HomeMy WebLinkAboutState of Washington Department of Health Consolidated Contracts Amendment 16 Page I of 33
JEFFERSON COUNTY PUBLIC HEALTH
2025-2027 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH32053 AMENDMENT NUMBER: 16
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"LH1",
pursuant to the Modifications/Waivers clause, and to make necessary changes within the scope of this contract and any
subsequent amendments thereto.
IT IS MIITUA LLY AGREED: That the contract is hereby amended as follows:
. 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:
baps:/istateofwasharepoint.corn.!sitesidoh-ofslundingresources.isitepages,home.aspx? e I.9a946t41 da2d94d3calt0ac7tbc32e4d7c
® Adds Statements of Work for the following programs:
Office of Resiliency& Health Security-PHEP- Effective July I,2026
® Amends Statements of Work for the following programs:
Infectious Disease Syndemic Prevention Services-SSP-Effective July 1,2026
WIC Nutrition Program - Effective January 1, 2025
❑ Deletes Statements of Work for the following programs:
2. Exhibit B-I6 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-15 Allocations
as follows:
® increase of S118,316 for a revised maximum consideration of$8,327,819.
❑ 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.
AU.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 WASHING ION STATE OF WASHINGTON
BOARD OF C NTY COMMISSIONERS DEPARTMENT OF HEALTH
(6(5' 41.11,6 _44#-Sazzo
10/07/2026
reg Brotherton,Chair D e Date
APPROV S T FORM ONLY: APPROVED AS TO FORM ONLY
0 Assistant Attorney General
09-21-2026
Jeremis�. LuVer, Date
Civil Deputy Prosecuting Attorney
Page i of I
cc 2.-1101-,Aib
EXHIBIT B-16 Page 2 of 33
Jefferson County Public Health ALLOCATIONS Contract Number: CLI132053
Contract Term:2025-2027 Date: August 1,2026
Indirect Rate January 1,2025 through December 31,2025:27.38%Public Health
Indirect Rate January 1,2026 through December 31,2026:32.64%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 Sub'l otal Total
FFY26 Brstfdg Peer Cn Pr Mgmt USDA 7WA700WA1 Amd 15 10.557 333.10.55 10/01/25 09/30/27 10/01/25 09/30/28 $26,770 $26,770 $54,286
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
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 5144,142
FFY26 WIC Client Svs Contracts USDA 7WA700WA7 Amd 16 10.557 333.10.55 10/01/25 09/30/26 10/01/25 09/30/26 $60,778 $199,871 $199,871
FFY26 WIC Client Svs Contracts USDA 7WA700WA7 Amd 15 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 13 10.557 333.10.55 10/01/25 09/30/26 10/01/25 09/30/26 $62,893
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 BEACHACTIAR(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
FFY26 PHEP BP3-CDC-LHJ Partners NU9OTU000055 \nut 16 93.069 333.93.06 07/01/26 06/30/27 07/01/26 06/30/27 S34,384 $34,384 $82,522
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
FFY25 PHEP BP2-CDC-LHJ Partners NU9OTU000055 Amd 7 93.069 333.93.06 07/01/25 06/30/26 07/01/25 06/30/26 $19,527
FFY24 PHEP BP1-CDC-LHJ Partners NU9OTU000055 Amd 1 93.069 333.93.06 01/01/25 06/30/25 07/01/24 06/30/25 $13,754 $13,754
FFY25 OD2A OID Prevent CDC NU17CE010218 Amd 16 93.136 333.93.13 07/01/26 08/31/26 09/01/25 08/31/26 $23,154 $23,154 $271,498
FFY25 OD2A OID Prevent CDC NU17CE010218 Amd 13 93.136 333.93.13 09/01/25 06/30/26 09/01/25 08/31/26 $30,667 $128,667
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
FFY24OD2AOIDCDCPrevent NU17CE010218 Amd 1 93.136 333.93.13 01/01/25 06/30/25 09/01/24 08/31/25 $49,000
Page 1 of 4
EXHIBIT B-16 Page 3 of 33
Jefferson County Public Health ALLOCATIONS Contract Number: CL1132053
Contract Term:2025-2027 Date: August 1,2026
Indirect Rate January 1,2025 through December 31,2025:27.38%Public Health
Indirect Rate January 1,2026 through December 31,2026:32.64%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
FFY26 Title X Fam Plan FPHPA YR5 FPHPA006560 Amd 15 93.217 333.93.21 04/01/26 03/31/27 04/01/26 03/31/27 $25,242 $25,242 $80,280
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
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 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
FFY2I CDC COVID-19 PHWFD-LHJ NU90TP922181 Amd 3 93.354 333.93.35 01/01/25 06/30/25 07/01/23 06/30/25 $51,330 $51,330 $51,330
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 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 Contracts HRSA YR1 B04MC55473 Amd 14 93.994 333.93.99 10/01/25 09/30/26 10/01/25 09/30/26 $12,233 $28,736 $28,736
FFY26 MCHBG LHJ Contracts HRSA YR1 B04MC55473 Amd 13 93.994 333.93.99 10/01/25 09/30/26 10/01/25 09/30/26 $7,646
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
SFY27 Sch Based Hlth Cent 1225 Proviso Amd 15 N/A 334.04.90 07/01/26 06/30/27 07/01/26 06/30/27 $140,000 $140,000 $280,000
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
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
SFY27 Drug User Health Program Amd 15 N/A 334.04.91 07/01/26 06/30/27 07/01/26 06/30/27 $80,500 $80,500 $201,250
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
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
Page 2 of 4
EXHIBIT B-16 Page 4 of 33
Jefferson County Public Health ALLOCATIONS Contract Number: CL1132053
Contract Term:2025-2027 Date: August 1,2026
Indirect Rate January 1,2025 through December 31,2025:27.38%Public Health
Indirect Rate January 1,2026 through December 31,2026:32.64%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 Sub'fotal Total
SFY27 Sexual&Rep Hlth Cost Share Amd 15 N/A 334.04.91 07/01/26 06/30/27 07/01/26 06/30/27 $38,074 $38,074 $175,135
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
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 15 N/A 334.04.93 07/01/25 06/30/27 07/01/25 06/30/27 $9,000 $16,500 $20,200
Rec Shellfish/Biotoxin Amd 6,15 N/A 334.04.93 07/01/25 06/30/27 07/01/25 06/30/27 $7,500
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
SFY27 FPHS-LHJ Funds-GFS Amd 15 N/A 336.04.25 07/01/26 06/30/27 07/01/26 06/30/27 $1,572,000 $1,572,000 $6,033,000
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
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
Page 3 of4
EXHIBIT B-16 Page 5 of 33
Jefferson County Public Health ALLOCATIONS Contract Number: C1.1132053
Contract Term:2025-2027 Date: August 1,2026
Indirect Rate January 1,2025 through December 31,2025:27.38%Public Health
Indirect Rate January 1,2026 through December 31,2026:32.64%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
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 $8,327,819 $8,327,819
Total consideration: $8,209,503 GRAND TOTAL $8,327,819
$118,316
GRAND TOTAL $8,327,819 Total Fed $1,352,110
Total State $6,975,709
*Assistance Listing Number fka Catalog of Federal Domestic Assistance
**Federal revenue codes begin with"333". State revenue codes begin with"334".
Page 4 of 4
Page 6 of 33
Exhibit A
Statement of Work
Contract Term: 2025-2027
DOH Program Name or Title: Infectious Disease Syndemic Prevention Services- Local Health Jurisdiction Name: Jefferson County Public Health
SSP-Effective July 1,2026
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 1,2026 through June 30,2027 ® State ❑ FFATA(Transparency Act) ❑ Fixed Price
❑ Other ❑ Research& Development
Statement of Work Purpose: The purpose of this statement of work(SOW)is to provide 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: To add$23,154 in FFY25 OD2A OID PREVENT CDC funds for the time period of 7/1/26-8/31/26 and update the task table;to update Section 14 of the
Program Specific Requirements.
