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Consent Agenda 7/24/2020 JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners Philip Morley, County Administrator FROM: Vicki Kirkpatrick, JCPH Director DATE: Augusts" , 2020 SUBJECT: Consolidated Contract Amendment #16 STATEMENT OF ISSUE: Approval of Consolidated Contract Amendment #16 ANALYSIS/STRATEGIC GOALS/PRO'S and CON'S: This is a routine Consolidated Contract Amendment that comes to local health jurisdictions every two months and includes both budgeted and new funding along with some tasks associated with the funding. FISCAL IMPACT/COST BENEFIT ANALYSIS: This amendment includes an increase of $88,742 for a revised maximum of $1,758,153. With the exception of the COVID-19 federal funds, these funds are included in the State 2019-2021 Biennial Budget and represent state fiscal year allocation. Individual allocations are as follows: • COVID-19 Federal funding: $57,656 for 6/1/2020 — 12/31/2021 • Family Planning: $16,545 for outreach for FP Effective 12/1/2019 • Infectious Disease: $7500 for Syringe Exchange Services Effective 7/1/2020 • Immunization Promotion to increase vaccination rates: $2800 Effective 7/1/2020 • Shellfish Biotoxin Increase: $3500 and extension to 12/31/2020 • WIC Increase: $741 to support COVID-19 Remote Access Needs RECOMMENDATIONS: Approve and ask the Board of County Commissioners Chair to sign Consolidated Contract Amendment #16. FE /I E BY:, 7 72 Ph. ' Morley:, C un Admihis - Date JEFFERSON COUNTY PUBLIC HEALTH 2018—2020 CONSOLIDATED CONTRACT CONTRACT NUMBER: CLH18247 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 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: • ELC COVID-19-Effective June 1,2020 • Infectious Disease Prevention Section(IDPS)-Effective July 1,2020 • OICP-Promotion of Immunizations to Improve Vaccination Rates-Effective July 1,2020 ® Amends Statements of Work for the following programs: • Family Planning-Effective December 1,2019 • Recreational Shellfish Activities-Effective July 1,2019 • WIC Nutrition Program-Effective January 1,2018 ❑ Deletes Statements of Work for the following programs: 2. Exhibit B-16 Allocations,attached and incorporated by this reference,amends and replaces Exhibit B-15 Allocations as follows: ® Increase of$88,742 for a revised maximum consideration of$1,758,153. ❑ 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-16 Schedule of Federal Awards,attached and incorporated by this reference,amends and replaces Exhibit C-15. 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 APPROVED AS TO FORM ONLY Assistant Attorney General Page 1 of 25 AMENDMENT#16 2018-2020 CONSOLIDATED CONTRACT EXHIBIT A STATEMENTS OF WORK TABLE OF CONTENTS DOH Program Name or Title: ELC COVID-19-Effective June 1,2020 3 DOH Program Name or Title: Family Planning-Effective December 1,2019 5 DOH Program Name or Title: Infectious Disease Prevention Section(IDPS)-Effective July 1,2020 12 DOH Program Name or Title: OICP-Promotion of Immunizations to Improve Vaccination Rates-Effective July 1,2020 14 DOH Program Name or Title: Recreational Shellfish Activities-Effective July 1,2019 16 DOH Program Name or Title: WIC Nutrition Program-Effective January 1,2018 18 Exhibit A,Statements of Work Page 2 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 Exhibit A Statement of Work Contract Term: 2018-2020 DOH Program Name or Title: ELC COVID-19-Effective June 1,2020 Local Health Jurisdiction Name: Jefferson County Public Health Contract Number: CLH18247 SOW Type: Original Revision#(for this SOW) Funding Source Federal Compliance Type of Payment Federal Subrecipient (check if applicable) ®Reimbursement Period of Performance: June 1,2020 through December 31,2020 ❑State ®FFATA(Transparency Act) ❑Fixed Price ❑Other ❑Research&Development Statement of Work Purpose: The purpose of this statement of work is to build and strengthen epidemiology,laboratory and health information systems capacity in local health jurisdictions. Note: Pending execution of an extension to the 2018-2020 consolidated contracts which currently end December 31,2020,DOH plans to extend the period of performance and funding in this statement of work through December 31,2021.Unspent funds through December 31,2020 will be carried forward into the new consolidated contract period beginning January 1,2021 and will allow for work to continue through December 31,2021. Revision Purpose: N/A Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change Total Revenue Index (LI-IJ Use Only) Consideration Consideration Start Date End Date Code Code Increase(+) FFY19 COVID CARES 93.323 333.93.32 1891029A 06/01/20 112/31/20 0 57,656 57,656 TOTALS 0 57,656 57,656 Task *May Support PlIAB Payment Number Task/Activity/Description Standards/Measures Deliverables/Outcomes Due Date/Time Frame Information and/or Amount 1 Establish a spending plan and staffing proposal to Submit spending plan and staffing August 15,2020 $57,656—MI support the work of COVID-19 case investigation proposal summary to the DOH 1891029A— and contact tracing. The spending plan and staffing Contract Manager. COVID CARES proposal should include proposed positions and define roles. ($57,656 for the 2 Hire,orient and/or train staff based on the negotiated Staff summary and training plan September 30,2020 period 06/01/20- staffing proposal.Develop a training plan in 12/31/21) consultation with DOH that is consistent with the DOH COVID-19 guideline.Training plan will be flexible depending on staff experience and based on for onboarding into new systems. Exhibit A,Statements of Work Page 3 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 Task *May Support PHABPayment Number Task/Activity/Description Standards/Measures Deliverables/Outcomes Due Date/Time Frame Information and/or Amount 3 Conduct case investigations,contact tracing and Data collected and reported into Daily monitoring in accordance with DOH COVID-19 DOH systems Infection Reporting and Surveillance Guidelines (DOH 420-107),Appendix 1:Case and Contact Investigation,pages 16-21: https://www.doh.wa.gov/Portals/1/Documents/5100/ 420-107-Guideline-COVID-19.pdf *For Information Only: Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a Standard/Measure. More detail on these and/or other Public Health Accreditation Board(PHAB)Standards/Measures that may apply can be found at: http://www.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf Special Requirements Federal Funding Accountability and Transparency Act(FFATA) 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 Data Universal Numbering System(DUNS®)number. 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/Narrative All work will be performed in accordance with the revised and approved project plans to be submitted to DOH by July 15,2020. Special Billing Requirements Payment: Upon approval of deliverables and receipt of an invoice voucher,DOH will reimburse for actual allowable costs incurred. Billings for services on a monthly fraction of the budget will not be accepted or approved. Submission of Invoice Vouchers: The LHJ shall submit correct monthly A19-1A invoice vouchers for amounts billable under this statement of work to DOH by the 25th of the following month or on a frequency no less often than quarterly. DOH Program Contact DOH Fiscal Contact Mike Boysun Summer Wurst DOH,Communicable Disease EPI DOH,Office of Program Financial Management 1610 NE 150'St,Shoreline,WA 98155 PO Box 47840,Olympia,WA 98504-7841 Ph:206-418-5518/Mike.Boysun@doh.wa.gov Ph:360-236-3486/Fax:360-664-2216/Summer.Wurst@doh.wa.gov Exhibit A,Statements of Work Page 4 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 Exhibit A Statement of Work Contract Term: 2018-2020 DOH Program Name or Title: Family Planning-Effective December 1,2019 Local Health Jurisdiction Name: Jefferson County Public Health Contract Number: CLH18247 SOW Type: Revision Revision#(for this SOW) 1 Funding Source Federal Compliance Type of Payment ❑Federal<Select One> (check if applicable) ®Reimbursement Period of Performance: December 1,2019 through December 31,2020 ®State ❑FFATA(Transparency Act) 0 Fixed Price 0 Other 0 Research&Development Statement of Work Purpose: The purpose of this statement of work(SOW)is to provide family planning services to Washington State residents.These services will comply with all state and DOH Family Planning Manual requirements.This statement of work replaces previous statements of work.It highlights specific requirements,but all must be complied with. Due dates after December 31,2020 are for reporting only.LHJ may not bill under this statement of work for work done in January 2021. Revision Purpose: The purpose of this revision is to provide additional family planning funding to be spent by 6/30/20 Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change Total Revenue Index (LHJ Use Only) Consideration Consideration Increase(+) Code Code Start,Date End Date FAMILY PLANNING COST SHARE N/A 334.04.91 78440100 12/01/19 12/31/20 99,263 0 99,263 FAMILY PLANNING COST SHARE N/A 334.04.91 78440100 12/01/19 06/30/20 0 16,545 16,545 TOTALS 99,263 16,545 115,808 *May Support Task Task/Activity/Description PHAB Deliverables/Outcomes Due Date/Time Payment Information and/or Number Frame Amount Standards/Measures 1. Family Planning Services—excluding abortion • Al9 invoice vouchers No more than Billing must be based on a and other surgical procedures related to family submitted timely and monthly and no current cost methodology planning accompanied with an R&E less than approved by DOH(see A. Comply with Washington State 2019 Family showing revenue and quarterly. Reporting Requirements Planning Manual,Family Planning Network expenses for the month billed table). requirements and all state laws.Also see and back up documentation Program Manual,Handbook,Policy per DOH policy. DOH reserves the right to References section below. During the COVIDI9 crisis withhold payment until: B. Provide medical services,community you may enter FTE related • Compliance issues related education and outreach,and staff training, expenses for family planning to this or a previous SOW consistent with state requirements: staff temporarily assigned to are resolved in a way 1. LHJ is responsible for making sure all other duties due to COVIDI9 accepted by DOH staff have the knowledge to carry out the or staff not working due to requirements of the SOW. COVIDI9,but still being paid Exhibit A,Statements of Work Page 5 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 Task *May Support Due Date/Time Payment Information and/or Number Task/Activity/Description PHAB Deliverables/Outcomes Frame Amount Standards/Measures 2. Medical,laboratory,and other services by your organization as paid • Current data is submitted related to abortion are not covered by leave. to,and accepted by, this task. • All reports described in As described in Ahlers. 