HomeMy WebLinkAbout121420_ca06Oyu
Public Health
TO:
FROM:
DATE:
SUBJECT:
615 Sheridan Street
Port Townsend, WA 98368
www.JeffersonCountyPublicHealth.org
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
Board of County Commissioners
Philip Morley, County Administrator
Vicki Kirkpatrick, JCPH Director
Consolidated Contract Amendment #18
Consent Agenda
STATEMENT OF ISSUE: Jefferson County Public Health requests Board approval of Consolidated Contract
Amendment #18; January 1, 2018 — December 31, 2021.
ANALYSIS/STRATEGIC GOALS/PRO'S and COWS: 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 $60,754 for a
revised maximum of $2,767,476. These funds are included in the State 2019-2021 Biennial Budget and
represent state fiscal year allocation. Individual allocations are as follows:
• FFY21 VFC Ops:
• FFY21 MCHBG LHJ:
• PHEP BP2 LHJ:
• State Drug User Health Program:
$2,800 for 7/1/20 — 6/30/21
$36,700 for 10/1/20 — 9/30/21
$13,754 for 7/1/20 — 6/30/21
$7,500 for 7/1/19 — 6/30/21
RECOMMENDATIONS: JCPH Management recommends BOCC approval and signature for Consolidated
Contract Amendment #18.
Community Health
Developmental Disabilities
360-385-9400
360-385-9401 (f)
Date
Always working for a safer and healthier community
Environmental Public Health
360-385-9444
(f) 360-379-4487
JEFFERSON COUNTY PUBLIC HEALTH
2018 - 2021 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH18247
AMENDMENT NUMBER: 18
PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as "DOH", and
JEFFERSON COUNTY PUBLIC HEALTH, a Local Health Jurisdiction, hereinafter referred to as "LHJ", pursuant to the
Modifications/Waivers clause, and to make necessary changes within the scope of this contract and any subsequent amendments
thereto.
IT IS MUTUALLY AGREED: On February 29, 2020, Governor Jay Inslee issued Proclamation 20-05 declaring a State of
Emergency due to the outbreak of COVID-19. In June 2020, DOH and LHJ agreed that to support the parties' ongoing response to
the emergency, the parties would extend the end date of the Contract rather than beginning a new three-year contract. For ease of
reference, the Contract as amended is attached and incorporated in this amendment showing the insertions, deletions, and revisions as
follows: Section 1 Purpose and Section 2 Statements of Work. Remove reference to repealed RCW 43.70.520 and RCW 43.70.580.
Section 33 Term. Extend the Contract term for a period of one year from December 31, 2020 through December 31, 2021. Heading
on page one and footers are updated to reflect the extended contract term.
1. Exhibit A Statements of Work, attached and incorporated by this reference, are amended as follows:
❑ Adds Statements of Work for the following programs:
® Amends Statements of Work for the following programs:
• Division of Emergency Preparedness & Response PHEP - Effective July 1, 2020
• Infectious Disease Prevention Section (IDPS) - Effective July 1, 2020
• Maternal & Child Health Block Grant - Effective January 1, 2018
• OICP-Promotion of Immunizations to Improve Vaccination Rates - Effective July 1, 2020
❑ Deletes Statements of Work for the following programs:
2. Exhibit B-18 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-17 Allocations as follows:
® Increase of $60,754 for a revised maximum consideration of 2 767 476.
❑ 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-18 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces Exhibit C-17.
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
upon execution of this amendment.
IN WITNESS WHEREOF, the undersigned has affixed his/her signature in execution thereof.
liclaliMIMH
Date
A roved s o f rm only:
C . Date: IZ t
Philip C. 11unsucker, Chief Civil Deputy Prosecuting Attorney
Jefferson County Prosecuting Attorney's Office
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
APPROVED AS TO FORM ONLY
Assistant Attorney General
Date
DOH CONTRACT #: CLH18247
2018 - 248 2021
WASHINGTON STATE
DEPARTMENT OF HEALTH
CONSOLIDATED CONTRACT
Page 1 of 17
DOH CONTRACT #: CLH18247
Table of Contents
1.