Master Assistance BARS Allocation
LHJ Funding Period Change Index Listing Revenue Current g Total
DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation Increase(+) Allocation
SFY27 DRUG USER HEALTH PROGRAM 12405170 N/A 334.04.91 07/01/26 06/30/27 80,500 0 80,500
FFY25 OD2A OID PREVENT CDC 12405252 93.136 333.93.13 07/01/26 08/31/26 0 23,154 23,154
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 80,500 23,154 103,654
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 Reimbursement of
services and tracking: the DOH/OID issued actual costs incurred,
Provide comprehensive Syringe Services Programs(SSP)to • number of sterile syringes distributed database for tracking SSP not to exceed $80,500.
people who use drugs(PWUD). This plan of action is • number of naloxone kits distributed activities by the 15th of
directed to distribute syringes to communities that use drugs • number of participant encounters each month following
to prevent transmission of infectious disease. SSPs will • number of referrals to health and social service. SFY27 DRUG USER
operate during scheduled hours to provide all required harm services HEALTH PROGRAM
reduction supplies,naloxone,and syringes to prevent MI /2405170
transmission of disease and overdose. SSPs will offer Submit Performance Objectives and Work Submit Performance $80,500
referrals to address social determinants of health. Plan that will include: Objectives and Work Plan for 7/1/26-6/30/27
• Outcomes aligned with program by September 1, 2026.
strategies and activities.
Exhibit A, Statement of Work Page 1 of 10 Contract Number CLH32053-Amendment 16
Page 7 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
# and/or Amount
Priority populations for Syringe Services Programs include • SMART objectives aligned with
people who use drugs,with a focus on: performance targets
• People systemically marginalized and underserved • Activities aligned with program
due to racism—Black/African American, outcomes
Latino/Latina/Latine/Latinx,American • Timeline for implementation(including
Indian/Alaska Native people and other communities staffmg of the proposed program,
for whom there are documented health disparities in training,etc.)
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 services and
Provide direct access to clinical services to improve the tracking:
health and well-being of people who use drugs.At • Number of wound care sessions
minimum,services must include onsite, low-barrier access to • Number of infectious disease tests
wound care, infectious disease testing, STI and hepatitis C conducted(hepatitis C,HIV,gonorrhea-
treatment,and medications for opioid use disorder. chlamydia,syphilis)
Additional services can include mental health services, • %positive of infectious disease tests
sexual and reproductive health care,and other primary care (hepatitis C,HIV,gonorrhea-chlamydia,
and psychosocial support services. syphilis)
• Number of participants started on
NOTE: See Special Requirements,Terms and Conditions hepatitis C treatment
—Section 6 Syringe Services Program,Clinical Services • Number of participants inducted on
Requirements for additional task information. medications for opioid use disorder
2 Syringe Services Programs:Harm Reduction Service Harm reduction care navigation outcomes Enter deliverable data into Reimbursement of actual
Navigation include delivering services and tracking: the DOH/OID issued costs incurred, not to
• number of participants enrolled in care database for tracking SSP exceed$23,154.
Provide appropriate referrals to SSP participants;facilitate navigation services activities by the 15th of
access to receive health care and medical services, social • number of care navigation sessions each month following FFY25 OD2A OID
services, behavioral health counseling and other services • number of referrals to health and social service. PREVENT CDC
including substance use treatment(including medications for services MI 12405252
opiate use disorder, or MOUD);housing; and advocacy, $23,154
including but not limited to criminal legal involvement, for 7/1/26-8/31/26
Exhibit A, Statement of Work Page 2 of 10 Contract Number CLH32053-Amendment 16
Page 8 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
# and/or Amount
medical providers, benefits navigation, and family • number of linkages to care for health
reunification. and social services
number of outreach attempts per participant
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
work completed using OD2A-S funds. Evaluation activities answers to qualitative questions(as it applies the DOH/OID issued
will involve: to your OD2A-S activities) on a DOH- template on the following
• As applicable, collecting data on CDC performance provided template dates:
measures to support DOH evaluation plan. • For reporting period
o Total number of harm reduction service 6/1/26-8/31/26
encounters(e.g., in person, mail, September 1, 2026
telephone, online)
o Zip code where harm reduction services
were provided(list "unknown"when
location is unknown)
o Total number of navigators located in a
harm reduction setting or other setting
o Number of referrals to harm reduction
services for each race ethnicity
o if possible, total number of hours spent by
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
o Number of referrals to behavioral health
treatment only(without MOUD)for each
race/ethnicity
Exhibit A, Statement of Work Page 3 of 10 Contract Number CLH32053-Amendment 16
Page 9 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
# and/or Amount
o Number of other referrals, if not to MOUD
and behavioral health, with a description
of the type of referral
• Providing answers to contextual performance
measures questions.
o How has access to care or treatment has
been improved, and what new/existing
community assets were leveraged?
o What are the barriers for people accessing
harm reduction services in your
jurisdiction?
o What are barriers to accessing or
receiving nalozone?
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
fmance-related inquiry,may be sent to finance@doh.wa.gov.
Program Specific Requirements
Special Requirements,Terms and Conditions
1. Definitions
a. ANONYMOUS SERVICES-HIV Prevention services including condom distribution,outreach and light touch.
b. CAPACITY BUILDING-The process by which individuals and organizations obtain,improve,and retain the skills,knowledge,tools, equipment, and
other resources needed to do their jobs competently.
c. CONTRACTOR—For the purposes of this Statement of Work Only,the entity receiving funds directly from Washington State Department of Health
(DOH)for client services to prevent or treat conditions named in the statement of work will be referred to as contractor.
d. HARM REDUCTION-Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.
e. INTEGRATED TESTING-For the purpose of this Statement of Work, Integrated Testing includes Human Immunodeficiency Virus(HIV),Gonorrhea
(GC),Chlamydia(CT),Syphilis,Hepatitis C(HCV)and Hepatitis B(HBV).
f. SOCIAL DETERMINANTS OF HEALTH-Social determinants of health(SDOH)are the conditions in the environments where people are born, live,
learn,work,play,worship,and age that affect a wide range of health,functioning,and quality-of-life outcomes and risks.
g. YOUTH-For purposes of this agreement,the term"youth"applies to persons under the age of 18.