3. Community education services must be Reporting Requirements table Reporting • A19 back up based on the needs of the community. below. Requirements documentation required 4. Outreach is to ensure all populations in table below. by DOH has been your community understands the submitted and approved. services available.Focus your outreach • Other data and documentation As requested by • Other deliverables have efforts on increasing equity. in format requested by DOH. DOH been met. (Includes copies of program Washington State Family Planning Network and financial audits and Payment is limited to the priority populations are: reviews including summaries maximum funds available for • People under 20 years old conducted by other entities.) funding source. • People with incomes at or below 250% FPL `' • To facilitate DOH desk As requested by DOH will reimburse for: • People who are uninsured or reviews—requested DOH • Actual allowable costs underinsured documentation available to according to your • People who require an extra level of DOH in requested format. approved cost confidentiality methodology(see • People with low English proficiency • To facilitate DOH site- Reporting Requirements Extra efforts should be made to provide visits—appropriate staff and table). information and services to people who intersect documentation readily or with multiple priority population categories. available prior to and during • The amount remaining in review. the SOW divided by the Provide all services in accordance with: number of months • DOH Family Planning Manual DOH performs site visits at least remaining in the funding • Other state and federal requirements every three-years.Follow-up site source,plus one, • LHJ's Current Scope Report(defined visits are performed until identified whichever is less. below) issues are resolved. Payment will be calculated by C. Collect,maintain,and provide data about R&E provided by DOH{see each family planning clinic visit as defined in Reporting Requirements the Family Planning Manual. table). 1. Maintain a computer system that includes normal safety precautions All services through 12-31-20 against loss of information. must be billed by 01-31-21. 2. Ensure data entry personnel protect The last dayof confidentiality of CVR data. CVR data submitted to DOH data 3. Have ability to retrieve all information contractor(Ahlers&Associates) the next month. for auditing and monitoring by DOH or electronically in a format Within thirty its designee. compatible with Ahlers software. (30)days of receiving Exhibit A,Statements of Work Page 6 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 Task *May Support Due Date/Time Payment Information and/or Number Task/Activity/Description PIIAB Deliverables/Outcomes Frame Amount Sta nd a rds/Measu res D. Notify DOH contract manager of all: • Data for each month error/rejection • Key staff and organizational changes. report or • Proposed clinic site additions.New • Corrected CVR data request from clinic sites must be approved by DOH DOH family before offering services supported by planning data SOW funding. manager. • Expected clinic site closures.Note:DOH may,at its sole discretion,recalculate LHJ's funding allocation if it closes a Email briefly describing change. As needed to clinic site. keep • Any other change that might affect information LHJ's ability to provide the family current. planning services described in this SOW. 2. Abortion and other surgical procedures Surgical A19 accompanied by No more than DOH will only reimburse LHJ related to family planning Surgical Services Summary and six(6)months for these services if this SOW A. LHJ may choose to use up to 3%of its total Health Insurance Claim Forms after date includes surgical funds. SOW funds for medical and surgical form for each visit billed. service was abortions and other family planning related "''= provided. DOH will pay for services at surgical procedures. DOH will provide Surgical Health Care Authority(HCA) B. LHJ must notify the DOH contract manager Services Summary forms and Medicaid reimbursement prior to providing services with SOW funds. surgical A19s as part of R&E amounts. DOH will move the appropriate amount to workbook for all LHJ's who • This will be considered the appropriate funding source.This may or receive surgical funds. payment in full. may not require an amendment. • LHJ will not seek C. Comply with Washington State 2019 Family additional payment from Planning Manual,Family Planning Network the client or any other requirements and all state laws.Also see person or organization. Program Manual,Handbook,Policy References section below. D. Eligible clients are those with incomes at or below 250%FPL. E. If LHJ bills for services provided by someone outside their organization the outside provider must agree to accept DOH payment as payment in full.LHJ is responsible for ensuring that the outside provider does not seek additional payment from the client or any other person or organization.(Also see Payment column.) Exhibit A,Statements of Work Page 7 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 Reporting Requirements: Title and Purpose Description Due 1. Current Scope Report This information must be reported using the template or format provided by DOH.All 01-31-20 signatures and forms must be completed by 01-31-20 It will include: Information required at the beginning this SOW Information about your agency contacts and your organization's staffing AND period.This information ensures that DOH has accurate information about LHJ's organization and A. Head of Organization As needed to maintain the services it provides. B. Head of Finance accuracy of information. C. Medical Director In addition,elements of this report allow DOH to D. The following(one person might fill more than one role) ensure that Washington State Family Planning a. Contract Coordinator Network requirements regarding client fees, b. Clinical representative required services,requirements.It also provides c. Billing contact other information to assist DOH to manage this d. Outreach and education contact SOW and the Washington State Family Planning e. Contact for CVR data Network as a whole. f Contact for EHR information Information regarding family planning related services offered at each clinic site: A. Cost analysis:How LHJ determines what it costs to provide services.LHJ uses this to help construct its fee schedule.A cost analysis must be performed by LHJ no more than three years prior to the start date of this SOW. B. Sliding fee schedule that includes all services required in the Family Planning Manual.Additional Task 1 family planning-related services may also be included on LHJ's sliding fee schedule. a Sliding fee schedule must be based on cost analysis described above. b. LHJ may use the last fee schedule approved prior to this SOW as long as it was approved later than 04-01-19.LHJ must email the DOH contract manager letting them know it is using a prior approved fee schedule. c. LHJ must not implement a revised fee schedule until it has been approved in writing by DOH. C. Income conversion tables must be updated annually and approved by DOH -- ----------------------- Information related to current Community Outreach Plan LHJ's community outreach plan follows a 5-year cycle.In the first year LHJ must assess, document and disseminate community health needs,this process must include the following steps: A. Define the populations LHJ serves and identify opportunities to expand reach within those populations and to unreached populations in each community it serves. B. Identify organizations and people representing the broad interests of the community and identify opportunities for partnership and collaboration. C. Gather available data and current assessments(secondary data) D. Seek community perspectives by gathering input from the various populations in LHJ's community(collect primary data) E. Aggregate secondary and primary data and analyze aggregated data Exhibit A,Statements of Work Page 8 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 F. Prioritize health issues,define areas of unmet need,and incorporate both in plans for outreach and education materials and activities G. Document and disseminate the community health needs assessment to LHJ's FFP consultant and appropriate stakeholders Information related to current Washington State Family Planning Network work plan Periodically,the Family Planning Network develops a statewide work plan.LHJ will be involved in developing and finalizing this plan.Activities focus on improving the strength of the Network and access to Network services for everyone who wants and needs them. Describe plans to address portions of the Network work plan that LHJ is responsible for or involved in.Include a description of the staff involved and timelines related to your activities. ------------------ -------- ----- Information related to billing and client fees Cost methodology:How LHJ determines appropriate expenses for the purpose of billing DOH. If LHJ cost methodology was approved by DOH after 04-01-19,LHJ does not have to resubmit unless changes were made. LHJ does need to email DOH contract manager informing them that no changes were made. 2. Progress Summary Report This information must be reported using the template or format provided by DOH.It will include information about LHJ's work during the previous SOW: Summary of activities from previous Family Planning services SOW.This information A. Progress on portions of the Network work plan LHJ was responsible for or allows DOH to provide required reports to the involved in. federal Office of Population of Affairs. B. Community education and outreach strategies and activities and a discussion of their effectiveness. It also informs quality improvement of the C. Staff training. Washington State Family Planning Network. 