Purpose....................................................................................................................................3
2.
Statements of Work.................................................................................................................3
3.
Exhibits.................................................................................................................................... 3
4.
Definitions...............................................................................................................................3
5.
Funding and Billing.................................................................................................................4
6.
Contract Management..............................................................................................................5
7.
Access to Records....................................................................................................................5
8.
All Writings Contained Herein................................................................................................ 5
9.
Assignment.............................................................................................................................. 5
10.
Assurances............................................................................................................................... 5
11.
Confidential Information.........................................................................................................6
12.
Ethics.......................................................................................................................................6
13.
Debarment Certification..........................................................................................................6
14.
Disputes...................................................................................................................................6
15.
Equipment Purchases...............................................................................................................6
16.
Governing Law and Venue...................................................................................................... 7
17.
Independent Capacity..............................................................................................................7
18.
Insurance.................................................................................................................................. 7
19.
Licensing, Accreditation and Registration..............................................................................7
20.
Maintenance of Records.......................................................................................................... 7
21.
Modifications and Waivers......................................................................................................7
22.
No Third -Party Rights Created................................................................................................ 7
23.
Nondiscrimination...................................................................................................................7
24.
Order of Precedence................................................................................................................ 8
25.
Ownership of Material/Rights in Data..................................................................................... 8
26.
Publications..............................................................................................................................8
27.
Responsibility for Actions.......................................................................................................
8
28.
Loss or Reduction of Funding.................................................................................................8
29.
Severability..............................................................................................................................
8
30.
Subcontracts.............................................................................................................................8
31.
Subrecipient.............................................................................................................................
9
32.
Survivability............................................................................................................................9
33.
Term.........................................................................................................................................9
34.
Termination for Convenience..................................................................................................
9
35.
Termination for Default...........................................................................................................9
36.
Termination Procedure............................................................................................................9
Standard
Federal Certifications and Assurances........................................................................
I I
Federal Assurances - Non -Construction Programs....................................................................16
2018-.20202021 Consolidated Contract Page 2 of 17
DOH CONTRACT #: CLH18247
CONSOLIDATED CONTRACT
between
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
(Referred to as "DOH")
and
JEFFERSON COUNTY PUBLIC HEALTH
(Referred to as "LHJ")
for
THE DELIVERY OF PUBLIC HEALTH SERVICES
FOR THE PERIOD OF
January 1, 2018 through December 31, 2AM 2021
1. Purpose
This Contract is entered into in accordance with C—W 43. ;zn c 2n DC—W 43. ;n can the general statutory powers of the
Secretary of the Department of Health (DOH), including at RCW 43.70.040, the general statutory powers of local health
jurisdictions (LHJs), including at RCW 70.05.060, RCW 70.08.020, and RCW 70.46.060, and the authority for joint or
cooperative action provided for under chapter 39.34 RCW. The purpose of this Contract is to define the parties' joint
and cooperative relationship. The contract and all statements of work adopted under its provisions are intended to
implement applicable objectives under the Public Health Improvement Plan and to facilitate the delivery of public health
services to the people in Washington State. This Contract is the result of cooperative planning efforts between the LHJ
and DOH.
2. Statements of Work
The individual program activities, requirements, and outcomes/deliverables to be achieved by the parties under this
Contract are described in Exhibit A, Statements of Work.
The LHJ shall furnish the necessary personnel, equipment, material and/or services and otherwise do all things necessary
for or incidental to the performance of the work as set forth in Exhibit A, Statements of Work.
3. Exhibits
This Contract incorporates by reference the following Exhibits:
• Exhibit A - Statements of Work
• Exhibit B - Allocations
• Exhibit C - Schedule of Federal Awards
4. Definitions
As used throughout this Contract and unless amended for a particular Statement of Work, the following terms shall have
the meanings set forth below:
"Budget, Accounting, and Reporting System (BARS)": The system designed by the State Auditor's office for
collecting, consolidating, and reporting financial budgeting and accounting information from all local governmental
units.