Exhibit A, Statement of Work Page 4 of 10 Contract Number CLH32053-Amendment 16
Page 10 of 33
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 fmal claims for payment for costs due and payable under this statement of work by July 31,2027. DOH will pay belated
claims at its discretion,contingent upon the availability of funds.
c. The CONTRACTOR will be placed on a three-month Corrective Action Plan(CAP)if invoice submissions are past due by 90 days.
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 staffmg plan
referencing positions described in the budget narrative.
b. The CONTRACTOR must provide job descriptions for any new or changed positions in the updated organizational chart.
i. Any new positions funded through the original contract funds,must have prior DOH approval.
c. The CONTRACTOR must notify their DOH contract manager within 30 days of any staff vacancies related to contracted positions and provide an updated
budget.
i. Any new fiscal staff responsible for invoicing on this contract will need to meet with the assigned OID Contract Manager within 60 days for DOH
invoice overview and training.
4. Syringe Services Program:Support for Operations Program Requirements
a. Operate for a minimum of 8 hours per week and 2 days per week.
b. Provide mobile and/or street outreach(note:programs must have a vehicle for mobile outreach.)
c. Offer safer injection supplies(see list of required safer injection supplies below).
d. Submit monthly SSP data in accordance with DOH standards.
e. Attend required capacity building/training opportunities provided by DOH.
f. Participate in annual site visits with DOH staff.
g. Demonstrate structure for receiving and incorporating participant feedback about services.
h. Partner with relevant local agencies to ensure effective outreach and service provision.(See Scope of Work narrative below for details on MOUs required.)
i. Develop and maintain a Universal Precautions and Sharps Handling policy and procedure, including clear,written policies on handling biohazardous waste,
avoiding unnecessary handling of sharps,and potential needle stick injuries to staff,volunteers,and participants.Programs should follow the universal precaution
guidelines established by the CDC and OSHA. SSPs may need to adapt those precautions to accommodate the circumstances of their work(e.g.,mobile and
outreach settings).Programs should also anticipate the potential of needlestick injury and have a"post-exposure-prophylaxis"protocol included in this document.
j. All staff and volunteers working directly with participants/clients must complete CPR certification within the first 3 months after contract start date(if not
already complete).
5. Syringe Services Program,Harm Reduction Care Navigation Requirements
a. Includes all requirements for Syringe Service Program operations(see above)
b. Attend Harm Reduction Care Navigation training provided by DOH.
c. Support participant transportation(e.g.,through the provision of bus passes,cab vouchers,or direct transportation).
d. Accompany participants to appointments or provide"warm hand-offs."
e. Full-time care navigators(1.0 FTE)shall not exceed a case load greater than 25 individuals.
f. Submit monthly outcome data in accordance with DOH standards.
Exhibit A, Statement of Work Page 5 of 10 Contract Number CLH32053-Amendment 16
Page 11 of 33
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:
i. Contract Year 3 Detailed Work Plan(For each funded service category)
ii. Program strategies and activities
iii. Outcomes aligned with program strategies and activities
iv. SMART objectives aligned with performance targets
v. Activities aligned with program outcomes
vi. Timeline for implementation(including staffmg of the proposed program,training,etc.)
vii. Anticipated capacity building or technical assistance needs.
c. Performance Objectives and Work Plans should be submitted by September 1,2026.
d. OID staff are available to support in developing Performance Objectives&Work Plans in collaboration with funded agencies.
e. Performance Objectives and Work Plans will be reviewed between OID staff and funded agencies at least quarterly.Performance Objectives&Work Plans can
be adjusted throughout the period of performance.
8. Participation in program evaluation activities—The Contractor is expected to participate in program evaluation activities,including evaluation planning, and collecting
and reporting qualitative and quantitative program data,as deemed necessary by OID staff.
Exhibit A, Statement of Work Page 6 of 10 Contract Number CLH32053-Amendment 16
Page 12 of 33
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. 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.
11. 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.
12. 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)
13. Participation in Program Monitoring Activities—
a. DOH will conduct semi-annual or annual performance site visits in the following areas:
i. Integrated testing
ii. Syndemic service navigation
iii. PrEP Housing
iv. Syringe Service Programs
v. Mail-order naloxone distribution program
vi. Fiscal Monitoring—To be scheduled by the DOH Fiscal Monitoring Unit
b. Corrective Action Plans—DOH may exercise the following options if the CONTRACTOR does not come into compliance or resolution with programmatic
and/or fiscal monitoring corrective action plan by the due date(s)identified in the CAP.i. §200.339 Remedies for noncompliance.
If a non-Federal entity fails to comply with the U.S.Constitution,Federal statutes,regulations or the terms and conditions of a Federal award,the Federal
awarding agency or pass-through entity may impose additional conditions, as described in§200.208.If the Federal awarding agency or pass-through entity
determines that noncompliance cannot be remedied by imposing additional conditions,the Federal awarding agency or pass-through entity may take one or more
of the following actions,as appropriate in the circumstances:
(a)Temporarily withhold cash payments pending correction of the deficiency by the non-Federal entity or more severe enforcement action by the Federal
awarding agency or pass-through entity.
(b)Disallow(that is,deny both use of funds and any applicable matching credit for)all or part of the cost of the activity or action not in compliance.
(c)Wholly or partly suspend or terminate the Federal award.
(d)Initiate suspension or debarment proceedings as authorized under 2 CFR part 180 and Federal awarding agency regulations(or in the case of a pass-through
entity,recommend such a proceeding be initiated by a Federal awarding agency).
(e)Withhold further Federal awards for the project or program.
(f)Take other remedies that may be legally available
Exhibit A, Statement of Work Page 7 of 10 Contract Number CLH32053-Amendment 16
Page 13 of 33
14. 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. Federal certification, assurances, and rules included with or referenced in this contract are only applicable to the federal funds and/or Rebate dollars
included herein or added via an amendment to this contract.
v. 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.
vi. 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.
vii. Travel—Out of staff travel requires prior approval from DOH and must follow GSA guidelines and reimbursement rates.
viii. Supervision,under DOH Community Programs contracts,will be understood as the delivery of a set of interrelated functions encompassing
administrative,educational and supportive roles that work collectively to ensure clinical staff(i.e.case managers,navigators,coordinators,assistants,
coaches)are equipped with the skills necessary to deliver competent and ethical services to clients that adhere to best practices within applicable fields
as well as all relevant Statewide Standards. Supervisors must meet the criteria set forth within the WA State HIV Case Management Standards and
provide the level of interaction and review detailed in that document.
