include new units of affordable housing within an existing structure, and facilities providing housing-related services, Households served will be"eligible households"meaning persons within any of the following population groups whose income is at or below sixty percent of median income: o Persons with mental illness o Veterans o Senior citizens o Homeless(or at-risk of being homeless) families with children o Unaccompanied homeless youth or young adults o Persons with disabilities o Domestic violence survivors Provide a brief description of recent, relevant and successful experiences in delivering similar programs and/or projects. Over the past 27 years, Habitat EJC has built and sold a total of 72 homes, rehabbed I,recycled 17 homes bought back from original Habitat owner, refurbished,then resold to a new Habitat family)and completed critical home repairs on 59 homes,primarily in areas of the county (Quilcene and Brinnon)where lack of public infrastructure is a barrier to new home construction. Historically,a large percentage of our homeowners(approximately half) are below 60%AMI and we have never had a foreclosure. Habitat EJC has completed several single-family home developments, all in Port Townsend, including the following: 20th and 2 I st Streets— 16 homes Birkenfeld Neighborhood— 12 homes with an active HOA Cliff Street—7 homes Eddy Street—9 homes Landes North —6 duplex-style homes All developments were built on land acquired by Habitat EJC either through an in-kind donation,or purchase. We are currently building the Cliff Street Cottages, six homes with an HOA, and will start the first six homes of 14 in late October 2025 on Landes Terrace, duplex-style homes with an HOA. We are in pre- construction planning for a 5-cottage development called Rosalynn Court on San Juan Ave, and the 138- home Mason Street Neighborhood in Port Hadlock, with groundbreaking targeted for September 2026. Briefly describe how the project aligns with the priorities and objectives of the Five-Year Homeless Housing Plan and the community outreach conducted for the project or program. (LIMIT 400 WORDS) Per the 2019-2024 Five-Year Homeless Housing Plan, our project addresses Objective#6: Increase the development of affordable housing through the following 1) Increase workforce housing units for those between 50-80% AMI (Action 3) 2) Supportive efforts aimed at ending homelessness by building homes for those earning 30-80%AMI Action 9) Additionally, under Objective#6, this project demonstrates one of the measures of success: Increase the development of affordable housing and alternative housing models through incentives and policy changes." A recent policy change by the City of Port Townsend subsequent to adoption of the Plan, the Zero Lot Line ordinance, is making possible the building of paired homes in the Landes Terrace neighborhood, reducing the cost to build. There is an extreme need for affordable housing in East Jefferson County. The City of Port Townsend offers a municipal perspective on the local housing shortage on its website https://cityofpt.us/engagept/page/housing). Daily, we hear from friends, neighbors and businesses who have family and employees who can't afford to live in the area. An adequate supply of safe, affordable housing is simply not available. Habitat EJC is diligently working to increase our capacity to build more affordable housing more rapidly. The proposal further aligns with the draft 2025-2030 Five Year Homeless Housing Plan, specifically: Objective 4 B, Expand supported affordable housing options for renters. By increasing the affordable units of housing available through an affordable homeownership model,options are expanded. Objective 5 A, Strengthen local partnerships to facilitate housing access across the housing spectrum by better matching underserved populations to housing that meets their types and levels of need. For the first 15 years, Habitat only served households under 60% AMI, viewing this as an underserved population that has lacked access to the most important generational wealth building tool that exists, homeownership. As we have grown, we have expanded to serve households up to 80% AMI but continue to serve those under 60%. A track record of zero foreclosures attests to the success of homeownership for very low-income households. A. APPROACH - Completeness of Proposal and Readiness (5 Points)(LIMIT 400 WORDS) Is the Project or Program ready to use the funding now or are there actions to be taken before the Project or Program can begin? If so, what are those actions? Yes. No additional actions are needed. Will the requested funds fully fund the Project or Program? If not, how does the organization intend to fill the gap? No, requested funds would not fully fund the project, however, we have applied for Housing Trust Fund affordability subsidies of$150,000 per house. We expect to only be awarded $130,000 or less per house. The County grant would be applied to any affordability gap that is left after Housing Trust Funds and the affordable mortgages are applied to the cost of land and building. Could the Project or Program be scaled (include the per unit cost of the Project or Program)? Yes, the project could be scaled and Habitat EJC is doing just that with our currently planned neighborhoods. Landes Terrace reuses the design piloted at Landes North, reducing our costs, allowing us to build more houses with less money. Likewise, the Rosalynn Court neighborhood, planned for the San Juan Avenue property next to the Baptist Church, reuses the cottage design being piloted this summer in our Cliff Street Cottage neighborhood. The per unit cost in the Landes Terrace neighborhood is$355,000. For the five homes that will serve 60% AMI homebuyers, the total cost will be $1,775,000 Have additional funds been requested or will be requested. Identify the sources for those requests and the status of the requests. Our Housing Trust Fund application is pending until December or January. We continue to fundraise for the rest of the Landes Terrace houses. B. IMPACT OF F t l)S - Leverage of Other Funds and \umber of Persons Assisted 10 Points) (LIMIT 400 \\ORDS) How would the project contribute to positive movement in Commerce's Homeless System Performance Measure: total project entries,length of time homeless, exits to permanent housing, returns to homelessness, and system prioritization. The Landes Terrace project contributes to the"expansion of services"measure by increasing the overall number of housing units,allowing the homeless response system to serve more individuals and families and supporting exits to permanent housing. What other funds, donors,or community support are involved with the project? Will these funds leverage other funds? Identify other sources of funds that would be leveraged with the requested funds and/or how these funds will be used to leverage other funds. See project budget below for other funding sources. We have strong community support through both donations and volunteers. We continue to fundraise for the rest of the Landes Terrace neighborhood and having support from the County would strengthen our case as we solicit donors, helping leverage further funding. How many new units will be brought online. How many existing units will be preserved? What services will be funded and how is sustainability achieved? Five units will be completed in 2026. Once construction is complete, homes will be sold to Habitat homebuyers under our Permanent Affordability program. In this model, Habitat EJC owns the land in perpetuity. Homes are sold to homebuyers at a below-market price with a 99-year ground lease. In exchange for this below-market sales price, resale is limited to 1.5% simple interest annual rate of appreciation. The home stays perpetually affordable and if the homeowner chooses to sell,the home is sold to another homeowner who qualifies for the program. The initial community investment is recycled over and over with each sale and purchase of the home. The Jefferson County Affordable Housing Fund's investment is thereby protected in perpetuity, staying with each house as it is sold to the next qualifying buyer. How many individuals will be served by these funds? Five units of housing which will serve 13 people in the short term, but many more as homes resell at a permanently affordable price in the future. Will these funds serve any special populations such as youth or domestic violence survivors? No How does this project serve marginalized populations and address risk of harm and barriers to housing stability? Habitat for Humanity's vision is a world where everyone has a decent place to live, but we recognize that a structure of intentional and systemic racial discrimination in the U.S. has created barriers to homeownership for many BIPOC families. Systemic discrimination has persisted in present policy, from redlining to inequitable access to mortgage credit. Taken together, these practices are barriers to saving for a down payment, getting a loan and affording a home—and they threaten the vitality and prosperity of every community. Habitat EJC is actively working to close the racial/ethnic homeownership gap in East Jefferson County. BIPOC / Latinx families apply to Habitat homes in a greater proportion than their presence in the qualified renters pool and they're accepted to become Homebuyer Families at an even higher rate. Overall, HFHEJC is serving a more diverse clientele than the county as a whole: 21.3%of our partner families are BIPOC / Latinx, almost triple their representation in the county. What is your plan for continuous impro%ement in order to serve historically underserved populations? HFHEJC participates in programs with Habitat for Humanity International and Habitat for Humanity of Washington that support closing the Black homeownership gap. HFHEJC staff members have received training, and we continue to incorporate changes into our organization. We also work with Usawa Consultants LLC to continually improve our outreach efforts. C. PROJECT OR PROGRAM BUDGET—A Feasible Financial Plan (5 Points) BUDGET FORMS Funding period begins January 1,2026, and ends December 31, 2026. Please use the attached budget templates. If you need additional space, you may insert rows. "Proposal"refers to the funds requested from these funds that will be applied to this specific Project or Program. Blank spaces are provided for additional categories. Justification for budget items must be specific, and that same specificity should be reflected in subsequent billings. A maximum 10% Administration fee is allowed for projects if needed, however, Administration fees are not allowed for Capital Projects. C kPI"l U Bl l)GE:"1 FOR REAL EST V1 F. 1)F\'FLOPMMFNT USES Financing Categories Estimate Basis of Estimate Total Acquisition Costs S400,000 Actual Construction 1,375,000 Constructl,,1 hi,l Construction Fees Financing Fees and Charges Guarantees and Reserves Developers Fee Subtotal TOTAL 1,775,000 SOURCES Financing Categories Estimator I Indicate if Committed or Application has been made. If not made indicate date application is to be submitted Private Loan Jefferson County 100,000 Dedicated to land acquisition (affordability subsidy) Funds Public Sources (State $650,000 Housing Trust Fund(WA Dept of Commerce) or Federal Funds) Foundations Donations Other 1,025,000 Affordable Mortgage income once homes are sold(committedL Low Income Housing $ Tax Credits(indicate 9%or 4%) Historic Tax Credits $ New Market Tax Credits Gap(it any) TOTAL I $1,775,000 Please include any budget narrative that is descriptive or helpful to explain any part of your proposed expenditures in your capital budget(s). (LIMIT 300 WORDS) Breakdown of Uses: House Budget, Landes Terrace I home 5 homes Land(Including Design & Infrastructure) 80,000 400,000 Site work & Foundation 61,7001 308,500 Shell/Dry In 58,0001 _ 290,000 Interior Systems/Trades 68,365 341,825 Finish 32,035 160,175 Supervision & Misc (Cumulative)54,900 274,500 Total Home Cost 355,000 1,775,000 ATTACHMENT A Required Insurance Coverages 1. Commercial General Liability. Recipient shall maintain commercial general liability coverage on a form acceptable to Jefferson County Risk Management for bodily injury, personal injury, and property damage, in an amount not less than two million dollars per occurrence($2,000,000)and an aggregate of not less than four million dollars($4,000,000), for bodily injury, including death, and property damage. The commercial general liability insurance coverage shall contain no limitations on the scope of the protection provided and include the following minimum coverage: o Broad form property damage, with no employee exclusion; o Person injury liability, including extended bodily injury; o Broad form contractual/commercial liability, including completed operations and product liability coverage; o Premises—operations liability(M&C); o Independent contractors and subcontractors; and, o Blanket contractual liability. Recipient's commercial general liability policy shall include employer's liability coverage. The County and its elected officials, officers and employees shall be named as an additional insured party under this insurance policy. 2. Automobile Liability. Recipient shall maintain business automobile Liability insurance on a form acceptable to Jefferson County Risk Management with a limit of not less than a combined single limit of 1,000,000 each occurrence. Coverage shall include owned, hired, and non-owned automobiles. 3. Workers' Compensation (Industrial Insurance). Recipient shall maintain workers' compensation insurance at its own expense, as required by Title 51 RCW, for the term of this Agreement and shall provide evidence of coverage to Jefferson County Risk Management, upon request. If the County incurs any cost to enforce the provisions of this subsection, all costs and fees shall be recoverable from Recipient. o Recipient shall provide Workers' Compensation and Employer's Liability on a state approved policy form providing benefits as required by law with employer's liability limits no less than $1,000,000 per accident or disease. o This coverage shall extend to any contractor or subcontractor that does not have their own workers' compensation and employer's liability insurance. o Recipient expressly waives by mutual negotiation all immunity and limitations on liability, with respect to the County, under any industrial insurance act,disability benefit act,or other employee benefit act of any jurisdiction, which would otherwise be applicable in case of such claim. 4. General Insurance Requirements. Insurance coverage shall be evidenced by one of the following methods: o Certificate of insurance; or, o Self-insurance through an irrevocable Letter of Credit from a qualified financial institution. Any deductibles or self-insured shall be declared to and approved by the County prior to the approval of this Agreement by the County. At the option of the County,the insurer shall reduce or eliminate deductibles or self-insured retention, or Recipient shall procure a bond guaranteeing payment of losses and related investigations,claim administration and defense expenses. Failure of Recipient to take out or maintain any required insurance shall not relieve Recipient from any liability under this agreement,nor shall the insurance requirements be construed to conflict with or otherwise limit the obligations concerning indemnification of the County. Recipient's insurers shall have no right of recovery or subrogation against the County including its employees and other agents and agencies), it being the intention of the parties that the insurance policies so affected shall protect all the parties and shall be primary coverage for all losses covered by the above described insurance. Insurance companies issuing Recipient's insurance policy or policies shall have no recourse against the County(including its employees and other agents and agencies) for payment of any premiums or for assessments under any form of insurance policy. All deductibles in Recipient's insurance policies shall be assumed by and be at the sole risk of Recipient. Any judgments for which the County may be liable, in excess of insured amounts required by this agreement,or any portion thereof, may be withheld from payment due,or to become due, to Recipient until Recipient shall furnish additional security covering such judgment as may be determined by the County. Any coverage for third party liability claims provided to the County by a"Risk Pool"created pursuant to Ch. 48.62 RCW shall be non-contributory with respect to any insurance policy Recipient shall provide to comply with this Agreement. The County may, upon Recipient's failure to comply with all provisions of this Agreement relating to insurance, withhold payment or compensation that would otherwise be due to Recipient. Recipient shall provide a copy of all insurance policies specified in this Agreement. Written notice of cancellation or change in Recipient's insurance required by this Agreement shall reference the project name and agreement number and shall be mailed to the County at the following address: Jefferson County Risk Management, P.O. Box 1220, Port Townsend, WA 98368. Recipient's liability insurance provisions shall be primary and noncontributory with respect to any insurance or self-insurance or self-insurance programs covering the County, its elected and appointed officers, officials,employees and agents. Any failure to comply with reporting provisions of the insurance policies shall not affect coverage provided to the County, its officers,officials, employees or agents. Recipient's insurance shall apply separately to each insured against whom claim is made or suit is brought,except with respect to the limits of the insurer's liability. Recipient shall include all subcontractors as insured under its insurance policies or shall furnish separate certificates and endorsements for each subcontractor. All insurance coverage for subcontractors shall be subject to all the requirements stated in this Agreement. The insurance limits mandated for any insurance coverage required by this Agreement are not intended to be an indication of exposure nor are they limitations on indemnification. Recipient shall maintain all required insurance policies in force from the time services commence until services are completed. Certificates, insurance policies, and endorsements expiring before completion of services will be promptly replaced. Recipient shall place insurance with insurers listed to business in the State of Washington and having A.M. Best Company ratings of no less than A-, with the exception that excess and umbrella coverage used to meet the requirements for limits of liability or gaps in coverage need not be place with insurers or re-insurers licensed in the State of Washington. Certificates of insurance as required by this Agreement shall be delivered to the County within fifteen (15)days of execution of the Agreement. To the extent a certificate lists or refers to any endorsements solely by name. description or number it shall be the responsibility of Recipient to obtain and provide to Jefferson County Risk Management a full and complete copy of the texts of such endorsements. The County shall be named as an "additional insured"on all insurance policies required by this Agreement. Recipient shall furnish the County with properly executed certificates of insurance that, at a minimum, shall include: o The limits of coverage; o The project name and agreement number to which it applies; o The certificate holder as Jefferson County, Washington and its elected officials, officers,employees and agents with the address of Jefferson County Risk Management, P.O. Box 1220, Port Townsend, WA 98368; and o A statement that the insurance policy shall not be cancelled or allowed to expire except on thirty(30)days prior written notice to the County. 111114 DATE(MM/OD/YYYY) AC4/ZO CERTIFICATE OF LIABILITY INSURANCE j 02/1912025 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME Lockton Affinity.LLC SHONE FAX P.O.Box 873401 A/C No.Extl 888-553-9002 c,No): Kansas City.MO 64187-3401E-MAILDRESS iINSURER(S)AFFORDING COVERAGE NAIL NSURER-A: ACE American Insurance Co. 22667 INSURED NSURER-B: ACE Property and Casualty 20699 Habitat for Humanity of East Jefferson County NSURER-C: Westchester Fire Ins.Co.10010 PO Box 658 2001 W.Sims Way NSURERJJ: Port Townsend.WA 98368-0658 INSURER-E: NSURER-F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADM BURR I POUCY EFF POLICY EXP LTR TYPE OF INSURANCE INCR YWD POUCY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) LIMITS A GENERAL.LIABILITY i 1 GL1065870-25 ; 04/01/2025 04/01/2026 EACH OCCURRENCE 1 $1,000,000 DAMAGE TO RENTED X COMMERCIAL.GENERAL LIABILITY PREMISES(Ea occurrence) $1,000,000 CLAIMS i MADE X OCCUR 1 MED EXP(Any one person) I $0 PERSONAL 3ADV INJURY i $1,000,000 GENERAL AGGREGATE 2,000,000 GEM.AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG i $2,000,000 X'Icv 71 I I AUTOMOBILE LIABILITY EDMaccdenIED SINGLE LIMIT ANY AUTO BODILY INJURY(Per Person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED .— NON-OWNED PROPERTY DAMAGE AUTOS AUTOS Per accident) B x JMBRELLA LIAB X OCCUR UN1065870-25 04/01/2025 04/01/2026 EACH OCCURRENCE 1,000,000 XCESS LIAR CLAIMS MADE AGGREGATE 1,000,000 ik)ED x I RETENTION ft0,000 WORKERS COMPENSATION WC STATU•OTH- AND EMPLOYERS'LIABILITY I TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE YM OFFICER/MEMBER EXCLUDED? I E.L.EACH ACCIDENT MANDATORY IN NM) If yes,cescnbe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Builder's Risk BR1065870-25 04/01/2025 04/01/2026 Limit I 1 $10,000,000SpecialFormDeductiblePerSchedule I i Insurer A:Property Incl.Crime,Policy#PC1065870-25,04/01/2025-04/01/2026,Limits Per Schedule on File with Lockton Affinity,LLC Insurer A:Directors&Officers Liability,Policy#D01065870-25,04/01/2025-04/01/2026,Limit:$1,000,000 Insurer C:Volunteer Accident Medical Expense,Policy#MED1065870-25,04/01/2025-04/01/2026,Limit:$250,000 Insurer C:Volunteer Disability,Policy#DIS1065870-25,04/01/2025-04/01/2026,Temporary Total Disability Limit:60%Salary I CERTIFICATE HOLDER CANCELLATION Proof of Coverage SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS i AUTHORIZED REPRESENTATIVE 1g.fi ..q ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1065870 JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS CONSENT AGENDA REQUEST TO: Jefferson County Board of Commissioners FROM: Carolyn Gallaway, Clerk of the Board DATE: 12 /I C /2 S— SUBJECT: AGREEMENT re: 2026 Affordable Housing/Homelessness Grant Funding; Habitat for Humanity of East Jefferson County Landes Terrace New Construction; in the amount of$90,000 STATEMENT OF ISSUE: On October 29, 2025 and November 4, 2025 the Housing Fund Board met and reviewed the RFPs received. On November 17, 2025, the Board of County Commissioners approved the Housing Fund Board's 2026 funding recommendations for Affordable Housing Fund 148, Homeless Housing Fund 149(1590 and 5386 Funds). One of the recommendations was to fund Habitat for Humanity—Landes Terrace New Construction; in the amount of$90,000. ANALYSIS: The attached Grant Agreement will provide $90,000 in funds approved by the Board of County Commissioners on November 17, 2025. FISCAL IMPACT: 90,000 from Fund 148 RECOMMENDATION: Approve the attached Grant Agreement. REVIEWED BY: CLOelECV.e7f) I DI( Joss . Peters, County Administrator Date 615 Sheridan Street Port Townsend, WA 98368 defehson www.JeffersonCountyPublicHealth.org Consent Agenda Public Healt 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: Mat/ I ( 2.42(- SUBJECT: Agenda Item — Consolidated Contracts Amendment #13 with the Department of Health; January 1, 2025 — December 31, 2027; $101,206 additional STATEMENT OF ISSUE: Jefferson County Public Health (JCPH) requests Board approval of Consolidated Contract Amendment #13 between JCPH and State of Washington Department of Health (DOH); January 1, 2025 — December 31, 2027; additional funding of $101,206 for a total to date of $6,280,282. ANALYSIS/STRATEGIC GOALS/PROS and CONS: The purpose of this agreement is to provide public health services to the people of Washington State. This amendment adds and/or amends statements of work (SOW) and funding for the following programs: Infectious Disease Syndemic Prevention Services ("syndemic" meaning occurring when two or more infectious diseases or health conditions interact within a population) (additional funding of $30,667). Maternal & Child Health Block Grant (MCHBG) —this revision adds funding which supports interventions that impact the target population of the MCHBG (additional funding of $7,646). WIC Nutrition Program —this revision updates caseload and adds funds within the Women, Infants, and Children Nutrition Program (additional $62,893). FISCAL IMPACT/COST BENEFIT ANALYSIS: Total consideration for this Contract Amendment is $101,206. The Consolidated Contract is funded by DOH, and comprises both Federal and State funds. RECOMMENDATION: JCPH Management recommends BoCC approval of Consolidated Contract Amendment #13 between JCPH and DOH; January 1, 2025 — December 31, 2027; additional funding of $101,206. REVIEWED BY: Lf 3v / Josh . Peters, County Administrator Date Community Health Developmental Disabilities Environmental Public Health 360-385-9400 360-385-9444 360-385-9401 (f) f) 360-379-4487 Always working for a safer and healthier community CC-25-001-A 13 CONTRACT REVIEW FORM Clear Form INSTRUCTIONS ARE ON THE NEXT PAGE) CONTRACT WITH: State of WA Dept of Health Contract No: CC-25-001-A13 Contract For: Consolidated Contracts, Amendment 13 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: $101,206 additional, fora total of$6,280,284 PROCESS: / Exempt from Bid Process Revenue: $101,206 Cooperative Purchase Expenditure:Competitive Sealed Bid Matching Funds Required:Small Works Roster Sources(s) of Matching Funds Vendor List Bid Fund # 127 RFP or RFQ Munis Org/Obj 12756220 Other: APPROVAL STEPS: STEP 1: DEPARTMENT CERTIFIES COMP ANCE W J 0 D CHAPTER 42.23 RCW. Apr. 28, 2026CERTIFIED: N/A: ' Glenn GI bert Date STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE COUNTY (CONTRACTOR) HAS NOT BEEN DEBAR ED Y ANY FEDERAL, STATE, OR LOCAL AGENCY. CERTIFIED: fl N/A: Apr. 28, 2026 Glenn Gilbert Date STEP 3: RISK MANAGEMENT REVIEW (will be added electronically through Laserfiche): Electronically approved by Risk Management on 4/29/2026. STEP 4: PROSECUTING ATTORNEY REVIEW (will be added electronically through Laserfiche): Electronically approved as to form by PAO on 4/29/2026. DPA Luther reviewed and approved on 4/29/26 STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND PROSECUTING ATTORNEY(IF REQUIRED). STEP 6: CONTRACTOR SIGNS STEP 7: SUBMIT TO BOCC FOR APPROVAL 1 Page 1 of 27 JEFFERSON COUNTY PUBLIC HEALTH 2025-2027 CONSOLIDATED CONTRACT CONTRACT NUMBER: CLH32053 AMENDMENT NUMBER: 13 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: hops://state.Rva.sharcnoint.com/sites/doh-ofsfundingresources/sitepages/homc.aspx?-e 1:9a94688da2194d3ea80ac7fbc32e4d7c Adds Statements of Work for the following programs: E Amends Statements of Work for the following programs: Infectious Disease Syndemic Prevention Services-SSP - Effective July 1, 2025 Maternal & Child Health Block Grant — Effective January 1, 2025 WIC Nutrition Program - Effective January 1, 2025 Deletes Statements of Work for the following programs: 2. Exhibit B-13 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-12 Allocations as follows: Increase of$101,206 for a revised maximum consideration of$6,280,284. 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 Greg Brotherton, Chair Date Date APPROVED AS TO FORM ONLY: APPROVED AS TO FORM ONLY Si 04/29/2026 Assistant Attorney General Jeremiah!:. L er, Date Deputy Prosecuting Attorney Page I of I CC-25-01 I-A 13 EXHIBIT B-13 Page 2 of 27 Jefferson County Public Health ALLOCATIONS Contract Number: CLH32053 Contract Term:2025-2027 Date: April 1,2026 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 11 10.557 333.10.55 01/01/25 09/30/27 10/01/24 09/30/27 1,994 23,449 27,516 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) 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 11 10.557 333.10.55 01/01/25 09/30/26 10/01/23 09/30/26 1,994) 4,067 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 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 13 10.557 333.10.55 10/01/25 09/30/26 10/01/25 09/30/26 S62.893 S113,693 SI 13,693 FFY26 WIC Client Svs Contracts USDA 7WA700WA7 Amd 12 10.557 333.10.55 10/01/25 09/30/26 10/01/25 09/30/26 25,400 FFY26 WIC Client Svs Contracts USDA 7WA700WA7 Amd 11 10.557 333.10.55 10/01/25 09/30/26 10/01/25 09/30/26 10,837 FFY26 WIC Client Svs Contracts USDA 7WA700WA7 Amd 9 10.557 333.10.55 10/01/25 09/30/26 10/01/25 09/30/26 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 FFY26 Swimming Beach Act IAR(ECY) 03J18701 Amd 12 66.472 333.66.47 03/01/26 10/31/26 07/01/25 11/30/26 8,000 8,000 21,500 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 FFY25 PHEP BP2-CDC-LHJ Partners NU90TU000055 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 NU90TU000055 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 NU90TU000055 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 Prevent CDC N1117(E010218 Amd 13 93.136 333.93.13 09/01/25 06/30/26 09/01/25 08/31/26 30,667 S128,667 248,344 FFY25 OD2A OID Prevent CDC NU17CE010218 Amd 10, 13 93.136 333.93.13 09/01/25 06/30/26 09/01/25 08/31/26 98,000 FFY24 OD2A OID CDC Prevent NU17CE010218 Amd 10 93.136 333.93.13 07/01/25 08/31/25 09/01/24 08/31/25 21,788 38,121 FFY24 OD2A OID CDC Prevent NU17CE010218 Amd 6 93.136 333.93.13 07/01/25 08/31/25 09/01/24 08/31/25 16,333 FFY24 OD2A OID CDC Prevent NU17CE010218 Amd 2 93.136 333.93.13 01/01/25 06/30/25 09/01/24 08/31/25 32,556 81,556 FFY24 OD2A OID CDC Prevent NU17CE010218 Amd 1 93.136 333.93.13 01/01/25 06/30/25 09/01/24 08/31/25 49,000 FFY25 FPHPA Title X Family Plan FPHPA006560 Amd 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 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 NU50CK000515 Amd I,7 93.323 333.93.32 01/01/25 12/31/25 01/15/21 07/31/26 15,580 15,580 15,580 Page 1 of 3 EXHIBIT B-13 Page 3 of 27 Jefferson County Public Health ALLOCATIONS Contract Number: CLH32053 Contract Term:2025-2027 Date: April 1,2026 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 FFY19 ELC ED Immunizations CDC NU5OCK000515 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 AI-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 AI-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 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('ontracts HRSA Y'R1 B04MC55473 Amd 13 93.994 333.93.99 10/01/25 09/30/26 10/01/25 09/30/26 57,646 16,503 S16,503 FFY26 MCHBG LHJ Contracts HRSA YR1 B04MC55473 Amd 12 93.994 333.93.99 10/01/25 09/30/26 10/01/25 09/30/26 2,140 FFY26 MCHBG LHJ Contracts HRSA YR1 B04MC55473 Amd 11 93.994 333.93.99 10/01/25 09/30/26 10/01/25 09/30/26 6,717 FFY26 MCHBG LHJ Contracts HRSA YR1 B04MC55473 Amd 9 93.994 333.93.99 10/01/25 09/30/26 10/01/25 09/30/26 ($36,700) 0 FFY26 MCHBG LHJ Contracts HRSA YR1 B04MC55473 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 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 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 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 Page 2 of 3 EXHIBIT B-13 Page 4 of 27 Jefferson County Public Health ALLOCATIONS Contract Number: CLH32053 Contract Term:2025-2027 Date: April 1,2026 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 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 01/0I/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 YR 1 Stimulus- Local Asst(10%of 15%)SS Amd 12 N/A 346.26.64 01/01/25 12/31/27 07/01/23 06/30/28 1,800 3,850 3,850 YR1 Stimulus-Local Asst(10%of 15%)SS Amd 11 N/A 346.26.64 01/01/25 12/31/27 07/01/23 06/30/28 250 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 YR 28 SRF-Local Asst(15%)SS Amd 11 N/A 346.26.64 01/01/25 12/31/27 07/01/24 06/30/29 200 200 200 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) 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 12 N/A 346.26.65 01/01/25 12/31/27 07/01/23 12/31/27 1,800 4,050 4,050 Sanitary Survey Fees SS-State Amd 11 N/A 346.26.65 01/01/25 12/31/27 07/01/23 12/31/27 450 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) 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 YR I Stimulus- Local Asst(10%of 15%)TA Amd 12 N/A 346.26.66 01/01/25 12/31/27 07/01/23 06/30/28 1,000 2,000 2,000 YR1 Stimulus-Local Asst(10%of 15%)TA Amd 6 N/A 346.26.66 01/01/25 12/31/27 07/01/23 06/30/28 1,000 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 I N/A 346.26.66 01/01/25 06/30/25 07/01/23 06/30/25 1,000 TOTAL 6,280,284 $6,280,284 Total consideration: 6,179,078 GRAND TOTAL 6,280,284 101,206 GRAND TOTAL 6,280,284 Total Fed 1,144,149 Total State 5,136,135 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 27 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) 2 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(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 additional funds to FFY25 OD2A for a start date of 9/1/25. 