"Client": An agency, firm, organization, individual or other entity applying for or receiving services provided by
the LHJ under this Contract.
"Catalog of Federal Domestic Assistance (CFDA)": The unique identifying code assigned to a federal assistance
program which identifies the awarding agency.
"Confidential Information": Information protected from disclosure under federal or state law.
2018-2020 2021 Consolidated Contract Page 3 of 17
DOH CONTRACT #: CLH18247
"Contract Coordinator": Each party's designated contact for all notices required or permitted under this Contract.
"Contracting Officer": The DOH Contracts and Procurement Office Director and his/her delegates within that
office authorized to execute this agreement on behalf of DOH.
"Contractor": An entity that provides goods or services to DOH and others. A contractor normally operates its
business in a competitive environment, provides its goods and/or services to many different purchasers during
normal business hours, and is not subject to the compliance requirements of the federal program.
"Equipment": When used in this Contract is defined as an article of non -expendable, tangible property other than
land, buildings, or fixtures which is used in operations and having a useful life of more than one year and an
acquisition cost of $5,000 or more or as otherwise provided in the Exhibit A, Statements of Work.
"Federal Assistance": Assistance provided by a federal agency in the form of grants, contracts, loans, loan
guarantees, property, cooperative agreements, interest subsidies, insurance, or direct appropriations, but does not
include direct federal cash assistance to individuals.
"Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act)": A federal act to make
information available online so the public can see how federal funds are spent.
"Fixed Assets": Fixed assets are property and/or equipment obtained through donation, gift, purchase, capital lease,
or construction with a service life of more than one year.
"Program Contact": Each party's designated contact for those purposes identified in the Exhibit A, Statements of
Work.
"Subcontractor": Any individual or group contracted with the LHJ to perform all or part of the services included
in this Contract. This term will also apply to situations where an LHJ's subcontractor contracts with another
individual or group to perform all or part of the services included in its agreement with the LHJ.
"Subrecipient" or "Subgrantee": A non-federal entity that receives a subaward of federal grant money or goods
directly or indirectly from DOH and makes decisions regarding who can receive what federal assistance; has its
performance measured against the objectives contained in the DOH agreement with the federal government; makes
decisions on how to operate the program to accomplish the program goals; has the obligation to comply with federal
subrecipient requirements; and/or use federal funds to carry out a program for the public purpose specified in the
authorizing statute.
5. Funding and Billing
A. DOH shall pay the LHJ for services as set forth in the Exhibit A, Statements of Work, not to exceed funding amounts
as detailed in the Contract Allocations, Exhibit B, for those services provided herein.
The LHJ will advise the Program Contact identified in the applicable Statement of Work in writing 90 calendar
days prior to the end of the funded period, or as soon as practicable thereafter, if the LHJ anticipates not using all
Contract funding.
B. If the Exhibit A, Statement of Work, is supported by federal funds that require compliance with FFATA (the
Transparency Act), the corresponding checkbox on the statement of work will be checked.
C. Total consideration for this Contract is $374,705, or as amended.
The LHJ will submit accurate and timely billings which, for clarity and consistency, will be prepared using the form
provided and following the instructions located on the DOH website, www.doh.wa.gov.
DOH will authorize payment only upon satisfactory completion and acceptance of deliverables and for allowable
costs as outlined in the statement of work and/or budget.
2018-2020 2021 Consolidated Contract Page 4 of 17
DOH CONTRACT #: CLH18247
D. The LHJ will submit a BARS A financial report by April 15 for the prior calendar year.
6. Contract Management
Unless otherwise specified in the Contract, the following individuals are the contacts ("Contract Coordinators") for all
notices required or permitted under this Contract:
LHJ Contract Coordinator:
DOH Contract Coordinator:
Name: Karen Abbott
Name: Brenda Henrikson
Title: Contracts Specialist
Mailing Address:
Mailing Address:
615 Sheridan Street, Port Townsend WA 98368-2439
PO Box 47905, Olympia WA 98504-7905
Physical Address:
Physical Address:
Same as above
101 Israel Rd. SE, Tumwater WA 98501-5570
Phone: 360-385-9400
Fax: 360-385-9401
Phone: 360-236-3933
Fax: 360-236-2401
Email Address:
Email Address:
kabbott@co.jefferson.wa.us
brenda.henrikson@doh.wa.gov
A party may change its Contract Coordinator or its Program Contact by providing written notice to the other party.