It is the understanding of DOH that Supervision funded under the direct program portion of this contract include at minimum the provision of at least
two of the three functions detailed here:administrative,educational or supportive supervision. Supervision that encompasses only administrative
functions will not be considered billable under Direct Program.To that end, it is the expectation of DOH that those personnel identified as Supervisors
have no more than one degree of separation from direct client care.Exceptions to this rule can be presented and considered to and by DOH Contract
Management. It will fall to the requesting organization to satisfactorily demonstrate that any Supervisory positions falling within the scope of Direct
Program are meeting the expectation of provision of educational or supportive supervision with the aim of directly impacting client experiences,quality
of services,and adherence to best practices and Statewide Standards.
ix. Small and Attractive items—Each Contractor shall perform a risk assessment(both financial and operational)on the agency's assets to identify those
assets that are particularly at risk or vulnerable to loss.Operational risks include risks associated with data security on mobile or portable computing
devices that store or have access to state data. Assets so identified that fall below the state's capitalization policy are considered small and attractive
assets.The Contractor shall develop written internal policies for managing small and attractive assets. Internal policies should take into consideration
the 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.
Exhibit A, Statement of Work Page 8 of 10 Contract Number CLH32053-Amendment 16
Page 14 of 33
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 Rangefmders
2. Cameras and Photographic Projection Equipment
3. Desktop Computers(PCs)
4. Television Sets,DVD Players, Blu-ray Players,and Video Cameras(home type)
x. Food and Refreshments—Food and refreshments are not allowable direct costs, unless provided in conjunction with allowable meetings,whose
primary purpose is the dissemination of technical information. Pre-approval is required when food and refreshments are purchased for these meetings.
A sign-in sheet with the clients' ID number from the DOH approved data system as well as an agenda is required to receive reimbursement for these
charges.
1. The CONTRACTOR shall follow 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
xi. Reimbursement of disallowed costs—The CONTRACTOR agrees to reimburse DOH for expenditures billed to the DOH for costs that are later
determined through audit or monitoring to be disallowed under the requirements of 2 CFR Part 200—Uniform Administrative Requirements,Cost
Principles,and Audit Requirements for Federal Audits.
b. Contract Modifications
i. Notice of Change in Services—The CONTRACTOR shall notify DOH program staff,within 45 days,if any situations arise that may impede
implementation of the services contained in the statement of work.DOH and the CONTRACTOR will agree to strategies for resolving any shortfalls.
DOH retains the right to withhold funds in the event of substantial noncompliance.
ii. Contract Amendments—Effective Date—The CONTRACTOR shall not begin providing services authorized by a contract amendment until the
CONTRACTOR has received a signed and fully executed copy of the contract amendment from DOH.
1. Local Health Jurisdiction(LHJ)Contractors—Request for contract amendments must be received no less than 60 days prior to the Draft Due
Date identified by the CON CON SOW Schedule on the CON CON Dashboard.
2. Non-LHJ Contractors—Request for contract amendments must be received no later than 60 days prior to the end of the Federal Fiscal Year
(FFY)and 90 days prior to end of the State Fiscal Year(SFY).
a) Amendments must be signed prior to the end of the FFY or SFY end date.
EX.FFY end date is 12/31,contract amendment request due to contract manager by 1 1/1
15. 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
Exhibit A, Statement of Work Page 9 of 10 Contract Number CLH32053-Amendment 16
Page 15 of 33
Olympia, WA 98504-7841
Phone: 360-810-1880
Email: Michael.Barnes@doh.wa.gov
16. 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.
17. 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.
18. Allowable Costs
All expenditures incurred and reimbursements made for performance under this statement of work shall be based on actual allowable costs. Costs can include direct labor,
direct material,and other direct costs specific to the performance of activities or achievement of deliverables under this statement of work.
For information in determining allowable costs,please reference OMB Circulars:
2 CFR200(State,Local and Indian Tribal governments)at: https://www.federalregister.gov/documents/2013/12/26/2013-30465/uniform-administrative-
requirements-cost-principles-and-audit-requirements-fo r-federal-awards.
**Disclosure of information is governed by the Washington Administrative Code(WAC)246-101-120, 520 and 635,and the Revised Code of Washington(RCW)
70.24.080,70.24.084,and 70.24.105 regarding the exchange of medical information among health care providers related to HIV/AIDS or STI diagnosis and treatment.
Please note that CONTRACTORs fit under the defmition of"health care providers"and"individuals with knowledge of a person with a reportable disease or condition"
in the WAC and RCW.
DOH statutory authority to have access to the confidential information or limited Dataset(s)identified in this agreement to the Information Recipient: RCW 43.70.050
Information Recipient's statutory authority to receive the confidential information or limited Dataset(s)identified in this Agreement:RCW 70.02.220(7)
Exhibit A, Statement of Work Page 10 of 10 Contract Number CLH32053-Amendment 16
Page 16 of 33
Exhibit A
Statement of Work
Contract Term: 2025-2027
DOH Program Name or Title: Office of Resiliency&Health Security-PHEP- Local Health Jurisdiction Name: Jefferson County Public Health
Effective July 1,2026
Contract Number: CLH32053
SOW Type: Original Revision#(for this SOW) Funding Source Federal Compliance Type of Payment
® Federal Subrecipient (check if applicable) ® Reimbursement
Period of Performance: July 1,2026 through June 30,2027 ❑ State ® FFATA(Transparency Act) Li Fixed Price
❑ Other ❑ Research&Development
Statement of Work Purpose: The purpose of this statement of work is to establish funding and tasks for LHJs to strengthen their capacity and capability around the Public
Health Response Readiness Framework(CDC)to prepare for,respond to,and recover from public health threats and emergencies through a continuous cycle of planning,
organizing,training,equipping,exercising,evaluating,and implementing corrective actions as described in the Public Health Emergency Preparedness(PHEP)Cooperative
Agreement.
Revision Purpose: NA
Master Assistance BARS Allocation
LHJ Funding Period Change Index Listing Revenue Current g Total
DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation Increase(+) Allocation
FFY26 PHEP BP3 -CDC-LHJ PARTNERS 31602264 93.069 333.93.06 07/01/26 06/30/27 0 34,384 34,384
0 _ 0 0
- 0 0 0
0 0 0
0 _ 0 0
0 0 0
TOTALS 0 34,384 34,384
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
# and/or Amount
1 Maintain accurate and up-to-date contact information. This includes Submit information by September 1,2026 Reimbursement for actual
names,position titles,email addresses,and phone numbers of key LHJ September 1,2026,and any Within 30 days of the costs not to exceed total
staff responsible for this statement of work, including primary LHJ PHEP changes within 30 days of the change. funding allocation
statement of work program contact,management(PHEP contact person's change. amount.
supervisor),and accounting or financial primary contact.
Mid-and end-of-year reports on December 31,2026
template provided by DOH. June 30,2027
Note any changes or no
changes.
Exhibit A, Statement of Work Page 1 of 11 Contract Number CLH32053-Amendment 16
Page 17 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
# and/or Amount
2 Develop a budget based on LHJ plans to invest the PHEP BP3 funds Budget,on template provided September 1,2026
July 1,2026—June 30,2027.This budget may serve as your request for by DOH.
preapproval for out-of-state travel,contracting, or anything else requiring
preapproval from DOH that is included in the budget. (See Preapproval Budget will be reviewed and When preapproval is
information below.) approved by DOH. needed for a change.