3. Family Planning Annual Report(FPAR) Organization-level data on clinical services emailed to DOH family planning data 01-31-20 manager Information DOH is requesting to develop trend data. All information is for calendar year 2020 Number of: (January through December 2020). A. Pap tests with an ASC or higher result B. Pap tests with an HSIL or higher result C. HIV Positive confidential tests D. HIV Anonymous tests E. FTE required to provide Title X services: • Physicians • Physician assistants+nurse practitioners+certified nurse midwives • Registered nurses with expanded scope of practice who are trained and permitted by state specific regulations to perform all aspects of the physical assessment. Financial data emailed to DOH Contract Manager A. R&E showing Other Revenue through 12-31-20 as described in item 5,below. Exhibit A,Statements of Work Page 9 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 4. Clinic Visit Reports(CVRs) Clinic visit records must include all elements specified in the Clinic Visit Record(CVR) Manual available at: https://www.doh.wa.gov/Portals/1/Docu ments/Pubs/930-139-CV RMa nual.pdf. CVR data must be submitted to DOH data contractor(Ahlers&Associates)electronically in a format compatible with Ahlers software. • Each month's CVR data The last day of the next month • Corrected CVR data Within thirty(30)days of receiving error or rejection report or request from DOH family planning data manager. 5. Revenue and Expense Reports(R&E) Completed R&E for time period that shows all revenue(including program income) Submitted with each that support Task 1 Family Planning Services and all expenses related to providing invoice(A19).No more those services.R&E workbook will be provided by DOH. than monthly and no A. Expenses must match General Ledger. less than quarterly. B. Other revenue/program income must reflect revenue actually received in the R&E showing all reporting month. sources of revenue that C. All entries on"Other"rows must be accompanied by a description of the revenue support services for: source or expense,including any calculations uses. • January-December 2019 due 01-31-20 • January-December 2020 due 01-31-21 *For Information Only: Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a Standard/Measure. More detail on these and/or other Public Health Accreditation Board(PHAB)Standards/Measures that may apply can be found at: http://www.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf Program Manual,Handbook,Policy References LHJ must comply with all state and DOH Family Planning requirements,policies,and regulations and with their DOH approved Current Scope Report. Reference documents include: • DOH Family Planning Manual(DOH publication 930-122,available at https://www.doh.wa.gov/portals/l/Documents/Pubs/930-122-FPRHManualComplete.pdf).Some provisions of this manual are highlighted in this SOW,but all provisions of the manual must be complied with. • Clinic Visit Record Manual(https://www.doh.wa.gov/Portals/1/Documents/Pubs/930-139-CVRManual.pdf) • Current Washington State Family Planning Network work plan • LHJ's approved Current Scope Report Special Billing Requirements See Payment column of Tasks and Deliverables table and R&E report description in Reporting Requirements table Exhibit A,Statements of Work Page 10 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 Special Instructions Accessibility of Services • Clients must not be denied services or subjected to variation in quality of services because of inability to pay. • LHJ must make sure their communities are informed of the services available. • LHJ must make sure that all services provided are accessible to target populations. o Facilities must be geographically accessible to the populations served. o As much as possible,services will be available at times convenient to those seeking services. o Clinics must comply with the Americans with Disabilities Act. o Facilities must meet applicable standards established by the Federal,State,and local governments,including local fire,building,and licensing codes. o Clinic settings must ensure respect for the privacy and dignity of the individual. • Clients must be accepted on referral from any source. • Services must be provided solely on a voluntary basis.Acceptance of family planning services must not be a prerequisite to eligibility for,or receipt of,services in any non-family planning programs of the LHJ. Availability of Emergency Services The LHJ must have written plans and procedures for the management of on-site medical emergencies,including emergencies that require transport and after-hours management of contraceptive emergencies.(See DOH Family Planning Manual) DOH Program Contact Carol Oakes PO Box 47880 Olympia,WA 98504-7880 Caro1.0alces@doh.wa.gov (360)236-3588 Exhibit A,Statements of Work Page 11 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 Exhibit A Statement of Work Contract Term: 2018-2020 DOH Program Name or Title: Infectious Disease Prevention Section(IDPS)- Local Health Jurisdiction Name: Jefferson County Public Health Effective July 1,2020 Contract Number: CLH18247 SOW Type: Original Revision#(for this SOW) Funding Source Federal Compliance Type of Payment ❑Federal<Select One> (check if applicable) ®Reimbursement Period of Performance: July 1,2020 through December 31.2020 ®State ❑FFATA(Transparency Act) El Fixed Price ❑Other ❑Research&Development Statement of Work Purpose: The purpose of this statement of work is to provide Syringe Service Programs to clients living in Jefferson County. Revision Purpose: N/A Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change Total Revenue Index (LILT Use Only) Consideration Increase(+) Consideration Code Code Start Date End Date STATE DRUG USER HEALTH PROGRAM N/A 334.04.91 12405100 07/01/20 112/31/20 0 7,500 7,500 TOTALS 0 7,500 7,500 Task Task/Activity/Description Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount Drug User Health Syringe Service To provide comprehensive Syringe Service Identify and submit annual projections LHJ must adhere to DOH $7,500—MI 12405100— Program(SSP) Program(SSP)to people who use drugs for each of the SSP deliverables. Infectious Disease(ID) State Drug User Health (PWUD). This plan of action is directed to Reporting Requirements distribute syringes to communities that use drugs to Enter SSP deliverable data into database $7,500 for 07/01/20-12/31/20 prevent transmission of infectious disease. SSP for tracking SSP activities by the 15th of programs will operate during scheduled hours to each month following service. provide new harm reduction supplies and syringes to prevent transmission of disease. SSP will offer referrals to address social determinants of health. *For Information Only: Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a Standard/Measure. More detail on these and/or other Public Health Accreditation Board(PHAB)Standards/Measures that may apply can be found at: http://www.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf Exhibit A,Statements of Work Page 12 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 Program Specific Requirements/Narrative Fiscal Guidance i) Funding—The LHJ shall submit all claims for payment for costs due and payable under this statement of work by January 25,2021.DOH will pay belated claims at its discretion,contingent upon the availability of funds. ii) The LHJ 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 Awards. iii) Submission of Invoice Vouchers—On a monthly basis,the LHJ shall submit correct A19-lA invoice vouchers for amounts billable to DOH under this statement of work. All A19-1A invoice vouchers must be submitted by the 25"'of the following month. The LHJ shall use and adhere to the DOH Infectious Disease Reimbursement Guidelines and Forms when submitting A19-IA invoice voucher payment requests to DOH. DOH Program Contact,SSP DOH Fiscal Contact Emalie Huriaux Abby Gilliland DOH,Infectious Disease Prevention DOH,Infectious Disease Operations Unit PO Box 47840,Olympia,WA 98504-7841 PO Box 47840,Olympia,WA 98504-7840 360-236-2315/Fax:360-664-2216 360-236-335I/Fax:360-664-2216 Emalie.Huriaux@doh.wa.gov Abby.Gilliland@,doh.wa.gov Exhibit A,Statements of Work Page 13 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 Exhibit A Statement of Work Contract Term: 2018-2020 DOH Program Name or Title: OICP-Promotion of Immunizations to Improve Local Health Jurisdiction Name: Jefferson County Public Health Vaccination Rates-Effective July 1,2020 Contract Number: CLH18247 SOW Type: Original Revision#(for this SOW) Funding Source Federal Compliance Type of Payment ®Federal Subrecipient (check if applicable) ®Reimbursement Period of Performance: July 1,2020 through December 31,2020 ❑State FFATA(Transparency Act) ❑Fixed Price ❑Other ❑Research&Development Statement of Work Purpose: The purpose of this statement of work is to contract with local health to conduct activities to improve immunization coverage rates. Revision Purpose: N/A Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change Total Revenue Index (LHJ Use Only) Consideration Increase(+) Consideration Code Code Start Date End Date FFY21 VFC Ops 93.268 333.93.26 74310202 07/01/20 112/31/20 0 2,800 2,800 TOTALS 0 2,800 2,800 Task *May Support PHAB Due Date/Time Payment Number Task/Activity/Description Standards/Measures Deliverables/Outcomes Frame Information and/or Amount 1 Develop a proposal to improve immunization Written proposal and a report that August 1,2020 Reimbursement for coverage rates for a target population by increasing shows starting immunization rates actual costs incurred, promotion activities and collaborating with for the target population not to exceed total community partners. The proposal must meet funding consideration guidelines outlined in the Local Health Jurisdiction amount. Funding Opportunity,Promotion of Immunizations to Increase Vaccination Rates announcement. *See Restrictions on Funds below. 