DOH Program Contacts can be found in the Exhibit A, Statements of Work, and on the DOH website at
www.doh.wa.gov.
7. Access to Records
To the extent authorized by applicable federal and state law, the parties shall provide access to records relevant to this
Contract to each other, the Joint Legislative Audit and Review Committee, the State Auditor, and authorized federal
officials, at no additional cost. Inspections shall occur at reasonable times and upon reasonable notice.
8. All Writings Contained Herein
This Contract contains all the terms and conditions agreed upon by the parties. No other understandings, oral or otherwise,
regarding the subject matter of this Contract shall be deemed to exist or to bind any of the parties hereto. The individuals
signing this Contract certify by their signatures that they are authorized to sign this Contract on behalf of their respective
entity.
9. Assignment
Except for subcontracting as authorized in this Contract, the LHJ shall not assign or delegate, in whole or in part, this
Contract or any of its rights, duties, obligations, or responsibilities, without the prior written consent of DOH's
Contracting Officer, which consent shall not be unreasonably withheld.
10. Assurances
The parties agree that all activity pursuant to this Contract shall be in accordance with all applicable current federal,
state and local laws, rules, and regulations.
The LHJ acknowledges its agreement to comply with federal certifications and assurances by signing and returning the
following:
1. Standard Federal Certifications and Assurances
2. Federal Assurances for Non -Construction Programs
2018-2020 2021 Consolidated Contract Page 5 of 17
DOH CONTRACT #: CLH18247
11. Confidential Information
The parties agree to comply with all state and federal statutes and regulations relating to Confidential Information. DOH
and LHJ will limit access to the Confidential Information to the fewest number of people necessary to complete the
work. Everyone having access to Confidential Information covered by this Contract must agree to protect the
confidentiality of the information.
Either party to this Contract may designate certain Confidential Information as "Confidential Information/Notice
Requested." The designation shall be made by clearly stamping, watermarking, or otherwise marking each page of the
Confidential Information. If a third party requestor seeks information that has been marked "Confidential
Information/Notice Requested," notice shall be given to the marking party prior to release of the information. Such
notice shall be provided to the program contact no less than five (5) business days prior to the date of disclosure, to
allow the party objecting to disclosure to seek a protective order from the proper tribunal.
DOH and LHJ agree to establish, document and maintain security practices and safeguards consistent with state and
federal laws, regulations, standards, and guidelines to prevent unauthorized access, use, or disclosure of Confidential
Information in any form. In accordance with federal and state contracting requirements, DOH may monitor, audit, or
investigate LHJ management of Confidential Information relating to this Contract. Working together, the LHJ and
DOH may use any and all tools available to track Contract related Confidential Information.
If one of the parties becomes aware of an actual or suspected breach of confidentiality, that party will promptly notify
the Contract Coordinator for the other party of the facts. The parties will work within their respective organizations to
take any steps necessary to determine the scope of the breach and to restore reasonable security to the Confidential
Information. Both parties agree to mitigate any known harmful effects of a breach in confidentiality, including notifying
affected individuals to the extent required by law. The parties will also reasonably cooperate with law enforcement as
appropriate.
12. Ethics
Both parties and their officers shall comply with all ethics laws applicable to their activities under this Contract,
including Chapters 42.23 and 42.52 RCW. If a violation occurs and is not cured within a reasonable time after notice,
the other party shall have the right to terminate this Contract. This section is expressly subject to the Disputes section
of this Contract.
13. Debarment Certification
The LHJ, by signing this Contract, certifies that the LHJ is not presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from participating in this Contract by any federal department or agency.