• Submit revised budget and request preapproval from DOH if you
want to move more than 10%of your total PHEP allocation from
one category to another(for example from staff to travel).
• Submit revised budget and request preapproval from DOH if you
want to contract or purchase equipment with PHEP funds. See
also Preapproval information and definition of"equipment"
below.
Develop a budget based on LHJ plans to invest the PHEP BP4 funds March 31,2027
July 1,2027—June 30,2028
3 As requested, submit additional information to DOH to comply with Information requested by DOH. Upon request from DOH.
federal grant requirements and/or DOH requirements.
4 Submit LHJ Performance Measure Data as requested on the form provided LHJ Performance Measure June 30,2027
by DOH. Data on the form provided by
DOH.
5 Jurisdictional Risk Assessment
Implementing the preparedness cycle in any organization or jurisdiction is dependent on information about jurisdictional hazards. DOH is
providing every local health jurisdiction with access to the Health and Hazards Risk Decision Support(H2azaRDS)tool that was developed
by the University of Washington.This Jurisdictional Risk Assessment(JRA)identifies,analyzes,and prioritizes potential public health and
medical threats and hazards within the jurisdiction.
5.1 Participate in the public health disaster risk assessment tool/report Participation in training. December 31,2026
(H2azaRDs tool)training,unless you participated in the training during
BP2. Mid-year reports on template
provided by DOH(note
This training will provide a foundational understanding of the tool and the participation in training).
rollout of it.
Notes:
• LHJs will be notified at least 30 days in advance of the training
date.
• If you participated in the H2azaRDs tool)training during BP2,
July 2025—June 2026, note that in your mid-report.
Exhibit A, Statement of Work Page 2 of 11 Contract Number CLH32053-Amendment 16
Page 18 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
• The pilot group training and completing the tool counts for this
training requirement.
5.2 Complete the H2azaRDS Tool,unless you have completed the tool Mid-year report.Note that you December 31,2026.
previously(see below). have completed or reviewed
and updated the tool.
If you completed the H2azaRDs tool previously,review and update it so
you have updated information for your participation in the Integrated
Preparedness Planning Workshop in early 2027. See Task#9.
You may opt to complete the H2azaRDS tool more than once.
6 Training
Maintaining baseline training competency is essential for a coordinated and effective public health emergency response.Ensuring staff
complete the appropriate Incident Command System(ICS)training enables them to operate within standardized response structures and
communicate effectively during emergencies.Requiring sub-awardees to verify completion through a DOH-approved training plan
promotes accountability and consistency across jurisdictions.
6.1 Ensure baseline National Incident Management System (NIMS)compliant Mid-and end-of-year reports on December 31,2026
training competency is maintained as determined by the LHJ. templates provided by DOH, June 30,2027
including titles,dates,and
PHEP funding may be used to support additional public health emergency sponsor of trainings.
response trainings identified by the LHJ.
7 Exercising
Both state and local health departments follow the Homeland Security Exercise and Evaluation Program(HSEEP)principles.Assessing the
effectiveness of our emergency response plans and the training of those who might respond to the public health impacts of disasters, is a
core component of the preparedness cycle. The act of exercising combined with the learning as demonstrated by an After-Action Report
(AAR)drives future planning and training. It is DOH's responsibility to meet the exercise requirements under our CDC PHEP Cooperative
Agreement. DOH uses the Multi-Year Preparedness Activities Calendar(MYPAC)to demonstrate that sub-recipients of the PREP funding
are participating in,or leading exercises.Local Jurisdictions and Tribes may use PHEP funding for any exercise that furthers their
preparedness.
7.1 Complete the WA DOH Exercise Notification Form 30 days prior to Exercise Notification Form As soon as the LHJ is
conducting any exercise. aware of the exercise date
and details.
7.2 Conduct,or participate in,at least one operational-based exercise using Submit a Completed After- For AARs that the LHJ are
Homeland Security Exercise and Evaluation Program(HSEEP)by Action Report/Improvement responsible for,90 days
June 30,2027. Plan(AAR/IP) after exercise completion.
For others,when the AAR
LHJs should coordinate preparedness exercises with local partners, is publicly available.
including Tribes,emergency management,healthcare facilities,and first
responder agencies. Participation in exercises hosted by other
Exhibit A, Statement of Work Page 3 of 11 Contract Number CLH32053-Amendment 16
Page 19 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
organizations within the jurisdiction or geographic region is strongly
encouraged to support regional coordination and strengthen multi-agency
response capabilities.
Note:A real-world response does not meet the requirement of this task.
7.3 Attend at least one of the Exercise Community of Practice quarterly Mid-and end-of-year reports on December 31,2026
meetings throughout the performance period. template provided by DOH. June 30,2027
8 Public Health Emergency Response Planning
A core component of every public health preparedness and response program is maintaining an up-to-date and complete emergency
response plan that describes how the jurisdiction will respond to the public health impacts of the most likely threats faced by the
jurisdiction.
8.1 Annually review, update or develop sections of the LHJ's own Emergency Describe progress to date on December 31,2026
Response Plan(s)addressing: mid-and end-of-year report June 30,2027
• Gaps and needs identified in an After-Action templates provided by DOH.
Report/Improvement Plan(AAR/IP), from an exercise or a real-
world response.
• Align with the National Incident Management System standards.
Coordinate with community-based organizations,healthcare,and local
emergency response agencies,as appropriate.
8.2 Participate in plan review opportunities(i.e.listening sessions/seminars or Mid-and end-of-year reports on December 31,2026
provide written feedback)associated with the review and update of DOH template provided by DOH. June 30,2027
plans.
Document which plan review
opportunity you participated in.
9 Integrated Preparedness Planning
Washington values the strengths of a decentralized public health system while recognizing that PHEP resources are limited.The Integrated
Preparedness Planning(IPP)process is intended to promote inter jurisdictional efficiency by aligning planning,training,and exercise
efforts across the many public health jurisdictions in the state.
9.1 Complete the Baseline Emergency Assessment of Capabilities,Outcomes BEACON Survey Response on Submit the BEACON
and Needs(BEACON)Survey. form provided by DOH. Survey Response 30 days
prior to the IPPW.
The BEACON survey is a part of the DOH Integrated Preparedness
Planning Workshop(IPPW)which will be centered on identifying
priorities and collaboration opportunities in public health response
readiness activities from 2026 to 2030.
Exhibit A,Statement of Work Page 4 of 11 Contract Number CLH32053-Amendment 16
Page 20 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
# and/or Amount
9.2 Participate in both days of the DOH Integrated Preparedness Planning Participation in IPPW(DOH DOH will provide IPPW
Workshop(IPPW),with at least one representative from your LHJ will be looking at sign in dates and location.
(virtually or in person). documents).
End-of-year report on template June 30,2027
provided by DOH.
10 Emergency Information Sharing
Effective emergency communication and notification are critical for ensuring a timely,coordinated response to public health incidents.
Immediate notification and accurate situation reporting enable rapid decision-making,resource deployment,and situational awareness at
the state,tribal,and local levels.Maintaining reliable communication systems and conducting regular drills help verify readiness,
strengthen coordination,and ensure that response protocols function as intended during real-world emergencies.