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 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 38,121 0 38,121 FFY25 OD2A OID PREVENT CDC 12405252 93.136 333.93.13 09/01/25 06/30/26 98,000 30,667 128,667 0 0 0 0 0 0 0 0 0 TOTALS 216,621 30,667 247,288 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$80,500 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 13 Page 6 of 27 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:DOWOID issued database for actual costs incurred, number of participants enrolled in care tracking SSP activities by the not to exceed$38,121 Provide appropriate referrals to SSP participants; navigation services 15th of each month following 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 13 Page 7 of 27 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information 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 898v000 benefits navigation,and family reunification. participant 128,667 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 were provided(list"unknow when March 1,2025 n' 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 13 Page 8 of 27 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 finance@a,doh.wa.gov. Federal Funding Accountability and Transparency Act(FFATA)(Applies to federal grant awards.) This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act(FFATA or the Transparency Act). The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent. To comply with this act and be eligible to perform the activities in this statement of work,the LHJ must have a Unique Entity Identifier(UEI)generated by SAM.gov. Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. 109-282. Program Specific Requirements 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 13 Page 9 of 27 b. CAPACITY BUILDING-The process by which individuals and organizations obtain,improve,and retain the skills,knowledge,tools,equipment,and other resources needed to do their jobs competently. c. CONTRACTOR—For the purposes of this Statement of Work Only,the entity receiving funds directly from Washington State Department of Health DOH)for client services to prevent or treat conditions named in the statement of work will be referred to as contractor. d. HARM REDUCTION-Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. e. INTEGRATED TESTING-For the purpose of this Statement of Work, Integrated Testing includes Human Immunodeficiency Virus(HIV),Gonorrhea GC),Chlamydia(CT),Syphilis,Hepatitis C(HCV)and Hepatitis B(HBV). f. SOCIAL DETERMINANTS OF HEALTH-Social determinants of health(SDOH)are the conditions in the environments where people are born,live, learn,work,play,worship,and age that affect a wide range of health, functioning,and quality-of-life outcomes and risks. g. YOUTH-For purposes of this agreement,the term"youth"applies to persons under the age of 18. 2. Submission of Invoice Vouchers— a. On a monthly basis,the CONTRACTOR shall submit complete and correct A19 invoice vouchers with amounts billable to DOH under this statement of work and the corresponding OID Expense Summary backup form.All A19 invoice vouchers must be submitted by the 25th of the following month. Prior approval is required for a different frequency of billing. 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 13 Page 10 of 27 j. All staff and volunteers working directly with participants/clients must complete CPR certification within the first 3 months after contract start date(if not already complete). 5. Syringe Services Program, Harm Reduction Care Navigation Requirements a. Includes all requirements for Syringe Service Program operations(see above) b. Attend Harm Reduction Care Navigation training provided by DOH. c. Support participant transportation(e.g.,through the provision of bus passes,cab vouchers,or direct transportation). d. Accompany participants to appointments or provide"warm hand-offs." e. Full-time care navigators(1.0 FTE)shall not exceed a case load greater than 25 individuals. f. Submit monthly outcome data in accordance with DOH standards. 6. Syringe Services Program,Clinical Services Requirements a. Includes all requirements for Syringe Service Program operations(see above) b. Must have clinical staff licensed to practice in the state of Washington to provide clinical services(e.g.,RN,PA,ARNP,LCSW). c. If providing advanced level clinical services(e.g., PA,ARNP, CNM),programs must have appropriate clinical oversight. 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 13 Page 11 of 27 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 13 Page 12 of 27 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 13 Page 13 of 27 functions will not be considered billable under Direct Program.To that end,it is the expectation of DOH that those personne 1 identified as Supervisors have no more than one degree of separation from direct client care.Exceptions to this rule can be presented and considered to and by DOH Contract Management. It will fall to the requesting organization to satisfactorily demonstrate that any Supervisory positions falling within the scope of Direct Program are meeting the expectation of provision of educational or supportive supervision with the aim of directly impacting client experiences, quality of services,and adherence to best practices and Statewide Standards. viii. Small and Attractive items—Each Contractor shall perform a risk assessment(both financial and operational)on the agency's assets to identify those assets that are particularly at risk or vulnerable to loss.Operational risks include risks associated with data security on mobile or portable computing devices that store or have access to state data.Assets so identified that fall below the state's capitalization policy are considered small and attractive assets.The Contractor shall develop written internal policies for managing small and attractive assets. Internal policies should take into consideration the WaTech IT Security Standard SEC-04,which includes SEC-04-06-S Mobile Device Security Standard and SEC-04-01-G Media Handling and Data Disposal Best Practices-https://watech.wa.gov/policies. 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 Up x. Reimbursement of disallowed costs—The CONTRACTOR agrees to reimburse DOH for expenditures billed to the DOH for costs that are later determined through audit or monitoring to be disallowed under the requirements of 2 CFR Part 200—Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Audits. Exhibit A, Statement of Work Page 9 of 11 Contract Number CLH32053-Amendment 13 Page 14 of 27 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. 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. 14. Whistleblower a. Whistleblower statue,41 U.S.C.&4712,applies to all employees working for CONTRACTOR,subcontractors,and subgrantees on federal grants and contracts. The statue(41 U.S.C.&4712) states that an"employee of a CONTRACTOR, subcontractor,grantee,or subgrantee,may not be discharged,demoted,or otherwise discriminated against as a reprisal for"whistleblowing." In addition,whistleblower protections cannot be waived by an agreement,policy, form,or condition of employment. b. The National Defense Authorization Act(NDAA) for Fiscal Year 2013 (Pub. L. 112-239,enacted January 2,2013)mandates a pilot program entitled"Pilot Program for Enhancement of Contractor Employee Whistleblower Protections."This program requires all grantees,their subgrantees,and subcontractors to: i. Inform their employees working on any federal award they are subject to the whistleblower rights and remedies of the pilot program ii. Inform their employees in writing of employee whistleblower protections under 41 U.S.C. &4712 in the predominant native language of the workforce;and, iii. CONTRACTOR and grantees will include such requirements in any agreement made with a subcontractor or subgrantee. 15. 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/20 1 3/1 2/26/20 1 3-3 0465/uniform-administrative- requirements-cost-principles-and-audit-requirements-for-federal-awards. Disclosure of information is governed by the Washington Administrative Code(WAC)246-101-120,520 and 635,and the Revised Code of Washington(RCW) 70.24.080,70.24.084,and 70.24.105 regarding the exchange of medical information among health care providers related to HIV/AIDS or STI diagnosis and treatment. Exhibit A,Statement of Work Page 10 of 11 Contract Number CLH32053-Amendment 13 Page 15 of 27 Please note that CONTRACTORs fit under the definition of"health care providers"and"individuals with knowledge of a person with a reportable disease or condition" in the WAC and RCW. DOH statutory authority to have access to the confidential information or limited Dataset(s)identified in this agreement to the Information Recipient: RCW 43.70.050 Information Recipient's statutory authority to receive the confidential information or limited Dataset(s)identified in this Agreement:RCW 70.02.220(7) Exhibit A,Statement of Work Page 11 of 11 Contract Number CLH32053-Amendment 13 Page 16 of 27 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) 5 Funding Source Federal Compliance Type of Payment Federal Subrecipient (check if applicable) Reimbursement Period of Performance: January 1,2025 through September 30,2026 State FFATA(Transparency Act)Fixed Price Other Research&Development Statement of Work Purpose: The purpose of this statement of work(SOW)is to 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 add additional FFY26 MCHBG LHJ CONTRACTS HRSA YR1 funding. 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 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 8,857 _ 7,646 16,503 FFY25 MCHBG SPECIAL PR HRSA 2 7810125A 93.994 333.93.99 10/01/25 09/30/26 3,376 0 3,376 0 0 0 0 0 0 0 0 0 TOTALS 39,758 7,646 47,404 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 1 of 5 Contract Number CLH32053-Amendment 13 Page 17 of 27 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount ld 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 1 e 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. if 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 13 Page 18 of 27 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-CHIF@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 ParentHelp123.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 3 e 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-CHIF@doh.wa.gov and indicate that zero clients were served during the quarter. No spreadsheet is necessary when zero clients are served. 3f Review your program's entry on Help Me Grow's Document in the Administrative box on your September 30,2026 ParentHelp123 Resource Finder annually for accuracy. MCHBG report that you have updated Exhibit A, Statement of Work Page 3 of 5 Contract Number CLH32053-Amendment 13 Page 19 of 27 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount 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 November 15,2025 document for example activities and priority areas. 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(aidoh.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. Exhibit A, Statement of Work Page 4 of 5 Contract Number CLH32053-Amendment 13 Page 20 of 27 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 A19-1A 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 13 Page 21 of 27 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) 7 Funding Source Federal Compliance Type of Payment Federal Subrecipient (check if applicable) Reimbursement Period of Performance: January 1,2025 through December 31,2027 State FFATA(Transparency Act) El Fixed Price Other Research&Development Statement of Work Purpose: To provide Women,Infants,and Children(WIC)Nutrition Program services by following WIC federal regulations,WIC state office policies and procedures, WIC directives,and other rules. Refer to the Program Specific Requirements section of this document. Revision Purpose: To add funds to FFY26 WIC CLIENT SVS CONTRACTS USDA and update caseload. 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 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 4,067 0 4,067 FFY25 BRSTFDG PEER CN PR MGMT USDA 76214250 10.557 333.10.55 , 01/01/25 09/30/27 23,449 0 23,449 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 50,800 62,893 113,693 0 0 0 TOTALS 223,622 62,893 286,515 Task 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 2. Reallocations are necessary to redistribute caseload through September 2026= statewide. 300 3. Caseload declines. Exhibit A,Statement of Work Page 1 of 7 Contract Number CLH32053-Amendment 13 Page 22 of 27 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount Authorized participating caseload for October 2025 through September 2026 = 350 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 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 Exhibit A,Statement of Work Page 2 of 7 Contract Number CLH32053-Amendment 13 Page 23 of 27 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount 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. Work with birthing hospitals to improve maternity care practices that affect WIC participant breastfeeding rates. Provide participants access to lactation consultants. Other projects will need pre-approval from the State WIC Office See"Billing3BreastfeedingPeerCounselingProgram(BFPO) Requirements" below. 3.1 Provide Breastfeeding Peer Counseling Program activities in Breastfeeding Peer Counseling Annual First year due 12/31/25 accordance with federal and state requirements. The WIC Report and expenditures from the 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. See"Billing4FarmersMarketNutritionProgram (FMNP) 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. Exhibit A, Statement of Work Page 3 of 7 Contract Number CLH32053-Amendment 13 Page 24 of 27 Program Specific Requirements Program Manual,Handbook,Policy References: The local agency shall be responsible for providing services according to rules,regulations and other information contained in the following: WIC Federal Regulations, USDA,and FNS 7CFR Part 246. Washington State WIC Nutrition Program Policy and Procedure Manual Office of Management and Budget, Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Awards,2 CFR 200 Farmers Market Nutrition Program Federal Regulations, USDA, FNS 7CFR Part 248 Other directives issued during the term of the contract Staffing Requirements: The local agency shall: Use Competent Professional Authority staff,as defined by WIC policy,to determine participant eligibility,prescribe an appropriate food package and offer nutrition education based on the participants' needs. Use a Registered Dietitian(RD)or other qualified nutritionist to provide nutrition services to high-risk participants,to include development of a high-risk care plan. The RD is also responsible for quality assurance of WIC nutrition services. See WIC Policy for qualifications for a Registered Dietitian and other qualified nutritionist. Assign a qualified person to be the Breastfeeding Coordinator to organize and direct local agency efforts to meet federal and state policies regarding breastfeeding promotion and support. The Breastfeeding Coordinator must be an International Board-Certified Lactation Consultant or attend an intensive lactation management course,or other state approved training. Restrictions on Funds(i.e.,disallowed expenses or activities,indirect costs,etc.): The local agency shall follow the instructions found in the Policy and Procedure Manual under WIC Allowable Costs and 2 CFR Part 200 Uniform Administrative Requirements, Cost Principles,and Audit Requirements for Federal Awards. Special References(i.e.,RCWs, WACs,etc.): What is the WIC program? 1. The WIC program in the state of Washington is administered by the Department of Health. 2. The WIC program is a federally funded program established in 1972 by an amendment to the Child Nutrition Act of 1966.The purpose of the program is to provide nutrition and health assessment;nutrition education;nutritious food;breastfeeding counseling; and referral services to pregnant,breastfeeding,and postpartum women, infants,and young children in specific risk categories. 3. Federal regulations governing the WIC program(7 CFR Part 246)require implementation of standards and procedures to guide the state's administration of the WIC program. These regulations define the rights,responsibilities,and legal procedures of WIC employees,participants,persons acting on behalf of a participant,and retailers.They are designed to promote: a. High quality nutrition services; b. Consistent application of policies and procedures for eligibility determination; c. Consistent application of policies and procedures for food benefit issuance and delivery;and d. WIC program compliance. 4. The WIC program implements policies and procedures stated in program manuals,handbooks,contracts, forms,and other program documents approved by the USDA Food and Nutrition Service. 5. The WIC program may impose sanctions against WIC participants for not following WIC program rules stated on the WIC rights and responsibilities. 6. The WIC program may impose monetary penalties against persons who misuse WIC benefits or WIC food but who are not WIC participants. Monitoring Visits(i.e.,frequency,type,etc.): Program and fiscal monitoring are done on a biennial(every two years)basis and are conducted onsite. The local agency must maintain on file and have available for review,audit and evaluation: Exhibit A,Statement of Work Page 4 of 7 Contract Number CLH32053-Amendment 13 Page 25 of 27 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." 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. Exhibit A, Statement of Work Page 5 of 7 Contract Number CLH32053-Amendment 13 Page 26 of 27 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 31,2027 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 30 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. Exhibit A,Statement of Work Page 6 of 7 Contract Number CLH32053-Amendment 13 Page 27 of 27 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 13 Page 1 of 21 JEFFERSON COUNTY PUBLIC HEALTH 2025-2027 CONSOLIDATED CONTRACT CONTRACT NUMBER: CLH32053 AMENDMENT NUMBER: 12 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: halls: staieolika.sharepoint.crarn;sites/doh-ofsfun iinaresuurcefi'siipayevtinine.. a eh9a94688ciaWNd3ea8tiac7fbc32e4d7c Adds Statements of Work for the following programs: BEACH Program - Effective March 1,2026 Amends Statements of Work for the following programs: Maternal &Child Health Block Grant—Effective January 1, 2025 Office of Drinking Water Group A Program -Effective January I, 2025 WIC Nutrition Program - Effective January 1, 2025 Deletes Statements of Work for the following programs: 2. Exhibit B-12 Allocations, attached and incorporated by this reference,amends and replaces Exhibit B-1 1 Allocations as follows: Increase of 540.140 for a revised maximum consideration of$6,179,07$. 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 OUNTY COMMISSIONERS DEPARTMENT OF HEALTH 4Ittactit.4 7 03/11/2026 Greg rotherton,Chair Dade Date AP OV,ED S TO FORM ONLY APPROVED AS TO FORM ONLY Jeremiah B.Luther,DPA Assistant Attorney General 02/27/2026 hi p .H isucker, Date Page I of 1 ief Ct ' eputy Prosecuting Attorney CC-25-001•A 12 EXHIBIT B-12 Page 2 of 21 Jefferson County Public Health ALLOCATIONS Contract Number: CLH32053 Contract Term:2025-2027 Date: February 1,2026 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 11 10.557 333.10.55 01/01/25 09/30/27 10/01/24 09/30/27 1,994 23,449 27,516 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) 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 11 10.557 333.10.55 01/01/25 09/30/26 10/01/23 09/30/26 1,994) 4,067 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 FFY24 Brstfdg Peer Cn Pr Mgmt USDA 7WA700WAI 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 IISDA 7WA700WA7 Amd 12 10.557 333.10.55 10/01/25 09/30/26 10/01/25 09/30/26 25,400 50,800 S50,800 FFY26 WIC Client Svs Contracts USDA 7WA700WA7 Amd 11 10.557 333.10.55 10/01/25 09/30/26 10/01/25 09/30/26 10,837 FFY26 WIC Client Svs Contracts USDA 7WA700WA7 Amd 9 10.557 333.10.55 10/01/25 09/30/26 10/01/25 09/30/26 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 FFY26 Swimming Beach Act IAR(FAN) 03J18701 Amd 12 66.472 333.66.47 03/01/26 10/31/26 07/01/25 11/30/26 8,000 8,000 21,500 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 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 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 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 NU I7CE010218 Amd 10 93.136 333.93.13 07/01/25 08/31/25 09/01/24 08/31/25 21,788 38,121 FFY24 OD2A OLD CDC Prevent NU17CE010218 Amd 6 93.136 333.93.13 07/01/25 08/31/25 09/01/24 08/31/25 16,333 FFY24 OD2A OLD 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 OLD CDC Prevent NUI7CE010218 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 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 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 Page 1 of 3 EXHIBIT B-12 Page 3 of 21 Jefferson County Public Health ALLOCATIONS Contract Number: CLH32053 Contract Term:2025-2027 Date: February 1,2026 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 PH Infrastructure Comp Al-LHJ NE11OE000053 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 NEI 1OE000053 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 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 B04MC55473 Amd 12 93.994 333.93.99 10/01/25 09/30/26 10/01/25 09/30/26 2,140 8,857 8,857 FFY26 MCHBG LHJ Contracts HRSA YRI B04MC55473 Amd 11 93.994 333.93.99 10/01/25 09/30/26 10/01/25 09/30/26 6,717 FFY26 MCHBG LHJ Contracts HRSA YRI B04MC55473 Amd 9 93.994 333.93.99 10/01/25 09/30/26 10/01/25 09/30/26 ($36,700) 0 FFY26 MCHBG LHJ Contracts HRSA YR1 B04MC55473 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 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 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 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 Page 2 of 3 EXHIBIT B-12 Page 4 of 21 Jefferson County Public Health ALLOCATIONS Contract Number: CLH32053 Contract Term:2025-2027 Date: February 1,2026 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 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 I N/A 336.04.25 01/01/25 06/30/25 07/01/24 06/30/25 $2,333,000 $2,333,000 YR 1 Stimulus- Local Asst(10%of 15%)SS Amd 12 N/A 346.26.64 01/01/25 12/31/27 07/01/23 06/30/28 1,800 S3,850 S3,850 YRI Stimulus-Local Asst(10%of 15%)SS Amd 11 N/A 346.26.64 01/01/25 12/31/27 07/01/23 06/30/28 250 YRI 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 YR 28 SRF-Local Asst(15%)SS Amd 11 N/A 346.26.64 01/01/25 12/31/27 07/01/24 06/30/29 200 200 200 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) 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 12 N/A 346.26.65 01/01/25 12/31/27 07/01/23 12/31/27 1,800 4,050 4,050 Sanitary Survey Fees SS-State Amd 11 N/A 346.26.65 01/01/25 12/31/27 07/01/23 12/31/27 450 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) 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 YR 1 Stimulus- Local Asst(10%of 15%)TA Amd 12 N/A 346.26.66 01/01/25 12/31/27 07/01/23 06/30/28 1,000 2,000 2,000 YR1 Stimulus-Local Asst(10%of 15%)TA Amd 6 N/A 346.26.66 01/01/25 12/31/27 07/01/23 06/30/28 1,000 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 6,179,078 $6,179,078 Total consideration: 6,138,938 GRAND TOTAL 6,179,078 40,140 GRAND TOTAL 6,179,078 Total Fed 1,042,943 Total State 5,136,135 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 21 Exhibit A Statement of Work Contract Term: 2025-2027 DOH Program Name or Title: BEACH Program-Effective March 1,2026 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: March 1,2026 through October 31,2026 State FFATA(Transparency Act) El Fixed Price Other Research&Development Statement of Work Purpose: The Beach Environmental Assessment,Communication,and Health(BEACH)Program works with LHJ to monitor water at marine swimming beaches for bacteria and provide public notification when levels are unsafe.This work is funded by an interagency agreement issued by Department of Ecology(ECY)for administration by DOH. Reference DOH Contract#GVS32430. 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 FFY26 SWIMMING BEACH GRANT IAR(ECY) 26505926 66.472 333.66.47 03/01/26 10/31/26 0 8,000 8,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTALS 0 8,000 8,000 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount 1 BEACH Program Administration and Annual Meeting: Time Summarize time spent on administrative Annual meeting held in Reimbursement for actual spent on administrative duties related to the BEACH duties in annual report. March 2026.Annual report costs up to$8,000 for Program and the 2026 Annual meeting. due October 31,2026. tasks 1-3. Sub-recipient 2 Bacteria Monitoring&Public Notification 1. Enter data into Department of Ecology's 1. Enter data results into may use their discretion in Collect samples and field observations in BEACH Program Database. database by Friday each prioritizing which task(s) accordance with BEACH Program Quality week of sample collection. to pay with this award. Assurance Project Plan(QAPP).Notify BEACH 2. Email copies of laboratory analytical Program Coordinator in advance if samples cannot reports to BEACH Program Coordinator.2. Email copies of reports be collected.Coordinate deviations from the QAPP upon receipt. and/or schedule with the BEACH Program 3. Include a list of swimming advisories in Coordinator. annual report. 3. Annual report due Post and/or remove swimming advisory signs as October 31,2026. needed. Provide public education about beach water Exhibit A, Statement of Work Page 1 of 2 Contract Number CLH32053-Amendment 12 Page 6 of 21 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount quality. Notify BEACH Program Coordinator of swimming advisories as soon as possible. 3 Illness Pollution Investigations 1. Provide notification via telephone to 1. Within fourteen(14) Notify BEACH Program Coordinator of any illness reports BEACH Program Coordinator. business days. related to recreational swimming beaches.Conduct illness investigations as needed. 2. Summarize illness investigation in annual 2. Annual report due report.October 31,2026. 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(cdoh.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 The funds for this project are being provided by an Environmental Protection Agency grant,Agreement Number CU-03J 18701-0,Catalog of Federal Domestic Assistance Number 66.472—Beach Monitoring and Notification Program Implementation Grants. Program Manual, Handbook,Policy References: Quality Assurance Project Plan https://apps.ecologv.wa.gov/publications/SummaryPages/19031 19.htmI Exhibit A, Statement of Work Page 2 of 2 Contract Number CLH32053-Amendment 12 Page 7 of 21 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) 4 Funding Source Federal Compliance Type of Payment Federal Subrecipient (check if applicable) Reimbursement Period of Performance: January 1,2025 through September 30,2026 State FFATA(Transparency Act) Fixed Price Other Research&Development Statement of Work Purpose: The purpose of this statement of work(SOW)is to 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 add additional FFY26 MCHBG LHJ CONTRACTS HRSA YR1 funding. 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 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 6,717 2,140 8,857 FFY25 MCHBG SPECIAL PR HRSA 2 7810125A 93.994 333.93.99 10/01/25 09/30/26 3,376 0 3,376 0 0 0 0 0 0 0 0 0 TOTALS 37,618 2,140 39,758 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 1 of 5 Contract Number CLH32053-Amendment 12 Page 8 of 21 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount ld 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 12 Page 9 of 21 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-CHIF@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 ParentHelp123.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-CHIF@doh.wa.gov and indicate that zero clients were served during the quarter. No spreadsheet is necessary when zero clients are served. 3f Review your program's entry on Help Me Grow's Document in the Administrative box on your September 30,2026 ParentHelp 123 Resource Finder annually for accuracy. MCHBG report that you have updated Exhibit A,Statement of Work Page 3 of 5 Contract Number CLH32053-Amendment 12 Page 10 of 21 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount 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 November 15,2025 document for example activities and priority areas. 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@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. Exhibit A,Statement of Work Page 4 of 5 Contract Number CLH32053-Amendment 12 Page 11 of 21 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 A19-1A 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 12 Page 12 of 21 Exhibit A Statement of Work Contract Term: 2025-2027 DOH Program Name or Title: Office of Drinking Water Group A Program - Local Health Jurisdiction Name: Jefferson County Public Health Effective January 1,2025 Contract Number: CLH32053 SOW Type: Revision Revision#(for this SOW) 4 Funding Source Federal Compliance Type of Payment Federal Contractor (check if applicable) Reimbursement Period of Performance: January 1,2025 through December 31,2027 Z State Z FFATA(Transparency Act) ® Fixed Price Other Research&Development Statement of Work Purpose: The purpose of this statement of work is to provide funding to the LHJ for conducting sanitary surveys and providing technical assistance to small community and non-community Group A water systems Revision Purpose: Correct total allocation column to reflect cumulative funding amount for SS and TA 2025 and 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 SANITARY SURVEY FEES SS-STATE 24112522 N/A 346.26.65 01/01/25 12/31/27 2,250 1,800 4,050 YR 27 SRF-LOCAL ASST(15%)SS 24119227 N/A 346.26.64 01/01/25 12/31/25 0 0 0 YR 27 SRF-LOCAL ASST(15%)TA 24119227 N/A 346.26.66 01/01/25 12/31/25 0 0 0 YR 28 SRF-LOCAL ASST(15%)SS 24119228 N/A 346.26.64 01/01/25 12/31/27 200 0 200 YRI STIMULUS-LOCAL ASST(10%OF 15%)SS 24144240 N/A 346.26.64 _ 01/01/25 12/31/27 2,050 1,800 3,850 YR 28 SRF-LOCAL ASST(15%)TA 24119228 N/A 346.26.66 01/01/25 12/31/27 0 0 0 YRI STIMULUS-LOCAL ASST(10%OF 15%)TA 24144240 N/A 346.26.66 01/01/25 12/31/27 1,000 1,000 2,000 0 _0 0 0 0 0 TOTALS 5,500 4,600 10,100 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount 1 Trained LHJ staff will conduct sanitary surveys of Provide Final* Sanitary Survey Reports Final Sanitary Survey Upon ODW acceptance of the Final small community and non-community Group A to ODW Regional Office. Complete Reports must be Sanitary Survey Report,the LHJ shall be water systems identified by the DOH Office of Sanitary Survey Reports shall include: received by the ODW paid$1,000 for each sanitary survey of a Drinking Water(ODW)Regional Office. 1. Cover letter identifying significant Regional Office within Transient Non-Community(TNC)system. deficiencies, significant findings, 30 calendar days of See Special Instructions for task activity. observations,recommendations,and conducting the sanitary Upon ODW acceptance of the Final referrals for further ODW follow- survey. Sanitary Survey Report,the LHJ shall be The purpose of this statement of work is to provide up. paid$1,500 for each sanitary survey of a funding to the LHJ for conducting sanitary surveys 2. Completed Small Water System non-Transient Non-Community(NTNC) and providing technical assistance to small checklist. Exhibit A,Statement of Work Page 1 of 4 Contract Number CLH32053-Amendment 12 Page 13 of 21 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount community and non-community Group A water 3. Updated Water Facilities Inventory and Community systems with 499 and less systems. W FI). connections. 4. Photos of water system with text identifying features Payment is inclusive of all associated costs 5. Any other supporting documents. such as travel,lodging,per diem. Final Reports reviewed and accepted by Payment is authorized upon receipt and the ODW Regional Office. acceptance of the Final Sanitary Survey Report within the 30-day deadline. Late or incomplete reports may not be accepted for payment. 2 Trained LHJ staff will conduct Special Purpose Provide completed SPI Report and any Completed SPI Reports Upon acceptance of the completed SPI Investigations(SPI)of small community and non- supporting documents and photos to must be received by the Report,the LW shall be paid$750 for each community Group A water systems identified by ODW Regional Office.ODW Regional Office SPI on Transient Non-Community(TNC) the ODW Regional Office. within 2 working days system. of the service request. See Special Instructions for task activity. Payment is inclusive of all associated costs such as travel,lodging,per diem. Payment is authorized upon receipt and acceptance of completed SPI Report within the 2-working day deadline. Late or incomplete reports may not be accepted for payment. 3 Trained LHJ staff will provide direct technical Provide completed TA Report and any Completed TA Report Upon acceptance of the completed TA assistance(TA)to small community and non- supporting documents and photos to must be received by the Report,the LHJ shall be paid$250 per hour community Group A water systems identified by ODW Regional Office.ODW Regional Office for each technical assistance activity. the ODW Regional Office. within 30 calendar days of providing Payment is authorized upon receipt and See Special Instructions for task activity. technical assistance. acceptance of completed TA Report within the 30-day deadline. Late or incomplete reports may not be accepted for payment. 