The LHJ also agrees to include the above requirement in all subcontracts into which it enters. The LHJ will notify DOH
of any such events that may occur during the term of the Contract.
14. Disputes
Except as otherwise provided in this contract, when a dispute arises between the parties and it cannot be resolved by
direct negotiation, the parties agree to participate in good faith in non -binding mediation. The mediator shall be chosen
by agreement of the parties. If the parties cannot agree on a mediator, the parties shall use a mediation service located
in Washington State that selects a qualified mediator for the parties. Each party shall bear its own costs for mediation
and each party shall contribute equally to the mediator's fee, if any. The parties agree that mediation shall precede any
action in a judicial tribunal.
Nothing in this contract shall be construed to limit the parties' choice of a mutually acceptable alternate dispute
resolution method in addition to the dispute resolution procedure outlined above.
15. Equipment Purchases
Equipment purchased by the LHJ for use by the LHJ or its subcontractors during the term of this Contract using federal
funds, in whole or in part, shall be the property of the LHJ. The use, management and disposal of the equipment must
comply with federal requirements. These requirements are found in the Office of Management and Budget's (OMB's)
2018-.2928 2021 Consolidated Contract Page 6 of 17
DOH CONTRACT #: CLH18247
Uniform Guidance, Title 2 Code of Federal Regulations Part 200 (2 CFR 200) - Uniform Administrative Requirements,
Cost Principles, and Audit Requirements for Federal Awards, or are included in the federal funding agency's
regulations.
16. Governing Law and Venue
The laws of the state of Washington govern this Contract. In the event of a lawsuit by the LHJ against DOH arising
under this Contract, venue shall be proper only in Thurston County, Washington. In the event of a lawsuit by DOH
against the LHJ arising under this Contract, venue shall be proper only in the county in which the LHJ is located or in
either of the two nearest judicial districts within the meaning of RCW 36.01.050.
17. Independent Capacity
The employees or agents of each party who are engaged in the performance of this Contract shall continue to be
employees or agents of that party and shall not be considered for any purpose to be employees or agents of the other
party.
18. Insurance
The LHJ certifies that it is self -insured, is a member of a risk pool, or maintains insurance coverage as required by this
Contract. Each party shall pay for losses for which it is found liable. The LHJ agrees to require all subcontractors to
maintain insurance in types and with limits as may be determined by the LHJ and/or its risk manager, unless the LHJ and
DOH agree otherwise.
19. Licensing, Accreditation and Registration
The LHJ shall comply with all applicable local, state, and federal licensing, accreditation and registration requirements
and standards, necessary for the performance of this Contract.
20. Maintenance of Records
Each party to this Contract shall maintain books, records, documents and other evidence that sufficiently and properly
reflect all direct and indirect costs expended by it. All books, records, documents, and other material relevant to this
Contract will be retained for six (6) years after expiration. If any litigation, claim or audit is started before the expiration
of the six -year period, the records shall be retained until all litigation, claims, or audit findings involving the records
have been resolved.
Each party will use reasonable security procedures and protections to assure that records and documents provided by
the other party are not erroneously disclosed to third parties. Both parties agree to continue protecting records until
such time as the information is destroyed in accordance with applicable state and federal records retention laws.
21. Modifications and Waivers
This Contract, or any term or condition, may be modified only by a written amendment signed by the DOH Contracting
Officer and the authorized representative for the LHJ. Either party may propose an amendment.
Failure or delay on the part of either party to exercise any right, power, privilege or remedy provided under this Contract
shall not constitute a waiver. No provision of this Contract may be waived by either party except in a writing signed by the
DOH Contracting Officer or the authorized representative of the LHJ.
22. No Third -Party Rights Created
This Contract, or any program hereunder, is entered into solely for the benefit of the two parties thereto and shall not
be construed as giving rise to any right, remedy or expectancy of any kind or nature on the part of any third party.