2 Upon approval of proposal,implement the plan to Written report describing the November 30,2020 increase immunization coverage rates with the progress made on reaching target population identified. milestones for activities identified in the plan(template will be provided) *For Information Only: Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a Standard/Measure. More detail on these and/or other Public Health Accreditation Board(PHAB)Standards/Measures that may apply can be found at: http://www,phaboard_org/ws-content/uploads/PHAB-Standards-and_Measures-Version_l:O.pdf Exhibit A,Statements of Work Page 14 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 Program Specific Requirements/Narrative Tasks in this statement of work may not be subcontracted without prior written approval from DOH OICP. Special Requirements Federal Funding Accountability and Transparency Act(FFATA) 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 Data Universal Numbering System(DUNS®)number. 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. Restrictions on Funds(what funds can be used for which activities,not direct payments,etc.) Allowable Uses of Federal Operations Funds document(dated 12/20/2017)is posted on the DOH Consolidated Contract website at this link. These federal funds may not be used for expenses related to travel or attendance at any non-DOH sponsored conference,training,or event without prior written approval from the DOH Office of Immunization and Child Profile. DOH Program Contacts DOH Program Contact Tawney Harper,MPA Misty Ellis,Project Manager Deputy Director I Operations Manager CDC Public Health Advisor Office of Immunization and Child Profile Office of Immunization and Child Profile Department of Health Department of Health PO Box 47843,Olympia WA 98504-7843 PO Box 47843,Olympia WA 98504-7843 tawney.harper@doh.wa.gov,360-236-3525 misty.ellis@doh.wa.gov 360-236-3675 Exhibit A,Statements of Work Page 15 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 Exhibit A Statement of Work Contract Term: 2018-2020 DOH Program Name or Title: Recreational Shellfish Activities- Local Health Jurisdiction Name: Jefferson County Public Health Effective July 1.2019 Contract Number: CLH18247 SOW Type: Revision Revision#(for this SOW) I Funding Source Federal Compliance Type of Payment ❑Federal<Select One> (check if applicable) ®Reimbursement Period of Performance: July 1,2019 through December 31,2020 El State ❑FFATA(Transparency Act) ❑Fixed Price ❑Other ❑Research&Development Statement of Work Purpose: The purpose of this statement of work is to provide funds for shellfish harvesting safety. Revision Purpose: The purpose of this revision is to extend the period of performance and funding from June 30,2020 to December 31,2020,add funding,revise language in task 2,revise deliverable due dates and payment information,and upate DOH program and fiscal contact information. Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change Total Revenue Index (LHJ Use Only) Consideration Increase(+) Consideration Code Code Start Date End Date Rec.Shellfish/Biotoxin N/A 334.04.93 26402600 07/01/19 12/31/20 6,500 3,500 10,000 TOTALS 6,500 3,500 10,000 Task *May Support PHAB Payment Number Task/Activity/Description StandardslMcasures Deliverables/Outcomes Due Date/Time Frame Information and/or Amount 1 Biotoxin Monitoring Submit report on DOH approved Email Report to DOH by: $6000$9,250 • Collect samples on schedule according to format of activities for the year, February 17,2020 Department of Health(DOH)Biotoxin including the number and names December 31,2020 Monitoring Plan,coordinate deviations from the of beaches posted for schedule with DOH,notify DOH in advance if classification. (See Special Instructions samples cannot be collected. below) • Post/remove recreational shellfish warning and /or classification signs on beaches and restock cages as needed. • This may also include recruiting,training,and coordination of volunteers,and fuel reimbursement funds for volunteer biotoxin monitoring. 2 Outreach Submit report including the Email Report to DOH by: $300$750 .Staffed earrema{beeths_at.(eeci1 ent.s a aumberofevents..staffed;...and February..17..2020 • Distribute safe shellfish harvesting information. amount of educational materials December 31,2020 distributed. Exhibit A,Statements of Work Page 16 of 25 Contract Number CLHI 8247-16 Revised as of May 15,2020 AMENDMENT#16 Task *May Support PHAB Payment Number Task/Activity/Description Standards/Measures Deliverables/Outcomes Due Date/Time Frame Information and/or Amount (See Special Instructions below.) *For Information Only: Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a Standard/Measure. More detail on these and/or other Public Health Accreditation Board(PHAB)Standards/Measures that may apply can be found at: http://www.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf Program Specific Requirements/Narrative Program Manual,Handbook,Policy References Department of Health's Biotoxin Monitoring Plan Special References(RCWs,WACs,etc) Chapter 246-280 WAC http_//wywy doh.wa.gov/CommuniandEnvironment/Shellfish/RecreationalShellf sh http://www.doh.wa.gov/AboutUs/ProgramsandServices/EnvironmentalPublicHealth/EnvironmentalHealthandSafety/ShellfishProgram/Bio toxins Special Instructions Report for work done the previous year must be submitted via email to Liz Maier by Febra+ery-4 -2©20 December 31,2020. The report format will be provided by DOH and may be modified throughout the period of performance via email announcement. DOH Program Contacts: Liz Maier,Office of Environmental Health and Safety,PO Box 47824,Olympia WA 98504-7824;360.236.3308;liz.maier@doh.wa.gov Krisy Warner,Office of Environmental Health and Safety,PO Box 47824,Olympia WA 98504-7824;360.701.7537;kristy.wamer(a,doh.wa.gov DOH Fiscal Contact: —En ir;nm.e.n a^'r'ealth-and-Safety;-PO-B©x--t74821,Olympia,WA 98501 7821;360.236.33'6; eidi ku 3+agev_ Pamela Ranes,Once of Financial Management;PO Box 47850,Olympia,WA 98504-7850;360.236.4528;pamela.ranes@doh.wa..ov Exhibit A,Statements of Work Page 17 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 Exhibit A Statement of Work Contract Term: 2018-2020 DOH Program Name or Title: WIC Nutrition Program-Effective January 1,2018 Local Health Jurisdiction Name: Jefferson County Public Health Contract Number: CLH18247 SOW Type: Revision Revision#(for this SOW) 11 Funding Source Federal Compliance Type of Payment ®Federal Subrecipient (check if applicable) ®Reimbursement Period of Performance: January 1,2018 through December 31,2020 0 State ®FFATA(Transparency Act) DI Fixed Price ❑Other ❑Research&Development Statement of Work Purpose: The purpose is 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: The purpose of this revision is to add FFY20 USDA WIC Client Services Contracts funds,add FFY20 USDA FMNP Program Management funds,update Special Requirement language from previous amendment and add Special Requirement language. Chart of Accounts Program Name or Title CFDA# BARS Master Funding I'eriod Current Change Total Revenue Index (LHJ Use Only) Consideration Consideration . Increase(+) Code Code Start Date End Date FFY18 CSS USDA WIC PROGRAM MGNT 10.557 333.10.55 76211280 01/01/18 09/30/18 74,490 0 74,490 FFY19 CSS USDA WIC PROGRAM MGNT 10.557 333.10.55 76211290 10/01/18 09/30/19 106,856 0 106,856 FFY20 USDA WIC PROGRAM MGNT 10.557 333.10.55 76101202 10/01/19 09/30/20 0 0 0 FFY21 CSS USDA WIC PROGRAM MGNT 10.557 333.10.55 76101212 10/01/20 12/31/20 0 0 0 FFY18 CSS USDA FMNP PROGRAM MGNT 10.572 333.10.57 76211284 01/01/18 09/30/18 500 0 500 FFY16 CASCADES USDA WIC PROGRAM MGNT-MIS 10.578 333.10.57 76411261 10/01/18 09/30/19 845 0 845 FFY19 CSS USDA FMNP PROGRAM MGNT 10.572 333.10.57 76211294 01/01/19 09/30/19 502 0 502 FFY19 MIS TECH GRANT 10.578 333.10.57 76411291 10/01/19 09/30/20 790 0 790 FFY20 USDA WIC CLIENT SVS CONTRACTS 10.557 333.10.55 76101204 10/01/19 09/30/20 104,672 260 104,932 FFY21 USDA WIC CLIENT SVS CONTRACTS 10.557 333.10.55 76101214 10/01/20 12/31/20 24,250 0 24,250 FFY20 USDA FMNP PROGRAM MGMT 10.572 333.10.57 76540201 10/01/19 09/30/20 0 481 481 TOTALS 312,905 741 313,646 Task "May Support PHAB Due Date/Time Payment Number Task/Activity/Description Standards/Measures Deliverables/Outcomes Frame Information and/or Amount See"Special Billing 1 WIC Nutrition Program Requirements"below. 1.1 Maintain authorized participating caseload at 100% 7.2 Outcomes based on monthly based on quarterly average as determined from participation data from state WIC monthly caseload management reports generated at caseload management reports. the state WIC office. Exhibit A,Statements of Work Page 18 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 Task *May Support PIIAB Due Date/Time Payment Number Task/Activity/Description Standards/Measures Deliverables/Outcomes Frame Information and/or Amount The Department of Health(DOH)State WIC Nutrition Program has the option of reducing authorized participating caseload and corresponding funding when: 1. Unanticipated funding situations occur. 