4 LHJ staff performing the activities under tasks 1,2 For training attended in person,prior to Annually For training attended in person, LHJ shall and 3 attend periodic required survey training as attending the training,submit an be paid mileage,per diem, lodging,and directed by DOH. Authorization for Travel(Non- registration costs as approved on the pre- Employee)"DOH Form 710-013 to the authorization form in accordance with the See Special Instructions for task activity. ODW Program Contact for approval(to current rates listed on the OFM Website ensure enough funds are available). http://www.ofm.wa.gov/resources/travel.asp Exhibit A,Statement of Work Page 2 of 4 Contract Number CLH32053-Amendment 12 Page 14 of 21 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 financena,doh.wa.gov. Federal Funding Accountability and Transparency Act(FFATA)(Applies to federal grant awards.) This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act(FFATA or the Transparency Act). The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent. To comply with this act and be eligible to perform the activities in this statement of work,the LHJ must have a Unique Entity Identifier(UEI)generated by SAM.gov. Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. 109-282. Program Specific Requirements Data Sharing The Office of Drinking Water will share water system information and files with the local health jurisdiction to support the work identified in this statement of work. To request water system data please contact the regional office with the name of the water system,water system ID#,specific information being requested and any timeline requirements. If allowable,please give administrative staff 3 to 5 business days to provide records. Program Manual,Handbook,Policy References: Field Guide(DOH Publication 331-486). Special References: Chapter 246-290 WAC is the set of rules that regulate Group A water systems. By this statement of work,ODW contracts with the LHJ to conduct sanitary surveys(and SPIs and provide technical assistance)for small community and non-community water systems with groundwater sources. ODW retains responsibility for conducting sanitary surveys(and SPIs and provide technical assistance) for small community and non-community water systems with surface water sources, large water systems,and systems with complex treatment. LHJ staff assigned to perform activities under tasks 1,2,and 3 must be trained and approved by ODW prior to performing work. See special instructions under Task 4,below. Special Billing Requirements The LHJ shall submit monthly invoices within 30 days following the end of the month in which work was completed,noting on the invoice the month and year being billed for. Payment cannot exceed a maximum accumulative fee of$4 410$8,1011 for Task 1,and$47900$2,000 for Task 2,Task 3 and Task 4 combined during the contracting period,to be paid at the rates specified in the Payment Method/Amount section above. When invoicing for sanitary surveys,bill half to BARS Revenue Code 346.26.64 and half to BARS Revenue Code 346.26.65. When invoicing for Task 1, submit the list of WS Name, ID#,Amount Billed,Survey Date and Letter Date for which you are requesting payment. When invoicing for Task 2-3,submit the list of WS Name, ID#,TA Date and description of TA work performed,and Amount Billed. When invoicing for Task 4, submit receipts and the signed pre-authorization form for non-employee travel to the ODW Program Contact below and a signed A19-1A Invoice Voucher to DOH Grants Management,billing to BARS Revenue Code 346.26.66 under Technical Assistance(TA). Special Instructions Task 1 Trained LHJ staff will evaluate the water system for physical and operational deficiencies and prepare a Final Sanitary Survey Report which has been accepted by ODW. Detailed guidance is provided in the Field Guide for Sanitary Surveys, Special Purpose Investigations and Technical Assistance (Field Guide).The sanitary survey will include an evaluation of the following eight elements: source;treatment;distribution system; finished water storage;pumps,pump facilities and controls;monitoring,reporting and data verification;system management and operation;and certified operator compliance. If a system is more complex than anticipated or other significant issues arise,the LHJ may request ODW assistance. Exhibit A, Statement of Work Page 3 of 4 Contract Number CLH32053-Amendment 12 Page 15 of 21 No more than 3 surveys of non-community systems with three or fewer connections be completed between January 1,2025,and December 31,2025. No more than 3 surveys of non-community systems with four or more connections and all community systems to be completed between January 1, 2025,and December 31,2025. No more than 3 surveys of Transient Non-Community(TNC)systems to be completed between January 1,2026,and December 31,2026. No more than 1 surveys of Non-Transient Non-Community(NTNC)and Community systems with 499 and less connections to be completed between January 1, 2026,and December 31,2026. The process for assignment of surveys to the LHJ,notification of the water system,and ODW follow-up with unresponsive water systems;and other roles and responsibilities of the LW are described in the Field Guide. Task 2 Trained LHJ staff will perform Special Purpose Investigations(SPIs)as assigned by ODW. SPIs are inspections to determine the cause of positive coliform samples or the cause of other emergency conditions. SPIs may also include sanitary surveys of newly discovered Group A water systems. Additional detail about conducting SPIs is described in the Field Guide.The ODW Regional Office must authorize in advance any SPI conducted by LHJ staff. Task 3 Trained LHJ staff will conduct Technical Assistance as assigned by ODW.Technical Assistance includes assisting water system personnel in completing work or verifying work has been addressed as required,requested, or advised by the ODW to meet applicable drinking water regulations. Examples of technical assistance activities are described in the Field Guide.The ODW Regional Office must authorize in advance any technical assistance provided by the LHJ to a water system. Task 4 LHJ staff assigned to perform activities under tasks 1,2,and 3 must be trained and approved by ODW prior to performing work. If required trainings,workshops or meetings are not available,not scheduled,or if the LHJ staff person is unable to attend these activities prior to conducting assigned tasks,the LHJ staff person may,with ODW approval, substitute other training activities to be determined by ODW. Such substitute activities may include one-on-one training with ODW staff,co-surveys with ODW staff,or other activities as arranged and pre-approved by ODW. LHJ staff may not perform the activities under tasks 1,2,and 3 without completing the training that has been arranged and approved by ODW. Exhibit A,Statement of Work Page 4 of 4 Contract Number CLH32053-Amendment 12 Page 16 of 21 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) 6 Funding Source Federal Compliance Type of Payment Federal Subrecipient (check if applicable) Reimbursement Period of Performance: January 1,2025 through December 31,2027 CI 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. Master Assistance BARS AllocationLHJFundingPeriodChangeIndexListingRevenueCurrentgTotal 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 4,067 0 4,067 FFY25 BRSTFDG PEER CN PR MGMT USDA 76214250 10.557 333.10.55 01/01/25 09/30/27 23,449 0 23,449 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 25,400 25,400 50,800 0 0 0 TOTALS 198,222 25,400 223,622 Task 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 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 12 Page 17 of 21 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 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. 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 12 Page 18 of 21 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information 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 See"Billing3BreastfeedingPeerCounselingProgram(BFPC) 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 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 12 Page 19 of 21 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 12 Page 20 of 21 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 12 Page 21 of 21 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 A19-1A 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 30 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 12 Page 1 of 19 JEFFERSON COUNTY PUBLIC HEALTH 202S-2027 CONSOLIDATED CONTRACT CONTRACT NUMBER: CLH32053 AMENDMENT NUMBER: 11 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: Inn). ; tatetrfua.•11441ePt'int oniV%ilea:dolt-af.tixtiJinTrL ur.e> tom-;sr`` el_'.0-it,5 dd.i.ci44tt11;;,14flaCii-.*2elti71.. 0 Adds Statements of Work for the following programs: Amends Statements of Work for the following programs: Maternal & Child Health Block Grant Effective January I,2025 Office of Drinking Water Group A Program- Effective January 1,2025 WIC Nutrition Program -Effective January I,2025 Deletes Statements of Work for the following programs: 2. Exhibit B-1 i Allocations, attached and incorporated by this reference,amends and replaces Exhibit B--10 Allocations as follows: 4 Increase of$18,454 for a revised maximum consideration of$6,138,938. 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 WASHI GTON STATE OF WASHINGTON BOARD OF QOUNTY ISSIONERS DEPARTMENT OF HEALTH 2 `Z 4v \-51,UkAAAA1 01/14/2026 Gre otherton,Chair ate Date APPROV D AS T`; FORM ONLY APPROVED AS TO FORM ONLY Assistant Attorney General January 7, 2026 Phillip C.Hunsucker, Date Chief Civil Deputy Prosecuting Attornery Page 1 of 1 CC-25d00I-A II EXHIBIT B-I1 Page 2 of 19 Jefferson County Public Health ALLOCATIONS Contract Number: CLH32053 Contract Term:2025-2027 Date: December 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 11 10.557 333.10.55 01/01/25 09/30/27 10/O1/24 09/30/27 51,994 23,449 27,516 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) FFY25 Brstfdg Peer Cn Pr Mgmt USDA 7WA700WAI 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 11 10.557 333.10.55 01/01/25 09/30/26 10/01/23 09/30/26 1,994) 4,067 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 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 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 FFV26 WIC Client Svs Contracts USDA 7WA700WA7 Amd 11 10.557 333.10.55 I0/01/25 09/30/26 10/01/25 09/30/26 10,837 25,400 S25,400 FFY26 WIC Client Svs Contracts USDA 7WA700WA7 Amd 9 10.557 333.10.55 10/01/25 09/30/26 10/01/25 09/30/26 14,563 FFY25 Farm Mkt Ntr Prog Mgmt USDA 7WA8I OWA7 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 lAR(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 NU90TU000055 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 NU90TU000055 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 NU90TU000055 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 OID CDC Prevent NU17CE010218 Amd 10 93.136 333.93.13 07/01/25 08/31/25 09/01/24 08/31/25 21,788 38,121 FFY24 OD2A OID CDC Prevent NU17CE010218 Amd 6 93.136 333.93.13 07/01/25 08/31/25 09/01/24 08/31/25 16,333 FFY24 OD2A OID CDC Prevent NU17CE010218 Amd 2 93.136 333.93.13 01/01/25 06/30/25 09/01/24 08/31/25 32,556 81,556 FFY24 OD2A OID CDC Prevent NU17CE010218 Amd 1 93.136 333.93.13 01/01/25 06/30/25 09/01/24 08/31/25 49,000 FFY25 FPHPA Title X Family Plan FPHPA006560 Amd 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 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 EDELHJs 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 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 Page 1 of 3 EXHIBIT B-Il Page 3 of 19 Jefferson County Public Health ALLOCATIONS Contract\umher: CLH32053 Contract Term:2025-2027 Date: December 1,2025 Indirect Rate January I,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 SuhTotal Total PH Infrastructure Comp AI-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 AI-LHJ NE110E000053 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 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 B04.\1055473 Amd II 93.994 333.93.99 10/01/25 09/30/26 10/01/25 1)9/30/26 6,717 6,717 6,717 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 FFY26 MCHBG LHJ Contracts HRSA YRI NGA Not Received Amd 7 93.994 333.93.99 10/0I/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 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 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 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 01/0I/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 Page 2 of 3 EXIIIBIT B-11 Page 4 of 19 Jefferson County Public Health ALLOCATIONS Contract Number: CI.1132053 Contract Term:2025-2027 Date: December 1,2025 Indirect Rate January I,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 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 S2,333,000 YR1 Stimulus-Local Asst(10%of 15%)SS Amd 11 N/A 346.26.64 (11/01/25 12/31/27 07/01/23 06/30/28 250 2,050 2,050 YRI 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 YR 28 SRF-Local Asst(15%)SS Amd I1 N/A 346.26.64 0I/01/25 12/31/27 07/01/24 06/30/29 200 200 200 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) 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 II N/A 346.26.65 (11/01/25 12/31/27 07/01/23 12/31/27 450 2,250 2,250 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) Sanitary Survey Fees SS-State Amd 1,6 N/A 346.26.65 01/01/25 12/31/27 07/01/23 12/31/27 2,200 YR1 Stimulus-Local Asst(10%of 15%)TA Amd 6 N/A 346.26.66 01/01/25 12/31/27 07/01/23 06/30/28 1,000 1,000 1,000 YR 28 SRF-Local Asst(15%)TA Amd 6 N/A 346.26.66 01/01/25 12/31/27 07/01/24 06/30/29 1,000) 0 0 YR 28 SRF-Local Asst(15%)TA Amd 4 N/A 346.26.66 01/01/25 12/31/27 07/01/24 06/30/29 1,000 YR 27 SRF-Local Asst(15%)TA Amd 4 N/A 346.26.66 01/01/25 06/30/25 07/01/23 06/30/25 1,000) 0 YR 27 SRF-Local Asst(15%)TA Amd 1 N/A 346.26.66 01/01/25 06/30/25 07/01/23 06/30/25 1,000 TOTAL S6,138,938 $6,138,938 Total consideration: 6,120,484 GRAND TOTAL 6,138,938 18,454 GRAND TOTAL 6,138,938 Total Fed 1,007,403 Total State 5,131,535 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 19 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) 3 Funding Source Federal Compliance Type of Payment Federal Subrecipient (check if applicable) Reimbursement Period of Performance: January 1,2025 through September 30,2026 State 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 add FFY26 MCHBG LHJ CONTRACTS HRSA YR I funding. 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 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 0 6,717 6,717 FFY25 MCHBG SPECIAL PR HRSA 2 7810125A 93.994 333.93.99 10/01/25 09/30/26 3,376 0 3,376 0 0 0 0 0 0 0 0 0 TOTALS 30,901 6,717 37,618 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. 1 Exhibit A, Statement of Work Page 1 of 5 Contract Number CLH32053-Amendment 11 Page 6 of 19 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount I d 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 1 e 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. I 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. I h 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 I I Page 7 of 19 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-CHIFna doh.wa.aov 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 ParentHelp123.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-CHIF@a,doh.wa.gov and indicate that zero clients were served during the quarter. No spreadsheet is necessary when zero clients are served. 3f Review your program's entry on Help Me Grow's Document in the Administrative box on your September 30,2026 ParentHelp123 Resource Finder annually for accuracy. MCHBG report that you have updated Exhibit A,Statement of Work Page 3 of 5 Contract Number CLH32053-Amendment 11 Page 8 of 19 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount 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(c doh.wa.sov. 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. Exhibit A,Statement of Work Page 4 of 5 Contract Number CLH32053-Amendment I I Page 9 of 19 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 I I Page 10 of 19 Exhibit A Statement of Work Contract Term: 2025-2027 DOH Program Name or Title: Office of Drinking Water Group A Program - Local Health Jurisdiction Name: Jefferson County Public Health Effective January 1,2025 Contract Number: CLH32053 SOW Type: Revision Revision#(for this SOW) 3 Funding Source Federal Compliance Type of Payment Federal Contractor (check if applicable) Reimbursement Period of Performance: January 1,2025 through December 31,2027 State FFATA(Transparency Act) Z Fixed Price 0 Other Research&Development Statement of Work Purpose: The purpose of this statement of work is to provide funding to the LHJ for conducting sanitary surveys and providing technical assistance to small community and non-community Group A water systems Revision Purpose: Corrected total allocation for 28 SRF-LOCAL ASST(15%) SS to cover invoice for$200 from March 2025. Provide funding for 3 surveys of Non Transient Community Systems.Decrease the number of Non Transient Non Community System surveys to 1. Update rate of reimbursement for each sanitary survey of Transient Non Community(TNC)systems to$1,000. Update rate of reimbursement to$1,500 for each sanitary survey of a Non Transient Non Community(NTNC)system of 499 connections and less. Update rate of reimbursement for Special Purpose Investigations(SPI)to$750 for each SPI on Transient Non Community Systems. Update rate of reimbursement for technical assistance to an hourly rate of$250 for each hour spent,rather then the tiered system of hourly reimbursement.Change from Quarterly Billing to Monthly. 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 SANITARY SURVEY FEES SS-STATE 24112522 N/A 346.26.65 01/01/25 12/31/27 1,800 450 2,250 YR 27 SRF-LOCAL ASST(15%)SS 24119227 N/A 346.26.64 01/01/25 12/31/25 0 0 0 YR 27 SRF-LOCAL ASST(15%)TA 24119227 N/A 346.26.66 01/01/25 12/31/25 0 0 0 YR 28 SRF-LOCAL ASST(15%)SS 24119228 N/A 346.26.64 01/01/25 12/31/27 0 200 200 YR1 STIMULUS-LOCAL ASST(10%OF 15%)SS 24144240 N/A 346.26.64 01/01/25 12/31/27 1,800 250 2,050 YR 28 SRF-LOCAL ASST(15%)TA 24119228 N/A 346.26.66 01/01/25 12/31/27 0 0 0 YR1 STIMULUS-LOCAL ASST(10%OF 15%)TA 24144240 N/A 346.26.66 01/01/25 12/31/27 1,000 0 1,000 0 0 0 0 0 0 TOTALS 4,600 900 5,500 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount Trained LHJ staff will conduct sanitary surveys of Provide Final* Sanitary Survey Reports Final Sanitary Survey Upon ODW acceptance of the Final small community and non-community Group A to ODW Regional Office. Complete Reports must be Sanitary Survey Report,the LHJ shall be water systems identified by the DOH Office of Sanitary Survey Reports shall include: received by the ODW paid Drinking Water(ODW)Regional Office. 1. Cover letter identifying significant Regional Office withineen+ni-uftity-systeni-with-fiifee-er-fewef deficiencies, significant findings, 30 calendar days of 1,000 for each sanitary See Special Instructions for task activity. observations,recommendations,and Exhibit A,Statement of Work Page 1 of 4 Contract Number CLH32053-Amendment II Page 11 of 19 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount referrals for further ODW follow- conducting the sanitary survey of a Transient Non-Community The purpose of this statement of work is to provide up. survey. TNC)system. funding to the LHJ for conducting sanitary surveys 2. Completed Small Water System and providing technical assistance to small checklist. Upon ODW acceptance of the Final community and non-community Group A water 3. Updated Water Facilities Inventory Sanitary Survey Report,the LHJ shall be systems. WFI). paid 4. Photos of water system with text identifying features 5. Any other supporting documents. 1,500 for each sanitary survey of a non- Transient Non-Community(NTNC)and Final Reports reviewed and accepted by Community systems with 499 and less the ODW Regional Office. connections. Payment is inclusive of all associated costs such as travel,lodging,per diem. Payment is authorized upon receipt and acceptance of the Final Sanitary Survey Report within the 30-day deadline. Late or incomplete reports may not be accepted for payment. 2 Trained LHJ staff will conduct Special Purpose Provide completed SPI Report and any Completed SPI Reports Upon acceptance of the completed SPI Investigations(SPI)of small community and non- supporting documents and photos to must be received by the Report,the LHJ shall be paid community Group A water systems identified by ODW Regional Office.ODW Regional Office SRI,$750 for each SPI on Transient Non- the ODW Regional Office. within 2 working days Community(TNC)system. Payment is of the service request. inclusive of all associated costs such as See Special Instructions for task activity.travel, lodging,per diem. Payment is authorized upon receipt and acceptance of completed SPI Report within the 2-working day deadline.Late or incomplete reports may not be accepted for payment. 3 Trained LHJ staff will provide direct technical Provide completed TA Report and any Completed TA Report Upon acceptance of the completed TA assistance(TA)to small community and non- supporting documents and photos to must be received by the Report,the LHJ shall be paid for each community Group A water systems identified by ODW Regional Office.ODW Regional Office the ODW Regional Office. within 30 calendar Up to 3 hours of work: $250 days of providing 3 6 hours of work: $500 See Special Instructions for task activity. technical assistance. 250 per hour for each technical assistance activity. Exhibit A, Statement of Work Page 2 of 4 Contract Number CLH32053-Amendment 11 Page 12 of 19 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount Payment is authorized upon receipt and acceptance of completed TA Report within the 30-day deadline. Late or incomplete reports may not be accepted for payment. 4 LHJ staff performing the activities under tasks 1,2 For training attended in person,prior to Annually For training attended in person,LHJ shall and 3 attend periodic required survey training as attending the training,submit an be paid mileage,per diem, lodging,and directed by DOH. Authorization for Travel(Non- registration costs as approved on the pre- Employee)"DOH Form 710-013 to the authorization form in accordance with the See Special Instructions for task activity. ODW Program Contact for approval(to current rates listed on the OFM Website ensure enough funds are available). http://www.ofm.wa.gov/resources/travel.asp DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site. Questions related to this SOW, or any other finance-related inquiry,may be sent to financeAdoh.wa.gov. Federal Funding Accountability and Transparency Act(FFATA)(Applies to federal grant awards.) This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act(FFATA or the Transparency Act). The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent. To comply with this act and be eligible to perform the activities in this statement of work,the LHJ must have a Unique Entity Identifier(UEI)generated by SAM.gov. Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. 109-282. Program Specific Requirements Data Sharing The Office of Drinking Water will share water system information and files with the local health jurisdiction to support the work identified in this statement of work. To request water system data please contact the regional office with the name of the water system,water system ID#,specific information being requested and any timeline requirements. If allowable,please give administrative staff 3 to 5 business days to provide records. Program Manual,Handbook,Policy References: Field Guide(DOH Publication 331-486). Special References: Chapter 246-290 WAC is the set of rules that regulate Group A water systems. By this statement of work,ODW contracts with the LHJ to conduct sanitary surveys(and SPIs and provide technical assistance)for small community and non-community water systems with groundwater sources. ODW retains responsibility for conducting sanitary surveys(and SPIs and provide technical assistance)for small community and non-community water systems with surface water sources, large water systems,and systems with complex treatment. LHJ staff assigned to perform activities under tasks 1,2,and 3 must be trained and approved by ODW prior to performing work. See special instructions under Task 4,below. Exhibit A, Statement of Work Page 3 of 4 Contract Number CLH32053-Amendment 11 Page 13 of 19 Special Billing Requirements The LHJ shall submit quarterly monthly invoices within 30 days following the end of the quarter month in which work was completed,noting on the invoice the quarter month and year being billed for. Payment cannot exceed a maximum accumulative fee of S-3;600-$4,500 for Task 1,and$1,000 for Task 2,Task 3 and Task 4 combined during the contracting period,to be paid at the rates specified in the Payment Method/Amount section above. When invoicing for sanitary surveys,bill half to BARS Revenue Code 346.26.64 and half to BARS Revenue Code 346.26.65. When invoicing for Task 1,submit the list of WS Name,ID#,Amount Billed,Survey Date and Letter Date for which you are requesting payment. When invoicing for Task 2-3,submit the list of WS Name,ID#,TA Date and description of TA work performed,and Amount Billed. When invoicing for Task 4,submit receipts and the signed pre-authorization form for non-employee travel to the ODW Program Contact below and a signed A19-1A Invoice Voucher to DOH Grants Management,billing to BARS Revenue Code 346.26.66 under Technical Assistance(TA). Special Instructions Task 1 Trained LHJ staff will evaluate the water system for physical and operational deficiencies and prepare a Final Sanitary Survey Report which has been accepted by ODW.Detailed guidance is provided in the Field Guide for Sanitary Surveys, Special Purpose Investigations and Technical Assistance (Field Guide).The sanitary survey will include an evaluation of the following eight elements: source;treatment;distribution system;finished water storage;pumps,pump facilities and controls;monitoring,reporting and data verification;system management and operation;and certified operator compliance. If a system is more complex than anticipated or other significant issues arise,the LHJ may request ODW assistance. No more than 3 surveys of non-community systems with three or fewer connections be completed between January 1,2025,and December 31,2025. No more than 3 surveys of non-community systems with four or more connections and all community systems to be completed between January 1,2025,and December 31,2025. No more than 3 surveys of Transient Non-Community(TNC)systems to be completed between January 1, 2026, and December 31, 2026. No more than 1 surveys ofNon-Transient Non-Community(NTNC)and Community systems with 499 and less connections to be completed between January 1, 2026, and December 31, 2026. The process for assignment of surveys to the LHJ,notification of the water system,and ODW follow-up with unresponsive water systems; and other roles and responsibilities of the LHJ are described in the Field Guide. Task 2 Trained LHJ staff will perform Special Purpose Investigations(SPIs)as assigned by ODW. SPIs are inspections to determine the cause of positive coliform samples or the cause of other emergency conditions. SPIs may also include sanitary surveys of newly discovered Group A water systems. Additional detail about conducting SPIs is described in the Field Guide.The ODW Regional Office must authorize in advance any SPI conducted by LHJ staff. Task 3 Trained LHJ staff will conduct Technical Assistance as assigned by ODW.Technical Assistance includes assisting water system personnel in completing work orr verifying work has been addressed as required,requested, or advised by the ODW to meet applicable drinking water regulations. Examples of technical assistance activities are described in the Field Guide.The ODW Regional Office must authorize in advance any technical assistance provided by the LHJ to a water system. Task 4 LHJ staff assigned to perform activities under tasks 1,2,and 3 must be trained and approved by ODW prior to performing work. If required trainings,workshops or meetings are not available,not scheduled,or if the LHJ staff person is unable to attend these activities prior to conducting assigned tasks,the LHJ staff person may,with ODW approval, substitute other training activities to be determined by ODW. Such substitute activities may include one-on-one training with ODW staff,co-surveys with ODW staff,or other activities as arranged and pre-approved by ODW.LHJ staff may not perform the activities under tasks 1,2,and 3 without completing the training that has been arranged and approved by ODW. Exhibit A, Statement of Work Page 4 of 4 Contract Number CLH32053-Amendment 11 Page 14 of 19 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) 5 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) 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 and to move funds from FFY24 BRSTFDG PEER CN PR MGMT USDA to FFY25 BRSTFDG PEER CN PR MGMT USDA. 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 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 1,994 4,067 FFY25 BRSTFDG PEER CN PR MGMT USDA 76214250 10.557 333.10.55 01/01/25 09/30/27 21,455 1,994 23,449 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 14,563 10,837 25,400 0 0 0 TOTALS 187,385 10,837 198,222 Task 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 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 11 Page 15 of 19 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 I.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 See"Billing2BreastfeedingPromotion Requirements" below. 2.I 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 1 1 Page 16 of 19 Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information 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 See"Billing3BreastfeedingPeerCounselingProgram(BFPC) 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 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 11 Page 17 of 19 Office of Management and Budget, Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Awards,2 CFR 200 Farmers Market Nutrition Program Federal Regulations, USDA, FNS 7CFR Part 248 Other directives issued during the term of the contract Staffing Requirements: The local agency shall: Use Competent Professional Authority staff,as defined by WIC policy,to determine participant eligibility,prescribe an appropriate food package and offer nutrition education based on the participants' needs. Use a Registered Dietitian(RD)or other qualified nutritionist to provide nutrition services to high-risk participants,to include development of a high-risk care plan. The RD is also responsible for quality assurance of WIC nutrition services. See WIC Policy for qualifications for a Registered Dietitian and other qualified nutritionist. Assign a qualified person to be the Breastfeeding Coordinator to organize and direct local agency efforts to meet federal and state policies regarding breastfeeding promotion and support. The Breastfeeding Coordinator must be an International Board-Certified Lactation Consultant or attend an intensive lactation management course,or other state approved training. Restrictions on Funds(i.e.,disallowed expenses or activities,indirect costs,etc.): The local agency shall follow the instructions found in the Policy and Procedure Manual under WIC Allowable Costs and 2 CFR Part 200 Uniform Administrative Requirements, Cost Principles,and Audit Requirements for Federal Awards. Special References(i.e.,RCWs,WACs,etc.): What is the WIC program? 1. The WIC program in the state of Washington is administered by the Department of Health. 2. The WIC program is a federally funded program established in 1972 by an amendment to the Child Nutrition Act of 1966.The purpose of the program is to provide nutrition and health assessment;nutrition education;nutritious food;breastfeeding counseling; and referral services to pregnant,breastfeeding,and postpartum women, infants,and young children in specific risk categories. 3. Federal regulations governing the WIC program(7 CFR Part 246)require implementation of standards and procedures to guide the state's administration of the WIC program. These regulations define the rights,responsibilities,and legal procedures of WIC employees,participants,persons acting on behalf of a participant,and retailers.They are designed to promote: a. High quality nutrition services; b. Consistent application of policies and procedures for eligibility determination; c. Consistent application of policies and procedures for food benefit issuance and delivery;and d. WIC program compliance. 4. The WIC program implements policies and procedures stated in program manuals,handbooks,contracts, forms,and other program documents approved by the USDA Food and Nutrition Service. 5. The WIC program may impose sanctions against WIC participants for not following WIC program rules stated on the WIC rights and responsibilities. 