10.1 For any incident that involves the implementation of emergency response Mid-and end-of-year reports on December 31,2026
plans and/or the activation of an incident command structure,notify the template provided by DOH. June 30,2027
Washington State Department of Health(DOH)Duty Officer at
360-888-0838 or via email at hanalert@doh.wa.gov.
10.2 Situation Reporting:Develop situation reports(sitreps)documenting Situation Reports Situation Reports are due
jurisdictional activities during all response incidents that extend beyond during time of emergency
two operational periods and require a written Incident Action Plan. to the DOH Duty Officer.
Situation reports may be prepared directly by the LI-U or by another
jurisdiction,provided they include input from the LHJ to ensure accuracy
and completeness.
Submit Situation Reports to DOH Duty Office(hanalert@doh.wa.gov)
during LHJ response as soon as they are available.
10.3 Maintain and verify that at least one leader identified in the Yellow Book Mid-and end-of-year reports on December 31,2026
is enrolled in and capable of receiving alerts through the Washington template provided by DOH. June 30,2027
Secure Electronic Communications,Urgent Response,and Exchange
System(WASECURES),the primary platform used by DOH to distribute
Health Alert Network(HAN)notifications.
Notes:
• Registered users must log in(or respond to an alert)quarterly at a
minimum.
• DOH will provide technical assistance to LHJs on using
WASECURES.
• LHJ may choose to use another notification system in addition to
WASECURES to alert staff during incidents.
Exhibit A,Statement of Work Page 5 of 11 Contract Number CLH32053-Amendment 16
Page 21 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
# and/or Amount
10.4 Participate in DOH-led notification drills. Mid-and end-of-year reports on December 31,2026
template provided by DOH. June 30,2027
10.5 Conduct at least one LHJ-led drill using the jurisdictions's preferred staff Submit results of the drill on December 31,2026
notification system to ensure operational effectiveness. the mid-OR end-of-year report OR
on template provided by DOH. June 30,2027
11 Volunteer Management
Effective volunteer management is essential for ensuring timely access skilled personnel during public health emergencies,enabling local
health jurisdictions to respond quickly and maintain continuity of operations under surge conditions. While LHJs are not expected to
sustain this capability independently,they must have plans in place to access and coordinate resources through local,mutual aid,and state
systems when needed.
11.1 Identify a main point of contact who will coordinate with public health Mid-and end-of-year reports December 31,2026
volunteer registries and help with volunteer screening,credential checks, on template provided by June 30,2027
and response readiness. DOH,including identified
volunteer management point
If a Medical Reserve Corps(MRC)is housed within the LHJ,confirm of contact.
who the official point of contact is.
Updated volunteer management As changes occur.
Refer to the Administration for Strategic Preparedness and Response point of contact,as needed.
(ASPR)Guide to Medical Reserve Corps Unit Leader Transitions for
more information.
12 Public Health Information and Warning
Effectively communicating with the public about health risks during emergencies is essential for reducing morbidity and mortality. When
people understand the nature of a threat and what actions they can take to stay safe,they are better equipped to protect themselves and
others.Timely,clear,and culturally appropriate messaging helps minimize confusion,supports informed decision-making,and ultimately
saves lives during public health emergencies.
12.1 If communication strategies were exercised in Budget Period(BP)2, Mid-and end-of-year reports on December 31,2026
incorporate lessons learned into planning and training. template provided by DOH. June 30,2027
If communication strategies were not exercised in BP2,include them in an
exercise.
The goal is to strengthen the LHJ's ability to manage and share accurate
information during emergencies,particularly with populations affected by
the LHJ's top public health hazards.
Note:A real-world response does not meet the requirement of this task.
Exhibit A, Statement of Work Page 6 of 11 Contract Number CLH32053-Amendment 16
Page 22 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
13 Healthcare Coalition Partnerships
Collaboration between local PREP recipients and healthcare coalitions is essential to align public health and healthcare system
preparedness capabilities,enhance interoperable response plans,and ensure efficient allocation of critical resources during emergencies.
13.1 Participate in the Northwest Healthcare Response Network(NWHRN) Mid-and end-of-year reports on December 31,2026
monthly or the Healthcare Alliance(HCA)bi-monthly meetings,at least template provided by DOH. June 30,2027
once during each contract reporting period.
The contract reporting periods are July 1—December 31,2026,and
January 1 —June 30,2027.
13.2 Participate in the following additional activities with the Northwest Mid-and end-of-year reports on December 31,2026
Healthcare Response Network(NWHRN)or the Healthcare Alliance template provided by DOH. June 30,2027
(HCA):
• Communications
• Planning
• Training,and/or exercises.
14 Coordination with Tribes
Tribes bring valuable cultural knowledge,governance structures,and community networks,essential for effective preparedness,response,
and recovery.Partnering with tribes enhances trust,optimizes resource use,and ensures equitable support during crises.
14.1 Seek to engage and coordinate with local tribes on preparedness activities, Mid-and end-of-year reports on December 31,2026
if you have federally recognized tribes within your LHJ. template provided by DOH. June 30,2027
Note:The jurisdictional risk assessment might be an opportunity to work
with tribes(Task#5).
15 Administrative Preparedness Plans/Procedures
Administrative preparedness is essential for LHJs to effectively fulfill their obligation to respond to public health emergencies in their
jurisdiction.Having established administrative procedures that allow your organization to implement appropriate flexibility during declared
emergencies—even in the absence of a formal plan—helps ensure rapid access to resources,contracts,staffing,and operational support
during public health emergencies.
15.1 Using the review conducted in Budget Period 2,document and validate Mid-and end-of-year reports on December 31,2026
local administrative preparedness processes that support rapid public template provided by DOH. June 30,2027
health emergency response.This can reference existing plans or policies
(such as COOP,All Hazards plans,fiscal,or procurement policies)rather Plan and/or procedures
than creating a new document.Validation may include reviewing existing available upon request
procedures with relevant staff,confirming roles and responsibilities,or
referencing where these processes are captured in current plans or policies.
LHJ should work with and support administrative leadership,finance staff,
and relevant program staff to help ensure there is shared awareness of
Exhibit A,Statement of Work Page 7 of 11 Contract Number CLH32053-Amendment 16
Page 23 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
emergency administrative procedures and how they may be implemented
during a response.
Activities may include:
• Document or update procedures that describe the conditions
under which expedited administrative processes can be activated.
• Confirm and document staff authorized to initiate and implement
emergency administrative processes and procedures.
• Identify and document processes for securing emergency funding
from local,state,or federal sources during a public health
emergency.
• Document accelerated procedures for procuring resources,
including supplies,contracts,and additional staffing(temporary
or permanent).
• Document criteria and processes for deactivating emergency
administrative procedures and transitioning back to normal
operations.
• Share or review these procedures with relevant LHJ leadership,
finance staff,and emergency response leadership to ensure
awareness and understanding.