2. Reallocations are necessary to redistribute caseload statewide. Authorized participating caseload for January 2018 through December 2020=320 Authorized participating caseload for January 2019 through December 2020=310 1.2 Submit the annual Nutrition Services Plan for each 9.2 Nutrition Services Plan First year due Payment withheld if year of the Contract. 11/30/18 not received by due Second year due date. 11/30/19 Third year due 11/30/20 1.3 Submit the annual Nutrition Services Expenditure 11,2 Nutrition Services Expenditure First year due Payment withheld if Report for each year of the Contract. Report 11/30/18 not received by due Second year due date. 11/30/19 Third year due 11/30/20 1.4 Tell clients about other health services in the 3.1 Documentation must be available Biennial WIC monitor agency. If needed,develop written agreements for review by WIC monitor staff. with other health care agencies and refer clients to these services. 1.5 Provide nutrition education services to clients and 3.1 Documentation must be available Biennial WIC monitor caregivers in accordance with federal and state for review by WIC monitor staff. requirements. 1.6 Issue WIC checks while assuring adequate check 11.2 Documentation must be available Biennial WIC monitor security and reconciliation. for review by WIC monitor staff. 1.7 Collect data,maintain records,and submit reports 7.1 Documentation must be available Biennial WIC monitor to effectively enforce the non-discrimination laws for review by WIC monitor staff. (Refer to Civil Rights Assurances below). Exhibit A,Statements of Work Page 19 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 Task *May Support PHAB Due Date/Time Payment Number Task/Activity/Description Standards/Measures Deliverables/Outcomes Frame Information and/or Amount 1.8a Submit WIC Budget Workbook for each year of 11.2 Budget Workbook First year due the contract. 10/31/18 Second year due 09/30/19 Third year due 09/30/20 1.8b Submit Rev-Exp Report spreadsheet from the WIC 11.2 Rev-Exp Report and revised Mid-year revision due Budget Workbook monthly with A19-invoice and Budget Workbook. 04/30/19 submit entire revised WIC Budget Workbook for Mid-year revision due each year of the contract. 04/30/20 See"Special Billing 2 Breastfeeding Promotion Requirements"below 2.1 Provide breastfeeding promotion and support 3,1 r Status report of chosen activities in First year due activities in accordance with federal and state Nutrition Services Plan. 11/30/18 requirements Second year due 11/30/19 Third year due 11/30/20 Documentation must be available Biennial WIC monitor for review by WIC monitor staff. 2.2 Work with community partners to improve 4.2 Status report of chosen activities in First year due practices that affect breastfeeding. Choose one or Nutrition Services Plan. 11/30/18 more of the following projects: Second year due 11/30/19 • Change worksite policies of employers who Third year due likely employ low income women 11/30/20 • Provide breastfeeding education to health care providers who serve low income pregnant and Documentation must be available Biennial WIC monitor breastfeeding women for review by WIC monitor staff. • Work with birthing hospitals to improve maternity care practices that affect WIC client breastfeeding rates • Provide clients access to lactation consultants • Provide staff and community partners breastfeeding training Other projects will need pre-approval from the State WIC Office. Exhibit A,Statements of Work Page 20 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 Task *May Support PHAB Due Date/Time Payment Number Task/Activity/Description Standards/Measures Deliverables/Outcomes Frame Information and/or Amount 3 Farmers Market Nutrition Program(FMNP) See"Special Billing Requirements"below 3.1 Distribute all Farmers Market Nutrition Program Send completed readable copy of Weekly June-Sept. checks to eligible WIC clients between June and FMNP check registers to State 2018 September 30 of current year. WIC office on a weekly basis Weekly June-Sept. following FMNP procedures. 2019 Weekly June-Sept. 2020 All registers sent by Oct.1,2018;Oct. 1, 2019,and Oct.1,2020 Documentation must be available Biennial WIC Monitor for review by WIC monitor staff. *For Information Only: Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a Standard/Measure. More detail on these and/or other Public Health Accreditation Board(PHAB)Standards/Measures that may apply can be found at: http://www.phaboard.org/wp-conten t/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf Program Specific Requirements/Narrative Federal Funding Accountability and Transparency Act(FFATA) 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 Data Universal Numbering System(DUNS®)number. 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 Manual,Handbook,Policy References: The LHJ shall be responsible for providing services according to rules,regulations and other information contained in the following: • WIC Federal Regulations,USDA,FNS 7CFR Part 246,3016,3017 and 3018 • Washington State WIC Nutrition Program Policy and Procedure Manual • Farmers Market Nutrition Program Federal Regulations,USDA,FNS 7CFR Part 248 • Other directives issued during the term of the Contract Exhibit A,Statements of Work Page 21 of 25 Contract Number CLH 18247-16 Revised as of May 15,2020 AMENDMENT#16 Staffing Requirements: The LHJ must: • Use Competent Professional Authority staff,as defined by WIC policy,to determine client eligibility,prescribe an appropriate food package and offer nutrition education based on the clients'needs. • Use a Registered Dietitian(RD)or other qualified nutritionist to provide nutrition services to high risk clients,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: The LHJ shall follow the instructions found in the Policy and Procedure Manual under WIC Allowable Costs. Monitoring Visits: Program and fiscal monitoring are done on a Biennial(every two years)basis,and are conducted onsite. The LHJ must maintain on file and have available for review,audit and evaluation: 1) All criteria used for certification,including information on income,nutrition risk eligibility and referrals 2) Program requirements 3) Nutrition education 4) All financial records Definitions: What is the WIC program? (1)The WIC program in the state of Washington is administered by DOH. (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,clients,persons acting on behalf of a client,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 clients 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 checks or WIC food but who are not WIC clients. Exhibit A,Statements of Work Page 22 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 Assurances/Certifications: 1. Computer Equipment Loaned by the DOH WIC Nutrition Program In order to perform WIC program activities,DOH requires computers and printers to be in local WIC clinics or to be transported to mobile clinics. This equipment("Loaned Equipment")is owned by DOH,and loaned to the local agency(LHJ). The Loaned Equipment is supported by DOH. This equipment shall be used for WIC business only or according to WIC Policy and Procedures. An inventory of Loaned Equipment is kept by DOH. Each time Loaned Equipment is changed,the parties shall complete the Equipment Transfer Form and DOH updates the inventory. A copy of the Transfer Form will be provided to the LHJ. Copies of the updated inventory list may be requested at any time. The LHJ agrees to: a.Defend,protect and hold harmless DOH 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. DOH may enforce this by: 1) Requiring reimbursement from the LHJ of the value of the Loaned Equipment at the time of the loss or damage. 2) Requiring the LHJ to replace the Loaned Equipment with equipment of the same type,manufacturer,and capabilities(as pre approved by DOH),or 3) Assertion of a lien against the LHJ's property. c.Notify DOH immediately of any damage to Loaned Equipment. d.Notify DOH prior to moving or replacing any Loaned Equipment. The Department recommends LHJs carry insurance against possible loss or theft. 2. Civil Rights Assurance The LHJ shall perform all services and duties necessary to comply with federal law in accordance with the following Civil Rights Assurance: a. "The LHJ 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 LHJ receives Federal financial assistance from FNS;and hereby gives assurance that it will immediately take measures necessary to effectuate this Contract. b. "By accepting this assurance,the LW 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 LHJ,its successors,transferees,and assignees,as long as it receives assistance or retains possession of any assistance from DOH.The person or persons whose signatures appear on the contract are authorized to sign this assurance on behalf of the LHJ." 3. 7CFR Parts 3016,3017,3018 The LHJ shall comply with all the fiscal and operations requirements prescribed by the state agency as directed by Federal WIC Regulations(7CFR part 246.6),7CFR part 3016,the debarment and suspension requirements of 7CFR part 3017,if applicable,the lobbying restrictions of 7CFR part 3018,and FNS guidelines and instructions and shall provide on a timely basis to the state agency all required information regarding fiscal and program information. Special Billing Requirements: I. Definitions Contract Period: January 1,2018-December 31,2020 Exhibit A,Statements of Work Page 23 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 Contract Budget Period: The time period for which the funding is budgeted. • There are four federal budget periods January 1,2018 through September 30,2018; October I,2018 through September 30,2019; October 1,2019 through September 30,2020; October 1,2020 through December 31,2020. 