6. The WIC program may impose monetary penalties against persons who misuse WIC benefits or WIC food but who are not WIC participants. Monitoring Visits(i.e.,frequency,type,etc.): Program and fiscal monitoring are done on a biennial(every two years)basis and are conducted onsite. The local agency must maintain on file and have available for review,audit and evaluation: 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 11 Page 18 of 19 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 I,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 II Page 19 of 19 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. A19s are submitted monthly and must be received by the Department within 30 days following the close of each calendar month.Additional A19s 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 I I Page 1et15 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: 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: hiIps.Psi atcofwa.staretornt.currusttes/dch.ofs(ttndingresources;sitet s;4s.2tomc.aspx? c1:9a94t"ftflda2d94d lea 8Jstc?the 12c4ri7c 0 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$6,120.4$4. 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 S,,'i 112 /Z3 s6t.acQ,ert Q.> 11/25/2025 eidi Eisenhour,Chair Date Date APPROYED2O FORM ONLY APPROVED AS TO FORM ONLY Assistant Attorney General JAY'., vi- for 11/18/2025 Philip C.Hunsucker, Date Chief Civil Deputy Prosecuting Attorney CC-25-001-Ata Page 1 of I EXHIBIT B-10 Page 2 of 15 Jefferson County Public health ALLOCATIONS Contract Number: CLI132053 Contract Term:2025-2027 Date: November 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 LH.I Funding Period Funding Period Period Accounts Chart of Accounts Program Title Identification# Amend#List#* Bode** 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)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 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 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 FFY25 OD2A OID CDC Prevent NU 17CE010218 Amd 10 93.136 333.93.13 09/01/25 06/30/26 09/01/25 08/31/26 98,000 S98,000 217,677 FFY24 OD2A OID CDC Prevent NU17CE010218 Amd 10 93.136 333.93.13 07/01/25 08/31/25 1)9/01/24 08/31/25 21,788 S38,121 FFY24 OD2A OID CDC Prevent NU17CE010218 Amd 6 93.136 333.93.13 07/01/25 08/31/25 09/01/24 08/31/25 16,333 FFY24 OD2A OID CDC Prevent NU17CE010218 Amd 2 93.136 333.93.13 01/01/25 06/30/25 09/01/24 08/31/25 32,556 81,556 FFY24 OD2A OID CDC Prevent NU17CE010218 Amd 1 93.136 333.93.13 01/01/25 06/30/25 09/01/24 08/31/25 49,000 FFY25 FPHPA Title X Family Plan FPHPA006560 Amd 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 NH23IP922619 Amd I 93.268 333.93.26 01/01/25 06/30/25 07/01/23 06/30/25 10,000 10,000 10,000 FFY20 ELC EDE LHJs CDC NU50CK000515 Amd 1,7 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 NU5OCK000515 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 AI-LHJ NE110E000053 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 Page 3 of 15 Jefferson County Public Health ALLOCATIONS Contract Number: CL1132053 Contract Term:2025-2027 Date: November 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 1.11.1 Funding Period Funding Period Period Accounts Chart of Accounts Program Title Identification# Amend#List#* ('ode** 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 YRl 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 I 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 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 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 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 YRI Stimulus-Local Asst(10%of 15%)TA Amd 6 N/A 346.26.66 01/01/25 12/31/27 07/01/23 06/30/28 1,000 1,000 1,000 YR 28 SRF-Local Asst(15%)TA Amd 6 N/A 346.26.66 01/01/25 12/31/27 07/01/24 06/30/29 1,000) 0 0 YR 28 SRF-Local Asst(15%)TA Amd 4 N/A 346.26.66 01/01/25 12/31/27 07/01/24 06/30/29 1,000 YR 27 SRF-Local Asst(15%)TA Amd 4 N/A 346.26.66 01/01/25 06/30/25 07/01/23 06/30/25 1,000) 0 YR 27 SRF-Local Asst(15%)TA Amd I N/A 346.26.66 01/01/25 06/30/25 07/01/23 06/30/25 1,000 TOTAL 6,120,484 $6,120,484 Total consideration: 6,000,696 GRAND TOTAL 6,120,484 119,788 GRAND TOTAL 6,120,484 Total Fed 989,849 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 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 Type of Payment Federal Subrecipient (check if applicable) Reimbursement Period of Performance: July 1,2025 through June 30,2026 State El FFATA(Transparency Act) Fixed Price Other 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/O1/25-08/31/25. 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 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 I 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$80,500 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 I 0 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 NOTE: See Special Requirements,Terms and started on 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. Syringe Services Programs: Harm Reduction Service Harm reduction care navigation outcomes Enter deliverable data into the Reimbursement of Navigation include delivering services and tracking: DOH/OID issued database for actual costs incurred, number of participants enrolled in care tracking SSP activities by the not to exceed$16,333 Provide appropriate referrals to SSP participants; navigation services 15th of each month following 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 Activity Deliverables/Outcomes Due Date/Time Frame Payment Information 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 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 I,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 n"were provided(list"unknow when location is unknown)For reporting period 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 II 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 finance(c1)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 USASpendina.aov by DOH as required by P.L. 109-282. Program Specific Requirements Special Requirements,Terms and Conditions 1. Definitions a. ANONYMOUS SERVICES-HIV Prevention services including condom distribution,outreach and light touch. 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 A19 invoice vouchers with amounts billable to DOH under this statement of work and the corresponding OID Expense Summary backup form.All A 19 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,LCSW). c. If providing advanced level clinical services(e.g.,PA,ARNP,CNM),programs must have appropriate clinical oversight. Note: Clinical services can be provided through sub-contractor arrangement or MOU with a Federally Qualified Health Center or other clinical partner if there is a justification the relationship will support efforts to reach people who use drugs and provide onsite and/or mobile clinical services. Clinical services can also be provided using telemedicine services with appropriate description of why in-person services cannot be provided and who the telemedicine partner(s)will be. NOTE: Funds from this contract may not be used to purchase basic safer injection supplies(listed below)—Instead,DOH will provide Contractors with supplies. Below is the list of required supplies for SSP to be provided to Contractors by DOH: 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 I 1 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 financial and operational)on the agency's assets to identify those assets that are particularly at risk or vulnerable to loss.Operational risks include risks associated with data security on mobile or portable computing devices that store or have access to state data.Assets so identified that fall below the state's capitalization policy are considered small and attractive assets.The Contractor shall develop written internal policies for managing small and attractive assets. Internal policies should take into consideration the WaTech IT Security Standard SEC-04,which includes SEC-04-06-S Mobile Device Security Standard and SEC-04-01-G Media Handling and Data Disposal Best Practices- https://watech.wa.gov/policies. 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 j Washington State Department of Health when purchasing food and refreshments for approved meetings. 2. Food for staff meetings/training is unallowable. PLEASE NOTE: If meals/refreshments are purchased for allowable meetings,food can only be purchased for clients at the per diem rate. Any expenses over per diem will be denied. U.S. General Services Administration Per Diem Look Up x. Reimbursement of disallowed costs—The CONTRACTOR agrees to reimburse DOH for expenditures billed to the DOH for costs that are later determined through audit or monitoring to be disallowed under the requirements of 2 CFR Part 200—Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Audits. 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, i i i. CONTRACTOR and grantees will include such requirements in any agreement made with a subcontractor or subgrantee. 16. Allowable Costs All expenditures incurred and reimbursements made for performance under this statement of work shall be based on actual allowable costs.Costs can include direct labor, direct material,and other direct costs specific to the performance of activities or achievement of deliverables under this statement of work. For information in determining allowable costs,please reference OMB Circulars: 2 CFR200(State,Local and Indian Tribal governments)at: https://www.federalregister.gov/documents/2013/12/26/2013-30465/uniform-administrative- requirements-cost-pri ncipl es-and-audit-requirements-for-federal-awards. Disclosure of information is governed by the Washington Administrative Code(WAC)246-101-120, 520 and 635,and the Revised Code of Washington(RCW) 70.24.080,70.24.084,and 70.24.105 regarding the exchange of medical information among health care providers related to HIV/AIDS or STI diagnosis and treatment. Please note that CONTRACTORs fit under the definition of"health care providers"and"individuals with knowledge of a person with a reportable disease or condition" in the WAC and RCW. DOH statutory authority to have access to the confidential information or limited Dataset(s)identified in this agreement to the Information Recipient: RCW 43.70.050 Information Recipient's statutory authority to receive the confidential information or limited Dataset(s)identified in this Agreement:RCW 70.02.220(7) Exhibit A, Statement of Work Page 11 of 11 Contract Number CLH32053-Amendment 10 Department of Public Works O Consent Agenda Page 1 of 1 Jefferson County Board of Commissioners Agenda Request To: Board of Commissioners Josh Peters, County Administrator From: Eric Kuzma, Public Works Director Agenda Date: 5/11/2026 Subject: Grant of License to Washington Coast Sustainable Salmon Foundation for use of the public right-of-way Upper Hoh Road Statement of Issue: Public Works' staff request approval of the attached License to the Washington Coast Sustainable Salmon Foundation (WCSSF) to install and maintain an educational sign related to the completed fish passage restoration project at the tributary to Hell Roaring Creek (historically and locally referred to as tilotkayachal or Little Hell Roaring Creek). Analysis/Strategic Goals/Pro's Ft Con's: This educational signage will enhance public awareness of the restoration of Little Hell Roaring Creek fish passage, foster community stewardship of natural resources without the use of County funds and promote visibility of collaborative salmon recovery projects involving the Hoh Tribe, Trout Unlimited and the Washington Coast Salmon Foundation. Fiscal Impact/Cost Benefit Analysis: The License does not require WCSSF to pay compensation for use of the County property. WCSSF agrees to indemnify and hold harmless the County for any claims, damage or injuries. The License also requires the NWSSF to maintain the site and remove and restore the property upon termination of the License. Staff time and recording fees to be paid by WCSSF. Recommendation: The Board is requested to sign the attached License and return it to Public Works for further processing. Department Contact: Josh Thornton, Real Property Specialist 385-9162. Reviewed By: Josh et rs, ounty Administrator Date / CONTRACT REVIEW FORM Clear Form INSTRUCTIONS ARE ON THE NEXT PAGE) 41/da52(-o,,6 - CONTRACT WITH: Washington Coast Sustainable Salmon Foundation(WCSSF) Contract No: WCSSF-2026-1 Contract For: License for use of the right-of-way; signage Term: until terminated COUNTY DEPARTMENT: Jefferson County Public Works Contact Person: Josh Thornton Contact Phone: 360-385-9162 Contact email: jhornton@co.jefferson.wa.us AMOUNT: N/A PROCESS: L Exempt from Bid Process Revenue: - Cooperative Purchase Expenditure: - Competitive Sealed Bid Matching Funds Required: - Small Works Roster Sources(s) of Matching Funds - Vendor List Bid Fund# _REP or RFQ Munis Org/Obj - Other: APPROVAL STEPS: STEP 1: DEPARTMENT CERTIFIES COMPLIANC WITH JCC 3.55.080 AND CHAPTER 42.23 RCW. CERTIFIED: ElN/A:Pi 7 -)a — c Signature Date STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE COUNTY (CONTRACTOR) HAS NOT BEEN DEBARRED BY ANY FEDERAL, STATE, OR LOCAL AGENCY. y' CERTIFIED: N/A: El /44,t 'U Signature Date STEP 3: RISK MANAGEMENT REVIEW(will be added electronically through Laserfiche): Electronically approved by Risk Management on 4/29/2026. STEP 4: PROSECUTING ATTORNEY REVIEW(will be added electronically through Laserfiche): Electronically approved as to form by PAO on 4/29/2026. DPA Luther reviewed and approved on 4/29/2026 STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND PROSECUTING ATTORNEY(1F REQUIRED). STEP 6: CONTRACTOR SIGNS STEP 7: SUBMIT TO BOCC FOR APPROVAL 1 Jefferson County Department of Public Works 623 Sheridan Street Port Townsend,WA 98368 Document Title:License for Use of County Property Grantor: Jefferson County, a political subdivision of the State of Washington Grantee: Washington Coast Sustainable Salmon Foundation,a Washington nonprofit Corporation Abbreviated Legal Description: Ptn. of NW Qtr S22 T27N R12W W.M. Assessor's Tax Parcel ID Number: 000-000-250; 712-220-000 RECITALS WHEREAS,Jefferson County(the "County")is a political subdivision of the State of Washington and holds right-of-way interests in and to Upper Hoh Road for public road purposes; and WHEREAS,the Washington Coast Sustainable Salmon Foundation(WCSSF)D/B/A Coast Salmon Partnership, a regional salmon recovery organization, in collaboration with Trout Unlimited and the Hoh Tribe,has recently completed a fish passage restoration project at the tributary to Hell Roaring Creek(historically and locally referred to as lildtkayachal or Little Hell Roaring Creek); and WHEREAS,WCSSF desires to install and maintain an educational sign within the County's right-of-way at or near Mile Post 1.24 of Upper Hoh Road,situated within the NW Qtr of Section 22, Township 27 North,Range 12 West, W.M., for the purpose of informing the public regarding salmon habitat restoration and the'Strong Salmon Future'campaign; and WHEREAS,the proposed location of the sign is adjacent to real property managed by the Washington State Department of Natural Resources(WA DNR); and WHEREAS,the County finds that the installation of such educational signage serves a public interest by fostering community awareness of local natural resources and collaborative restoration efforts,provided such installation does not interfere with the safe operation and maintenance of the county road system, Page 1 of 9 NOW, THEREFORE, THE BOARD OF COUNTY COMMISSIONERS OF JEFFERSON COUNTY,WASHINGTON,HEREBY RESOLVE AS FOLLOWS: The GRANTOR,Jefferson County, a Washington municipal corporation, in order to facilitate public education regarding regional salmon habitat restoration and the "Strong Salmon Future" campaign,and for no monetary consideration, does hereby grant and convey to GRANTEE,Washington Coast Sustainable Salmon Foundation,a Washington Nonprofit Corporation, a license over, across, and upon the real property known as the Upper Hoh Road Right-of-Way, situated in the County of Jefferson, State of Washington(the "Property"). The area subject to this license(the "License Area") is a portion of the Northwest Quarter of Section 22,Township 27 North, Range 12 West, W.M., located at or near Mile Post 1.24, and is more particularly shown on the diagram labeled Exhibit B, attached hereto and by this reference made a part hereof, subject to the following terms and conditions: 1. Use of License Area for Installation,Maintenance& Operation of Educational Signaget No Representations or Warranties. The License Area may be accessed and used by Grantee solely for the purpose of the installation, operation,and maintenance of an educational sign and its supporting structure related to the "Strong Salmon Future" campaign. Grantor makes no representations or warranties as to the condition of the Property,the stability of the roadside slope, or its suitability for Grantee's permitted uses. Grantee accepts the License Area "as-is" and acknowledges that the Property is an active public right-of-way subject to traffic,environmental elements, and routine road maintenance. 2. Retained Rights of County. Except as otherwise explicitly limited under this License, Grantor retains all rights to access,use,and manage the affected area as part of the Upper Hoh Road right-of-way, including the right to perform routine maintenance, drainage improvements, or road widening. In the event the Grantor is required to enter the affected area to remediate any public health or safety issue, or to remove obstructions resulting from Grantee's use of the affected area,the Grantor shall have the right to seek compensation from Grantee and to lien Grantee's property in the event Grantee fails to timely reimburse Grantor for such work. 3. Public Benefit in Lieu of Monetary Consideration. The County acknowledges that compensation is typically required for the use of County property to comply with the state constitutional prohibition against conferring benefits on private interests where the public interest is not primarily served. In this particular case,the benefits to Grantee in the limited use of the County right-of-way under this License are deemed fully offset by the following public benefits: (1)enhancing general public awareness regarding the restoration of the lildtkaya.chal (Little Hell Roaring Creek) fish passage; (2)providing educational signage that fosters community stewardship of natural resources without the use of County funds; and(3)promoting the visibility of collaborative salmon recovery Page 2 of 9 efforts involving the Hoh Tribe,Trout Unlimited, and the Washington Coast Salmon Foundation,which serves as a significant community and environmental asset. These benefits serve a fundamental governmental purpose in protecting natural resources and providing an educational benefit to the community. Therefore,no additional monetary compensation is required in exchange for the County granting this License. 4. Grantee to Acquire Any Required Permits. Grant of this License does not satisfy or guarantee approval of any permits which may be required under Jefferson County Code. It is Grantee's responsibility to acquire any required permits for work on the Property, including but not limited to any necessary traffic control plans or environmental permits required for the installation of the Signage. 5. Ownership of Educational Signage; Removal at End of License Term. During the term of this License,Grantee shall retain ownership of the educational sign and its supporting structure. Ownership shall not be transferred or assigned without the written permission of Grantor. At the end of the term of this License,or upon earlier termination as provided herein, Grantee shall remove all improvements installed by Grantee and shall repair any damage resulting from Grantee's use of the Property,restoring the roadside area to a condition satisfactory to the County Engineer. 6. No Dumping; Maintenance of the Property. Grantee shall not deposit, or allow to be deposited, any waste material on the Property. Grantee shall be solely responsible for all regular monitoring and maintenance of the License Area. This responsibility includes, but is not limited to,the upkeep of Grantee's improvements,the removal of all trash,and the control of any vegetation immediately surrounding the Signage to ensure that the Signage remains visible and does not obstruct the sightlines of the traveling public. Grantee shall immediately notify Grantor in the event of any vandalism of Grantee's improvements on the Property. Under no circumstances shall Grantor be responsible for the cost or labor associated with the maintenance, cleaning, or repair of the Signage or the License Area. 7. Term of this License. The term of this License commences upon execution and terminates upon sixty(60)days written notice by either party.Notwithstanding the foregoing, Grantor reserves the right to terminate this License upon shorter notice in the event of an emergency or if the License Area is required for County road construction, maintenance, or timber-related road expansion where sixty(60)days notice is not feasible. Upon termination, Grantee shall follow the removal and restoration requirements set forth in Condition 5 of this License. 8. Shared Use of the Property. During the License term, Grantee shall ensure that the Property, including the License Area,remains reasonably accessible for use by the Grantor for County and public purposes. 9. Indemnification. Grantee shall defend, indemnify and hold the County, its officers, officials, employees, agents and volunteers(and their marital communities)harmless Page 3 of 9 from any claims, injuries, damages, losses or suits, including attorney's fees,arising out of or resulting from the acts,errors or omissions of the Grantee in performance of this Agreement,except for injuries and damages caused by the sole negligence of the County. Should a court of competent jurisdiction determine this Agreement is subject to RCW 4.24.115 if liability for damages occurs arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Grantee and the County, its officers,officials, employees, agents and volunteers (and their marital communities)the Grantee's liability, including the duty and cost to defend, shall be only for the Grantee's negligence. It is further specifically understood that the indemnification provided constitutes the Grantee's waiver of immunity under Industrial Insurance, Title 51 RCW, solely for the purposes of this indemnification. This waiver has been mutually negotiated by the parties. This section shall survive the expiration or termination of this Agreement. 10. Insurance. Grantee shall obtain and keep in force during the term of this License,the following insurance: liability and property damage insurance in an amount not less than a single limit of one million and 00/100 dollars ($1,000,000),two million aggregate 2,000,000) for bodily injury, including death and property damage pre occurrence. Jefferson County shall be named on all certificates of insurance as an additional insured. The certificates of insurance shall cover the activities allowed in the County's right-of- way under this License. All insurance shall be obtained from an insurance company authorized to do business in Washington State. Grantee shall submit a certificate of insurance to the County within 30 days after the recording of this License. 11. Grantor's Contact. The contact person and contact information for Grantor during the term of this License shall be: Name: Jefferson County Public Works Telephone:360-385-9160 Email: pubworks(a,co jefferson.wa.us 12. Grantee's Contact. The contact person and contact information for Grantee during the term of this License shall be: Name: Alex Bradberry Telephone: 360-532-9113 Email: alex(a,coastsalmonpartnership.org 13. Covenants. Grantor covenants that it has lawful jurisdiction and control over the public right-of-way described herein, which includes the county road known as Upper Hoh Road, and possesses the authority to regulate the use thereof by granting this License. Grantee covenants that the person signing this License on behalf of Grantee is fully authorized to do so.. Page 4 of 9 THIS LICENSE requires the signature of all parties and shall be considered to have been executed as of the date of the last signature below. Signatures on following pages] Page 5 of 9 Approved this of 2026 by the Jefferson County Board of County Commissioners. GRANTOR: Jefferson County Approved as to form only: Board of County Commissioners Jefferson County, Washington By: By: 04/29/2026 Greg Brotherton, Chair Jeremi B ther Date Deputy Prosecuting Attorney State of Washington County of Jefferson This record was acknowledged before me on by Greg Brotherton as the Chair of the Jefferson County Board of County Commissioners. Notary Public in and for the State of Washington. My Commission Expires Page 6 of 9 GRANTEE: Washington Coast Sustainable Salmon Foundation N 11.ORBy: CO OZ4*.4 Ja Atha, Executive Director i014 ? r. %z State of Washington s: °°,,'.:;t0 rA oIIWASN x County of Q\OyS 1-i 0\.000( This record was acknowledged before me on INVi1 1 (19 21)210, by Jane Atha as the Executive Director of Washingto Coast Sustaina. e Salmon Foundation. j /A I O otary illi.lic in and for the ate of Washington. My Commission Expires 5.'e_ ,V I 1.011 Page 7 of 9 EXHIBIT A Legal Description of License Area A LICENSE TO OCCUPY A PORTION OF THE PUBLIC RIGHT-OF-WAY OF UPPER HOH ROAD, LOCATED WITHIN SECTION 22, TOWNSHIP 27 NORTH, RANGE 12 WEST, W.M., JEFFERSON COUNTY, WASHINGTON, MORE PARTICULARLY DESCRIBED AS FOLLOWS: A 5-FOOT BY 5-FOOT SQUARE AREA SITUATED ON THE SOUTHERLY SHOULDER OF THE UPPER HOH ROAD RIGHT-OF-WAY, LOCATED WITHIN THE SOUTH HALF OF THE NORTHWEST QUARTER (S'/2 NW'/4) OF SAID SECTION 22. SAID LICENSE AREA IS CENTERED AT APPROXIMATE STATION 64+27 AS DEPICTED ON RIGHT OF WAY PLAT NO. 3245, SHEET 2 OF 2 (FILED IN THE OFFICE OF THE COMMISSIONER OF PUBLIC LANDS AT OLYMPIA, WASHINGTON). THE SPECIFIC LOCATION IS FURTHER IDENTIFIED AS BEING CONTIGUOUS WITH THE SOUTHEAST TERMINAL END OF THE EXISTING GUARDRAIL AT THE TRIBUTARY TO HELL ROARING CREEK (LITTLE HELL ROARING CREEK), AS SHOWN ON THE AS-BUILT PLANS DATED OCTOBER 21, 2025. SAID LICENSE AREA IS CONTAINED ENTIRELY WITHIN THE EXISTING ROADWAY EASEMENT GRANTED TO JEFFERSON COUNTY BY THE STATE OF WASHINGTON UNDER DNR EASEMENT NO. CR-3245. AS DEPICTED IN THE ATTACHED EXHIBIT B. Page 8 of 9 EXHIBIT B License Area ROADWAY CENTERLINE EDGE OF PAVEMENT/FOG LINE GUARDRAIL License Area 5'x 5') Right of Way Limit TO HWY 101 TO HOH RAINFOREST f-- Tax Parce1:712220000 EXHIBIT B: LICENSE AREA DETAIL UPPER HOH ROAD MP 1.24 NOT TO SCALE Page 9 of 9 AC® R D DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 04/16/2026 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CNTNAME ACT Cindy McGowan Strand Insurance of Ocean Shores IA/CNE FAX No.Extl: (360)289-2808 NC,No): 113 Lee St SE EMAIL ADDRESS: Cindy@strandinsurance.com TUMWATER,WA 98501 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Ohio Security Insurance Company 24082 INSURED INSURER B WASHINGTON COAST SUSTAINABLE SALMON FOUNDATION INSURER C: 100 S 1ST STE 103 INSURER D: ABERDEEN,WA 98520 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 00047754-260416122114 REVISION NUMBER: 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.'LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.LIMITS SHOWN ARE INCLUSIVE OF AMOUNTS REQUESTED BY THE CERTIFICATE HOLDER AND MAY NOT REFLECT POLICY LIMIT AMOUNTS IN EXCESS OF THOSE REQUESTED.*Not Applicable in WY INSR TYPE OF INSURANCE INSD SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITSMM/DDIYYYYI (MMIDD/YYYYI A X COMMERCIAL GENERAL LIABILITY Y Y BZS55605947 07/01/2025 07/01/2026 EACH OCCURRENCE 2,000,000 DAMAGE TO CLAIMS-MADE OCCUR PREMISES(EaENTEDoccurrence) $ 2,000,000 MED EXP(Any one person) $ 15,000 PERSONAL BADVINJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY JE(° LOC PRODUCTS-COMP/OPAGG $ 4,000,000 OTHER: A AUTOMOBILE LIABILITY BZS55605947 07/01/2025 07/01/2026 (E°acBcINdeED SINGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGEXAUTOSONLYXAUTOSONLYPeraccident) UMBRELLA UAB OCCUR EACH OCCURRENCE EXCESS UAB CLAIMS-MADE AGGREGATE DED RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'UABIUTY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Jefferson County as added an and Additional Insured per BP 79 96 09 16 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Jefferson County THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Department of Public Works ACCORDANCE WITH THE POLICY PROVISIONS. 623 Sheridan St AUTHORIZED REPRESENTATIVE PORT TOWNSEND,WA 98368 j yt' Gl 1,V ,? `l)V CCM) ACORD 25(2025/12) 1988-2025 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by CCM on 04/16/2026 at 12:29PM BUSINESSOWNERS BP79960916 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS LIABILITY EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM Below is a summarization of the coverages provided by this endorsement. No coverages are given by this summary. Actual coverage descriptions are within this endorsement. SECTION SUBJECT A. Supplementary Payments Bail Bonds Loss Of Earnings B. Broadened Coverage For Damage To Premises Rented To You C. Incidental Medical Malpractice Injury D. Mobile Equipment E. Blanket Additional Insured (Owners, Contractors Or Lessors) F. Newly Formed Or Acquired Organizations G. Aggregate Limits H. Duties In The Event Of Occurrence, Offense, Claim Or Suit I. Liability And Medical Expenses Definitions Bodily Injury Insured Contract Personal And Advertising Injury Section II -Liability is amended as follows: A. Supplementary Payments Section A.1. Business Liability is modified as follows: 1. The $250 limit shown in Paragraph A.1.f.(1)(b) Coverage Extension - Supplementary Payments for the cost of bail bonds is replaced by a $3,000 limit. 2. The $250 limit shown in Paragraph A.1.f.(1)(d) Coverage Extension - Supplementary Payments for reasonable expenses and loss of earnings is replaced by a $500 limit. B. Broadened Coverage For Damage To Premises Rented To You 1. The last paragraph of Section B.1. Exclusions - Applicable To Business Liability Coverage is replaced by the following: With respect to the premises which are rented to you or temporarily occupied by you with the permis- sion of the owner, Exclusions c., d., e., g., h., k., I., m., n.and o. do not apply to "property damage". 2016 Liberty Mutual Insurance BP 79 96 09 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 4 2. Paragraph D.2. Liability And Medical Expenses Limits Of Insurance is replaced by the following: The most we will pay under this endorsement for the sum of all damages because of all "property damage" to premises while rented to you or temporarily occupied by you with the permission of the owner is the Limit of Insurance shown in the Declarations. 3. Paragraph D.3. Liability And Medical Expenses Limits Of Insurance does not apply. C. Incidental Medical Malpractice Injury 1. Paragraph (4) under Paragraph B.1 j. Exclusions - Applicable To Business Liability Coverage - Profes- sional Services does not apply to "Incidental Medical Malpractice Injury" coverage. 2. With respect to this endorsement, the following is added to Section F. Liability And Medical Expenses Definitions: a. "Incidental Medical Malpractice Injury" means bodily injury arising out of the rendering of or failure to render, during the policy period, the following services: 1) Medical, surgical, dental, x-ray or nursing service or treatment or the furnishing of food or beverages in connection therewith; or 2) The furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances. b. This coverage does not apply to: 1) Expenses incurred by the insured for first-aid to others at the time of an accident and the Duties in the Event of Occurrence, Offense, Claim or Suit Condition is amended accordingly. 2) Any insured engaged in the business or occupation of providing any of the services described under a. above. 3) Injury caused by any indemnitee if such indemnitee is engaged in the business or occupation of providing any of the services described under a. above. D. Mobile Equipment Section C. Who Is An Insured is amended to include any person driving "mobile equipment" with your permission. E. Blanket Additional Insured (Owners, Contractors Or Lessors) 1. Section C. Who Is An Insured is amended to include as an insured any person or organization whom you are required to name as an additional insured on this policy under a written contract or written agreement. The written contract or agreement must be: a. Currently in effect or becoming effective during the term of this policy; and b. Executed prior to the "bodily injury", "property damage", or "personal and advertising injury". 2. The insurance afforded to the additional insured is limited as follows: a. The person or organization is only an additional insured with respect to liability arising out of: 1) Real property, as described in a written contract or written agreement, you own, rent, lease, maintain or occupy; and 2) Caused in whole or in part by your ongoing operations performed for that insured. b. The Limit of Insurance applicable to the additional insured are those specified in the written contract or written agreement or the limits available under this policy, as stated in the Declara- tions, whichever are less. These limits are inclusive of and not in addition to the Limit of Insurance available under this policy. c. The insurance afforded to the additional insured does not apply to: 1) Liability arising out of the sole negligence of the additional insured; 2) "Bodily injury", "property damage", "personal and advertising injury", or defense coverage under the Supplementary Payments section of the policy arising out of an architect's, en- gineer's or surveyor's rendering of or failure to render any professional services including: 2016 Liberty Mutual Insurance BP 79 96 09 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 2 of 4 a) The preparing or approving of maps, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and b) Supervisory, inspection, architectural or engineering activities. 