23. Nondiscrimination
During the performance of this Contract, the LHJ and DOH shall comply with all federal and state nondiscrimination laws,
regulations and policies. In the event of the LHJ's noncompliance or refusal to comply with any nondiscrimination law,
regulation or policy, this Contract may be rescinded, canceled or terminated in whole or in part, and the LHJ may be declared
2018-2028 2021 Consolidated Contract Page 7 of 17
DOH CONTRACT #: CLH18247
ineligible for further contracts with DOH. The LHJ shall, however, be given a reasonable time in which to cure this
noncompliance. Any dispute may be resolved in accordance with the "Disputes" procedure set forth herein.
24. Order of Precedence
In the event of an inconsistency in the terms of this Contract, or between its terms and any applicable statute or rule, the
inconsistency shall be resolved by giving precedence in the following order:
• Applicable state and federal statutes, and local laws, rules and regulations.
• Terms and conditions of this Contract.
• Statements of Work.
• Any other provisions of this Contract, including other materials incorporated by reference.
25. Ownership of Material/Rights in Data
Records and other documents relevant to this Contract, in any medium, furnished by one party to this Contract to the
other party, will remain the property of the furnishing party, unless otherwise agreed. Data which is delivered under
the Contract shall be transferred to DOH with a nonexclusive, royalty -free, perpetual, irrevocable license to publish,
translate, reproduce, modify, deliver, perform, dispose of, and to authorize others to do so; provided that such license
shall be limited to the extent which the LHJ has a right to grant such a license. The LHJ shall exert all reasonable effort
to advise DOH, at the time of delivery of data furnished under this Contract, of all known or potential invasions of
privacy contained therein and of any portion of such document which was not produced in the performance of this
Contract. DOH shall receive prompt written notice of each notice or claim or copyright infringement received by the
LHJ with respect to any data delivered under this Contract. DOH shall have the right to modify or remove any restrictive
markings placed upon the data by the LHJ, provided that if DOH modifies or removes such markings without the LHJ's
approval, it assumes all liability for doing so.
26. Publications
Any program reports, articles, and publications that result from information gathered through use of state and federal
funds must acknowledge receiving support from DOH and/or the appropriate federal agencies. Correspondingly, such
documents resulting from information gathered through use of local funds must acknowledge receipt of such local
support.
27. Responsibility for Actions
Each party to this Contract shall be solely responsible for the acts and omissions of its own officers, employees, and
agents in the performance of this Contract. Neither party to this Contract will be responsible for the acts and omissions
of entities or individuals not party to this Contract. DOH and the LHJ shall cooperate in the defense of tort lawsuits,
when possible.
28. Loss or Reduction of Funding
In the event funding from state, federal, or other sources is withdrawn, reduced, or limited in any way after the effective
date of this contract and prior to normal completion, DOH may elect to suspend or terminate the contract, in whole or
in part, under the "Termination for Convenience" clause with a ten (10) business day notice to LHJ, to the extent
possible, subject to renegotiation at DOH's discretion under those new funding limitations and conditions.
29. Severability
If any term or condition of this Contract is held invalid, such invalidity shall not affect the validity of the other terms or
conditions of this Contract, provided, however, that the remaining terms and conditions can still fairly be given effect.
30. Subcontracts
The LHJ may subcontract any or all of the services or other obligations specified in this Contract. The LHJ will require
the subcontractor to comply with all the applicable terms and conditions of this Contract, including all terms, conditions,
certifications and assurances. The LHJ agrees it is responsible for assuring adequate performance on the part of the
subcontractor.
2018-2020 2021 Consolidated Contract Page 8 of 17
DOH CONTRACT #: CLH18247
The parties agree that all subcontractors must be responsible for any liabilities created by their actions or omissions. In
the event DOH, LHJ, and subcontractor are found by a jury or trier of fact to be jointly and severally liable for personal
injury damages arising from any act or omission, then each entity shall be responsible for its proportionate share.