2. Billing Information a Billings are submitted on an A19-1A form,which is coded and provided by DOH prior to each federal fiscal budget period.Submit summary level financial data to support each individual program billing. b. A19-1A forms are submitted monthly following the close of each calendar month or upon completion of services,before the end of the federal contract budget period. c. Funds are allocated by budget categories(refer to Chart of Accounts Program names)and by state and federal budget periods(refer to the allocation sheet). d. Expenses are incurred only during the budget period;no carry forward from previous time periods,or borrowing from future time periods is allowed.Advance payments are not allowed. e. Payments for a budget period are limited to the amounts allocated for the budget period for each budget category. f. Billings are based on actual costs,with back up documentation retained by the LHJ and available for inspection by DOH 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. Special Instructions: The LHJ 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 the LHJ to have a single audit performed should LHJ spend$750,000 or more of federal grants or awards from all sources.The LHJ is a subrecipient of federal funds. 3) Staff must 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 clients.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 clients. Special Requirements: Contract Funding Period Time Period Special Requirement Amount Description of Special Requirement Funds Available January 2018-September 2018 January 2018-September 2018 $4,700 Added in the USDA/WIC Program Management"Other"category to fund training and travel expenses for WIC staff to attend WIC-related trainings. This doesn't include out of state trainings. Exhibit A,Statements of Work Page 24 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 AMENDMENT#16 October 2018-September 2019 October 2018-September 2019 $4,530 Added in the USDA/WIC Program Management"Other"category to fund training and travel expenses for WIC staff to attend WIC-related trainings. This doesn't include out of state trainings. January 2019—September 2019 January 2019—September 2019 $6,401 Added in WIC/USDA CSS Other category to fund training and travel expenses for WIC staff to attend WIC-related trainings.This does not include out of state trainings. October 2018-September 2019 October 2018-September 2019 $845 Added in the FFY16 Cascades USDA WIC Program Management-MIS category to fund training and travel expenses for WIC staff to attend Cascades trainings. October 2019—September 2020 October 2019—December 2019 $2,381 Added in WIC/USDA CSS Other category to fund staff salaries,training and travel expenses for WIC staff to attend WIC—related trainings.This does not include out of state trainings. October 2018-September 2019 January 2019-September 2019 $6,400 Added in the CSS Program Management Other category to fund part-time staff salaries and benefits to support staff completing Cascades training. October 2019—September 2020 October 2019-September 2020 $2,381 Added in the USDA/WIC CSS Program Management Other category to fund training and travel expenses for all WIC staff to attend WIC-related trainings. This doesn't include out of state trainings. October 2019—September 2020 October 2019-September 2020 $790 Added in the MIS tech grant category to fund training and travel expenses for WIC staff to attend Cascades trainings. October 2018-September 2019 October 2018-September 2019 $750 Added in the CSS USDA Program Management category to purchase a scanner. October 2018-September 2019 October 2018-September 2019 $30 Added in the CSS USDA Program Management category to fund staff time for Cascades training and rollout activities. October 2019—September 2020 October 2019-September 2020 $640 Added in the CSS USDA Program Management category to fund staff time for Cascades training and rollout activities. October 2019-September 2020 January 2020-September 2020 $2,270 Added in the USDA WIC Client Services Contracts category to fund training and travel expenses for all WIC staff to participate in WIC-related trainings. With this amendment,these training funds may be used to purchase items to support COVID-19 Remote Access needs.All COVID-19 Remote Access purchases must be approved by the Local Program Operations supervisor or designee prior to purchase. October 2019-September 2020 January 2020-September 2020 $260 Added in the WIC/USDA Client Services Contracts category to purchase items to support COVID-19 Remote Access needs.All COVID-19 Remote Access purchases must be approved by the Local Program Operations supervisor or designee prior to purchase. Other Any program requirements that are not followed may be subject to corrective action,and may result in monetary fines,repayment of funds,or withholding of Contract payment. DOH Program Contact DOH Fiscal Contact Michael Schweizer HSC Chris Keesee,FA WIC Nutrition Program WIC Nutrition Program PO Box 47886,Olympia,WA 98504-7886 PO Box 47886,Olympia,WA 98504-7886 mike.schweizer@doh.wa.gov christopher.keesee@doh.wa.gov 360-236-3714 360-236-3631 or 1-800-841-1410 x 3631 Exhibit A,Statements of Work Page 25 of 25 Contract Number CLH18247-16 Revised as of May 15,2020 EXHIBIT B-16 Jefferson County Public Health ALLOCATIONS Contract Number: CLHI8247 Contract Term:2018-2020 Date: May 15,2020 Indirect Rate as of January 2018:32.33% Indirect Rate as of January 2019:33.85%Public Health Indirect Rate as of January 2020:33.28%Public Health BARS Statement of Work Funding Chart of Federal Award Revenue Funding Period Period Accounts Chart of Accounts Program Title Identification# Amend# CFDA" Code'• Start Date End Date Start Dare'End Dale'. Amount Sub Total Total FFY21 USDA WIC Program Mgnt CSS NGA Not Received Amd 15 10.557 333.10.55 10/01/20 12/31'20 10/01/20 12`31,/20 ($24,250) $0 $181,346 FFY21 USDA WIC Program Mgnt CSS NGA Not Received Amd 6 10.557 333.10.55 10/01/20 12/31/20 10/01,70 12 31 f20. $4,820 FFY2I USDA WIC Program Mgnt CSS NGA Not Received N/A 10.557 333.10.55 10/01/20 12/31/20 10/01/20 12/31/20" $19,430 FFY20 USDA WIC Program Mgnt CSS 207WAWA7W1003 Amd 15 10.557 333.10.55 10/01/19 09/30/20 IO/O!19 09;30/20 ($102,402) $0 FFY20 USDA WIC Program Mgnt CSS 207WAWA7W1003 Amd 10 10.557 333.10.55 10I01/19 09/30/20 10/01/19 09f30F20P $640 FFY20 USDA WIC Program Mgnt CSS 207WAWA7W1003 Amd 8 10.557 333.10.55 10/01/19 09/30/20 10/01/19 °oat+ $2,381 FFY20 USDA WIC Program Mgnt CSS 207WAWA7W1003 Amd 6 10.557 333.10.55 10/01/19 09/30'20 10/01"19 09/30/20 $21,661 FFY20 USDA WIC Program Mgnt CSS 207WAWA7W1003 N/A 10.557 333.10.55 10/01/19 09,30'20 10/0119 09/30/200 $77,720 FFYl9 CSS USDA WIC Program Mgnt 187WAWA7W1003 Amd 10 10.557 333.10.55 10/01/18 09/30/19 10/01/18 09/30111 $780 $106,856 FFY19 CSS USDA WIC Program Mgnt 187WAWA7W1003 Amd 9 10.557 333.10.55 10/01/18 09/30/19 10/01/1 K 09130119 $200 FFY19 CSS USDA WIC Program Mgnt 187WAWA7W1003 Amd 8 10.557 333.10.55 10/01/18 09/30/19 1 _ $6,515 FFY19 CSS USDA WIC Program Mgnt 187WAWA7W1003 Amd 6 10.557 333.10.55 10/01/18 09/30/19 'I $17,111 FFY19 CSS USDA WIC Program Mgnt 187WAWA7W1003 Amd 5 10.557 333.10.55 10/01/18 09/30/19 10/01-4,14 $4,530 FFYl9 CSS USDA WIC Program Mgnt 187WAWA7W1003 N/A 10.557 333.10.55 10/01/18 09/30/19 10/01/1c, $77,720 FFY18 CSS USDA WIC Program Mgnt 187WAWA7W1003 Amd 3 10.557 333.10.55 01/01/18 09/30/18 10/01/17 09/30/1t1 $2,800 $74,490 FFYl1 CSS USDA WIC Program Mgnt 187WAWA7W1003 Amd 2 10.557 333.10.55 01/01/18 09/30/18 10/01/17 09/30/18 $4,700 FFYII CSS USDA WIC Program Mgnt 187WAWA7W1003 Amd 1 10.557 333.10.55 01/01/18 09/30/18 10/01/17 09130/18: $8,700 FFY18 CSS USDA WIC Program Mgnt 187WAWA7W1003 N/A 10.557 333.10.55 01/01/18 09/30/18 10/01/17 09/30/J8 $58,290 FFY21 USDA WIC Client Svs Contracts NGA Not Received Amd 15 10.557 333.10.55 10/01/20 12/31/20 10/01/20 12/31/20 $24,250 $24,250 $129,182 FFY20 USDA WIC Client Svs Contracts 207WAWA7W1003 Amd 16 10.557 333.10.55 10/01/19 09/30/20 10/011 ,` $260 $104,932 FFY20 USDA WIC Client Svs Contracts 207WAWA7W1003 Amd 15 10.557 333.10.55 10/01/19 09/30/20 10/or $102,402 FFY20 USDA WIC Client Svs Contracts 207WAWA7W1003 Amd 12 10.557 333.10.55 10/01/19 09/30/20 . 0 $2,270 1. 9r:,.. FFY20 USDA FMNP Frog Mgmt 207WAWA7Y8604 Amd 16 10.572 333.10.57 10/01/19 09/30/20 1111, S481 $481 81,483 FFY19 CSS USDA FMNP Prog Mgnt 197WAWA7Y8604 Amd 8 10.572 333.10.57 01/01/19 09/30/19 10/0E, $502 $502 FFYl8 CSS USDA FMNP Prog Mgnt 187WAWA7Y8604 Amd 2 10.572 333.10.57 01/01/18 09/30/I8 10/01,f� $500 $500 FFYl6 Cascades USDA WIC Prog Mgnt-MIS 16157WAWA6W522 Amd 6,8 10.578 333.10.57 10/01/18 09/30/19 03/11/16 09/30n,, $845 $845 $845 FFYl9 MIS Tech Grant 197WAWA1G5212 Amd 8 10.578 333.10.57 10/01/19 09/30/20 10/01/18 09/30/20 $790 $790 $790 PS SSI 1-5 BEACH Task 4 01J18001 Amd 13 66.123 333.66.12 03/01/20 10/31/20 0710/17 06/30/23 $10,000 $10,000 $32,400 PS SSI 1-5 BEACH Task 4 01118001 Amd 9 66.123 333 66.12 03/01/19 10/31/19 0' 1117 06/30/23 i $2,000 $12,200 PS SSI 1-5 BEACH Task 4 01J18001 Amd 7 66.123 333 66 12 03/01/19 10/31/19 07/01,117 06/3 $10,200 PS SSI 1-5 BEACH Task 4 01J18001 Amd 1 66.123 333.66 12 03/01/18 10/31/18 07/00117 06/3� $10,200 $10,200 n PS SSI 1-5 OSS Task 4 01J18001 Amd 12 66.123 333.66.12 05/01/19 12/31/20 07/011i6 1<,_,,,,,;,,,,,,,w $300,000 $300,000 $300,000 Page 1 of 4 EXHIBIT B-16 Jefferson County Public Health ALLOCATIONS Contract Number: CLH18247 Contract Term:2018-2020 Date: May 15,2020 Indirect Rate as of January 2018:32.33% Indirect Rate as of January 2019:33.85%Public Health DOII Use Only. 1 Indirect Rate as of January 2020:33.28%Public Health BARS Statement of Work Chart of Accounts Funding Chart of Federal Award Revenue