3) Any "occurrence" that takes place after you cease to be a tenant in the premises described in the Declarations; or 4) Structural alterations, new construction or demolition operations performed by or for the person or organization designated in the Declarations. 3. Any coverage provided hereunder shall be excess over any other valid and collectible insurance avail- able to the additional insured whether primary, excess, contingent or on any other basis unless a contract specifically requires that this insurance be primary or you request that it apply on a primary basis. F. Newly Formed Or Acquired Organizations s The following is added to Section C.Who Is An Insured: Any business entity acquired by you or incorporated or organized by you under the laws of any individual state of the United States of America over which you maintain majority ownership interest exceeding fifty percent. Such acquired or newly formed organization will qualify as a Named Insured if there is no similar insurance available to that entity. However: 1. Coverage under this provision is afforded only until the 180th day after the entity was acquired or incorporated or organized by you or the end of the policy period, whichever is earlier; 2. Section A.1. Business Liability does not apply to: a. "Bodily injury" or "property damage" that occurred before the entity was acquired or incorporated or organized by you; and b. "Personal and advertising injury" arising out of an offense committed before the entity was ac- quired or incorporated or organized by you. 3. Records and descriptions of operations must be maintained by the first Named Insured. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. G. Aggregate Limits The following is added to Paragraph D.4. Aggregate Limits Liability and Medical Expenses Limits Of Insurance: 1. The Aggregate Limits apply separately to each of the "locations" owned by or rented to you or temporarily occupied by you with the permission of the owner. 2. The Aggregate Limits also apply separately to each of your projects away from premises owned by or rented to you. For the purpose of this endorsement only, "location" means premises involving the same or connect- ing lots, or premises whose connection is interrupted only by a street, roadway, waterway or right- of-way of a railroad. H. Duties In The Event Of Occurrence, Offense, Claim Or Suit 1. Paragraph E.2.a. Duties In The Event Of Occurrence, Offense, Claim Or Suit Liability And Medical Expenses General Condition applies only when the "occurrence" is known to any insured listed in Paragraph C.1. Who Is An Insured or any "employee" authorized by you to give or receive notice of an occurrence" or claim. 2. Paragraph E.2.b. Duties In The Event Of Occurrence, Offense, Claim Or Suit Liability And Medical Expenses General Condition will not be considered breached unless the breach occurs after such claim or "suit" is known to any insured listed under Paragraph C.1. Who Is An Insured or any "employee" authorized by you to give or receive notice of an "occurrence" or claim. 2016 Liberty Mutual Insurance BP 79 96 09 16 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 3 of 4 I. Section F.Liability And Medical Expenses Definitions is modified as follows: 1. Paragraph F.3. is replaced by the following: 3. "Bodily Injury" means bodily injury, sickness, disease, or incidental medical malpractice injury sustained by a person, and includes mental anguish resulting from any of these; and including death resulting from any of these at any time. 2. Paragraph F.9. is replaced by the following: 9. "Insured contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of prem- ises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; b. A sidetrack agreement; c. Any easement or license agreement, except in connection with construction or demolition operations on or within 50 feet of a railroad; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an indem- nification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization, provided the "bodily injury" or "property damage" is caused, in whole or in part, by you or by those acting on your behalf. However, such part of a contract or agreement shall only be considered an "insured contract" to the extent your assumption of the tort liability is permitted by law. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: 1) That indemnifies a railroad for "bodily injury" or "property damage" arising out of con- struction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road-beds, tunnel, underpass or crossing; 2) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opin- ions, reports, surveys, field orders, change orders or drawings and specifications; or b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or 3) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (2) above and supervisory, inspection, architectural or engineering activities. 3. Paragraph F.14.b. Personal And Advertising Injury is replaced by the following: b. Malicious prosecution or abuse of process; 2016 Liberty Mutual Insurance BP 79 96 09 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 4 of 4 Consent Agenda Commissioners Office JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners FROM: Sarah Melancon, Human Resources Director DATE: May 11,2026 SUBJECT: ADVISORY BOARD APPOINTMENTS (1) re: Law Enforcement Officers and Firefighters (LEOFF)- I Disability Retirement Board-Appointment of Andrew Pernsteiner to Law Enforcement Representative STATEMENT OF ISSUE: The LEOFF-I Disability Retirement Board has had a vacant Law Enforcement Representative position since January 27, 2026. PER RCW 41.26.110, the LEOFF-I Disability Retirement Board held an election for the vacant Law Enforcement Representative position with a closing date of April 30, 2026. From this process, Andrew Pernsteiner was unanimously elected for the vacant position of Law Enforcement Representative. ANALYSIS: It is recommended that the Board of County Commissioners approve the following advisory board appointment: Andrew Pernsteiner—Law Enforcement Representative on the LEOFF-I Disability Retirement Board for a term beginning on May 11, 2026 and expiring on December 31, 2026. RECOMMENDATION Approve the letter of appointment: Andrew Pernsteiner, LEOFF-I Disability Retirement Board, Law Enforcement Representative REVIEWED BY: be W 5l11 Jos . Peters, County Administrator Date Consent Agenda Commissioners Office JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners FROM: Wendy Housekeeper, Executive Assistant DATE: May 11, 2026 SUBJECT: ADVISORY COMMITTEE RESIGNATION (1) re: Jefferson County Marine Resources Committee; District 2 NWSC Representative, Jeff Taylor STATEMENT OF ISSUE: On May 4, 2026, Jeff Taylor, of the Jefferson County Marine Resources Committee District 2 NWSC Representative, resigned from his position on this committee. His term will expire on July 22, 2028, and he has chosen to resign before his term expires. RECOMMENDATION Accept the Jefferson County Marine Resources Committee Representative resignation and sign the thank you letter for committee service. REVIEWED BY: Josh W eters, County Administrator Date ON CMG Asr s/VING ' Payroll Expense Report 5/5/2026 PAYROLL DATE 260505 PAYROLL WARRANT# Payroll Checks: $10,153.88 Check#'s: 15960-15962 Payroll Direct Deposit: $1,407,812.39 Advice#'s: 10101488-10101802 Benefits Paid: $ 1,147,992.78 AP Warrant#'s: 100246051-100246075; Elect. Pymnts Total: $2,565,959.05 Payment of Jefferson County Payroll Warrants Dated May 5,2026 Totaling $2,565,959.05. (Records of all claims submitted for payment along with A/P Warrants approved by the Payroll Services Manager are retained in the Jefferson County Auditor's Office.) BoCC Chair c,0N C' lad IkS NG ' Payroll Expense Report 5/5/2026 PAYROLL DATE 260505 PAYROLL WARRANT# Payroll Checks: $0 Check#'s: N/A Payroll Direct Deposit: $0 Advice #'s: N/A Benefits Paid: $186,889.20 AP Warrant#'s: Elect. Pymnt Total: $186,889.20 Payment of Jefferson County Payroll Warrants Dated May 5, 2026 Totaling $186,889.20 (Records of all claims submitted for payment along with A/P Warrants approved by the Payroll Services Manager are retained in the Jefferson County Auditor's Office.) BoCC Chair 1SHIN G Payroll Expense Report 5/7/2026 PAYROLL DATE M1308 PAYROLL WARRANT# Payroll Checks: $0 Check#'s: N/A Payroll Direct Deposit: $236.64 Advice #'s: 10101803 Benefits Paid: $48.80 AP Warrant#'s: 100246077-100246080; Elect. Pymnts Total: $285.44 Payment of Jefferson County Payroll Warrants Dated May 7, 2026 Totaling $285.44 (Records of all claims submitted for payment along with A/P Warrants approved by the Payroll Services Manager are retained in the Jefferson County Auditor's Office.) BoCC Chair Department of Public Works O Consent Agenda Page 1 of 1 Jefferson County Board of Commissioners Agenda Request To: Board of Commissioners Josh Peters, County Administrator From: Eric Kuzma, Public Works DirectorC Agenda Date: May 11, 2026 Subject: Change Order No. 16, Phase 2 - Water Reclamation Plant for the Port Hadlock UGA, Project No. 405-2114-0, Commerce Project No. 22-96515-026 Statement of Issue: Change Order No. 16 with Interwest Construction of Burlington, Washington. Analysis/Strategic Goals/Pro's Et Con's: This change order modifies and changes the original scope by adding miscellaneous underground pipe fitting; adding lighting under the mezzanine in the admin building; and installing the owner supplied eyewash station in the MBR building. Fiscal Impact/Cost Benefit Analysis: The total amount for Change Order No. 16 is 21,389.94 (includes 9.5% Washington State Sales Tax). The contract amount will increase from $10,712,377.70 to $10,733,767.64. The project is funded at 100% by the Department of Commerce. Recommendation: Public Works recommends that the Board authorize Change Order No. 16 with Interwest Construction, and return one original to Public Works. Department Contact: Samantha Harper, P.E., Project Manager, 385-9175. Reviewed By: 54(0-6 Josh ters, County Administrator Date JEFFERSON COUNTY Sheet 1 of 2 DEPARTMENT OF PUBLIC WORKS Change 1 G Date: 5/5/2026 CHANGE ORDER Order No. 16 Ordered by County Engineer under terms of JArticie 9 and 11 of the General and Supplemental Conditions d115 1.114 U Contract No. Change proposed by Contractor To: Interwest Construction Endorsedor by: I,t-I eAlVes4 t s+, 1—iik , 4575 Fey Rd r ' Contractor Firm Name Port Angeles,WA 98363 04/S n lure Dote! Otte_ PECs4—c-&jLk- Title Consent given by Surety:(when required) Project Title Phase 2-Water Reclamation Facility for By:the PH Sewer Attorney-in-fact Dote You are ordered to perform the following described work upon receipt of an approved copy of this change order: The changes for this change order are miscellaneous underground pipe changes;additional lighting under the mezzanine in the admin building; and electrical and mechanical work to connect owner supplied eyewash station in the MBR building. I All work materials and measurement to be in accordance with the provisions of the standard specifications and special provisions for the type of construction involved. ORIGINAL CURRENT ESTIMATED ESTIMATED CONTRACT CONTRACT NET CHANGE CONTRACT TOTAL AMOUNT(Incl.9.1%WSST) AMOUNT(Incl.9.1%WSST) THIS ORDER(Incl.9.5%WSST) AFTER CHANGE(Incl.9.1%WSST) 10,020,835.00 $10,712,377.70 521,389.94 10,733,767.64 ORIGINAL CURRENT CONTRACT TIME NEW CONTRACT CONTRACT TIME CONTRACT TIME CHANGE(Add/deduct) TIME 502 606 0 606 APPROVAL RECOMMENDED APPR VAL RECOEt: iOfp._...e----..—_,44f 625/240 Project Manager Date County Engineer or Public Works Director Dote APPROVAL RECOMMENDED APPROVED EngYi/k ing Services Manager Dote Choir,Jefferson County Commissioners Dote I JEFFERSON COUNTY 1 Contract No. 405-2114-0 Sheet 2 of 2 DEPARTMENT OF PUBLIC WORKS i Change Date: 5/5/2026 CHANGE ORDER ESTIMATE I Order No. [16 ESTIMATED ESTIMATED UNIT UNIT QUANTITY AMOUNT MEASURE PRICE CHANGE CHANGE COP No. DESCRIPTION 49.1 Misc. UG pipe changes LS 1,677.87 1 1,677.87 56/OCR8 lighting under the mezzanine LS 8,632.19 1 8,632.19 Electrical and mechanical to connect owner 57 supplied eyewash station in the MBR building LS 9,277.80 1 9,277.80 CO 16 Subtotal $19,587.86 I ESTIMATED NET CHANGE SUBTOTAL: $19,587.86 ESTIMATED NET C 9 5%Sales Tax $1,802.08 HANGE TOTAL: $21,389.94 Department of Public Works O Consent Agenda Page 1 of 1 Jefferson County Board of Commissioners Agenda Request To: Board of Commissioners Josh Peters, County Administrator From: Eric Kuzma, Public Works Director ( Agenda Date: May 11, 2026 Subject: 2025 Transportation Benefit District Annual Report Statement of Issue: In accordance with RCW 36.73.160(2) and Jefferson County Code (JCC) 3.90.040, attached please find the 2025 Annual Report for the Jefferson County Transportation Benefit District TBD). Analysis/Strategic Goals/Pro's & Con's: Jefferson County formed a Transportation Benefit District (TBD) in 2025. The Board of County Commissioners also acts as the Board of the TBD. Each year, a report of TBD activities, expenditures, and revenues is to be prepared and made available to the Board. In 2025, all of the TBD revenues were used for pavement maintenance and preservation activities including chip sealing, crack sealing, asphalt dig outs and repairs, and asphalt pre leveling. Without the TBD, the chip seal program would have been cancelled. Fiscal Impact/Cost Benefit Analysis: This is an informational report. Recommendation: This is an informational report. No action is needed. Department Contact: Monte Reinders, County Engineer Fleet/Roads Operations Manager x242 Reviewed By: 79-‘, Josh P ers; County Administrator Date Jefferson County r+Department of Public Works 623 Sheridan St. Port Townsend, WA 98368 360)385-9160 Monte Reinders, P.E. Public Works Director/County Engineer Memorandum To:Jefferson County Board of Commissioners From: Monte Reinders P.E.,County Engineer Date: April 29,2026 Re:2025 Transportation Benefit District(TBD)Annual Report In accordance with RCW 36.73.160(2) and Jefferson County Code (JCC) 3.90.040, the following is the 2025 Annual Report for the Jefferson County Transportation Benefit District(TBD). Background Jefferson County formed a TBD in early 2025 with a primary emphasis on county road maintenance and preservation. Traditional sources of road revenue consisting of the road levy property tax),motor vehicle fuel tax(MVFT), and federal forest harvest were no longer adequate to address basic needs. The road levy is limited to 1%annual growth plus new construction. The motor vehicle fuel tax has stagnated with increasing vehicle fuel efficiency, a shift to "work from home"post-Covid, and the increasing prevalence of on-line shopping rather than driving to stores. The federal timber harvest share was cut to approximately 30%of traditional levels in 2010 with no recovery predicted. At the same time,the cost of road maintenance and construction was exceeding a 5%annual rate of inflation. As a result, dramatic cuts to the maintenance and preservation of county roads occurred such as the chip seal program dropping from 35 miles per year in the mid-2000s to 15 miles per year more recently with further cuts on the horizon. Jefferson County recognizes that pavement maintenance and preservation is an essential government function, and that sentiment has been echoed by many in the community. The County simply cannot afford to let roads deteriorate and fail since the cost of rebuilding them is vastly more expensive. Also,roads in poor condition can pose a danger and inconvenience to the traveling public and negatively impact commerce. To address this need, Jefferson County turned to the one tool available—the Transportation Benefit District. Many cities in Washington had implemented this tool already, but Jefferson County was the first county in the State to fund a TBD. (Several other counties are now investigating the formation of TBDs to help backfill their failing road maintenance budgets). The Jefferson TBD was funded with a 0.1% sales tax and a$20 car license tab fee. It was estimated that the combined revenue from these sources would be in the $900,000 to $1,000,000 range per year. For 2025,the sales tax began in April and the car license fee in July/August. The Jefferson County Board of Commissioners has assumed the duties of the Transportation Benefit District Board. They are one and the same. TBD monies are deposited in their own separate fund. They are then transferred to the County's Road Fund for expenditure as needed. In late 2025, the Board elected to place a ballot measure before the voters to authorize another 0.2% sales tax for the TBD. It was approved by the voters with about 65% in favor. These additional revenues do not begin until mid-year 2026. 2025 TBD Report In 2025, TBD revenues collected were as follows: Sales Tax: $336,406.62 Car Tabs: $191,762.57 Interest: 4,458.52 Total: 532,627.71 In 2025, $531,177.00 was transferred from the TBD fund to the Jefferson County Road Fund and used for pavement maintenance and preservation activities. In 2025,Jefferson County chip/fog sealed approximately 18 centerline miles of county road at a cost of approximately $889,000. In addition, a three-year supply of chip rock was purchased and delivered to Jefferson County of which approximately $536,000 remains on hand for future years. Costs for pavement preparation(crack sealing, asphalt dig outs and patching, and asphalt pre-leveling)were approximately $327,000. Of this combined total cost($1,752,000), approximately $209,000 was covered with County Arterial Preservation Program funds from the State(derived from gas tax). All of the TBD revenue was applied to the 2025 pavement preservation program with the balance covered by traditional Road Fund revenues (road levy and MVFT). Without the TBD, the chip/fog seal program would have been cancelled in 2025. I s y rk fie x 9 k I."- T. 4' - , S,X..W `•n0 2?! 4^ VC R a.t -.O.-*,.. e,, 1 1fi 1,. ' K. i gyp is>' rs N t p ` r }Y 0 k •11 lw 'Ly* i Y.-. e y.1 •`C',:g7 ' ' 1•'-- a y y .. m 944r?, J1- p I L ° d F 77 ti . 111ti H..,: n ''.. , . ,,,, T,;,..4.. ...,_. r,r G r.Eg ' r.{ ra a •. 1` i g 1f! Y`Lei e I a tilli \i Rs, ' x < i. x t ' am r --,: a. s Y r Tab.. r r ii i,k i 1 1 ,,, F.tWiP' a 1 t'r' r ZZn V'24 ti 7, 1•F'l •• ''' • 4Wi.. l!'":-''• ,,• '- iiV".• • k‘4.4• f "> 4, --A.ad'' i...NIt '/ - ----` \I I\14.11'1.' j1, ly e tom last;. ' f .)X -1., e a - r • v , a f. .. Chip Sealing Van Trojen Road,Jefferson County,WA(2025) FOR 2025 13 CCOUNTS FOR: ORIGINAL REVISED AVAILABLE PCT 182 JC TRANSPORTATION BEN DISTRICT APPROP BUDGET YTD ACTUAL MTD ACTUAL ENCUMBRANCES BUDGET USE/COL ik:t ittille il*fS3 Pttt4LsW:1A4-1111r_+:1QIRI:10) 18231321 313210 SALES TAX - JCTBD 0 -350,000 -336,406.62 00 00 -13,593.38 96.1%' 18231760 317600 VEHICLE FEES - JCT 0 -350,000 -191,762.57 00 00 -158,237.43 54.8%' 11a#L?1A4111IWWWIlaWat4Jsy1 18236111 361100 INVESTMENT INTERES 0 0 4,458.52 00 00 4,458.52 100.0% 11:Y4'i`7L':11G'_1:rya1: '1Ul 597180 TR TO ROADS 18259700 597180 TR TO ROADS 0 700,000 531,177.00 531,177.00 00 168,823.00 75.9% TOTAL JC TRANSPORTATION BEN DISTR 0 0 1,450.71 531,177.00 00 1,450.71 100.0% TOTAL REVENUES 0 -700,000 -532,627.71 00 00 -167,372.29 TOTAL EXPENSES 0 700,000 531,177.00 531,177.00 00 168,823.00 Consent Agenda Commissioners Office JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners FROM:Adiel McKnight, Deputy Clerk of the Board DATE: May 11, 2026 SUBJECT: ADVISORY COMMITTEE REAPPOINTMENTS (3)re: Jefferson County Tourism Coordinating Council (TCC); Diane Smeland, Port Ludlow Representative; Marsha Massey, Regional Marketing DMO Representative; Amy Neil, West End Representative STATEMENT OF ISSUE: The Jefferson County Tourism Coordinating Council (TCC) advertised positions to serve as Citizen Representatives for Brinnon,Chimacum,Port Hadlock/Tri Area/Discovery Bay,Marrowstone/Nordland,Port Ludlow, Quilcene/Coyle, and the West End. These are four-year terms. With the recently approved By-laws on February 17, 2026, the three members serving in their positions were expiring and would like to be reappointed to this committee: 1. Reappointment for Smeland, Port Ludlow Representative 2. Reappointment for Marsha Massey, Regional Marketing DMO Representative 3. Reappointment for Amy Neil, West End Representative ANALYSIS: The three (3) Jefferson County TCC members, listed above, have submitted their interest in reappointment to this committee. Their desire to service is greatly appreciated and was approved by the TCC on May 5, 2026. RECOMMENDATION Jefferson County Tourism Coordinating Council recommends that the Board approve the following: 1. Smeland, Port Ludlow Representative—Four(4) Year Term expiring May 11, 2030 2. Marsha Massey, Regional Marketing DMO Representative—Four(4) Year Term expiring May 11, 2030 3. Amy Neil, West End Representative—Four(4) Year Term expiring May 11, 2030 REVIEWED BY: D Jos . Peters, County Administrator Date r"C JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS CONSENT AGENDA REQUEST TO: Board of County Commissioners FROM: Commissioner Heidi Eisenhour Amanda Christofferson,Grants Administrator DATE: May 4,2026 SUBJECT: Thriving Communities Small Grants Program Contracts for Execution STATEMENT OF ISSUE: Jefferson County BOCC committed awards for the Thriving Communities Small Grants program in January. Attached are contracts for the final two community organizations that the County awarded funds to. ANALYSIS: The awardees have provided W9 documentation and the contracts with them will secure the County's interests. These various projects will bring benefit to many communities. FISCAL IMPACT: The County allocated$10,000 in the 2026 budget in order to fund the Thriving Communities Small Grant program. RECOMMENDATION: Staff recommends that the Board of County Commissioners make a motion to approve of the awards. REVIEWED BY: 4.0.‘ Jo I . Peters, County Administrator Date CONTRACT REVIEW FORM Clear Form INSTRUCTIONS ARE ON THE NEXT PAGE) CONTRACT WITH: Thriving Communities Grant Awardees Contract No: TC Award PurtLudiuwVillaye 2026 Contract For: TC Grant Award Term: Execution-December 31, 2026 COUNTY DEPARTMENT: Auditors Office Contact Person: Amanda Christofferson Contact Phone: 360-385-9232 Contact email: amchristofferson@co.jefferson.wa.us AMOUNT: $500.00 PROCESS: n Exempt from Bid Process Revenue: Cooperative Purchase Expenditure: 4 Q 2 G© Competitive Sealed Bid Matching Funds Required: Small Works Roster Sources(s) of Matching Funds Vendor List Bid Fund# -tom 00 0 cog RFP or RFQ Munis Org/Obj , 121-nusr1 Other: APPROVAL STEPS:601 . t,00 t?74"12 I 4-i O 1 STEP 1: DEPARTMENT CERTIFIES COMPLIANCE WITH JCC 3.55.080 AND CHAPTER 42.23 RCW. CERTIFIED: ElN/A:fl 4M-C t 2/1/Lea, L 4/8/2026 Signature Date STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE COUNTY (CONTRACTOR) HAS NOT BEEN DEBARRED BY ANY FEDERAL, STATE, OR LOCAL AGENCY. CERTIFIED: El N/A: IT 4yptag-da- e/: C & Af- 4/8/2026 Signature Date STEP 3: RISK MANAGEMENT REVIEW(will be added electronically through Laserfiche): Electronically approved by Risk Management on 4/17/2026. STEP 4: PROSECUTING ATTORNEY REVIEW(will be added electronically through Laserfiche): Electronically approved as to form by PAO on 4/16/2026. DPA JBL reviewed and approved on 4-16-2026 STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND PROSECUTING ATTORNEY(IF REQUIRED). STEP 6: CONTRACTOR SIGNS STEP 7: SUBMIT TO BOCC FOR APPROVAL 1 INSTRUCTIONS Do not apply digital signatures until the entire packet is ready to submit. APPROVAL STEPS: STEP 1: COMPLIANCE WITH JCC 3.55.080 3.55.080 and Chapter 42.23 RCW. Department Heads or Elected Officials for departments who are proposing the contract must check one of the two boxes: (1) Check the "Certification" box, demonstrating compliance with that JCC 3.55.080 and Chapter 42.23 RCW;or,(2)Check the"N/A"box,verifying that certification does not apply: a)For approval of contracts before a contractor is selected;or,(b)For contracts with other government agencies, including interlocal agreements.Department Heads or Elected Officials may delegate this responsibility to certify the Contract Review Form in writing to a person who has been trained to determine compliance with JCC 3.55.080 and Chapter 42.23 RCW. JCC 3.55.080 states: "All persons involved in county purchasing are required to follow the rules regarding conflicts of interest as set forth in Chapter 42.23 RCW,as now or hereafter amended, and, in addition thereto, are expressly prohibited from accepting, directly or indirectly, from any person, company, firm, or corporation to which any procurement or contract is or might be awarded, any rebate, gift, money or anything of value whatsoever,except where given for the use and benefit of the county." STEP 2: CERTIFICATION THAT THE CONTRACTOR HAS NOT BEEN DEBARRED BY ANY FEDERAL, STATE,OR LOCAL AGENCY.Department Heads or Elected Officials for departments who are proposing the contract must check one of the two boxes: (1) Check the "Certification" box, demonstrating that the contractor has not been debarred by a government agency; or, (2) Check the"N/A"box,verifying that certification does not apply: (a) For approval of contracts before a contractor is selected; or, (b) For contracts with other government agencies that do not involve grant funding,including interlocal agreements.Department Heads or Elected Officials may delegate this responsibility to certify the Contract Review Form in writing to a person who has been trained to determine whether contractors have been debarred by a government agency. Contractors who have been debarred by a government agency are not eligible to contract with that agency or Jefferson County. Jefferson County does not want to contract with debarred contractors because they are considered untrustworthy. In addition, where grant funding is involved, debarred contractors usually are not eligible to receive grant money and,if they are given grant funding,the County may be required to repay spent grant funding. At a minimum,checking the certified box requires checking: Exclusions Section of the Federal Government Services Administration System for Award Management (SAM) at https://sam.gov/content/exclusions; and, The Washington State Department of Labor&Industries Debarred Contractors List website https://secure.lni.wa.gov/debarandstrike/ContractorDebarList.aspx). In addition,before checking the"Certification"box,the department should ask contractors to verify they have not been debarred by a federal, state or local government agency. The department may satisfy Step 2 by attaching the standard debarment certificate completed by the contractor. However, even if a standard debarment certificate is attached, the "Certification" box still must be checked to satisfy Step 2. STEP 3: RISK MANAGEMENT REVIEW. Risk management review of all contracts is required by the County's relationship with the Washington Counties Risk Pool and by the County's risk management resolution. Risk management review involves determining whether the contract is a valid contract and whether the contract language, including risk allocation provisions like indemnity and insurance requirements,adequately protect the County from risks posed by the contract. STEP 4: PROSECUTING ATTORNEY REVIEW. Legal review of all contracts by the Prosecuting Attorney's Office (PAO) is required by the County's relationship documents with the Washington Counties Risk Pool and by the County's risk management resolution. Review by the PAO involves determining whether the contract is a valid and unambiguous contract and may include whether the contract language,including risk allocation provisions,adequately protect the County from risks posed by the contract. STEP 5: REVISIONS,IF REQUIRED BY RISK MANAGEMENT OR THE PAO.If required,the department makes revisions suggested by risk management or the PAO.Then,the department resubmits the revised contract to risk management and the PAO. STEP 6: CONTRACTOR SIGNS. Obtain the contractor's signature before submitting to the Board of County Commissioners BoCC)for approval. STEP 7:SUBMIT TO BOCC FOR APPROVAL. 1. Print 3 duplicate originals of the contract for the Commissioners'signature. 2. The submittal should include: a. The 3 duplicate originals,each with PAO's signature approving the contract as to form; b. This Contract Review Form showing approval by Risk Management and the PAO;and, c. An Agenda Request. 3. Send all together in a hard copy packet to Attn:Julie/BoCC Office via interoffice mail to submit to the BoCC Agenda.The Deadline for Agenda Items is Tuesday's by 4:30 p.m. in order to be included on the following Monday's Agenda. If the submission does not meet this deadline,it will be added to the agenda for next Monday regular meeting of the BoCC. QUESTIONS: Questions about contracting and contract review should be presented first to the person in the department responsible for submission of contracts for approval.If questions cannot be answered within the department,then questions should be presented to Risk Management or the PAO's Civil Department. For questions about scheduling Agenda items, posting Agenda items, etc., please email or call Julie Shannon,BoCC Office,x384. 2 AGREEMENT FOR 2026 THRIVING COMMUNITIES SMALL GRANT FUNDING FOR PORT LUDLOW VILLAGE COUNCIL This Agreement is by and between Jefferson County,Washington(the COUNTY) and PORT LUDLOW VILLAGE COUNCIL("PORT LUDLOW VILLAGE COUNCIL"). WHEREAS, PORT LUDLOW VILLAGE COUNCIL is a non-profit corporation registered with the Secretary of State of the State of Washington under UBI number 91-2000400; WHEREAS, the COUNTY desires to support projects that promote a safe, secure, and satisfying way of life for Jefferson County residents and visitors. Sought projects that promote a sense of belonging, so that residents and visitors feel welcomed to share in the many activities, opportunities, and experiences available across Jefferson County; WHEREAS, the COUNTY allocated $ 10,000.00 to a fund a Thriving Communities (TC) small grant program; WHEREAS, the COUNTY published a request for proposals on September 4, 2025 that required each proposal to contain an evaluation plan; WHEREAS, PORT LUDLOW VILLAGE COUNCIL submitted a qualified TC proposal to the Jefferson County Board of Commissioners(BoCC); WHEREAS, PORT LUDLOW VILLAGE COUNCIL'S qualified proposal contains an evaluation plan with criteria; WHEREAS, the BoCC staff reviewed and recommended funding all or part of PORT LUDLOW VILLAGE COUNCIL's qualified proposal; WHEREAS, the BoCC reviewed the staff recommendation for funding all or part of PORT LUDLOW VILLAGE COUNCIL's qualified proposal; IN CONSIDERATION of the mutual covenants and agreements herein it is agreed by the parties as follows: 1.SERVICES TO BE PERFORMED USING THE THRIVING COMMUNITIES AWARD a. PORT LUDLOW VILLAGE COUNCIL shall use its capabilities and utilize up to the total amount of Final TC Award for the approved scope of work for the Project described in PORT LUDLOW VILLAGE COUNCIL's proposal for the 2026 fiscal year, a copy of which is attached as Exhibit A. b. The budget for the Project is described in Exhibit B, attached. Thriving Communities Grant Award Agreement for PORT LUDLOW VILLAGE COUNCIL'S Page 1 2. RESPONSIBILITIES OF PORT LUDLOW VILLAGE COUNCIL a. No later than January 31, 2027, PORT LUDLOW VILLAGE COUNCIL shall submit a report to the BoCC Staff describing the final results as compared to the requirements in the evaluation plan during the term of this Agreement due. b. PORT LUDLOW VILLAGE COUNCIL shall maintain books, records, documents and other evidence that sufficiently and properly reflect all direct and indirect costs expended by it to perform this Agreement. These records shall be subject to inspection, review or audit by personnel of both parties, other personnel duly authorized by either party, the Office of the State Auditor, and federal officials so authorized by law. All books,records, documents, and other material relevant to this Agreement will be retained for six years after expiration of agreement. The Office of the State Auditor, federal auditors, the Jefferson County Auditor, and any persons duly authorized by the parties shall have full access and the right to examine these materials during this period. If any litigation, claim or audit is started before the expiration of the six (6) year period, the records shall be retained until all litigation, claims, or audit findings involving the records have been resolved. Records and other documents, in any medium, furnished by PORT LUDLOW VILLAGE COUNCIL to the COUNTY, shall remain the property of the PORT LUDLOW VILLAGE COUNCIL, unless otherwise agreed. 3. RESPONSIBILITY OF JEFFERSON COUNTY a. The COUNTY shall provide PORT LUDLOW VILLAGE COUNCIL $500.00 in funding from the Thriving Communities small grant to be used in support PORT LUDLOW VILLAGE COUNCIL'S qualified program. b. Said funding is in the amount of the Final TC Award for the 2026 fiscal year. 4. TERM This Agreement shall be for a term of one year, commencing on January 1, 2026 and ending on December 31,2026,except for the reports required in Section 2,which are due January 31,2027. 5. NO ASSIGNMENT A party's interest in this in this Agreement shall not be assigned to any other person. 