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Washington State, Department of Health, Amendment No. 12 - 081417
I��.F ERSON COUNTY PUBLIC HEALTH 2 15 — 2017 CONSOLIDATED �CONTRACT CONTRACT NUMBER: C17112 AMENDMENT NUMBER: 12 PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as "DOH", and JEFFERSON COUNTY PUBLIC HEALTH 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: • OSS LMP Implementation - Effective July 1, 2017 • Recreational Shellfish Activities - Effective July 1, 2017 ® Amends Statements of Work for the following programs: Office of Immunization & Child Profile - Effective January 1, 2017 ❑ Deletes Statements of Work for the following programs: 2. Exhibit B-12 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-11 Allocations as follows: ® Increase of $33,250 for a revised maximum consideration of $1,233,400. ❑ 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-12 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces Exhibit C-11. 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 STATE OF WASHINGTON DEPARTMENT OF HEALTH Date date ApAved as t f rm: 1' Date: APPROVED AS TO FORM ONLY Philip C. 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LL LL LL F 0 Cl) N m (o a 615 Sheridan Street Port Townsend, WA 98368 �efenson www.JeffersonCountyPublicHeaIth.org Public He� �uiy ioA2oi� JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners Philip Morley, County Administrator FROM: Vicki Kirkpatrick, Director DATE: 91 141 Do 1'4- . SUBJECT: Agenda Item — Consolidated Contracts A-12 with the Department of Health; January 1, 2015 — December 31, 2017; Add'I $33,250 for a total of $1,233,400 STATEMENT OF ISSUE: Jefferson County Public Health requests Board approval of the Consolidated Contracts A-12 between JCPH and State of Washington Department of Wealth; January 1, 2015 - December 31, 2017; add'I $33,250 for a total of $1,233,400. ANALYSIS/ STRATEGIC GOALS/PRO'S and CON'S: This agreement with the Department of Health comprises State and Federal funds. This amendment adds $33,250 in revenue to the existing contract and amends Statements of Work as follows: • $30,000. Wastewater Management — GFS: added statement of work to fund implementation of the on-site sewage system (OSS) local management plan (LPM) for the remainder of 2017. The period of performance for this statement of work is July 1, 2017 through December 31, 2017. • $3,250. Recreational Shellfish Activities: added statement of work to provide funds for shellfish harvesting safety. The period of performance for this statement of work is July 1, 2017 through December 31, 2017. • $0 Net. Office of Immunization & Child Profile: Transfer funds ($700) from FFY15 to FFY16. FISCAL IMPACT/COST BENEFIT ANALYSIS: Total consideration for this Contract Amendment is $33,250 for a total of $1,233,400. 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-12; January 1, 2015 — December 31, 2017; add'I $33,250 for total of $1,233,400. REV E BY:, Ph p Morley unty Adminjistratdr Date 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 615 Sheridan Street Port Townsend, WA 98368 www.JeffersonCountyPublicHealth.org CONTRACT REVIEW FORM CONTRACT WITH: Department of Health CONTRACT FOR: Consolidated Contracts Amendment #12 CC-15-02-Al2 JUL 17 2017 TERM: January 1. 2015 — Dec. 31. 2017 COUNTY DEPARTMENT: Jefferson County Public Health For More Information Contact: Julia Danskin Contact Phone #: X420 RETURN TO: Jenny Matter RETURN BY: ASAP AMOUNT: Add'I $33,250 for total $1,233,400 Revenue: Expenditure: Matching Funds Required: Source(s) of Matching Funds: Step 1 V, APPROVED FORM Comments: REVIEW BY Review by Date ReJ PROCESS: D Exempt from Bid Process ❑ Consultant Selection Process ❑ Cooperative Purchase ❑ Competitive Sealed Bid ❑ Small Work Roster ❑ Vendor List Bid ❑ RFP or RFQ ❑x Other: rned for revision (See Comments) Step 2: REVIEW BY PROS TING T RNEY Review by: _ Date Re wed: p APPROVED AS TO FORM LY Returned for revision (See Comments) Comments: �C C VVL kA Cf — Ga nof � � At." la I. (This form to stay with contract throughout the contract review process) 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 (t) 360-379-4487