Funding Period '..'Funding'Period Period Accounts Chart of Accounts Program Title Identification# Amend# CFDA* Code** Start Date End Date Start Date Emil Dale Amount Sub Total Total PS SSI I-5 Subaward Process Task 4 01J18001 Amd 12 66.123 333.66.12 05/01/19 12/3120 07'01,10 0S/31.'23 ($300,000) $0 $0 PS SSI 1-5 Subaward Process Task 4 01J18001 Amd 9 66.123 333.66.12 05/01/19 12'3120 i4<07/01!16 0S'31 23 $300,000 FFY20 Swim Beach Act Grant IAR(ECY-NEP) NGA Not Received Amd 15 66.456 333.66.45 03/01/20 10/31/20 12 1>1 S 12,14,"_0 $2,315 $2,315 $2,315 FFY19 Swimming Beach Act Grant IAR(ECY) 01749701 Amd 7 66.472 333.66.47 03/01/19 10.3 I=19 1_'1 5'18 1031,19 $2,000 $2,000 $4,000 FFY18 Swimming Beach Act Grant IAR(ECY) 00J75501 Amd 1 66.472 333.66.47 03/01/18 10'31 IS 12113.1 7 12 14'1 8 $2,000 $2,000 FFY17 EPR PHEP BPI LHJ Funding NU90TP921889-01 Amd2 93.069 333.93.06 01/01/18 06/3018 07,01 l 7 0702'18 $1,145 $15,024 $15,024 FFY17 EPRPHEP BPI LHJ Funding NU90TP921889-01 N/A 93.069 333.93.06 01/01/18 06/30/18 07'01 17 07.'02/1S $13,879 FFY18 EPR PREP BPI Supp LHJ Funding NU90TP921889-01 Amd 5 93.069 333.93.06 07/01/18 06/30/19 07--`01 18 00 30/19 $619 $34,384 $34,384 FFY18 EPR PHEP BPI Supp LIU Funding NU90TP921889-01 Amd 4 93.069 333.93.06 07/01/18 06/30/19 07'0I 18 u0'3019 $33,765 FFY19 PHEP BPI LHJ Funding NU90TP922043 Amd 10 93.069 333.93.06 07/01/19 66/30/20 07'01,19 00 30 20 $34,384 $34,384 $34,384 FFY19 Family Planning Title X FPHPA006462 Amd 8,12 93.217 333.93.21 04/01/19 06/30/19 04'0I 19 0331'20 $26,467 $26,467 $65,099 FFYlS Family Planning Title X FPHPA006359 Amd 4 93.217 33393.21 09/01/18 03/31/19 09 91,18 08,31;19 $19,048 $19,048 FFY17 Family Planning Title X FPHPA106286 Amd 3 93.217 333 93 21 01/01/18 08/31/18 0401'17 0 ,§, $13,603 $19,584 FFY17 Family Planning Title FPHPA106286 N/A,Amd 3 93.217 333.93.21 01/01/18 08/31/18 04i01 17 03 $5,981 FFY17317 Ops 5NH231P000762-05-00 N/A 93.268 333.93.26 01/01/18 06/30/18 04901/17 063018:.. $333 $333 $333 AFDC AF 5NH23IP000762-05-00 N/A 93.268 333.93.26 01/01/18 06/30/18 '04/01/17' b6/30118= $1,113 $1,113 $1,113 FFYI 7 Increasing Immunization Rates NH23IP000762 Amd 3,4 93.268 333.93.26 07/01/18 06/30/19 07/01/18 06/30/19= $5,600 $5,600 $5,600 FFY20 PPHF Ops NH23IP922619 Amd 15 93.268 333.93.26 07/01/19 06/3020 07/01/19 06/30/20 ($500) $0 $500 FFY20 PPHF Ops NH23IP922619 Amd 9 93.268 333.93.26 07/01/19 06/3020 07/01/19 06/30/20 $500 FFYI7 PPHF Ops N11231P000762 Amd 3,4 93.268 333.93.26 07/01/18 0613019 07/01/18 06/30/19 $500 $500 FFY21 VFC Ops NGA Not Received Amd 16 93.268 333.93.26 07/01/20 12/31/20 07/01)20 06/30/21 $2,800 S2,800 $8,957 FFY20 VFC Ops NH23IP922619 Amd 9 93.268 333.93.26 07/01/19 06/30/20 07/01/19 06/30/20y $5,600 $5,600 FFY17 VFC Ops 5NH231P000762-05-00 N/A 93.268 333.9326 01/01/18 06/30/18 04/01/17 06/30/ORz''. $557 $557 FFY19 COVID CARES NU50CK000515 Amd 16 93.323 333.93.32 06/01/20 12/31/20 06/01/20 06/30/21 $57,656 $57,656 S57,656 FFY20 CDC COVID-19 Crisis Resp LHJ-Tribe NU90TP922069 Amd 14 93.354 333.93 35 01/20/20 12/31/20 OMIPI/20 , r* • $78,522 $78,522 $78,522 Page 2 of 4 EXHIBIT B-16 Jefferson County Public Health ALLOCATIONS Contract Number: CLH18247 Contract Term:2018-2020 Date: May 15,2020 Indirect Rate as of January 2018:32.33 Indirect Rate as of January 2019:33.85%Public Health `' .,« ly Indirect Rate as of January 2020:33.28%Public Health BARS Statement of V.ark Cba 4, Funding Chart of Federal Award Revenue Funding Period Fund ng'P Period Accounts Chart of Accounts Program Title Identification# Amend# CFDA• Code** Start Date rod Date Start Dale Eri¢ fe Amount Sub Total Total FFY20 MCHBG LHJ Contracts B04MC32578 Amd 10 93.994 333.93.99 10/01/19 09,�30i20 1Q/Q1/ $36,700 $36,700 $100,925 FFY19 MCHBG LHJ Contracts B04MC32578 Amd 4 93.994 333.93.99 10/01/I R 09l30i 19 111p'� g, $36,700 $36,700 FFYl8 MCHBG LHJ Contracts B04MC31524 N/A 93.994 333.93.99 01/01/18 09/30/18 1 €39T3t111%� $27,525 $27,525 SFY20 Family Planning Cost Share Amd 12 N/A 334.04.91 12/01/19 12/31/20 a t,. .taI $99,263 $99,263 $306,909 SFY20 Family Planning Cost Share Amd 16 N/A 334.04.91 12/01/19 06/31120 a _a r $36,545 516,545 SFY20 Family Planning Cost Share Amd 8,12 N/A 334.04.9I 07/01l19 11/30/19 0717}1119 03' 1120 $36,250 $46,O1l SFY20 Family Planning Cost Share Amd 4,12 N/A 334.04.91 07/01/19 11/30/19 07/01/19 03131/20 $9,761 SFYl9 Family Planning Cost Share Amd 7 N/A 334.04.91 09/01/18 03/31/19 07/Q111$ 06/30f19 $5,589 $5,589 SFYl9 Family Planning Cost Share Amd 8 N/A 334.04.91 09/01/18 06/30/19 fl7/01/18 06I30ft9 $1,393 $50,196 SFYl9 Family Planning Cost Share Amd 4 N/A 334.04.91 09/01/18 06/30/19 07/01/1& 0/19 $48,803 SFYl9 Family Planning Cost Share Amd 3 N/A 334.04.91 07/01/18 08/31/18 071p)11 $16,311 $16,311 SFY18 Family Planning Cost Share Amd I N/A 334.04.91 01/01/18 06/30/18 07/01/17 - $56,987 $72,994 SFY18 Family Planning Cost Share N/A,Amd 1 N/A 334.04.91 01/01/18 06/30/I t 07/01/17 ,,,,,,..4.4 $16,007 :3 Zoonotics-GFS Amd 9 N/A 334.04.91 07/01/19 06/30/20 07/O1119 �:t $4,029 $4,029 $5,000 Zoonotics-GFS Amd 9 N/A 334.04.91 06/01/19 06/30/19 07f01/I7 Qfr30/89- $971 $971 State Drug User Health Program Amd 16 N/A 334.04.91 07l01/20 12/31/20 fl7141/10 06130121 '. $7,500 $7,500 $22,500 State Drug User Health Program Amd 9 N/A 334.04.91 07/01/19 06J30/20 fl7/01119 06130f21 $15,000 $15,000 FY20/21 COVID-19 Disaster Response Acct Amd 14 N/A 334.04.92 01/20/20 12/31/20 01/01/20 06130/21 $71,478 $71,478 $71,478 SFYI Lead Environments of Children Amd I N/A 334.04.93 01/01/18 06/30/18 071fl7117 06f30f18.'. $2,000 $2,000 $2,000 Rec ShellCishBiotoxin Amd 16 N/A 334.04.93 07/01719 12/31/20 •07/01/19 06(30k,,� $3,500 S10,000 $19,750 Rec ShellfishBiotoxin Amd 9,16 N/A 334.04.93 07/01/19 12/31/20'x�. $6,500 Rec Shel shBiotoxin N/A N/A 334.04.93 01/01/18 06/30/19' $9,750 $9,750 Small Onsite Management(ALEA) Amd 9 N/A 334.04.93 07/01/19 06/30/20 06/30l2t $45,000 $45,000 $79,948 Small Onsite Management(ALEA) Amd 9 N/A 334.04.93 07/01/18 06/30/19 07/01' • 06t30/09 $4,948 $13,616 Small Onsite Management(ALEA) Amd 5 N/A 334.04.93 07/01/18 06/30/19 fl7/01/3 t)6/30/19: $8,668 Small Onsite Management(ALEA) Amd 5 N/A 334.04.0- -01/01/18 06/30/1 07f0111 ($8,668) $21,332 Small Onsite Management(AI,EA) N/A,Amd 5 N/A 334.0493 01/01718 06/30/18 0710 11 $30,000 Wastewater Management-GFS Amd 9 N/A 334.04.93 07/01120 12/37,20 07f01/19 06/3012 $30,000 $30,000 $55,052 Wastewater Management-GFS Amd 9 N/A 334.04.93 07/01/18 06/30,'19 07/01/ ($4,948) $25,052 Wastewater Management-GFS N/A N/A 334.04.93 07/01/18 06/30/19 07f41✓1, $30,000 PFY20 Swim Beach Act Grant IAR(ECY-ALEA) Amd 15 N/A 334.04 96 03/01/20 10/31/20 12d15/09a�,121t41,ZO $1,685 $1,685 $1,685 Page 3 of 4 EXHIBIT B-16 Jefferson County Public Health ALLOCATIONS Contract Number: CLH18247 Contract Term:2018-2020 Date: May 15,2020 Indirect Rate as of January 2018:32.33% Indirect Rate as of January 2019:33.85*/o Public Health r,�' afiy Indirect Rate as of January 2020:33.28%Public Health BARS Statement of N ork R n g'ffi of S. Funding Chart of �xev Federal Award Revenue Funding Period �:uudmg,End D Period Accounts Chart of Accounts Program Title Identification# Amend# CFDA* Code** Start Date Fnd Date Start Date Date' Amount Sub Total Total FPHS Funding for LHJs Amd l l N/A 336.04 25 07/01/20 12/31 20 07%01.19 06130/21 ($4,238) $42,000 $126,000 FPHS Funding for LHJs Amd 10 N/A 333366.0125 25 0710120 12/31'20 07//I 19 06130J21 $46,238 FPHS Funding for LHJs Amd 11 N/A 336.04 25 07/01/19 06/30/20 07/01!19 06/30121 ($4,238) $42,000 FPHS Funding for LHJs Amd 10 N/A 336.04.25 07/01/19 06/30/20 07/01/19 06/30/21" $46,238 FPHS Funding for LHJs Dir Amd 3 N/A 336.04.25 07/01/18 06/30/19 07,01/17 06/30I1 9 $42,000 $42,000 YR 20 SRF-Local Asst(15%)(FS)-SS Amd I N/A 346 26.64 01/01/18 12/31/18 07/01/17 12J31f28'. ($2200) $0 $0 YR 20 SRF-Local Asst(15%)(FS)-SS N/A N/A 346.26.64 01/01/18 12/31/18 07/01/17 12/31/28 $, $2,200 YR 21 SRF-Local Asst(I5/)(FS)SS Amd 10 N/A 346 26.64 01101/7 8 06/30/7 9 07/tt1l13 06150/ (2,000) $0 $0 YR 21 SRF-Local Asst(15%)(FS)SS Amd 6,10 N/A 346.26.64 01/01/19 06/30I19 D'7/01/1T 06/30/1 $2,000 44 YR22 SRF-Local Asst(15%)(FO-SW)SS Amd 12 N/A 346.26.64 01/01/19..12/31/20 01/01/19 06/30/20` $3,000 $4,800 $4,800 YR22 SRF-Local Asst(15%)(FO-SW)SS Amd 10,12 N/A 346.26.64 01/01/19 12/31/20 01/01/19 06/30/21 $1,800 Sanitary Survey Fees(FO-SW)SS State Amd 12 N/A 346.26.65 01/01l18 12P31/20 07/01/17 06130h27 $3,000 $4,800 $4,800 Sanitary Survey Fees(FO-SW)SS State Amd 10,12 N/A 346.26.65 01/01/19 1.2/31/20 f17 ` 0/2b" ($200) Sanitary Survey Fees(FO-SW)SS State Amd 6,12 N/A 346.26.65"01t01/79 12/31/30 " 1; $2,000 Sanitary Survey Fees(FO-SW)SS-State Amdl N/A 346.26.65 01/01/18 12/31/l8 B_ ($2,200) $0 Sanitary Survey Fees(FO-SW)SS-State N/A N/A 346'26.65 01/01/18 12/31/18 $2,200 YR 20 SRF-Local Asst(15/)(FS)TA Amd 3 N/A 346.26.66 01101/18 12/31/18 mIQ1/17 ($2,000) $0 $0 YR 20 SRF-Local Asst(15%)(FS)-TA N/A N/A 346.26.66 01/01/18 12/3 I'18 , !11 d" $2,000 YR 21 SRF-Local Asst(15%)(FS)TA Amd 10 N/A 346 26.66 0€/01/18. 