6. TERMINATION a. This Agreement may be terminated, in whole or in part, by the COUNTY upon thirty (30) days written notice if expected or actual revenue from the grant is reduced or limited in any way, or for non-performance of duties under this Agreement, or for any reason. b. PORT LUDLOW VILLAGE COUNCIL may terminate this Agreement upon thirty (30) days written notice to the COUNTY. If there is termination under this clause,the COUNTY shall be liable to pay only for services rendered prior to the effective date of termination. If termination covers a period for which payment has already been made, PORT LUDLOW VILLAGE COUNCIL shall refund to the COUNTY a pro-rated share of the payment based upon the balance of time remaining in the paid period,unless otherwise negotiated. Thriving Communities Grant Award Agreement for PORT LUDLOW VILLAGE COUNCIL'S Page 2 7. HOLD HARMLESS a. PORT LUDLOW VILLAGE COUNCIL shall indemnify and hold the COUNTY, and its officers, employees, agents and volunteers (and their marital communities) harmless from and shall process and defend at its own expense, including all costs, attorney fees and expenses relating thereto, all claims, demands, or suits at law or equity arising in whole or in part, directly or indirectly, from PORT LUDLOW VILLAGE COUNCIL's negligence or breach of an of its obligations under this Agreement; provided that nothing herein shall require PORT LUDLOW VILLAGE COUNCIL to indemnify the COUNTY against and hold harmless the COUNTY from claims, demands or suits based solely upon the conduct of the COUNTY, its officers, employees, agents and volunteers (and their marital communities), and; provided further that if the claims or suits are caused by or result from the concurrent negligence of: (a) PORT LUDLOW VILLAGE COUNCIL's agents or employees; and, (b) the COUNTY, its officers, employees agents and volunteers (and their marital communities), this indemnity provision with respect to claims or suits based upon such negligence, and or the costs to the COUNTY of defending such claims and suits, etc., shall be valid and enforceable only to the extent of PORT LUDLOW VILLAGE COUNCIL's negligence, or the negligence of PORT LUDLOW VILLAGE COUNCIL's agents or employees. b. PORT LUDLOW VILLAGE COUNCIL specifically assumes potential liability for actions brought against the COUNTY by PORT LUDLOW VILLAGE COUNCIL's employees, including all other persons engaged in the performance of any work or service required of PORT LUDLOW VILLAGE COUNCIL under this Agreement and, solely for the purpose of this indemnification and defense, PORT LUDLOW VILLAGE COUNCIL specifically waives any immunity under the state industrial insurance law, Title 51 RCW. PORT LUDLOW VILLAGE COUNCIL recognize that this waiver was specifically entered into pursuant to provisions of RCW 4.24.115 and was subject of mutual negotiation. 8. INSURANCE PORT LUDLOW VILLAGE COUNCIL shall obtain and keep in force during the term of this Agreement the following insurance: a. Commercial General Liability Insurance. PORT LUDLOW VILLAGE COUNCIL shall maintain commercial general liability coverage on a form acceptable to COUNTY Risk Management for bodily injury, personal injury, and property damage, with a limits of not less than in the amount of at least $1 million per occurrence, for bodily injury, including death, and property damage; and b. Worker's Compensation (Industrial Insurance). PORT LUDLOW VILLAGE COUNCIL shall maintain workers' compensation insurance at its own expense, as required by Title 51 RCW, for the term of this Agreement and shall provide evidence of coverage to COUNTY Risk Management,upon request. Thriving Communities Grant Award Agreement for PORT LUDLOW VILLAGE COUNCIL'S Page 3 9. INDEPENDENT CONTRACTOR a. PORT LUDLOW VILLAGE COUNCIL and the COUNTY agree that PORT LUDLOW VILLAGE COUNCIL is an independent contractor with respect to the services provided pursuant to this Agreement. b. Nothing in this Agreement shall be considered to create the relationship of employer and employee between the parties hereto. c. Neither PORT LUDLOW VILLAGE COUNCIL nor any employee of PORT LUDLOW VILLAGE COUNCIL shall be entitled to any benefits accorded COUNTY employees by virtue of the services provided under this Agreement. d. The COUNTY shall not be responsible for withholding or otherwise deducting federal income tax or social security or for contributing to the state industrial insurance program, otherwise assuming the duties of an employer with respect to PORT LUDLOW VILLAGE COUNCIL, or any employee, representative, agent or subcontractor of PORT LUDLOW VILLAGE COUNCIL. e. PORT LUDLOW VILLAGE COUNCIL shall be responsible for all applicable withholdings, deductions, state industrial insurance, tax reports, business licenses, registrations, and all other obligations of an independent organization. Thriving Communities Grant Award Agreement for PORT LUDLOW VILLAGE COUNCIL'S Page 4 10. SUBCONTRACTING REQUIREMENTS a. PORT LUDLOW VILLAGE COUNCIL Owns Contract Performance. PORT LUDLOW VILLAGE COUNCIL is responsible for meeting all terms and conditions of this Agreement including standards of service, quality of materials and workmanship, costs and schedules. Failure of a subcontractor to perform is no defense to a breach of this Agreement. Port Ludlow Village Council assumes responsibility for all liability for the actions and quality of services performed by any subcontractor. b. Subcontractor Disputes. Any dispute arising between PORT LUDLOW VILLAGE COUNCIL and any subcontractors or between subcontractors must be resolved with involvement of any kind on the part of the COUNTY and without detrimental impact on the delivery of contracted goods and services. 11. LEGAL AND REGULATORY COMPLIANCE While performing under this Agreement, PORT LUDLOW VILLAGE COUNCIL, subcontractors, and their employees are required to comply with all applicable local, state and federal laws, codes, ordinances and regulations, including but not limited to: a. Applicable regulations of the Washington State Department of Labor and Industries, including WA-DOSH Safety Regulation; and b. State and Federal Anti-Discrimination Laws. 12. COMPLIANCE WITH LAWS PORT LUDLOW VILLAGE COUNCIL shall comply with all Federal, State, and local laws and ordinances applicable to the work to be done under this Agreement. 13. CHOICE OF LAW The parties agree that this Agreement is entered into in the State of Washington. This Agreement shall be governed by and construed under the laws of the United States, the State of Washington and the County of Jefferson, as if applied to transactions entered into and to be performed wholly within Jefferson County, Washington between Jefferson County residents. No party shall argue or assert that any state law other than Washington law applies to the governance or construction of this Agreement. 14. DISPUTES a. The parties agree to use their best efforts to prevent and resolve disputes before they escalate into claims or legal actions. Any disputed issue not resolved under this Agreement shall be submitted in writing within 10 days to the County Risk Manager, whose decision in the matter shall be final, but shall be subject to judicial review. b. If either party deem it necessary to institute legal action or proceeding to enforce any right or obligation under this Agreement, each party in such action shall pay for its own attorney's fees and court costs. Thriving Communities Grant Award Agreement for PORT LUDLOW VILLAGE COUNCIL'S Page 5 c. Any legal action shall be initiated in the Superior Court of the State of Washington for Jefferson County, subject to the venue provisions for actions against counties in RCW 36.01.050. The parties agree that the parties have the right of appeal from such decisions of the Superior Court under the laws of the State of Washington. d. PORT LUDLOW VILLAGE COUNCIL consents to the personal jurisdiction of the courts of the State of Washington. 15. DISCRIMINATION PROHIBITED PORT LUDLOW VILLAGE COUNCIL shall not discriminate on the grounds of age, sex, marital status, sexual orientation, race, creed, color, national origin, honorably discharged veteran or military status, or the presence of any sensory, mental, or physical disability or the use of a trained dog guide or service animal by a person with a disability, unless based upon a bona fide occupational qualification in the selection and retention of employees, materials, supplies, or subcontractors. 16. INTEGRATED AGREEMENT This agreement together with attachments or addenda represents the entire and integrated agreement between the COUNTY and PORT LUDLOW VILLAGE COUNCIL and supersedes all prior negotiations,representations, or agreements written or oral. 17. PUBLIC RECORDS ACT Notwithstanding any provisions of this Agreement to the contrary, to the extent any record, including any electronic, audio, paper or other media, is required to be kept or indexed as a public record in accordance with the Washington Public Records Act, Chapter 42.56 RCW, as may be amended, PORT LUDLOW VILLAGE COUNCIL agrees to maintain all records constituting public records and to produce or assist the COUNTY in producing such records, within the time frames and parameters set forth in state law. PORT LUDLOW VILLAGE COUNCIL further agrees that upon receipt of any written public record request, PORT LUDLOW VILLAGE COUNCIL shall, within two business days, notify the COUNTY by providing a copy of the request per the notice provisions of this Agreement. This Agreement and any reports submitted by PORT LUDLOW VILLAGE COUNCIL are subject to disclosure as a public record under the Public Records Act, RCW Chapter 42.56. 18. RECORDS RETENTION AND AUDIT AUTHORIZATION a. A minimum of six years, PORT LUDLOW VILLAGE COUNCIL shall maintain documented proof of payments made, contracts executed and other expenditures authorized under your Agreement with COUNTY. b. Upon reasonable notice, PORT LUDLOW VILLAGE COUNCIL shall provide access to the COUNTY or State representatives to audit records related to the funds provided to PORT LUDLOW VILLAGE COUNCIL under this Agreement. Thriving Communities Grant Award Agreement for PORT LUDLOW VILLAGE COUNCIL'S Page 6 19. NO SEVERABILITY The terms of this Agreement are not severable. If any provision of this Agreement or the application of this Agreement to any person or circumstance shall be invalid, illegal, or unenforceable to any extent,the remainder of this Agreement and the application this Agreement shall not be enforceable. 20. SURVIVAL Those provisions of this Agreement that by their sense and purpose should survive the term of this Agreement shall survive the term of this Agreement for a period equal to any and all relevant statutes of limitation, plus the time necessary to fully resolve any claims, matters or actions begun within that period. Without limiting the generality of the preceding sentence, and for the avoidance of doubt, the provisions that survive the term of this agreement include: (a)controlling law; (b) insurance; and, (c) indemnification. 21. AMENDMENT,MODIFICATION AND WAIVER a. This Agreement may be not be amended or modified to change the approved scope of services in the Final TC Award. b. Only the BoCC or their delegee by writing (delegation to be made prior to action) shall have the expressed, implied, or apparent authority to sign, alter, amend, modify, or waive any clause or condition of this Agreement. c. Any alteration, amendment, modification, or waiver of any clause or condition of this Agreement is not effective or binding unless made in writing and signed by the BoCC or their delegee. SIGNATURES ARE ON THE FOLLOWING PAGE Thriving Communities Grant Award Agreement for PORT LUDLOW VILLAGE COUNCIL'S Page 7 JEFFERSON COUNTY WASHINGTON PORT LUDLOW VILLAGE COUNCIL Board of COUNTY Commissioners Jefferson COUNTY, Washington By: Signature By: Heidi Eisenhour,Chair Date Name: By: Title: Greg Brotherton, Member Date Date: By: Heather Dudley-Nollette,Member Date SEAL: ATTEST: Carolyn Gallaway, CMC Date Clerk of the Board Approved as to form only: 04/16/2026 Pr,"!- - Date Chief Civil Dcputy Prosecuting Attorney Jeremiah B. Luther, Deputy Prosecuting Attorney Thriving Communities Grant Award Agreement for PORT LUDLOW VILLAGE COUNCIL'S Page 8 EXHIBIT A- SCOPE OF WORK PORT LUDLOW VILLAGE COUNCIL has been awarded $500.00 (the "Final TC Award"), after recommendation by the TC staff. Port Ludlow Village Council shall use the Final TC Award consistently with its response to the request for proposal submitted. A true and correct copy of the PORT LUDLOW VILLAGE COUNCIL's response to the request for proposal is attached as Exhibit C. Thriving Communities Grant Award Agreement for PORT LUDLOW VILLAGE COUNCIL'S Page 9 EXHIBIT B—BUDGET PORT LUDLOW VILLAGE COUNCIL has been awarded$500.00(the"Final TC Award"), after recommendation by the TC staff. Port Ludlow Village Council shall use the Final TC Award consistently with its response to the request for proposal submitted to the BOCC. A true and correct copy of the PORT LUDLOW VILLAGE COUNCIL's response to the request for proposal is attached as Exhibit C. Applicant: Port Ludlow Village Council Contact: Gary Hammond Address: P.O. Box 65012, Port Ludlow, WA 98365 Phone: Email: treasurer@portludlowvillagecouncil.org Thriving Communities Grant Award Agreement for PORT LUDLOW VILLAGE COUNCIL'S Page 10 Exhibit C PORT LUDLOW VILLAGE COUNCIL'S PROPOSAL Request for Proposal(RFP)starts after this page Thriving Communities Grant Award Agreement for PORT LUDLOW VILLAGE COUNCIL'S Page 11 RECEIVED Grant Application:Community Opportunity Fair,2026 0 C T 2 3 2025 A Port Village Council Committee Proposal JEFFERSON COUNTY COMMISSIONERS Project Overview The Community Opportunity Fair is a biennial event organized by a non-profit 501(c)(3) committee under the Port Ludlow Village Council.The Fair serves as a dynamic platform for community engagement and connection, fostering collaboration among local organizations, service groups, and residents. The Fair encourages volunteerism in our community by showcasing many of the groups who operate in our area and extending beyond Port Ludlow. Volunteers keep communities thriving and dramatically reduce the cost for the vital mission of non profits. Community Impact The Fair has demonstrated a strong positive impact, attracting over 500 attendees in 2022 and 2024. The venue is ADA compliant, ensuring accessibility for all participants. Growing attendance and enthusiastic feedback indicate that the event effectively meets the evolving needs of the Port Ludlow community. Project Scope Scheduled for August 2026, the Fair will bring together 50-75 exhibitors under one roof for a day of networking, discovery, and fun. Exhibitors represent a broad spectrum of local clubs, organizations, sports and exercise groups, and service providers, including: Clubs &Organizations: Book Clubs, Singing Groups, Dine & Discover, Quitters by the Bay, Pride Port Ludlow, Concerts in the Barn,Art League, Fly Fishers, US Coast Guard Auxiliary Sports &Activities: Golfing, Pickleball,Tennis, Model Sailboats, Inner Joy Qigong,Tai Chi, Pilates, Tap Dance,Yoga, Zumba Service Groups: AAUW, Rotary, Friends of the Library, Food Bank, Habitat for Humanity, Housing Solutions Network, Humane Society, Dove House, ECHHO, Jefferson Land Trust, Friends of Fort Flager,YMCA To address limited on-site parking,two shuttle vans provide frequent service from a larger lot located just 1.5 miles away, ensuring smooth arrival and departure for both exhibitors and attendees. Exhibitors can conveniently unload supplies before parking and shuttling back to the venue. The Fair features musical entertainment, a pickleball demonstration on the terrace, refreshments, and food trucks. Thanks to generous local donations, every participant receives a swag bag. A free raffle at the end of the Fair offers prizes such as personal training or physical therapy sessions, gift certificates to local businesses and eateries, a handmade quilt, gift baskets, gardening supplies, and a four-hour cruise for four on Ludlow Bay. Volunteer Coordination The organizing committee has developed an effective volunteer strategy: each exhibitor provides one volunteer to assist during the Fair.This collaborative model ensures adequate staffing and smooth event operations. Planning and Publicity Committee work begins with an evaluation of the previous event. Planning meetings are held bi-monthly from August to December, then monthly until the Fair. A comprehensive publicity campaign includes: Canvas signage at strategic village locations 8.5 x 11 flyers at local businesses Emails to the Village Council list Articles in The Voice magazine Posts on Next Door and Facebook Announcements on Homeowner Association electronic bulletin boards Handouts at Homeowner Association front desks and select businesses Organization Profile The Community Opportunity Fair introduces attendees to a remarkable array of volunteer opportunities. Exhibitors consistently report increased volunteer recruitment as a result of their participation. Originally launched in the early 2000s as the Newcomers Open House, the event has expanded to welcome the entire community,with new exhibitors joining each cycle. Mission and Outreach The Fair's mission is to connect newcomers and long-term residents with local organizations. In addition to widespread publicity, personalized invitations (including a free raffle ticket) are sent to residents who have lived in Port Ludlow for less than two years. This targeted outreach yields a 75%attendance rate among invitees, demonstrating exceptional success in engaging newcomers. To encourage active participation, attendees can earn a free raffle ticket by collecting stamps from 16 exhibitors on their event passport. Organizational Qualifications The organizing committee brings extensive experience in non-profit management, with backgrounds in organizations such as Children's Council, Habitat for Humanity, and The Lindsay Wildlife Museum. Members also offer expertise in law, advertising, state government, writing, and graphic arts. Evaluation Plan Post-event evaluation is conducted through surveys distributed to exhibitors and participants, gathering feedback on successes and areas for improvement.The committee reviews survey results to inform future planning and ensure continuous enhancement of the Fair. References (attached following budget) John Goldwood-Former PLVC President, 2024-2025 Vickie Norris-Former Project Manager, Community Opportunity Fair Diana Smeland-President, Port Ludlow Associates Project Budget Category Amount(USD) Publicity 1,200 Postage 200 Building Rental 700 Music 500 Tables 300 Food 200 Van Rental 150 Decorations 100 Miscellaneous Supplies 200 Total 3,550 Funding is also sought from Port Ludlow Village Council, Ludlow Maintenance Commission, South Bay Community Association, Port Ludlow Brokers, Active Life Physical Therapy, and Coldwell Banker Realty. Letter of Reference in support of 2026 Community Opportunity Fair grant proposal October 22, 2025 My name is Vickie K Norris. I reside in Port Ludlow. I was the volunteer project manager of the Community Opportunity Fair (COF) in 2022 and 2024. I write this letter in support of the grant proposal submitted by the Port Ludlow Village Council (PLVC), the primary sponsor of the COF. This event was born out of a desire to reintroduce the greater Port Ludlow community to volunteer opportunities in Jefferson County following the shut downs caused by COVID. The original COF committee, consisting of four women put their heads together and their time and effort to developed a structure for the event which worked remarkably well. County wide non- profits, clubs, classes and governmental entities were invited to showcase their organizations at the South Bay Club. Over 50 organizations participated each year. Each organization was asked to donate a volunteer to help with the fair. That's how four women were able to pull off an event that included fair branding, printing, advertising, volunteer training, a raffle, food, live music, shuttle service, feedback forms, greeters, swag bags and the booths for the exhibitors. Whew! Each year, PLVC, community businesses and clubs helped financially sponsor the COF. We were good stewards of these funds with the fair coming in under budget each year. Each year the event was well received by the community. Non-profits reported upticks in volunteers. In fact, COF got an additional committee member in 2024 from a 2022 fair attendee. Representative feedback included: "As new resident, I was blown away by all the groups to be involved in." "Very organized, clear directions, good communications." My own volunteerism throughout my life has been extensive, most recently as a Trustee of the Jefferson County Library District. (One of the COF attendees!). I was happy to be part of introducing Port Ludlow residents both new and old to the many volunteer opportunities in Jefferson County. These grant funds to COF can introduce more Jefferson County citizens to the many ways they can help out. Vickie K Norris 256 Anchor Lane Port Ludlow, WA 98365 October 22, 2025 Josh Peters County Administrator Jefferson County, Washington Dear Mr. Peters, I am writing in support of the Grant Request being submitted by Tam McDearmid to help fund the Port Ludlow Community Opportunity Fair, held every two years here in Port Ludlow. When my wife and I first moved to Port Ludlow, we had the opportunity to attend our first Community Opportunity Fair and were amazed by both the depth and breadth of volunteer opportunities we discovered. That event in 2022 led us to numerous volunteer activities that we would otherwise never have known about nor considered. In fact, I became President of Port Ludlow Village Council because of volunteering to serve on its Board of Directors. As is true for many small communities such as Port Ludlow, our ability to thrive is contingent upon sustaining, and hopefully increasing, the volunteer base that provides so many of our organizations and activities with the necessary personnel to sustain those organizations and their ongoing efforts. Although the overall budget for this event is comparatively small, the impact of this event for improving the quality of life for our residents here and for surrounding communities is great! I hope you will consider that impact as you make your decision to support their efforts. Thank you. 7/4K 7oIdtod John Goldwood 173 Greenview Lane Port Ludlow, WA 98365 PORT LL'DLON Assoc IA ES LLC October 22, 2025 Jefferson County Board of Commissioners Re: Support for Port Ludlow Village Council-2026 Community Opportunity Fair(Thriving Communities Small Grants Program) To the Board of Commissioners: I am writing in strong support of the Port Ludlow Village Council's(PLVC)proposal to the Thriving Communities Small Grants Program for its 2026 Community Opportunity Fair. As President of Port Ludlow Associates, I see firsthand how quickly our community grows and changes—and how vital it is to help both new residents and long-time community members connect with the many nonprofits, service clubs,and public-benefit organizations that make Port Ludlow such a special place to live. The Community Opportunity Fair is a practical, welcoming way for residents to learn what resources, programs, and volunteer opportunities exist—and equally important—for the organizations themselves to discover what each other is doing. This project aligns directly with the program's purpose to promote a sense of belonging so residents feel invited to share in our local activities and experiences. The fair's simple, proven format—tables and demonstrations from local organizations, and easy sign-up opportunities— makes it highly feasible at a modest cost. Outcomes are clear and measurable: number of participating organizations, resident attendance, volunteer sign-ups and resource referrals. From a sustainability perspective, the fair creates durable benefits beyond the event day: residents discover year-round programs; nonprofits expand their volunteer pipelines; and organizations build cross-referral pathways that strengthen service delivery county-wide. These outcomes advance Jefferson County's goals while requiring only a small monetary investment. Thank you for considering this proposal. The Community Opportunity Fair is exactly the kind of belonging-building,collaboration-forward effort the Thriving Communities Small Grants Program is designed to support. Please feel free to contact me with any questions. Sincerely, CLA-Vce.vt-r1 Diana Smeland President, Port Ludlow Associates I't rt I utlltm iate,' LI,( ilic,,k i I one I Port LU(IIt1%\,t\',\ ,55< liui if i(;0-457-.2ti,. 100I),,rlltu)l<<%kd '(lt rum JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS CONSENT AGENDA REQUEST TO: Board of County Commissioners FROM: Carolyn Gallaway,Clerk of the Board DATE: May 11,2026 SUBJECT: DISCUSSION and POTENTIAL ACTION re: (2)Opportunity Zone Letters of Support: 1)Port Townsend Tract; and 2)Brinnon/West End STATEMENT OF ISSUE: EDC Team Jefferson Director David Ballif is requested that the Commissioners consider approval of two letters of support for Opportunity Zone 2.0 nominations submitted through the Emerald Coast Opportunity Zone (ECOZ) Consortium. The proposed nominations include: 1) Census Tract 53031950603 in Port Townsend; and 2) Census Tract 53031950702 covering Brinnon and the West End. The letters support designation of these areas as Qualified Rural Opportunity Zones to help attract long-term private investment for healthcare, housing, childcare, infrastructure, commercial development, and rural economic development projects. ANALYSIS: The Port Townsend tract serves as the County's primary healthcare and service center and includes Jefferson Healthcare, workforce housing opportunities, childcare facilities, and other community-serving infrastructure. The Brinnon/West End tract includes rural and economically vulnerable communities with identified needs related to healthcare access, economic diversification, infrastructure, and climate resilience. FISCAL IMPACT: Potential long-term benefits may include increased private investment, expanded tax base,job creation, housing development, and infrastructure improvements within the designated tracts. RECOMMENDATION: Approve the two support letters for Opportunity Zones in Port Townsend and Brinnon/West End. REVIEWED BY: S 6/g Josh . _ eters, County Administrator Date CoNMssl Board of County Commissioners 49 #7 o° O1_ 1820 Jefferson Street 0 w p PO Box 1220 • Port Townsend, WA 98368 /s. - " Heather Dudley-Nollette,District 1 Heidi Eisenhour,District 2 Greg Brotherton,District 3 ifINv May 11,2026 Andrea Chartock Assistant Director,Office of Economic Development and Competitiveness Washington State Department of Commerce 1011 Plum Street SE PO Box 42525 Olympia, WA 98504 Re: Letter of Support—Opportunity Zone 2.0 Nomination,Census Tract 53031950702(Brinnon/West End) Dear Ms. Chartock, On behalf of the Jefferson County Board of County Commissioners, I write to offer the County's strongest possible support for the Emerald Coast Opportunity Zone(ECOZ)consortium's nomination of Census Tract 53031950702—covering Brinnon, Pleasant Harbor,the Dosewallips and Duckabush river corridors,the Hood Canal coastline, and the West End communities including the Hoh Tribe—for designation as a Qualified Rural Opportunity Zone under OZ 2.0. As the District 3 Commissioner who represents this geography,and as Chair of the Board, I want this designation to land. The County has separately submitted a letter in support of the Port Townsend tract;this letter addresses the rural tract specifically. This is the part of Jefferson County that the conventional economic development conversation most often overlooks,and it is the part where the Qualified Rural Opportunity Fund tool will do the most work. The tract is large,dispersed,and demographically vulnerable—federal data documents the tract's elevated poverty rate and median income well below 70 percent of area median. It has longer travel times to healthcare and other essential services,and a dependence on resource-based industries—timber, shellfish, recreation,and tourism—that are subject to genuine market and regulatory pressures. It also has the kind of natural assets,cultural heritage,and underdeveloped commercial potential that,with the right capital structure,can generate sustainable rural prosperity.OZ 2.0 designation is the single most important federal tool we have to bring patient private capital into a geography that the conventional capital markets pass over. The pipeline of investment-ready projects is real. The Pleasant Harbor Master Planned Resort,advanced by the Statesman Group with Hearing Examiner approval secured, is among the largest single private investments ever proposed on the North Olympic Peninsula—and one whose financing economics work substantially better with OZ-eligible capital. The Hoh Tribe is pursuing village relocation,climate adaptation,and economic development priorities on the West End that align with both the OZ tool and federal Indian Country development frameworks. Whitney Gardens Nursery,a six-decade specialty horticulture operation in Brinnon, is approaching ownership succession with investor interest. Rocky Brook Falls offers clean-energy generation potential. McKay's Crab& Shrimp and other working seafood businesses on the Pacific coast represent value-added processing and operating-business investment opportunities. Several private property owners in the Brinnon commercial zone—including longtime landowners working with EDC Team Jefferson on potential commercial and mixed-use development— have signaled interest in partnering on OZ-aligned projects. Wage Rural healthcare access is a persistent and growing concern in this geography. Residents in Brinnon,the Hood Canal corridor,and the West End face significant travel times to Jefferson Healthcare in Port Townsend,and the limited rural health infrastructure that exists is constrained by capital. The OZ 2.0 application's missing-community-services scoring category was written with exactly these geographies in mind. Investments in rural healthcare access points,telehealth-capable clinical infrastructure,and the workforce housing that lets clinical and care-economy staff serve rural areas would all benefit from designation.The County is committed to coordinating across the Board of County Commissioners, EDC Team Jefferson,the PUD,the hospital district,the Hoh Tribe,and Jefferson County DCD to put designation to work—including through targeted permit-streamlining,county-owned land contributions where appropriate,and the kind of anchor-tenancy commitments that make rural project economics pencil. The Brinnon and West End communities are ready. The community is unified in this request. We urge Commerce and the Governor's Office to grant the designation. Sincerely, Heather Dudley-Nollette, Dist. 1 Heidi Eisenhour, Dist. 2 Greg Brotherton, Dist. 3-Chair 2IPage ve0' ,ON e Board of County Commissioners 4 ¢� 0 o� 1820 Jefferson Street ti PO Box 1220 Port Townsend, WA 98368 / C'` Heather Dudley-Nollette,District 1 Heidi Eisenhour,District 2 Greg Brotherton,District 3 SIZING\ May 11,2026 Andrea Chartock Assistant Director,Office of Economic Development and Competitiveness Washington State Department of Commerce 1011 Plum Street SE PO Box 42525 Olympia, WA 98504 Re: Letter of Support—Opportunity Zone 2.0 Nomination, Census Tract 53031950603 (Port Townsend) Dear Ms. Chartock, On behalf of the Jefferson County Board of County Commissioners,I write to offer the County's strongest and most unqualified support for the Emerald Coast Opportunity Zone(ECOZ)consortium's nomination of Census Tract 53031950603 for designation as a Qualified Rural Opportunity Zone. Although this tract sits geographically within the City of Port Townsend, it functions as the urban service core for the entire county. The hospital that anchors healthcare for our 33,000 residents is in this tract. The childcare and early-learning facilities that working families across Jefferson County depend on are concentrated here.A critical share of our county-wide employment base—and a critical share of our housing supply—sits within these boundaries. What gets built or not built here over the next decade will shape what county government can deliver in every corner of Jefferson County,from Port Hadlock to Quilcene to Brinnon and the West End. Healthcare is the most consequential element of this case. Jefferson Healthcare—a public hospital district and one of the largest employers in the county—recently completed a$96 million Campus Modernization and Expansion Project. The new Castle View wing,which opened in August 2025,nearly doubled clinical space from approximately 30,000 to 56,000 square feet.Jefferson Healthcare is now the first critical access hospital in Washington State to operate a linear accelerator,allowing radiation oncology to be delivered locally rather than requiring patients to travel to Silverdale or Seattle multiple times per week.New service lines—neurology, pulmonology,dermatology,ENT,and expanded OBGYN—are projected to add 70 to 75 jobs over the next five years. The hospital earned the Washington State Hospital Association's Critical Access Hospital Achievement of Excellence gold-level award in 2025,placing it in the top 9 percent of U.S. hospitals with obstetric services and the top 5 percent in outpatient care. Jefferson Healthcare's full campus, the new Castle View wing,and the immediately adjacent properties—including a planned pharmacy and additional healthcare-adjacent investments—sit within Census Tract 53031950603. The County's interest in OZ designation is direct and