31. Subrecipient
For those activities designated as "subrecipient" on Exhibit A, Statements of Work, the LHJ must comply with
applicable federal requirements, including but not limited to OMB's Uniform Guidance at 2 CFR 200, Subparts D
(Administrative Requirements), E (Cost Principles) and F (Audit Requirements), and program specific federal
regulations. If the LHJ expends $500,000 or more in federal awards from all sources, it is responsible for obtaining
appropriate audits. If the LHJ expends $750,000 or more in federal grants or awards from all sources, it is responsible
for obtaining the required single audit.
32. Survivability
The terms and conditions contained in this Contract, which by their sense and context are intended to survive the
expiration of the Contract, shall survive. Surviving terms include, but are not limited to: Access to Records, Confidential
Information, Disputes, Responsibility for Actions, Maintenance of Records, Ownership of Material/Rights in Data,
Subcontracts, Termination for Convenience, Termination for Default, and Termination Procedure.
33. Term
This Contract will be in effect following execution by the parties from January 1, 2018 through December 31, 242-0
2021, unless terminated earlier as provided herein.
34. Termination for Convenience
Except as otherwise provided in this Contract, either party may terminate or suspend this Contract, or any program
hereunder, for convenience by providing at least thirty (30) days' advance written notice to the other party.
If DOH elects to suspend the Contract, in whole or in part, LHJ shall stop work as of the effective date of DOH's written
notice of suspension. During suspension, each Party will reasonably notify the other of any conditions that may affect
resumption of performance. Upon DOH's written notice to resume performance, LHJ shall resume work unless the
LHJ provides notice to DOH that services cannot be resumed. If LHJ cannot resume performance, the Contract or
affected Exhibit A, Statement of Work, will be deemed terminated upon the date the LHJ received notice to suspend
performance.
35. Termination for Default
(a) In the event of a default by either party under this Contract, the nondefaulting party may give written notice to the
defaulting party that it intends to terminate this Contract, or any program hereunder, if the default is not cured within
thirty (30) days of the date of the notice, or such longer period of time as may be reasonable under the circumstances.
If the default is not cured within that time, the nondefaulting party may then notify the defaulting party in writing
that this Contract is terminated. In the event of such termination, the nondefaulting party shall have all rights and
remedies available to it under general law.
(b) A disputed termination for default is expressly subject to the Disputes section of this Contract.
36. Termination Procedure
Upon termination DOH may require the LHJ to deliver to DOH any non-LHJ-owned equipment, data, or other property
specifically produced or acquired for the performance of such part of this Contract as has been terminated.
DOH shall pay to the LHJ the agreed upon price, if separately stated, for completed work and services accepted by
DOH. In addition DOH shall pay the amount determined by DOH's Contracting Officer for (a) completed work and
services for which no separate price is stated, (b) partially completed work and services, (c) other property or services
which are accepted by DOH, and (d) the protection and preservation of the property. Disagreement by the LHJ with
the determination of DOH's Contracting Officer that relates to the obligations or amounts due to the LHJ shall be
considered a dispute within the meaning of the "Disputes" clause of this Contract.
2018-2029 2021 Consolidated Contract Page 9 of 17
DOH CONTRACT #: CLH 18247
DOH may withhold from any amounts due the LHJ for such completed work or services such sum as DOH's Contracting
Officer reasonably determines to be necessary to protect DOH against potential loss or liability.
The rights and remedies of DOH provided in this section shall not be exclusive and are in addition to any other rights
and remedies provided by law or under this Contract.
After receipt of a written notice of termination, the LHJ shall:
• Stop work under the Contract on the date and to the extent specified in the notice;
• Place no further orders or subcontracts for materials, services, or facilities, except as necessary to complete such
portion of the work not terminated;
• Assign to DOH, to the extent reasonably directed by DOH's Contracting Officer and to the extent that the LHJ
has the legal right to do so, all of the right, title, and interest of the LHJ under the orders and subcontracts in
which case DOH has the right, at its reasonable discretion, to settle or pay any or all claims arising out of the
termination of such orders and subcontracts.