16 Build Highly Qualified PHEP Workforce
Maintaining a qualified PHEP workforce is essential for ensuring operational readiness and effective emergency response.Ongoing
participation in communities of practice fosters shared learning,supports the dissemination of best practices,and strengthens workforce
competencies needed to execute critical public health preparedness functions.
16.1 Engage in at least one DOH community of practice(CoP)group that Mid-and end-of-year reports on December 31,2026
identifies problems,solutions,and best practices in public health template provided by DOH. June 30,2027
emergency preparedness.This can be a community of practice in exercise,
planning or medical countermeasures(MCM).
17 Medical Countermeasures—All LHJs,including non-Cities Readiness Initiative(CRI)*LHJs,must be able to meet medical
countermeasure(MCM)capabilities to ensure timely protection of their communities during public health emergencies.Building and
maintaining this capability supports equitable access to life-saving interventions and strengthens the overall statewide response system.
*Non-CRI LHJs are LHJs that do not receive Cities Readiness Initiative(CRI)funding. In Washington State,the LHJs that receive CRI
funding are Clark County Public Health,Public Health—Seattle&King County, Snohomish County Health Department,and Tacoma—
Pierce County Health Department.
17.1 Provide an updated summary of any changes made to the LHJ's MCM Mid-and end-of-year reports on December 31,2026
plan between July 1,2026 and June 30,2027. template provided by DOH. June 30,2027
Exhibit A,Statement of Work Page 8 of 11 Contract Number CLH32053-Amendment 16
Page 24 of 33
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
If no changes have occurred,report no changes. Additionally,indicate
whether the current plan accurately reflects the LHJ's present operational
readiness or if updates are needed.
DOH recommends summaries should be no longer than two paragraphs.
17.2 Demonstrate improved operational readiness to dispense and administer Documentation supporting December 31,2026
medical countermeasures through planning,organizing,equipping, increase in operational June 30,2027
training,exercising,and response activities.Evidence may include readiness for medical
updated plans,partner coordination,resource or inventory management, countermeasures.
trainings,exercises,after-action reports,or lessons learned from real-
world responses. Mid-and end-of-year reports on
template provided by DOH
DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site. Questions related to this SOW,or any other
finance-related inquiry,may be sent to finance@doh.wa.gov.
Federal Funding Accountability and Transparency Act(FFATA)(Applies to federal grant awards.)
This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act(FFATA or the Transparency Act).
The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent.
To comply with this act and be eligible to perform the activities in this statement of work,the LHJ must have a Unique Entity Identifier(UEI)generated by SAM.gov.
Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. 109-282.
Program Specific Requirements
Special Requirements:
These requirements apply to all MI Codes in this Statement of Work.
Guidance Documents-LHJs are strongly encouraged to use the following documents to inform the implementation of activities in this statement of work.
DOH will provide copies of the documents.
New Statement of Work Guidance Document(under development)
Washington State Doctrine for Enhancing Resiliency, Health Security, Response, and Recovery.
Public Health Response Readiness Framework(CDC) —2024-2028 PHEP Program Priorities—Defines Excellence in Response Operations
Public Health Emergency Preparedness and Response Capabilities:National Standards for State, Local, Tribal, and Territorial Public Health
Public Health Emergency Preparedness(PHEP) Cooperative Agreement(2024—2029 Guidance Document)
Exhibit A,Statement of Work Page 9 of 11 Contract Number CLH32053-Amendment 16
Page 25 of 33
Follow all Federal requirements for use of Federal funds:
Code of Federal Regulations(CFR),Title 2,Subtitle A,Chapter II,Part 200
Uniform Administrative Requirements,Cost Principle,and Audit Requirements for Federal Awards
CFR:: 2 CFR Part 200--Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Awards
Recipients may only use funds for reasonable program purposes,including personnel,travel,supplies,and services. (PHEP Notice of Funding Opportunity:Funding Limitations
Supplemental Guidance—February 2024)
The following expenses are not allowable with these funds:
• Clothing(except for vests to be worn during exercises or responses).
• Salaries at a rate above Federal Executive Schedule Level II.
• Vehicles(with preapproval,funds may be used to lease vehicles).
• Pay or reimburse backfilling costs for staff.
• Vaccines for seasonal influenza mass vaccination clinics or other routine vaccinations covered by CDC/ACIP schedules.
• Influenza vaccines for the public.
• Promotional items and memorabilia.
• Construction or major renovations.
Preapproval from DOH is required to use these funds for:
• Budget change of more than 10%-If you want to move more than 10%of your total allocation from one category to another(for example from staff to travel). Submit
revised budget with request.
• Contracting. Submit revised budget with preapproval request.
• Purchasing food or beverages is generally not allowable(unless employees are in travel status,then reimbursement of food and beverages is allowable).
• Purchasing equipment(see definition of equipment in 2 CFR 200,link above). Submit revised budget with preapproval request.
• Disposition of equipment with a current value as directed in 2 CFR 200(see link above).
• Leasing vehicles.
• Out of state travel.
• Overtime pay for staff directly associated with this statement of work.
• Purchase of caches of vaccine for public health responders and their households to ensure the health and safety of the public health workforce.
• Purchase of caches of vaccine for select critical workforce groups to ensure their health and safety during an exercise testing response plans.
See also DOH A19 Documentation Matrix for additional expenses that may require preapproval.
BILLING
Please refer to the Billing Instructions for the 2025—2027 Consolidated Contract.
All expenses on invoices must be related to the Statement of Work Tasks.
Submit invoices monthly on a signed Al 9 form with backup documentation appropriate for risk level.DOH will provide A19 form and risk level.
• LHJs are encouraged to submit invoices monthly for the prior month's services provided(unless the related ConCon amendment has not been executed,in that case
submit invoices as soon as possible after the amendment is executed).
• Please do not submit invoices until the ConCon amendment including the funds has been executed.
• If invoices include indirect costs,there must be a DOH-approved indirect rate.
• If there are no expenses related to this Statement of Work for a month,email the DOH Contact to let them know.
Exhibit A, Statement of Work Page 10 of 11 Contract Number CLH32053-Amendment 16
Page 26 of 33
• If you are submitting a supplemental,revised,corrected, or any additional invoice for a month,please clarify your intentions in the email with the invoice.
• Submit final billing within 45 days of the end of the funding period.
Exhibit A, Statement of Work Page 11 of 11 Contract Number CLH32053-Amendment 16
Page 27 of 33
Exhibit A
Statement of Work
Contract Term: 2025-2027
DOH Program Name or Title: WIC Nutrition Program -Effective January 1,2025 Local Health Jurisdiction Name: Jefferson County Public Health
Contract Number: CLH32053
SOW Type: Revision Revision#(for this SOW) 9 Funding Source Federal Compliance Type of Payment
® Federal Subrecipient (check if applicable) ® Reimbursement
Period of Performance: January 1,2025 through December 31,2027 El State ® FFATA(Transparency Act) ❑ Fixed Price
❑ Other ❑ Research&Development
Statement of Work Purpose: To provide Women,Infants,and Children(WIC)Nutrition Program services by following WIC federal regulations,WIC state office policies and
procedures, WIC directives,and other rules. Refer to the Program Specific Requirements section of this document.