substantial.Jefferson County is a federally designated Health Professional Shortage Area and Medically Underserved Area. We have the highest median age of any county in Washington,and our demographic trajectory—sustained growth in retirement-age population paired with decline in working-age population—makes building healthcare and care-economy capacity an Wage existential economic priority,not just a service priority. The hospital expansion is necessary but not sufficient.Clinicians and clinical staff need places to live.The early-learning workforce that serves the hospital's families needs facilities. The missing community services scoring category in the OZ 2.0 application is precisely calibrated to the kinds of investments this tract requires. The YMCA-led childcare facility planned on land donated by the school district,the workforce housing planned by New Visions Community on Jefferson Street,the senior living and assisted-living investments under discussion,and the integrated set of healthcare-adjacent commercial investments around the hospital campus would all benefit from the patient OZ capital that designation makes available. Beyond healthcare,the County maintains a deep stake in the housing,commercial,and infrastructure investments that the OZ designation would catalyze. Our county-wide service delivery—from public health to the Sheriffs Office to library services to community-based behavioral health—depends on a workforce that can afford to live and work in Jefferson County. The tract's housing capacity is the most significant near- term lever the county has to address that need. Investments here directly support service delivery in Port Hadlock,Quilcene, Brinnon, and the West End,because the institutional anchor of the county—the hospital,the courthouse,the central public health functions,and the community-based services that operate from Port Townsend—must be staffed by people who live within reasonable commuting distance. The Board of County Commissioners has been briefed by EDC Team Jefferson Executive Director on the OZ 2.0 program,the ECOZ consortium approach,and the specific projects in the pipeline within this tract. The County's commitment is institutional and durable. We will support the success of this nomination with project data,healthcare and demographic documentation, and any additional support required. We urge designation of Census Tract 53031950603 as a Qualified Rural Opportunity Zone. Sincerely, Heather Dudley-Nollette,Dist. 1 Heidi Eisenhour, Dist. 2 Greg Brotherton,Dist. 3-Chair 2 ' Page o oN� �sl Board of County Commissioners 49wS c° 02 1820 Jefferson Street 0 ti PO Box 1220 Port Townsend, WA 98368 qHeathers. Dudley-Nollette,District 1 Heidi Eisenhour,District 2 Greg Brotherton,District 3 1IJNv May 11,2026 The Honorable Governor Bob Ferguson Office of the Governor 416 14th Ave SW Olympia, WA 98504 Re: Letter of Support for the joint,collaborative Emerald Coast Opportunity Zone application—Census Tract 53031950603 (Port Townsend) Dear Governor Ferguson, On behalf of the Jefferson County Board of County Commissioners, I am writing to you today to voice our support for the joint Emerald Coast Opportunity Zone application that continues the historic collaboration between Tribal,city and county governments. On the Olympic Peninsula,our communities have many potential opportunities that could become not only attractive investment opportunities, but catalysts for innovative economic growth in the North Olympic Peninsula. The Emerald Coast Opportunity Zone application consists of five rural census tracts located in Jefferson and Clallam Counties. We are supportive of each of these five applications being forwarded by EDC Team Jefferson(EDCTJ)and the Clallam County Economic Development Council(EDC)in their respective capacities as the Associated Development Organizations(ADOs). The continued engagement,cooperation,and collective tone build on the nationwide marketing effort that our communities have pursued since 2018. Our community website,www.EmeraldFunds.org,generates substantial interest from major national investors. We have applied the lessons learned to target five ready- for-investment census tracts. It is our intention to catalyze sustainable economic growth that is aligned with the cultural and environmental values of the Peninsula. We enthusiastically support the following five census tracts to be selected as Opportunity Zones as part of the Emerald Coast Opportunity Zone 2.0: Rural Census Tract County Location Description 53031950603 Jefferson Port Townsend including Boatyard areas 53031950702 Jefferson West End of Jefferson and Hoh Tribal Lands& Brinnon 53009002400 Clallam West End of Clallam and Quileute Tribal Lands 53009000700 Clallam Port Angeles including shuttered paper mill site 53009000900 Clallam Downtown Port Angeles targeted for redevelopment While the original Emerald Coast Opportunity Zone footprint included 14 census tracts, extensive engagement with investors has enabled us to refine our proposal. The selected tracts represent locations where there is strong alignment between targeted and defined market interest and community priorities, ensuring that future investment supports locally driven economic outcomes. Wage Census Tract 53031950603, although geographically within the City of Port Townsend, functions as the urban service core of the entire county. Jefferson Healthcare—our public hospital district,the principal healthcare provider for our 33,000 residents,and one of the largest employers in the county—anchors the tract.Jefferson Healthcare recently completed a$96 million Campus Modernization and Expansion Project; the new Castle View clinical wing nearly doubled clinical space, and Jefferson Healthcare is now the first critical access hospital in Washington State to operate a linear accelerator. Healthcare-adjacent businesses, the workforce that staffs the hospital,county-wide childcare and early-learning facilities, and a critical share of the county's housing supply all sit within this tract. The County's interest in OZ designation here is institutional and durable.Jefferson County is a federally designated Health Professional Shortage Area and Medically Underserved Area,with the highest median age of any county in Washington. The clinical workforce that staffs Castle View,the early-learning workforce that supports those families,and the broader county-wide service workforce all face an acute housing- affordability crisis that the OZ 2.0 tool is well positioned to help address. The County is in the final adoption phase of our 2025-2045 Comprehensive Plan, with adoption targeted for June 30,2026 consistent with the Department of Commerce GMA Periodic Update schedule.Across this tract,the policy alignment between the County's planning framework and the OZ 2.0 program—particularly around housing,healthcare access, climate resilience,and capital facilities planning—is direct and substantial. The following County policies,plans,and strategies align directly with the Emerald Coast Opportunity Zone 2.0 application for this tract: • 2025-2045 Jefferson County Comprehensive Plan(final adoption targeted June 30,2026) • Climate Element of the Comprehensive Plan(per HB 1181) • Jefferson County/City of Port Townsend Multi-Hazard Mitigation Plan • Joint Climate Action Committee(with City of Port Townsend) • Coordinated Water System Plan(CWSP)update • Jefferson Healthcare Strategic Plan(public hospital district) • Capital Facilities Plan Element • North Olympic Development Council Comprehensive Economic Development Strategy • Recompete Pilot Program implementation strategy Our communities have struggled economically as historic industries of fishing and forestry have declined and we have experienced retirees choosing our area for second homes or short-term rentals. Continuation of this investment program is critical for the communities within the Emerald Coast Opportunity Zone to reach their near-term potential. Sincerely, Greg Brotherton Chair,Board of County Commissioners District 3 Jefferson County 2IPage p� CoMitt,s,sj. Board of County Commissioners k-cv e.? 1820 Jefferson Street 0 4 PO Box 1220 Port Townsend, WA 98368 ql0� Heather Dudley-Nollette,District 1 Heidi Eisenhour,District 2 Greg Brotherton,District 3 SflING'S May 11,2026 The Honorable Governor Bob Ferguson Office of the Governor 416 14th Ave SW Olympia, WA 98504 Re: Letter of Support for the joint,collaborative Emerald Coast Opportunity Zone application—Census Tract 53031950702 (Brinnon/West End) Dear Governor Ferguson, On behalf of the Jefferson County Board of County Commissioners, I am writing to you today to voice our support for the joint Emerald Coast Opportunity Zone application that continues the historic collaboration between Tribal,city and county governments. On the Olympic Peninsula,our communities have many potential opportunities that could become not only attractive investment opportunities, but catalysts for innovative economic growth in the North Olympic Peninsula. The Emerald Coast Opportunity Zone application consists of five rural census tracts located in Jefferson and Clallam Counties. We are supportive of each of these five applications being forwarded by EDC Team Jefferson(EDCTJ)and the Clallam County Economic Development Corporation(EDC) in their respective capacities as the Associated Development Organizations(ADOs). The continued engagement,cooperation,and collective tone build on the nationwide marketing effort that our communities have pursued since 2018. Our community website,www.EmeraldFunds.org,generates substantial interest from major national investors. We have applied the lessons learned to target five ready- for-investment census tracts. It is our intention to catalyze sustainable economic growth that is aligned with the cultural and environmental values of the Peninsula. We enthusiastically support the following five census tracts to be selected as Opportunity Zones as part of the Emerald Coast Opportunity Zone 2.0: Rural Census Tract County Location Description 53031950603 Jefferson Port Townsend including Boatyard areas 53031950702 Jefferson West End of Jefferson and Hoh Tribal Lands& Brinnon 53009002400 Clallam West End of Clallam and Quileute Tribal Lands 53009000700 Clallam Port Angeles including shuttered paper mill site 53009000900 Clallam Downtown Port Angeles targeted for redevelopment While the original Emerald Coast Opportunity Zone footprint included 14 census tracts,extensive engagement with investors has enabled us to refine our proposal.The selected tracts represent locations where there is strong alignment between targeted and defined market interest and community priorities, ensuring that future investment supports locally driven economic outcomes. 1lPage Census Tract 53031950702—covering Brinnon, Pleasant Harbor,the Dosewallips and Duckabush river corridors,the Hood Canal coastline,and the West End communities including Hoh Tribal Lands—is the rural geography of Jefferson County. As the District 3 Commissioner who represents this area,and as Chair of the Board,I want this designation to land. This is the part of Jefferson County that the conventional economic development conversation most often overlooks,and it is the part where the Qualified Rural Opportunity Fund tool will do the most work. Federal data underlying the tract's eligibility shows poverty above 20 percent and area median income at roughly 62 percent—well below the OZ 2.0 threshold and well below the levels at which conventional capital alone can deliver scaled investment. The pipeline of investment-ready projects is real. The Pleasant Harbor Master Planned Resort,advanced by the Statesman Group with Hearing Examiner approval secured, is among the largest single private investments ever proposed on Hood Canal. The Hoh Tribe is pursuing village relocation, climate adaptation, and economic development priorities on the West End that align with both the OZ tool and federal Indian Country development frameworks. Rocky Brook Falls offers clean-energy potential. Across these projects, the County's planning framework—particularly the Comprehensive Plan in final adoption,the HB 1181 Climate Element,the 2024 Community Wildfire Protection Plan, and the climate vulnerability and sea level rise studies that document this tract's exposure—provides the policy foundation for OZ-eligible private investment to land effectively. The following County policies,plans,and strategies align directly with the Emerald Coast Opportunity Zone 2.0 application for this tract: • 2025-2045 Jefferson County Comprehensive Plan(final adoption targeted June 30,2026) • Climate Element of the Comprehensive Plan(per HB 1181) • 2024 Community Wildfire Protection Plan(CWPP) • Jefferson County Climate Vulnerability Assessment • Jefferson County Sea Level Rise Study(2023) • Climate Impacts Summary(2024) • Coordinated Water System Plan(CWSP)update • Critical Areas Ordinance(in update) • North Olympic Development Council Comprehensive Economic Development Strategy • Recompete Pilot Program implementation strategy Our communities have struggled economically as historic industries of fishing and forestry have declined and we have experienced retirees choosing our area for second homes or short-term rentals. Continuation of this investment program is critical for the communities within the Emerald Coast Opportunity Zone to reach their near-term potential. Sincerely, Greg Brotherton Chair, Board of County Commissioners District 3 Commissioner Jefferson County Wage Regular Agenda JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners FROM: Adiel McKnight,Deputy Clerk of the Board DATE: May 11,2026 SUBJECT: HEARING re: Proposed Appropriations/Extensions Additional 2026; Various County Departments; Hearing Scheduled for Monday, May 11, 2026 at 10:30 a.m. in the Commissioners Chambers STATEMENT OF ISSUE: Various county departments have requested changes to their respective 2026 budgets. This set of proposed budget changes is referred to as Additional 2026 Budget Appropriations. Per RCW 36.40.140, the Board of County Commissioners must hold a public hearing on May 11, 2026 at 10:30 a.m. regarding the proposed budget changes. ANALYSIS: These budget changes are intended to address unanticipated revenues and expenditures of the requesting departments. The Hearing Notice was published in the Port Townsend Leader on April 29 and May 6, 2026. FISCAL IMPACT: See attached department fund requests. RECOMMENDATION: Hear public testimony and consider approval of a resolution to adopt the Additional 2026 Budget Appropriations on Monday, May 11, 2026 at 10:30 a.m. REVIEWED BY: S(7 96 Jos . Peters, County Administrator Date STATE OF WASHINGTON COUNTY OF JEFFERSON RESOLUTION APPROVING 2026 ADDITIONAL BUDGET RESOLUTION NO. APPROPRIATIONS FOR VARIOUS COUNTY DEPARTMENTS WHEREAS,the Jefferson County Board of Commissioners did on the 27th day of April 2026,declare that a need existed for the listed expenses which are funded by additional sources which were not anticipated at the time of preparing said budgets; and such sources include unanticipated revenues received from fees,or grants from the State and Federal government, or proceeds from the sale of bonds,or budgeted but unexpended monies from the prior budget year; and WHEREAS,RCW 36.40.100 authorizes supplemental appropriations,provided"the board shall publish notice of the time and date of the meeting at which the supplemental appropriations resolution will be adopted, and the amount of the appropriation, once each week, for two consecutive weeks prior to the meeting in the official newspaper of the county,"and WHEREAS,a supplemental appropriation for 2026 Additional Appropriation is necessary as described in the table below: eneral Fund-001 Revenue Expense One- Dept Dept Name Description One-time Ongoing time Ongoing 021 Elections Secretary of State Award 80,000 Ballot Boxes 23,847 MS Office 365 License Renewal 56,153 261 Operating Transfer Transfer to Parks 87,125 Total General Fund 80,000 167,125 ther Funds Revenue Expense One- Fund Fund Name Description One-time Ongoing time Ongoing 104 Hava 3 Grant Ballot Box Installations 86,410 Transfer In, Rents&Leases, 174 Parks& Recreation Reduce Private Contributions 19,119 S&B,Interfund Rents,Supplies, Insurance,Supplies 132,081 Total Other Funds 19,119 86,410 132,081 Total Appropriations 99,119 253,535 132,081 WHEREAS, the Jefferson County Board of Commissioners did on the 27th day of April,2026, set a hearing on said need for the 11th day of May 2026,at the hour of 10:30 a.m. in the County Commissioners' Chamber, Courthouse,Port Townsend, Washington, (Hybrid); and WHEREAS, Jefferson County has published notice of this hearing as provided in RCW 36.40.100 on April 29,2026 and May 6, 2026 in the official newspaper of Jefferson County; and WHEREAS, this being the time and place set forth for said hearing and no objection or objection was interposed. NOW THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF JEFFERSON COUNTY,STATE OF WASHINGTON: Section 1. Whereas Clauses Adopted as Findings of Fact. The Jefferson County Board of Commissioners hereby adopts the above "Whereas" clauses as Findings of Fact. Section 2. Supplemental Budget Appropriations Approved. The Supplemental Budget Appropriations above is hereby approved. Section 3. Severability. If any section, subsection, sentence, clause, phrase or section of this resolution or its application to any person or circumstance is held invalid, the remainder of this resolution or its application to other persons or circumstances shall be fully valid and shall not be affected. Section 4. Effective Date. This resolution is effective upon adoption. Section 5. SEPA Categorical Exemption. This resolution is categorically exempt from the State Environmental Policy Act under WAC 197-11-800(19). SIGNATURES FOLLOW ON THE NEXT PAGE) Page 2 of 3 APPROVED this 11th day of May,2026 JEFFERSON COUNTY SEAL:BOARD OF COMMISSIONERS ATTEST: Greg Brotherton, Chair Heidi Eisenhour, Member Carolyn Gallaway,CMC, Date Clerk of the Board Heather Dudley-Nollette, Member Approved as to form only: Philip C. Hunsucker, Date Chief Civil Deputy Prosecuting Attorney Page 3 of 3 2026 Budget Appropriations are set by the Budget Calendar. They are also referred to as budget amendments. Budget Appropriations give fund directors and II1 dgetmanagerstoadjusttheirbudgetthroughout the year due to changes in revenues and expenditures. The budget appropriations are submitted to the BoCC staff. These are then given to the Finance Manager for review and discussions as Appropriationsneeded. Once they have been reviewed,they are returned with a summary to the BoCC to setup a public hearing. Notice of the public hearing is advertised for two weeks in the County's designated publication. J ` ii a r e rDuringthepublichearing,the Finance Manager presents the appropriations to the BoCC and answers questions. The public has the opportunity to participate. The BoCC can then make a motion to accept the appropriations. To complete the process,once the resolution has been signed,the Chief Accountant updates the budget in Munis Financial. The Revised Budget reporting column is the original budget and the appropriations amount. General Fund-001 Revenue Expense Dept Dept Name Description One-time Ongoing One-time Ongoing 060 Commissioners Vehicle 1,442 065 Human Resources Vehicle 1,442 Subscription-NEOGOV 8,000 Professional Svcs-Braun&Assoc 13,000 180 Sheriff Grants-Project Lifesaver,Equipment 31,584 31,584 250 Treasurer Transfer In-SRS from Roads 291,753 270 Non-Departmental Public Defense,Berry Dunn 184,244 Total General Fund 323,337 236,828 2,884 Other Funds Revenue Expense Fund Fund Name Description One-time Ongoing One-time Ongoing 107 Boating Safety Grant-Safer Boating 12,500) 12,282) 123 Grants Management ARPA Distribution 100,000 127 Public Health Grants Redistribution,Transfers 25,000) 47,085 128 Water Quality Transfer In 25,000 148 Affordable Housing OlyCAP CBV 2025 92,674 180 Roads Transfer Out to GF-SRS 291,753 501 ER&R Capital Outlay-Equipment 457,880 Total Other Funds 12,500) 977,110 Total Appropriations 310,837 1,213,938 2,884 Reset Request for Budget Appropriation/Extension and Amendment Department/Fund Name: General Fund-Commissioners,Human Resources Budget Year:2026 1 Revenue: A revenue source(i.e.grant,new fee)has been received which was not approved in the annual budget. Therefore,I request an appropriation and budget extension in the amount reflected below: One-time On-going Fund# Org# Revenue Obj# Description Current Budget Appropriation Appropriation Amended Budget 0.00 0.00 0.00 0.00 TOTAL REVENUE: 0.00 0.00 0.00 0.00 FROM: If the revenue source is being transferred from another county fund,identify the information for the fund providing the revenue. Fund# Org# 1 Expenditure Obj# Description 0.00 Expenditure:After a thorough examination of my current budget it appears that the amount allocated is insufficient to pay necessary expenses for this year. Therefore,I request an appropriation and budget extension in the amount reflected below: OTHER FUNDS(Non General Fund):Is there enough Fund Balance to cover this additional expenditure? nYes FINo One-time On-going Fund# Org# Expenditure Obj# Description Current Budget Appropriation Appropriation Amended Budget 001 C051160 450108 CARPOOL 0.00 1,442.00 1,442.00 001 hr51810 450108 CARPOOL 0.00 1,442.00 1,442.00 0.00 0.00 0.00 0.00 TOTAL EXPENDITURE: 0.00 0.00 $2,884.00 2,884.00 TO: If the expenditure is providing a revenue source to another county fund,identify the receiving fund information. Fund# Org# Revenue Obj# Description 0.00 Reason for budget appropriation: Previously,$6,000 had been budgeted for a different vehicle and was removed from the 2026 budget.It was later determined that HR and the Commissioners require a County vehicle to help reduce long-term costs associated with mileage reimbursements,currently at$0.75 per mile.The proposed vehicle differs from the original and results in a lower overall cost. Submitted by(Elected Official/Department Head): try l 114,e0 Date: 3/13/2026 Reset Request for Budget Appropriation/Extension and Amendment Department/Fund Name: HUMAN RESOURCES 065 Budget Year: 2026 Quarter: 1 Revenue: A revenue source(i.e.grant,new fee)has been received which was not approved in the annual budget. Therefore,I request an appropriation and budget extension in the amount reflected below: One-time On-going Fund# Org It Revenue Obj# Description Current Budget Appropriation Appropriation Amended Budget 0.00 0.00 0.00 o.00 TOTAL REVENUE: 0.00 0.00 0.00 0.00 FROM: If the revenue source is being transferred from another county fund,identify the information for the fund providing the revenue. Fund# Org# !Expenditure Obj# Description 0.00 Expenditure:After a thorough examination of my current budget it appears that the amount allocated is insufficient to pay necessary expenses for this year. Therefore,I request an appropriation and budget extension in the amount reflected below: OTHER FUNDS(Non General Fund):Is there enough Fund Balance to cover this additional expenditure? Yes ENo One-time On-going Fund# Org# Expenditure Obj# Description Current Budget, Appropriation Appropriation Amended Budget 065 HR51810 490000 Subscription Service-NEOGOV 8,000.00 8,000.00 065 HR51810 410000 Professional Services-Braun&Assoc 17,000.00 $13,000.00 30,000.00 0.00 0.00 0.00 0.00 TOTAL EXPENDITURE: $17,000.00 $21,000.00 0.00 38,000.00 TO: If the expenditure is providing a revenue source to another county fund,identify the receiving fund information. Fund# Org# Revenue Obj# 1 Description 0.00 Reason for budget appropriation: Contract with NEOGOV approved for implementation/subscription service for professional employee advertising/recruiting platform;amount requested is cost for Year 2,July'26-July'27. Annual total Braun&Assoc contract for Labor Consultant Services is$30,000.Although total$30,000 requested in FY26 Budget,only$17,000 approved. Submitted by(Elected Official/Department Head): 94 _!/ui fit Q of tit Date: /64.2 c rya--CP Reset Request for Budget Appropriation/Extension and Amendment Department/Fund Name: JCSO General Fund Budget Year: 2026 Quarter: 1 Revenue: A revenue source(i.e.grant,new fee)has been received which was riot approved in the annual budget. Therefore,I request an appropriation and budget extension in the amount reflected below: One-time On-going Fund# Org# Revenue Obj# Description Current Budget Appropriation Appropriation Amended Budget 001 SH36991 346901 Project Lifesaver-Grant 0.00 $2,000.00 2,000.00 001 SH33401 334116 Fingerprint machine-Grant 0.00 $24,884.00 24,884.00 001 SH33320 333001 Traffic Safety Equipment-Grant 0.00 $4,700.00 4,700.00 0.00 TOTAL REVENUE: 0.00 $31,584.00 0.00 31.584.00 FROM: If the revenue source is being transferred from another county fund,identify the information for the fund providing the revenue. Fund# Org* 1-Expenditure Obj# Description 0.00 Expenditure:After a thorough examination of my current budget it appears that the amount allocated is insufficient to pay necessary expenses for this year. Therefore,I request an appropriation and budget extension in the amount reflected below: OTHER FUNDS(Non General Fund):Is there enough Fund Balance to cover this additional expenditure? Yes Do One-time On-going Fund# Org# Expenditure Obj# Description Current Budget Appropriation Appropriation Amended Budget 001 SH56900 340002 Project Lifesaver-Grant 320.00 $2,000.00 2,320.00 001 SH52310 640000 Fingerprint machine-Grant 0.00 $24,884.00 24,884.00 001 SH52170 310117 Traffic Safety Equipment-Grant 0.00 $4,700.00 4,700.00 0.00 0.00 0.00 TOTAL EXPENDITURE:320.00 $31,584.00 0.00 31,904.00 TO: If the expenditure is providing a revenue source to another county fund,identify the receiving fund information. Fund# Org# I Revenue Obj# i Description 0.00 Reason for budget appropriation: We received a private grant through WASPC to supplement our Project Lifesaver program. The fingerprint machine grant was actually appropriated last year,but the installation did not occur until late in the year,so the invoicing and subsequent reimbursement didn't happened until 2026. The Traffic Safety grant is an award we get yearly.What we are allowed to purchase is dictated by WASPC. This year it is for radars and driver's license scanners. Submitted by(Elected Official/Department Head): Date: 3-70_2‘ Reset Request for Budget Appropriation/Extension and Amendment Department/Fund Name: General Fund-Non Departmental Budget Year: 2026 1 Revenue: A revenue source(i.e.grant,new fee)has been received which was not approved in the annual budget. Therefore,I request an appropriation and budget extension in the amount reflected below: One-time On-going Fund# Org If Revenue Obj# Description Current Budget Appropriation Appropriation Amended Budget 0.00 0.00 0.00 0.00 TOTAL REVENUE: 0.00 0.00 0.00 0.00 FROM: If the revenue source is being transferred from another county fund,identify the information for the fund providing the revenue. Fund if Org# I Expenditure Obj# Description 0.00 Expenditure:After a thorough examination of my current budget it appears that the amount allocated is insufficient to pay necessary expenses for this year. Therefore,I request an appropriation and budget extension in the amount reflected below: OTHER FUNDS(Non General Fund):Is there enough Fund Balance to cover this additional expenditure? nYes No One-time On-going Fund# Org# Expenditure Obj# Description Current Budget Appropriation Appropriation Amended Budget 001 ND51221 410059 PUBLIC DEFENSE 950,427.00 $179,974.00 1,130,401.00 001 ND51890 410000 PROFESSIONAL SERVICES 20,000.00 $4,270.00 24,270.00 0.00 0.00 0.00 0.00 TOTAL EXPENDITURE: $970,427.00 $184,244.00 . $0.00 $1,154,671.00 TO: If the expenditure is providing a revenue source to another county fund,identify the receiving fund information. Fund# Org# Revenue Obj# ! Description 1 0.00 Reason for budget appropriation: Contract with Jefferson Associated Counsel has been fully executed and WA legislature has not added any additional funding as hoped,resulting in an increase to meet the contracted amount with JAC. Professional Services contract with Berry Dunn to complete work on the Strategic Plan and the last budgeted amount for Berry Dunn. Submitted by(Elected Official/Department Head): 1A11 Date: 3/13/2026 Reset Request for Budget Appropriation/Extension and Amendment Department/Fund Name: Jefferson County Sheriff's Office Budget Year: 2026 Quarter: 1 Revenue: A revenue source(i.e.grant,new fee)has been received which was not approved in the annual budget. Therefore,I request an appropriation and budget extension in the amount reflected below: One-time On-going Fund It Org tt Revenue Obj St Description Current Budget Appropriation Appropriation Amended Budget 107 10733397 333117 Safer Boating Grant 12,500.00 -$12,500.00 0.00 0.00 0.00 0.00 TOTAL REVENUE: $12,500.00 -$12,500.00 0.00 0.00 FROM: If the revenue source is being transferred from another county fund,identify the information for the fund providing the revenue. Fund it Org S !Expenditure Obj St Description 0.00 Expenditure:After a thorough examination of my current budget it appears that the amount allocated is insufficient to pay necessary expenses for this year. Therefore,I request an appropriation and budget extension in the amount reflected below: OTHER FUNDS(Non General Fund):Is there enough Fund Balance to cover this additional expenditure? CYes ENo One-time On-going Fund tt Org It Expenditure Obj tt Description Current Budget Appropriation Appropriation Amended Budget 107 10752130 100500 Overtime 31,800.00 -$11,100.00 20,700.00 107 10752130 200000 Benefits 5,280.00 -$1,442.00 3.838.00 107 10752130 320000 Fuel 1,500.00 $1,900.00 3,400.00 107 10752130 430000 Travel 140.00 -$140.00 0.00 107 10752130 450101 Moorage 4,780.00 -$4,377.00 403.00 107 10752130 480000 Repair and Maintenance 500.00 $2,877.00 3,377.00 TOTAL EXPENDITURE: $44,000.00 -$12,282.00 0.00 31,718,00 TO: If the expenditure is providing a revenue source to another county fund,identify the receiving fund information. Fund N Org# 1! Revenue Obj# I Description 0.00 Reason for budget appropriation: Due to not receiving our yearly Safer Boating Grant we need to reduce and reallocate our expenditures.We cancelled all training so we reduced the overtime(and subsequently the benefits)and reallocated the travel budget.We were able to move our vessels to locations that do not require moorage fees,but due to these locations we anticipate the need for more fuel.We reallocated more funds to Repair and Maintenance.as we were short in that line item at the end of last year. Submitted by(Elected Official/Department Head): Date: 3—e 2e Reset Request for Budget Appropriation/Extension and Amendment Department/Fund Name: Grants Management Budget Year: Revenue: A revenue source(i.e.grant,new fee)has been received which was not approved in the annual budget. Therefore,I request an appropriation and budget extension in the amount reflected below: One-time On-going Fund# Org# Revenue Obj# Description Current Budget Appropriation Appropriation Amended Budget 0.00 0.00 0.00 0.00 TOTAL REVENUE: 0.00 0.00 0.00 0.00 FROM: If the revenue source is being transferred from another county fund,identify the information for the fund providing the revenue. Fund# Org* Expenditure Obj# Description 0.00 Expenditure:After a thorough examination of my current budget it appears that the amount allocated is insufficient to pay necessary expenses for this year. Therefore,I request an appropriation and budget extension in the amount reflected below: OTHER FUNDS(Non General Fund):Is there enough Fund Balance to cover this additional expenditure? []Yes No One-time On-going Fund# Org# Expenditure Obj# Description Current Budget Appropriation Appropriation Amended Budget 123 12351863 518064 ARPA Distribution to Others 0.00 $100,000.00 100,000.00 0.00 0.00 0.00 0.00 0.00 TOTAL EXPENDITURE: 0.00 $100,000.00 0.00 $100,000.00 TO: If the expenditure is providing a revenue source to another county fund,identify the receiving fund information. Fund# Org U Revenue Obj# Description 0.00 Reason for budget appropriation: Several years ago,ARPA awards were made to remodel the Quilcene Community Center kitchen and PT Pump Track at$50,000 each.Due to these two projects taking some time to be completed,they were not in the 2026 Budget.These awards will be used in 2026. Submitted by(Elected Official/Department Head): Date: 3/13/2026 Reset Request for Budget Appropriation/Extension and Amendment Department/Fund Name: 127/Public Health Budget Year: 2026g Quarter: 1 Revenue: A revenue source(i.e.grant,new fee)has been received which was not approved in the annual budget. Therefore,I request an appropriation and budget extension in the amount reflected below: One-time On-going Fund# Org# Revenue Obj# Description Current Budget Appropriation Appropriation Amended Budget 127 12733390 I 333009 PH Infrastructure 110,570.00 $75.000.00 35,570.00 127 12733603 336010 PH Assist-ADMIN BARS3360424 0.00 -$126,028.001 126,028.00 127 12733603 336015 FPHS-BARS 3360425 i -$ 2,128,000.00 $1,335,000.00_ 793,000.00 127 12739700 397010 TR FROM GF-ADMIN 100,000.00 $60,000.00 40,000.00 TOTAL REVENUE: -$2,338,570.00 $1,343,972.00 0.00 -$994,598.00 FROM: If the revenue source is being transferred from another county fund,identify the information for the fund providing the revenue. Fund# I Org# Expenditure Obj# 1 Description I I I 1 I I I 0.00 Expenditure:After a thorough examination of my current budget it appears that the amount allocated is insufficient to pay necessary expenses for this year. Therefore,I request an appropriation and budget extension in the amount reflected below: OTHER FUNDS(Non General Fund):Is there enough Fund Balance to cover this additional expenditure? f }Yes INo One-time On-going Fund# Org# Expenditure Obi# Description Current Budget Appropriation Appropriation Amended Budget 127 12756200 460000 Insurance 249,589.00 $22,085.00 271,674.00 0.00 I 0.00 0.00 0.00 0.00 TOTAL EXPENDITURE: $249,589.007 $22,085.00 0.00 $271,674.00 TO: If the expenditure is providing a revenue source to another county fund,identify the receiving fund information. Fund# Org# Revenue Obj# I Description I i 0.00 Reason for budget appropriation: Requesting these amendments due to entry errors in the 2026 budget,unanticipated higher cost of insurance,and to reflect the updated decision of the Board,which is to support the Lake Water Monitoring and Footcare programs using portions of the$100,000 transfer of G/F originally allocated to Public Health. Submitted by(Elected Official/Department Head): 7r;(t-A_, / -1,(--,, Date:_21 j 22Q2 I Reset Request for Budget Appropriation/Extension and Amendment Department/Fund Name: 127/Public Health Budget Year: 2026 Quarter: 1 Revenue: A revenue source(i.e.grant,new fee)has been received which was not approved in the annual budget. Therefore,I request an appropriation and budget extension in the amount reflected below: One-time On-going Fund# Org# Revenue Obj# Description Current Budget Appropriation Appropriation Amended Budget 127 12733393 333009 PH Infrastructure 0.00 -$75,000.00 75,000.00 127 12733604 336010 PH Assist-CH 184,080.00 $126,028.00 58,052.00 127 12733604 336015 FPHS 0.00 -$720,000.00 720,000.00 12/ 12734146 341007 Contract Mgmt-MH/CD 0.00 -$24,452.00 24,452.00 TOTAL REVENUE: -$184,080.00 -$693.424.00 0.00 -$877,504.00 FROM: If the revenue source is being transferred from another county fund,identify the information for the fund providing the revenue. Fund# I Org# !Expenditure Obj# I Description 0.00 Expenditure:After a thorough examination of my current budget it appears that the amount allocated is insufficient to pay necessary expenses for this year. Therefore,I request an appropriation and budget extension in the amount reflected below: OTHER FUNDS(Non General Fund):Is there enough Fund Balance to cover this additional expenditure? ]Yes No One-time On-going Fund# Org# Expenditure Obj# Description Current Budget Appropriation Appropriation Amended Budget 0.00 0.00 0.00 0.00 0.00 0.00 TOTAL EXPENDITURE: 0.00 0.00 0.00 0.00 TO: If the expenditure is providing a revenue source to another county fund,identify the receiving fund information. Fund# ( Org# ( Revenue Obj# ( Description It 0.00 Reason for budget appropriation: Figures above are necessary to correct budget entry errors and to reflect change in the responsibility of contract management for the Chemical Dependency/Mental Health Program. 