06'30/19 07/01/IT 06/30`" ($3,627) $373 $373 YR 21 SRF-Local Asst(I5%)(FS)TA Amd 6,10 N/A 346.26 66 01/01/18 06/30 19 07/01/17 06130/14 $2,000 YR 21 SRF-Local Asst(15%)(FS)TA Amd 3,6,10 N/A 346 26 66 01/01/18 06/30/19 07/01/17 06/30/19 $2,000 YR 22 SRF-Local Asst(15%)(FO-SW)TA Amd 15 N/A 346 26.66 01/01/19 12/31�0 (tJT,"lt. ls ($1,000) $3,000 $3;000 YR 22 SRF-Local Asst(I5/)(FO-S W)TA Amd 12 N/A 346.26.66 01/01/19 12131/20 flT/E#T�143 '' 3# 1;'? $2,000 YR 22 SRF-Local Asst(15%)(FO-S W)TA Amd 10,12 N/A 346.26.66 01/01/19 12/31/20 01/01/19 Ot"i/30/21, $2,000 TOTAL S1,758,153 S1,758,153 Total consideration: $1,669,411 GRAND TOTAL $1,758,153 S88,742 GRAND TOTAL $1,758,153 Total Fed $1,054,858 Total State $703,295 *Catalog of Federal Domestic Assistance **Federal revenue codes begin with"333". State revenue codes begin with"334". Page 4 of 4 Exhibit C-16 Schedule of Federal Awards AMENDMENT#16 Date:May 15,2020 JEFFERSON COUNTY PUBLIC HEALTHSWV0002430-07 CONTRACT CLH18247-Jefferson County Public Health CONTRACT PERIOD:01/01/2018-12/31/2020 DOH Total Amt Allocation Period Chart of Accounts Program Title BARS Federal Federal Start End Contract CFDA CFDA Program Title Federal Agency Name Federal Award Federal Grant Award Name Award Date Award Date Date Amt Identification Number NGA Not NGA Not Special Supplemental Nuon Depar Agnwlture Food FFY21 USDA WIC CLIENT SVS CONTRACTS 333.10.55 Received Received 10/07/20 12/31/20 $24,250 10.557 Program for Women,Infants,and and Nutmritientonof Service NGA Not Received NGA Not Received Children Speclal Supplemental N trNon Department of AgncoRare Food FFY20 USDA WIC PROGRAM MGMT CSS 333.10.55 10/01/19 $6,161,312 10/01/19 09G020 $104 932 10.557 Program for Women Infants,end 207WAWA7W1003 WOMEN,INFANTS AND CHILDREN Children and Nutnbon Service Special Supplemental Nutrition Departrrient of Agriculture Food FFY19 CSS USDA WIC PROGRAM MGMT 333.10.55 10/01/17 $40,101,357 10/01/18 09/30/19 $106,856 10.557 Program for Women,Infants,and 787WAWA7W1003 WOMEN,INFANTS AND CHILDREN Children and Nutrition Service Special Supplemental Notation Departme t f Agriculture Food FFY18 CSS USDA WIC PROGRAM MGMT 333.10,55 10/02/17 $27576,710 01/01/18 09/30/18 $74490. 10.557 Program for Women,Infants,and 187WAWA7W1003 USDA-WIC ADMIN Children and Nutrition Service FFY20 USDA FMNP PROG MGMT 333.10.57 10/01/19 $129,791 10/01/19 09/30/20 $481 10572 WIC Farmers Market Nutrition Department of AgnwlWre-Food 207WAWA7Y8604 COMMODITY ASSISTANCE PROGRAM Program(FMNP) and Nutrition Service FFY19 CSS USDA FMNP FROG MGNT 333.1057 10/01/18 $130,973 01/01/19 09/30/19 $502 10.572 WIC Farmers.Market Nutrtion Department of Agricu/to Food 197WAWA7Y8604 COMMODITYASS/STANCE PROGRAM Program(FMNP) and Nutrition Service FFY18 CSS USDA FMNP FROG MGNT 333.10.57 10/01/17 $86,117 01/01/18 09/30/18 $500 10.572 WIC Farmers Market Nutrition Department of Agriculture Food 187WAWA7Y8604 COMMODITY ASSISTANCE PROGRAM Program(FMNP) and Nutrition Service FFY19 MIS TECH GRANT 333.10.57 0128/19 $2,209,026 10/01/19.09/30/20 $790 10.578 WIC Grants to States(WGS) Department of Agriculture Food 197WAWA1G5212 WIC CONTINGECY and Nutrition Service FFY16 CASCADES USDA C PROG MGNT-MIS 333.10.57 03/11/16 $2,224,476 10/01/18 09/30/19 $845 10.578 WIC Grants to States(WGS) Department of Agricultore Food 16157WAWA6W522 WOMEN,INFANTS AND CHILDREN WI and Nutrition Service WIC SAM PROJECTS Puget Sountl Acton Agenda. Technical lnvestga11ons and Env mnmental Protection Agency PUGET SOUND SHELLFISH PS SS1130SS TASK 4 333.66.12 08/02/16 $5,000,000 05/01/19. 12/31/20 $300,000 66.123 01J180D1 Implementat on Assistance Region 10.:. : STRATEGIC INITIATIVE LEAD ., ...:....._....,....�............:........... ., Program Puget Sound Acton Agenda PS 55115 BEACH TASK 4 333.66.12 08/02/16 89,200,000 03/01/18 10/31/20 $32,400 66.123 Techniollnvestgations and Environmental Protection Agency 01J18001 PUGET SOUND SHELLFISH Implementation Assistance Region 10 STRATEGIC INITIATIVE LEAD NGA Not NGA Not Beach MonRonng and Notificadon Environmental Protection Agency FFY20 SWIM BEACH ACT GRANT IAR(ECY-NEP) 333 66 47 03/01/20 10/3120 $2,315 66.4]2 NGA Not Received NGA Not Received Received Received. Program Implementation Grants Office of Water Beach Monitonng and No9ficanon Env fat Protection Agency MARINE SWIMMING BEACH FFY19 SWIMMING BEACH ACT GRANT IAR(ECY) 333.66.47 12/01/18 591.991 03/01/19 10/31/19 E2,000 66 672 Program Implementation Grants Office of Water 01J49]01 MONITORING AND PUBLIC NOTIFICATION Beach Mon toting and N hficarton Env ronmental Protection Agency MARINE SWIMMING BEACH FFY78 SWIMMING BEACH ACT GRANT IAR(ECY) 333.66.47 12/15/17 $91,690 03/01/18 10/31/18 $2,000 66.472 Program Implementation Grants Office of Water OOJ75501 MONITORING AND PUBLIC NOTIFICATION Page 1 of 3 • Exhibit C-16 Schedule of Federal Awards AMENDMENT#16 Date:May 15,2020 JEFFERSON COUNTY PUBLIC HEALTHSINV0002430-07 CONTRACT CLH18247Jefferson County Public Health CONTRACT PERIOD:01/01/2018-12/31/2020 DOH Total Anti Allocation Period Federal Federal Start End Contract Federal Award Chart of Accounts Program Title BARS Award Date Award Date Date Amt CFDA CFDA Program Title Federal Agency Name Identification Number Federal Grant Award Name Public Health Emergency Departrnent of Health and Human PUBLIC HEALTH EMERGENCY FFYI9 PREP BPI LHJ FUNDING 333.93.06 0629/19 $11,307,904 07/01/19 06/30/20 534,384 93.069 preparedness Services Centers for Disease NU90TP922043 PREPAREDNESS/PHEP) Control and Prevention COOPERATNE AGREEMENT Department&Health and Human HOSPITAL PREPAREDNESS FFYIB EPR PHEP 8PI SUPP LHJ FUNDING 333 93 06 08/01/18 $11,062,782 07/01/18 06/30/19 $34,384 93069 Public Health EmergenceServices Center:for Dsease NU9OTP921889-01 PROGRAM AND PUBLIC HEALTH Preparedness Control and Prevention EMERGENCY PREPAREDNESS COOPERATIVE.AGREEMENT rgency Department of Heats and Human FFY17 EPR PHEP 8P1 LHJ FUNDING 333 93.06 07/18/17 $11,062,782 01/01/18 06/30/18 $15,024 93069 Public Health Eme Services Centers for Disease NU90TP921889-01 HPP AND PHEP COOPERATNE Preparedness Control and Prevention AGREEMENT Department of Health and Human FFY19 FAMILY PLANNING TITLE X 333.93.21 0326/19 54,100,000 04/01/19 06/30/19 $26 467 93.217 Family Planning Services Services Office.of Population FPHPA006462 TITLE X FAMILY PLANNING SERVICES Affairs Department of Health and Human FFYIS FAMILY PLANNING TITLE X 333.9321 09/12/18 52,783,000 09/01/18 03/31/19 519,048 93.217 Family Planning_Services Services Office of Population FPHPA006359 TITLE X FAMILY PLANNING SERVICES Affairs Department of Health and Human TITLE X FAMILY PLANNING SERVICES FFY17 FAMILY PLANNING TITLE X 333.93.21 03/30/17 $1,940,000 01/01/18 08/31/18 $19,584 93.217 Family Planning Services Services Office of Population FPHPA106286 GRANT Affairs NGA Not NGA Immunaaticn Cooperehve Department of Health and Human FFVII VFC OPS 333.93.26 Received Receivedot 07/0120 17/3120 $2,600 93.266 Agreements Services Centers for Disease NGA Not Received NGA Not Received Control and Prevention Department of Health n d H IMMUNIZATION GRANT AND FFV20 VFC OP$ 333.93% 07/01/19 E9,234,835 07/01/19 06/30/20 ES,fi00 93 268 uni bon Cooperative Services Centers for Disease NH231P922619 VACCINES FOR CHILDREN Agreements Control and Prevention PROGRAM Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND FFY17 VFC OPS 333 93 26 03/03/17 $1,201,605 01/01/18 06/30/18 $557 93268 Agreements Services Centers for Disease 5NH231P000762-05-00 VACCINES FOR CHILDREN'S Control and Prevention PROGRAM Immuni ion Cooperative Department of Hea8h ndHuman. IMMUNIZATION.GRANT AND F FY17 PPHFOPS 333.93.26 0629/18 53,634512 07/01/18 06/30/19 $500 93268 Agreements Services Centers for Disease NH231P000762 VACCINES FOR CHILDREN'S Control and Prevention PROGRAM.. ni bon Coopereb a Department of Health and Human IMMUNIZATION GRANT AND FFY17 INCREASING IMMUNIZATION RATES 333.93.26 0629/18 51,722,443 07/01/18 06/30/19 $5,600 93268 Agreements Services Cantors for Dsease NH231P000762 VACCINES FOR CHILDREN'S Control and Prevention PROGRAM Immunization Cooperative Department of Health and Human IMMUNIZATION GRANT AND FFY17 AFIX 3339326 03/03/17 $1,672,289 01/01/18 06/30/18 $1,113 93268 Services Centers for Disease 5NH23IP000762-05-00 VACCINES FOR CHILDREN'S Agreements Control and Prevention PROGRAM Immunization Cooperative Deprtrrent of HealthandH r a IMMUNIZATION GRANT AND FFY17317 OPS 333 93 26 03/03/17 $575,969 01/01/18 06/30/18 $333 93268 Agreements Services Centers for Disease 5NH231P000762-05-00 VACCINES FOR CHILDREN'S Control and Prevention PROGRAM __. , „ ... a.„...— .. Epidemiology and Laboratory EPIDEMIOLOGY&LABORATORY Capacity for Infectious Diseases Department of Heats and Human CAPACITYFOR INFECTIOUS FFVIS COVID CARES 333.93.32 04/23/20 $22,581,799 06/01/20 12/31/20 $57,656 93.323 )ELC}Building and Strengthening Services Centers for Disease NU50CK000515 DISEASES(ELD)-BUILDINGB Epidemiology Laboratory and Control and Prevention STRENGTHENING EPIDEMIOLOGY, Page 2 of 3 Exhibit C-16 Schedule of Federal Awards AMENDMENT#16 Date:May 15,2020 JEFFERSON COUNTY PUBLIC HEALTHSVJV0002430-07 CONTRACT CLH18247Jefferson County Public Health CONTRACT PERIOD:01/01/2018-12/31/2020 DOH Total Amt Allocation Period Chart of Accounts Program Title BARS Federal Federal Start End Contract CFDA CFDA Program Title Federal Agency Name Federal Award Federal Grant Award Name Award Date Award Date Date Amt Identification Number Public Health Emergency CDC COOPERATIVE AGREEMENT Department of Heats and Human Response:Cooperative FOR EMERGENCY RESPONSE: FFY20 CDC COVID-19 CRISIS RESP LHJ-TRIBE 333.93.35 03/16/20 $13,230,799 01/20/20 12/31/20 578,522 93.354 Agreement for Emergency Services Centers for Disease NU90TP922069 PUBLIC HEALTH CRISIS RESPONSE Response:Public Health Cnsis Control and Prevention CDC-RFA-TP18-1802 Department of Health and Human Maternal and Child Health MATERNAL AND CHILD HEALTH FF'20 MCHBG LHJ CONTRACTS 33393.99 11/14/18 52,225977 10/01/19 09/30/20 536,700 93.994 Services Health Resources and B04MC32578 Services Block Grant to the States SERVICES BLOCK GRANT Services Administramn Department of Health and Human FFY19 MCHBG LHJ CONTRACTS 333.93.99 11/14/18 52,225,977 10/01/18 09/30/19 E36,700 93.994 Maternal and Chill Health Services Health Resources and B04MC32578 MATERNAL AND CHILD HEALTH Services Block Grant to the States Services Administration SERVICES BLOCK GRANT Department of Health and Human M:mal and Child Health MATERNAL AND CHILD HEALTH FFY18 MCHBG LHJ CONTRACTS 333.93.99 1020/17 51,650,528 01/01/18 09/30/18 527,525 93.994 ServicesHealth Resources and 604MC31524 Services Bock Giant to the States Services Administration SERVICES TOTAL 51,054,858 Page 3 of 3