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Washington State, Department of Health, Amendment No. 9 - 030617
� O P(4 3/b/17 Te-4c�(Y) joo3 CC,. YW , 3 (� JEFFERSON COUNTY PUBLIC HEALTH 2015 — 2017 CONSOLIDATED CONTRACT CONTRACT NUMBER: C17112 AMENDMENT NUMBER: 9 PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as "DOH", and JEFFERSON COUNTY PUBLIC HEALTH hereinafter referred to as "LHJ", pursuant to the Modifications/Waivers clause, and to make necessary changes within the scope of this contract and any subsequent amendments thereto. IT IS MUTUALLY AGREED: That the contract is hereby amended as follows: 1. Exhibit A Statements of Work, attached and incorporated by this reference, are amended as follows: ® Adds Statements of Work for the following programs: • Office of Immunization & Child Profile - Effective January 1, 2017 ® Amends Statements of Work for the following programs: • Family Planning - Effective January 1, 2016 • Maternal & Child Health Block Grant - Effective January 1, 2015 • Office of Drinking Water Group A Program - Effective January 1, 2015 • WIC Nutrition Program - Effective January 1, 2015 ❑ Deletes Statements of Work for the following programs: 2. Exhibit B-9 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-8 Allocations as follows: ® Increase of $122,380 for a revised maximum consideration of $1,127,531. ❑ Decrease of for a revised maximum consideration of ❑ No change in the maximum consideration of Exhibit B Allocations are attached only for informational purposes. Exhibit C-9 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces Exhibit C-8. Unless designated otherwise herein, the effective date of this amendment is the date of execution. ALL OTHER TERMS AND CONDITIONS of the original contract and any subsequent amendments remain in full force and effect. IN WITNESS WHEREOF, the undersigned has affixed his/her signature in execution thereof. JEFFERSON COUNTY PUBLIC HEALTH 'kap ", -4-c" 3 -- � , )r q Date STATE OF WASHINGTON DEPARTMENT OF HEALTH APPROVED AS TO FORM ONLY a 23 t� Assistant Attorney General Cv� Ow�ec Page 1 of 33 • � .—� N N � N r z U O U H kr) U �o N � A pqEy U R A U O N I� �y Z •=+ w N N bOA EO cd a cd Q a o U O . o �C7UW N x3•�' W �bbN0 �U.o N U U U CIS Z4. 4. o H H H H H o N 00000 3� z z z z z PLO a;aa,a; xxxxx A A AAA w r� Le, L � •3 ti o' L M N M .Nti 0 t" btb .'C u F®❑ y Cd RR H U O V O r.+ .L d Q tZ 4u U dj d V V 0 Cm vi 'b >M t z E to 00 Old i. 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A m A z z D 0 n D O ic o a CD v 3 n 3 m FID c, Z 2 m cn 615 Sheridan Street Port Townsend, WA 98368 01, Mon www.JeffersonCc�"90L#WPlealth.org January 13, 2017 Public Healt JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners Philip Morley, County Administrator FROM: Vicki Kirkpatrick, Director Tammey Newton, Community Health Director DATE: -3) ( W SUBJECT: Agenda Item — Consolidated Contracts A-9 with the Department of Health; January 1, 2015 — December 31, 2017; Add'I $122,380 for a total of $1,127,531 STATEMENT OF ISSUE: Jefferson County Public Health requests Board approval of the Consolidated Contracts A-9 between JCPH and State of Washington Department of Health; January 1, 2015 - December 31, 2017; add'I $122,380 for a total of $1,127,531. ANALYSIS/ STRATEGIC GOALS/PRO'S and CON'S: This agreement with the Department of Health comprises State and Federal funds. This amendment adds $122,380 in revenue to the existing contract, extends periods of performance and amends Statements of Work as follows: • $4,007. Office of Immunization & Child Profile: added statement of work to define required immunization tasks, deliverables, and funding. The period of performance for this statement of work is divided into two funding allocation periods - January through March 2017 and April through December 2017. Tasks and deliverables will be divided