1Submittedby(Elected Official/Department Head): 7.-f c, _I149 Date:_ Reset Request for Budget Appropriation/Extension and Amendment Department/Fund Name: 127/Public Health Budget Year: 2026 Quarter: 1 Revenue: A revenue source(i.e.grant,new fee)has been received which was not approved in the annual budget. Therefore,I request an appropriation and budget extension in the amount reflected below: One-time On-going Fund# Org# Revenue Obj# Description Current Budget Appropriation Appropriation Amended Budget 127 12734146( 341007 COORD/Admin-Opioid Settlement 0.00 -$25,000.00 25,000.00 127 12734621 341015 JHC-SBHC(Chim) 30,950.00 $17,180.00 13,770.00 127 12734621 341119 JHC-SBHC(Blue Heron) 0.00 -$17,180.00 17,180.00 127 12739720 397010 TR FROM GF-CH 0.00 -$35,000.00 35,000.00 TOTAL REVENUE: -$30,950.00 -$60,000.00 0.00 90.950.00 FROM: If the revenue source is being transferred from another county fund,identify the information for the fund providing the revenue. Fund St Org# Expenditure Obj# ( Description 0.00 Expenditure:After a thorough examination of my current budget it appears that the amount allocated is insufficient to pay necessary expenses for this year. Therefore,I request an appropriation and budget extension in the amount reflected below: OTHER FUNDS(Non General Fund):Is there enough Fund Balance to cover this additional expenditure? nYes nNo One-time On-going Fund# Org# Expenditure Obj# Description Current Budget Appropriation Appropriation Amended Budget 0.00 0.00 0.00 0.00 0.00 0.00 TOTAL EXPENDITURE: 0 00 0.00 0.00 0.00 TO: If the expenditure is providing a revenue source to another county fund,identify the receiving fund information. Fund# Org# Revenue Obj# ( Description I 0.00 Reason for budget appropriation: Figures above are necessary to correct budget entry errors and to reflect the updated decision of the Board,which is to support the Footcare program using a portion of the$100,000 transfer of G/F originally allocated to Public Health. Submitted by(Elected Official/Department Head): j'/ L C„_ Date: 3/4/,2C1/ Reset Request for Budget Appropriation/Extension and Amendment Department/Fund Name: 127/Public Health Budget Year: 2026 Quarter: Revenue: A revenue source(i.e.grant,new fee)has been received which was not approved in the annual budget. Therefore,I request an appropriation and budget extension in the amount reflected below: One-time On-going Fund# Org# Revenue Obj# Description Current Budget Appropriation Appropriation Amended Budget 127 12733605 336015 FPHS 0.00 -$615,000.00 615,000.00 127 12734146 341007 Contract Mgmt-MH/CD 49,452.00 $49,452.00 0.00 0.00 0.00 TOTAL REVENUE: -$49,452.00 -$565,548.00 0.00 -$615,000.00 FROM: If the revenue source is being transferred from another county fund,identify the information for the fund providing the revenue. Fund# Org# Expenditure Obj# Description 0.00 Expenditure:After a thorough examination of my current budget it appears that the amount allocated is insufficient to pay necessary expenses for this year. Therefore,I request an appropriation and budget extension in the amount reflected below: OTHER FUNDS(Non General Fund):Is there enough Fund Balance to cover this additional expenditure? Yes No One-time On-going Fund# Org# Expenditure Obj# Description Current Budget Appropriation Appropriation Amended Budget 0.00 0.00 0.00 0.00 0.00 0.00 TOTAL EXPENDITURE: 0.00 0.00 0.00 0.00 TO: If the expenditure is providing a revenue source to another county fund,identify the receiving fund information. Fund# Org# Revenue Obj# Description 12733605 0.00 Reason for budget appropriation: Figures above are necessary to correct budget entry errors and to reflect change in the responsibility of contract management for the Chemical Dependency/Mental Health Program. Submitted by(Elected Official/Department Head): f Date: Reset Request for Budget Appropriation/Extension and Amendment Department/Fund Name: 128/Water Quality Budget Year: 2026 Quarter: Revenue: A revenue source(i.e.grant,new fee)has been received which was not approved in the annual budget. Therefore,I request an appropriation and budget extension in the amount reflected below: One-time On-going Fund# I Org# I Revenue Obj# Description Current Budget Appropriation Appropriation Amended Budget 128 12839700 397010 TRANSFER FROM G/F-LAKES 0.00 -$25,000.00 25,000.00 I I I I 0.00, I 0.001 0.00 TOTAL REVENUE: 0.00 -$25,000.00 0.00 25,000.00 FROM: If the revenue source is being transferred from another county fund,identify the information for the fund providing the revenue. I Fund# I Org# I Expenditure Obj# I Description I I I 127 127397001 397010 I Transfer In from GF 100 000 I 25,000 I I $75,000.00 Expenditure:After a thorough examination of my current budget it appears that the amount allocated is insufficient to pay necessary expenses for this year. Therefore,I request an appropriation and budget extension in the amount reflected below: OTHER FUNDS(Non General Fund):Is there enough Fund Balance to cover this additional expenditure? nYes nNo One-time On-going Fund# I Org# I Expenditure Obj# Description Current Budget Appropriation Appropriation Amended Budget 25,000.00 0.001 I l I I 0.001 0.001 I I I I 0.001 I 0.00 TOTAL EXPENDITURE: 0.00 0.00 0.00 0.00 TO: If the expenditure is providing a revenue source to another county fund,identify the receiving fund information. I Fund# I Org# I Revenue Obj# I Description I I I I I 1 12839700 I I I I I 0.001 Reason for budget appropriation: To reflect the updated decision of the Board,which is to support the Lake Water Monitoring program using a portion of the$100,000 transfer of G/F originally allocated to Public Health. L_I it Submitted by(Elected Official/Department Head):j ,CMG bate: J1.4 1 2 L/ t Reset Request for Budget Appropriation/Extension and Amendment Department/Fund Name: FUND 148/AFFORDABLE HOUSING Budget Year: 2026 Quarter: Revenue: A revenue source(i.e.grant,new fee)has been received which was not approved in the annual budget. Therefore,I request an appropriation and budget extension in the amount reflected below: One-time On-going Fund# Org# Revenue Obj# Description Current Budget Appropriation Appropriation Amended Budget 0.00 0.00 0.00 0.00 TOTAL REVENUE: 0.00 0.00 0.00 0.00 FROM: If the revenue source is being transferred from another county fund,identify the information for the fund providing the revenue. Fund# Org# 1 Expenditure Obj# I Description 0.00 Expenditure:After a thorough examination of my current budget it appears that the amount allocated is insufficient to pay necessary expenses for this year. Therefore,I request an appropriation and budget extension in the amount reflected below: OTHER FUNDS(Non General Fund):Is there enough Fund Balance to cover this additional expenditure? Yes ( ,No One-time On-going Fund# Org# Expenditure Obj If Description Current Budget Appropriation Appropriation Amended Budget 148 14855150 551521 OLYCAP CASWELL BROWN OPERATING 171,000.00 $92,674.00 263,674.00 0.00 0.00 0.00 0.00 0.00 TOTAL EXPENDITURE: $171,000.00 $92,674.00 0.00 $263,674.00 TO: If the expenditure is providing a revenue source to another county fund,identify the receiving fund information. Fund# Org# Revenue Obj# ( Description Il o.00 Reason for budget appropriation: In 2025,OlyCAP received grant funding in the amount of$660,000 for their Caswell-Brown Village project.In February 2026,we received a request to fund a late 2025 invoice for that project.On March 13,2026,the Housing Fund Board recommended to allow OlyCAP the ability to use their unexpended 2025 funds-which is$92,674-and apply to their 2026 award of 171,000. Submitted by(Elected Official/Department Head): Date: Reset Request for Budget Appropriation/Extension and Amendment Department/Fund Name: PUBLIC WORKS/ROADS Budget Year: 2026g Quarter:1ST Revenue: A revenue source(i.e.grant,new fee)has been received which was not approved in the annual budget, Therefore,I request an appropriation and budget extension in the amount reflected below: One-time On-going Fund# Org# Revenue Obi# Description Current Budget Appropriation Appropriation Amended Budget 180 18033210 332068 FEDERAL FOREST TITLE I 111,517.00 $291,753.00 403,270.00 0.00 0.00 0.00 TOTAL REVENUE: $111,517.00 $291,753.00 0.00 403,270.00 FROM: If the revenue source is being transferred from another county fund,identify the information for the fund providing the revenue. Fund# Org# Expenditure Obi# Description 0.00 Expenditure:After a thorough examination of my current budget it appears that the amount allocated is insufficient to pay necessary expenses for this year. Therefore,I request an appropriation and budget extension in the amount reflected below: OTHER FUNDS(Non General Fund):Is there enough Fund Balance to cover this additional expenditure? Yes No One-time On-going Fund# Org# Expenditure Obi# Description Current Budget Appropriation Appropriation Amended Budget 180 18059700 597011 TR OUT TO GENERAL FUND 0.00 $291,753.00 291,753.00 0.00 0.00 0.00 0.00 0.00 TOTAL EXPENDITURE: 0.00 $291,753.00 0.00 $291,753.00 TO: If the expenditure is providing a revenue source to another county fund,identify the receiving fund information. Fund# Org# Revenue Obj# Description 001 TR39700 397180 TR IN FROM ROADS 0.00 $291,753.00 291,753.00 Reason for budget appropriation: Additional 2024 Secure Rural Schools Title I funds have been received so PW is returnin PIL funds transfered from the General Fund in 2025 to make up for the reduction to the SRS funds received in 2025 for 2024. Submitted by(Elected Official/Department Head): Date: 431[01144 ResetRequestforBudgetAppropriation/Extension and Amendment Department/Fund Name: PUBLIC WORKS/ER&R Budget Year: 2026 Quarter: 1 Revenue: A revenue source(i.e.grant,new fee)has been received which was not approved in the annual budget. Therefore,I request an appropriation and budget extension in the amount reflected below: One-time On-goingFund# Org# Revenue Obj# Description Current Budget Appropriation Appropriation Amended Budget 0.00 o.00 0.00 o.00 TOTAL REVENUE: 0.00 0.00 0.00 0.00 FROM: If the revenue source is being transferred from another county fund,identify the information for the fund providing the revenue. Fund* Org# !Expenditure Obj# Description 0.00 Expenditure:After a thorough examination of my current budget it appears that the amount allocated is insufficient to pay necessary expenses for this year. Therefore,I request an appropriation and budget extension in the amount reflected below: OTHER FUNDS(Non General Fund):Is there enough Fund Balance to cover this additional expenditure? I Yes _No One-time On-going Fund# OrB# Expenditure Obj# Description Current Budget Appropriation Appropriation Amended Budget 501 50159448 640000 CAPITAL OUTLAY-EQUIPMENT 900,000.00 $457,880.00 1,357,880.00 0.00 S 0.00 0.00 0.00 0.00 TOTAL EXPENDITURE: $900,000.00 $457,880.00 0.00 $1,357,880.00 TO: If the expenditure is providing a revenue source to another county fund,identify the receiving fund information. Fund# Org# Revenue Obj# 1 Description o.00 Reason for budget appropriation: The Broom Bear street sweeper was ordered in August of 2024 with an original expe ted livery date of May 2025,which is the year the purchase was budgeted in. The actual deliverydatewasFebruary2026. The budget authority from 2025 needs to be carried forwar into 2026. Submitted by(Elected Official/Department Head): Date: $1(0 flo24 JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners Josh Peters, County Administrator FROM: Chelsea Pronovost, Administrative Services Manager, DCD Brandon Brown, Senior Building Inspector Mitchell Cartmel, Building Inspector Brian Tracer, Deputy Fire Marshal Vincent Maniaci, Building & Fire Inspector Gabriel Shepherd, Permit Technician Lead Andrea Kesgard, Permit Technician DATE: May 11, 2026 RE: PROCLAMATION re: Proclaiming May 2026 as Building Safety Month STATEMENT OF ISSUE: Each May,the International Code Council brings attention to building safety and the importance of safe, resilient infrastructure in our communities. Building Safety Month provides an opportunity to recognize the essential work happening every day through our local code officials, inspectors, plans examiners, permit technicians, and administrative staff. The Department of Community Development takes pride in its role in protecting public safety and supporting community resilience. Our Building and Fire Safety team works closely with community partners and state agencies, and actively participates in continuing education and credentialing through organizations such as the Washington Association of Building Officials,the Washington State Fire Marshal's Association, and the International Code Council to stay current with evolving codes and best practices. FISCAL IMPACT: There is no fiscal impact to Jefferson County. RECOMMENDATION: Approve Proclamation re: Proclaiming May 2026 as Building Safety Month REVIEWED BY: Jo Peters, County Administrator Date 1 PROCLAMATION BUILDING SAFETY MONTH WHEREAS, Jefferson County recognizes that safe and resilient homes, buildings, and infrastructure are fundamental to the health, safety, and strength of our community, and; WHEREAS, this safety is made possible through the dedication of building inspectors, fire inspectors, the Fire Marshal, plans reviewers,permit technicians, and the broader community of design and construction professionals who work year-round to ensure buildings are constructed and maintained safely, and; WHEREAS,these dedicated professionals are members of the Washington Association of Building Officials and International Code Council, nonprofit organizations that bring together local, state,territorial, tribal and federal officials to develop and advance consistent, high-quality standards for the built environment, to protect us in the buildings where we live, learn, work, play, and; WHEREAS,these modern building codes provide critical safeguards against hazards such as wildfire, flooding, earthquakes, and severe weather, helping to protect lives, property, and community resilience, and; WHEREAS,Building Safety Month, sponsored by the International Code Council and Washington Association of Building Officials, raises awareness of the essential role building safety and fire prevention professionals play in ensuring safe, sustainable, and resilient communities, and; WHEREAS, the 2026 theme, "Built to Last,"encourages individuals and communities to recognize the importance of building safety and to support efforts that strengthen resilience at the local and global level, and; WHEREAS, communities around the world join in recognizing Building Safety Month and the essential services provided by building safety and fire prevention professionals in protecting lives and property, NOW, THEREFORE,BE IT RESOLVED THAT the Jefferson County Board of Commissioners hereby proclaim the month of May 2026, as BUILDING SAFETY MONTH in Jefferson County,and acknowledge the essential service provided to all of us by local, state,tribal, territorial, and federal building safety and fire prevention departments, in protecting lives and property. APPROVED this 11t'day of May,2026. SEAL: JEFFERSON COUNTY BOARD OF COMMISSIONERS Greg Brotherton, Chair ATTEST: Heidi Eisenhour, Member Carolyn Gallaway, CMC, Clerk of the Board Heather Dudley-Nollette, Member JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners FROM: Adiel McKnight,Deputy Clerk of the Board DATE: May 11,2026 SUBJECT: PROCLAMATION re: Proclaiming the Week of May 10-16, 2026 as National Police Week and Observe May 15, 2026 as Peace Officers' Memorial Day STATEMENT OF ISSUE: Leanne Dotson,Jefferson County District Court Clerk and wife of Jefferson County Deputy Sheriff Darrin Dotson has requested approval of the proclamation proclaiming the week of May 10-16, 2026 as National Police Week and observe May 15, 2026 as Peace Officers' Memorial Day. FISCAL IMPACT: There is no fiscal impact. RECOMMENDATION: Approve Proclamation re: Proclaiming the week of May 10-16, 2026 as National Police Week and observe May 15, 2026 as Peace Officers' Memorial Day by lowering the flag to half-staff. REVIEWED BY: et1759E dL Jo . Peters, County Administrator Date PROCLAMATION WHEREAS, The Congress and President of the United States have designated May 15 as Peace Officers' Memorial Day, and the week in which May 15,2026 falls as National Police week; and WHEREAS, the members of our law enforcement agencies play an essential role in safeguarding our rights and freedoms in Jefferson County; and WHEREAS, it is important that all residents know and understand the duties, responsibilities, hazards, and sacrifices of their law enforcement agencies, and that members of our law enforcement agencies recognize their duty to serve the people by safeguarding life and property, by protecting them against violence and disorder, and by protecting the innocent against deception and the weak against oppression; and WHEREAS,the men and women in law enforcement of Jefferson County unceasingly provide a vital public service; NOW, THEREFORE, BE IT RESOLVED THAT we, the Board of County Commissioners, call upon all residents of Jefferson County and upon all patriotic, civic and educational organizations to observe the week of May 10-16, 2026, as National Police Week with appropriate ceremonies and observances in which all of our people may join in commemorating law enforcement officers, past and present, who, by their faithful and loyal devotion to their responsibilities, have rendered a dedicated service to their communities and, in so doing, have established for themselves an enviable and enduring reputation for preserving the rights and security of all residents. We further call upon all residents of Jefferson County to observe May 15, as Peace Officers' Memorial Day in honor of those law enforcement officers who, through their courageous deeds, have made the ultimate sacrifice in service to their community or have become disabled in the performance of duty, and let us recognize and pay respect to the survivors of our fallen heroes. BE IT FURTHER RESOLVED THAT, the courthouse flag be lowered to half-staff in observance of Peace Officers Memorial Day on Thursday, May 15, 2026. APPROVED, this 11th day of May, 2026. SEAL: JEFFERSON COUNTY BOARD OF COMMISSIONERS Greg Brotherton, Chair Heather Dudley-Nollette, Member Carolyn Gallaway, CMC, Heidi Eisenhour, Member Clerk of the Board JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners Josh Peters, County Administrator FROM: Jeremy Williammee, Community Development Director/Fire Marshal Brian Tracer, Deputy Fire Marshal DATE: May 11, 2026 SUBJECT: Moderate Fire Risk Declaration Update STATEMENT OF ISSUE: Under Jefferson County Code (JCC) 8.72.040(1)the County Fire Marshal, in consultation with local fire officials, has the authority to designate fire risk level based on atmospheric and environmental conditions. Any changes to the Fire Danger level shall be reported to the Board at its next regularly scheduled meeting. ANALYSIS: After reviewing fire behavior indicators and atmospheric conditions,the County Fire Marshal and Fire Chiefs have jointly determined that elevating the fire danger level is necessary. This decision is based on information and forecasts provided by the Washington Department of Natural Resources (DNR), Olympic Region Clean Air Agency (ORCAA),National Weather Service (NWS),and other state, federal, and local partner agencies. FISCAL IMPACT/COST-BENEFIT ANALYSIS: There are no direct fiscal impacts associated with this update. Department of Community Development and Office of the Fire Marshal recommend a coordinated communications approach by the County and Fire Districts to educate and inform the public about fire risks and preparations for the wildfire season. RECOMMENDATION: Receive an update and increase public awareness through discussion in this public meeting. REVIEWED BY: Jo•P. Peters, County Administrator Date 1 Department of Community Developmentyr. Office of the Fire Marshal 621 Sheridan St• Port Townsend WA 98368 Phone: 360.379.4450 Web: wwvv.co.jefferson.wa.us For Immediate Release May 5,2026 JEFFERSON COUNTY DECLARES MODERATE (BLUE)FIRE DANGER EFFECTIVE MAY 8 Port Townsend, WA—The Jefferson County Fire Marshal and the Jefferson County Fire Chiefs are responsible for ensuring community safety by reducing fire risks and protecting residents, firefighters, emergency responders, property, and other community assets. Under Jefferson County Code (JCC) 8.72.040, the County automatically enters a MODERATE (Blue)fire danger level each year from July 1 through September 30. Due to current atmospheric and observed field conditions, this designation is being implemented early for the 2026 fire season,with the MODERATE level taking effect on May 8,2026. After reviewing fire behavior indicators and environmental conditions, the County Fire Chiefs and the Jefferson County Fire Marshal have jointly determined that elevating the fire danger level is necessary. This decision is based on information and forecasts provided by the Washington Department of Natural Resources(DNR), Olympic Region Clean Air Agency (ORCAA),National Weather Service (NWS), and other state, federal, and local partner agencies. MODERATE Fire Danger Restrictions and Guidance: The following activities are prohibited: burn barrels, land-clearing or yard-debris burning, and sky lanterns. Recreational fires are allowed in permanent or portable barbecues, outdoor fireplaces, or grills. Portable fire pits, fireplaces, and chimineas are allowed when placed on non-combustible surfaces, or when surrounding combustible material is cleared down to mineral soil for at least 1.5 feet around the device. Only natural wood may be used, and fuel must not extend outside the device. All fires must be constantly attended until fully extinguished. In summary, recreational burning, or"campfires," are allowed during a MODERATE fire danger level, and all barbecue appliances may continue to be used. Large brush, yard-debris, and land-clearing fires remain restricted until a LOW fire danger level is re-established. Duration of Restrictions The MODERATE (Blue) fire danger level will remain in effect until atmospheric and field conditions improve for a sustained period and the risks to residents, property, and emergency responders decrease to acceptable levels. Based on current forecasts, a minimum MODERATE level is expected to remain in place until at least September 30, 2026. Conditions will be monitored continuously, and fire danger levels are likely to be further elevated as the season progresses. For more information,please visit the Jefferson County Department of Community Development/Office of the Fire Marshal website at: www.co.jefferson.wa.us/1687/Office-of-the-Fire-Marshal. Jefferson County Community Development Office of the Fire Marshal w-^- -2 I I>L ri:Lin st • I',rt I,,,,nscnJ \\ \ 08368 www.co.jefferson.wa.us/1687 1360.379.4450 Jefferson County Fire Danger levels and Restrictions Low: Green HIGH Low fire risk, No restrictions. NOOENRTE VfRY NIGX LOW i EXTREMEWhen the fire danger is "low" it means that fuels do not ignite easily from small embers, but a more intense heat 0 Fire Danger:Low source, such as lightning may start fires in duff or dry rotten wood. Fires in open, dry grasslands may burn easily a few hours after a rain, but most wood fires will spread slowly, creeping or smoldering. Control of fires is generally easy. Allowed devices/activities: No restrictions, all lawful activities allowed Please note that ONLY recreational fires are allowed in Urban Growth Areas Urban growth area means land, generally including and associated with an incorporated city, designated by a county for urban growth under RCW 36.70A.030 Moderate: Blue HEN July 1 County Wide Restriction of all Residential Burning MODERATE VERY HIGH i and Land Clearing burning fires or as otherwise directed LOW EIRRfME based on atmospheric and field conditions. 0 Fire Danger:Moderate Prohibited devices/activities: Burn barrels, land clearing or yard debris burning, sky lanterns When the fire danger is "moderate" it means that fires can start from most accidental causes, but the number of fire starts is usually pretty low. If a fire does start in an open, dry grassland, it will burn and spread quickly on windy days. Most wood fires will spread slowly to moderately. Average fire intensity will be moderate except in heavy concentrations of fuel, which may burn hot. Fires are still not likely to become serious and are often easy to control. Page 1 of 3 Jefferson County Community Development 2Offi'ce of the Fire Marshal 6- 1 Ii,ri,kiii 't • I'I ri I,,vv n;enLi \\ \ 08368 www.co.jefferson.wa.us/1687 1360.379.4450 High: Yellow HIGH Prohibited devices/activities: Fireworks, charcoal MODERATE _ VERY NIGH grills, exploding targets, incendiary ammunition, E EIETREME firearm discharge on unimproved county lands, tiki style torches, no open flame devices Fire Danger:High When the fire danger is Thigh", fires can start easily from most causes and small fuels (such as grasses and needles) will ignite readily. Unattended campfires and brush fires are likely to escape. Fires will spread easily, with some areas of high-intensity burning on slopes or concentrated fuels. Fires can become serious and difficult to control unless they are put out while they are still small. No person shall operate or use any device liable to start or cause fire in or upon a "high" fire hazard. Restricted Open Flame Devices. No Wood, Charcoal Cooking Fires (BBQ). Tiki Torches. Liquid Fuel Candles or Lanterns. Gas or Propane Fired Weed Burners. Discharge of Fireworks of Any Type. Discharge of Fire Arms (Open Lands) - Undeveloped Lands of Jefferson County. Only Gas or Propane Fueled Appliances. - Enclosed Flame Only. Example: - UL listed Wood Pellet Fed or Propane Barbeque Grills, Smokers.) Charcoal Grills are allowed at a place of residence only. Very High: Orange a0H Prohibited devices/activities: No open or enclosed MODERATE VERYNIGM flame devices other than UL listed residential propane LOW E.,,IEME or wood pellet grills 0 Fire Danger:Very High When the fire danger is "very high", fires will start easily from most causes. The fires will spread rapidly and have a quick increase in intensity, right after ignition. Small fires can quickly become large fires and exhibit extreme fire intensity, such as long-distance spotting and fire whirls. These fires can be difficult to control and will often become much larger and longer-lasting fires. Page 2 of 3 Jefferson County Community Development405 4 .'1'-.: Office of the Fire Marshal 621 Sheridan St • Port Toww n,cnd1 \\ \ Q8368 www.co.jefferson.wa.us/1687 1360.379.4450 No person shall build, ignite, or maintain any outdoor fire of any kind or character, or for any purpose whatsoever, in a Very High fire hazard area. No Outdoor Burning or Discharge of Fire arms. ONLY Gas or Propane Fueled Appliances. Extreme: Red No Outdoor Fire, Burning, or Discharge of Any kind or MODERATE _ VERY HIGH Type. No allowed devices at this level FULL BAN on LOW E%TREME any fire or burning related activity 0 Fire Danger:Extreme When the fire danger is "extreme", fires of all types start quickly and burn intensely. All fires are potentially serious and can spread very quickly with intense burning. Small fires become big fires much faster than at the "very high" level. Spot fires are probable, with long distance spotting likely. These fires are very difficult to fight and may become very dangerous and often last for several days. Open burning, residential burning or land clearing burning will be prohibited during any period of impaired are quality as designated by ORCAA or the Department of Ecology or during times of high fire danger Questions about devices or activities not listed please contact the Fire Marshal's Office or your local Fire District Page 3 of 3 JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS WORKSHOP AGENDA REQUEST TO: Board of County Commissioners FROM: Danny Milholland,The Production Alliance(TPA)Director Reilly Berkshire, TPA Events Coordinator DATE: May 11,2026 RE: WORKSHOP re: 2026 Connectivity Summit Debrief STATEMENT OF ISSUE: Jefferson County Connectivity Summit, a countywide civic engagement and community- building event involving schools, nonprofits, youth groups, and government organizations. The Production Alliance (TPA)organized the 2026 Connectivity Summit for Jefferson County on March 27, 2026. ANALYSIS: The Connectivity Summit brings together over 100 community organizations. County participation in the Connectivity Summit enables us to: Strengthen communication between county departments and residents Increase youth and community outreach Collect community input on planning,public health, resilience, and county services Increase visibility and transparency of county programs Support interagency collaboration and community education FISCAL IMPACT: There is no fiscal impact. RECOMMENDATION: Engage with TPA in a debriefing of the 2026 Connectivity Summit. REVIEWED BY: L;(-7( -6" Josh . Peters, County Administrator Date JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners FROM: Heather Dudley-Nollette, County Commissioner DATE: May 10, 2026 RE: DISCUSSION of Survey design and frequency STATEMENT OF ISSUE: The Board of County Commissioners (BoCC) and county staff had previously discussed the implementation of a series of short surveys that could be offered to Jefferson County residents as a tool for engaging feedback on a variety of topics. To test the use of a short-survey tool, an initial survey was offered at the Jefferson County information table at the Connectivity Summit event on March 27-29, 2026. The county's Communications Specialist published this initial survey on Jefferson County's Facebook and Instagram pages a few days before the event, and a paper version was also made available at the event on March 28 and 29. On April 6, 2026, the Board of County Commissioners, County Administrator, Central Services Director, and Communications Specialist held a debrief of Connectivity Summit survey results. The discussion also included best practices for survey design and the desire to discuss future survey opportunities. FISCAL IMPACT: If the surveys are conducted using current software, there will be no significant fiscal impact except the use of staff time to design, draft, publish and report the survey results. RECOMMENDATION: Decide whether the BoCC would like to publish a regular community survey. If so, discuss frequency, which survey tool(s) to use, how the surveys should be designed, and how the questions will be selected. REVIEWED BY: 7/?t Jo Peters, County Administrator Date