Revision Purpose: To add funds to FFY26 WIC CLIENT SVS CONTRACTS USDA.
Master Assistance BARS Allocation
LHJ Funding Period Change Index Listing Revenue Current g Total
DOH Chart of Accounts Master Index Title Code Number Code Start Date End Date Allocation Increase(+) Allocation
FFY25 USDA WIC CLIENT SVS CONTRACTS 76101251 10.557 333.10.55 01/01/25 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 09/30/26 139,093 60,778 199,871
FFY26 BRSTFDG PEER CN PR MGMT USDA 76214260 10.557 333.10.55 10/01/25 09/30/27 26,770 0 26,770
0 0 0
TOTALS 338,685 60,778 399,463
Task Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
# and/or Amount
See"Billing
1 WIC Nutrition Program Requirements" below.
1.1 Maintain authorized participating caseload at 100%based on Outcomes based on monthly participation Authorized participating
quarterly average as determined from monthly caseload data from state WIC caseload 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 16
Page 28 of 33
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"Billing
2 Breastfeeding Promotion 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 16
Page 29 of 33
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"Billing
3 Breastfeeding Peer Counseling Program(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 (FM NP) 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 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.
Exhibit A,Statement of Work Page 3 of 7 Contract Number CLH32053-Amendment 16
Page 30 of 33
Program Specific Requirements
Program Manual,Handbook,Policy References:
The local agency shall be responsible for providing services according to rules,regulations and other information contained in the following:
• WIC Federal Regulations,USDA,and FNS 7CFR Part 246.
• Washington State WIC Nutrition Program Policy and Procedure Manual
• Office of Management and Budget, Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Awards,2 CFR 200
• Farmers Market Nutrition Program Federal Regulations,USDA,FNS 7CFR Part 248
• Other directives issued during the term of the contract
Staffing Requirements:
The local agency shall:
• Use Competent Professional Authority staff,as defined by WIC policy,to determine participant eligibility,prescribe an appropriate food package and offer nutrition
education based on the participants'needs.
• Use a Registered Dietitian(RD)or other qualified nutritionist to provide nutrition services to high-risk participants,to include development of a high-risk care plan. The
RD is also responsible for quality assurance of WIC nutrition services. See WIC Policy for qualifications for a Registered Dietitian and other qualified nutritionist.
• Assign a qualified person to be the Breastfeeding Coordinator to organize and direct local agency efforts to meet federal and state policies regarding breastfeeding
promotion and support. The Breastfeeding Coordinator must be an International Board-Certified Lactation Consultant or attend an intensive lactation management
course,or other state approved training.
Restrictions on Funds(Le.,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(Le.,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 16
Page 31 of 33
• All criteria used for certification,including information on income,nutrition risk eligibility and referrals
• Program requirements
• Nutrition education
• All financial records
Assurances/Certifications:
1. Computer Equipment Loaned by the Department of Health WIC Nutrition Program
In order to perform WIC program activities,the Department requires computer equipment,such as computers,signature pads,document scanners,card readers and printers to
be in local WIC clinics or to be transported to mobile clinics. This equipment("Loaned Equipment")is owned by the Department and loaned to the local agency(Contractor).
The Loaned Equipment is supported by the Department. This equipment shall be used for WIC business only or according to WIC Policy and Procedures.
An inventory of Loaned Equipment is kept by the Department. Each time Loaned Equipment is changed,the parties shall complete the Equipment Transfer Form and the
Department updates the inventory. A copy of the Transfer Form will be provided to the contractor. Copies of the updated inventory list may be requested at any time.
The local agency agrees to:
a. Defend,protect and hold hannless 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 16
Page 32 of 33
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-lA 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 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 16
Page 33 of 33
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 16
615 Sheridan Street
Port Townsend, WA 98368
den-Olson 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: Oe�' 1�e 'c, Z�Z
SUBJECT: Agenda Item — Consolidated Contracts Amendment #16 with the Department
of Health; January 1, 2025 — December 31, 2027; $118,316 additional
STATEMENT OF ISSUE:
Jefferson County Public Health (JCPH) requests Board approval of Consolidated Contract Amendment #16
between JCPH and State of Washington Department of Health (DOH); January 1, 2025 — December 31, 2027;
additional funding of $118,316 for a total to date of $8,327,819.
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 program(s):
• Adds SOW for Office of Resiliency & Health Security to establish funding and tasks for Local Health
Jurisdictions to strengthen their ability to prepare, respond and recover from public health threats (adds
funding of $34,384)
• Updates task table for Infectious Disease Syndemic (occurring when two or more infectious diseases or
health conditions cluster and interact within a population) Prevention Services (additional funding of
$23,154).
• WIC Nutrition Program —this revision adds funds within the Women, Infants, and Children Nutrition
Program (additional $60,778).
FISCAL IMPACT/COST BENEFIT ANALYSIS:
Total consideration for this Contract Amendment is $118,316. The Consolidated Contract is funded by DOH,
and comprises both Federal and State funds.
Community Health
Developmental Disabilities Environmental Public Health
360-385-9400 360-385-9444
360-385-9401 (f) (f) 360-379-4487
Always working for a safer and healthier community
CC-25-001-A 16
RECOMMENDATION:
JCPH Management recommends BoCC approval of Consolidated Contract Amendment #16 between JCPH and
DOH; January 1, 2025 — December 31, 2027; additional funding of $118,316.
REVIEWED BY:
c1/d I3/,
Josh D. Peters, County Administrator Date
Community Health Environmental Public Health
Developmental Disabilities 360-385-9444
360-385-9400 Always working for a safer and healthier community (f) 360-379-4487
360-385-9401 (f)
CONTRACT REVIEW FORM Clear Form
(INSTRUCTIONS ARE ON THE NEXT PAGE)
CONTRACT WITH: State of WA Dept of Health Contract No: CC-25-001-A16
Contract For: Consolidated Contracts, Amendment 16 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: additional$118,316 for a total of$8,327,819 PROCESS. ✓ Exempt from Bid Process
Revenue: $118,316 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 COM LIANCE WITH JCC 3.55.080 AND CHAPTER 42.23 RCW.
CERTIFIED: N/A: ■ _ —= Sep\-crn ,c,- 1`6, Zoi(d
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.
■ c. bi e r �,2aZ(v
CERTIFIED: N/A: "kv>.
� �
Signature Date
STEP 3: RISK MANAGEMENT REVIEW(will be added electronically through Laserfiche):
STEP 4: PROSECUTING ATTORNEY REVIEW(will be added electronically through Laserfiche):
Electronically approvedby Risk
STEP 5: DEPARTMENT MAKES REREVISIONNIadaggftlitIbtITIOKINWISK MANAGEMENT AND
PROSECUTING ATTORNEY(IF REQUIRED).
STEP 6: CONTRACTOR SIGNS
STEP 7: SUBMIT TO BOCC FOR APPROVB bctronically approved as to form by PAO on
9/21/2026.
DPA Luther reviewed and approved on 09-21-
2026. i