proportionately between the two funding periods. • $26,897. Family Planning: amended state of work to extend the period of performance from January 15, 2017 to April 30, 2017; add funding and extend funding periods from December 2016 to March 31, 2017 and add task deliverables, due dates and payment information. • $0. Maternal and child health block grant: amended to add new billing language to the "Special Billing Requirements" section. • $7,100. Office of Drinking Water Group A Program: amended to increase funding consideration and extend funding period end dates from December 31, 2016 to December 31, 2017, revise Payment Information on Task 4, revise Special Billing Requirements and Special Instructions, and change DOH Contact name. • $84,376. WIC Nutrition Program: amended to add FFY17 and FFY18 USDA WIC NLS funds and extend the funding period for FFY17 from December 31, 2016 to September 30, 2017, change the due date for Nutrition Services Plan, add language to Assurances/Certification, review Special Instructions, and change DOH program and fiscal contracts. Community Health Developmental Disabilities 360-385-9400 360-385-9401 (f) Always working for a safer and healthier community Environmental Health Water Quality 360-385-9444 (f) 360-379-4487 615 Sheridan Street Port Townsend, WA 98368 www.JeffersonCountyPublicHealth.org FISCAL IMPACT/COST BENEFIT ANALYSIS: Total consideration for this Contract Amendment is $122,380 for a total of $1,127,531. The Consolidated Contract is funded by the Department of Health, and comprises both Federal and State funds. RECOMMENDATION: JCPH management request approval of Consolidated Contracts, A-9; January 1, 2015 — December 31, 2017; add'I $122,380 for total of $1,127,531. FA NO �wAdministrator Community Health Developmental Disabilities 360-385-9400 360-385-9401 (f) Date Always working for a safer and healthier community Environmental Health Water Quality 360-385-9444 (f) 360-379-4487 1-7,10 615 Sheridan Street Port Townsend, WA 98368 �e, oson, www.JeffersonCountyPublicHealth.org is Heeallt CC -15-02-A9 CONTRACT REVIEW FORM CONTRACT WITH: Department of Health .I�', 17 ,?,'�17 CONTRACT FOR: Consolidated Contracts Amendment #9 TERM: January 1, 2015 — Dec. 31, 2017 COUNTY DEPARTMENT: Jefferson County Public Health For More Information Contact: Tammey Newton Contact Phone #: X443 ( E W/EFD) RETURN TO: Jenny Matter RETURN BY: ASAP JAN 19 2017 Step 1: REVIEW BY R G !/�? Review b Date Re iew PPROVED FORM ❑ Returned for revision (See Comments) Comments: Step 2: REVIEW BY PROSECUTI AT RNN Review by: G Date Reviewed: 2— �L- APPROVED AS TO FORM LJ Retur ed for revision (See Comments) Comments: (This form to stay with contract throughout the contract review proc C r 0WE© JAN 19 2017 JEFFERSON COUNTY PROSECUTING ATTORNEY Community Health Environmental Health Developmental Disabilities Water Quality 360-385-9400 360-385-9444 360-385-9401 (f) Always working for a safer and healthier community (f) 360-379-4487 JEFFERSON COUNTY' AMOUNT: Add'I $122,380 for total PROCESS: 0 Exempt from Bid Process $1,127,531 ❑ Consultant Selection Process Revenue: ❑ Cooperative Purchase _ Expenditure: ❑ Competitive Sealed Bid Matching Funds Required: ❑ Small Work Roster Source(s) of Matching Funds: ❑ Vendor List Bid ❑ RFP or RFQ ❑x Other: Step 1: REVIEW BY R G !/�? Review b Date Re iew PPROVED FORM ❑ Returned for revision (See Comments) Comments: Step 2: REVIEW BY PROSECUTI AT RNN Review by: G Date Reviewed: 2— �L- APPROVED AS TO FORM LJ Retur ed for revision (See Comments) Comments: (This form to stay with contract throughout the contract review proc C r 0WE© JAN 19 2017 JEFFERSON COUNTY PROSECUTING ATTORNEY Community Health Environmental Health Developmental Disabilities Water Quality 360-385-9400 360-385-9444 360-385-9401 (f) Always working for a safer and healthier community (f) 360-379-4487