• Settle all outstanding liabilities and all claims arising out of orders or subcontracts, with the approval or
ratification of DOH's Contracting Officer to the extent he/she may reasonably require, which approval or
ratification shall be final for all the purposes of this clause;
• Transfer title to DOH and deliver, as reasonably directed by DOH's Contracting Officer, any property which, if
the Contract had been completed, would have been required to be furnished to DOH;
• Complete performance of such part of the work not terminated by DOH's Contracting Officer; and,
• Take such action as may be necessary, or as DOH's Contracting Officer may reasonably direct, for the protection
and preservation of the property related to this Contract which is in the possession of the LHJ, or its
subcontractors, and in which DOH has or may acquire an interest.
IN WITNESS WHEREOF, the parties have executed this Contract.
JEFFERSON COUNTY PUBLIC HEALTH STATE OF WASHINGTON
DEPARTMENT OF HEALTH
Signature
Title:
Print Name:
Date:
Signature
Title:
Print Name:
Date:
2018-2029 2021 Consolidated Contract Page 10 of 17
DOH CONTRACT #: CLH18247
Standard Federal Certifications and Assurances
Following are the Assurances, Certifications, and Special Conditions that apply to all federally -funded (in whole or in part)
agreements administered by the Washington State Department of Health.
CERTIFICATIONS
1. CERTIFICATION REGARDING DEBARMENT AND SUSPENSION
The undersigned (authorized official signing for the contracting organization) certifies to the best of his or her
knowledge and belief, that the contractor, defined as the primary participant in accordance with 45 CFR Part 76, and
its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
covered transactions by any Federal Department or agency;
Have not within a 3-year period preceding this contract been convicted of or had a civil judgment rendered against
them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or
performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of
Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
B. Are not presently indicted or otherwise criminally or civilly charged by a governmental entity (Federal, State, or
local) with commission of any of the offenses enumerated in paragraph (b) of this certification; and
C. Have not within a 3-year period preceding this contract had one or more public transactions (Federal, State, or
local) terminated for cause or default.
Should the contractor not be able to provide this certification, an explanation as to why should be placed after the
assurances page in the contract.
The contractor agrees by signing this contract that it will include, without modification, the clause titled Certification
Regarding Debarment, Suspension, In eligibility, and Voluntary Exclusion --Lower Tier Covered Transactions in all
lower tier covered transactions (i.e., transactions with sub- grantees and/or contractors) and in all solicitations for lower
tier covered transactions in accordance with 45 CFR Part 76.
2. CERTIFICATION REGARDING DRUG -FREE WORKPLACE REQUIREMENTS
The undersigned (authorized official signing for the contracting organization) certifies that the contractor will, or will
continue to, provide a drug -free workplace in accordance with 45 CFR Part 76 by:
A. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession
or use of a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be
taken against employees for violation of such prohibition;
B. Establishing an ongoing drug -free awareness program to inform employees about:
1) The Dangers of drug abuse in the workplace;
2) The contractor's policy of maintaining a drug -free workplace;
3) Any available drug counseling, rehabilitation, and employee assistance programs; and
4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;
C. Making it a requirement that each employee to be engaged in the performance of the contract be given a copy of
the statement required by paragraph 1) above;
2018-202 2021 Consolidated Contract Page 11 of 17
DOH CONTRACT #: CLH18247
D. Notifying the employee in the statement required by paragraph 1), above, that, as a condition of employment
under the contract, the employee will:
1) Abide by the terms of the statement; and
2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring
in the workplace no later than five calendar days after such conviction;
E. Notifying the agency in writing within ten calendar days after receiving notice under paragraph D. 2) from an
employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must
provide notice, including position title, to every contract officer or other designee on whose contract activity the
convicted employee was working, unless the Federal agency has designated a central point for the receipt of such
notices. Notice shall include the identification number(s) of each affected grant;
F. Taking one of the following actions, within 30 calendar days of receiving notice under paragraph D. 2) with
respect to any employee who is so convicted:
1) Taking appropriate personnel action against such an employee, up to and including termination, consistent
with the requirements of the Rehabilitation Act of 1973, as amended; or
2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program
approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate
agency;
G. Making a good faith effort to continue to maintain a drug -free workplace through implementation of paragraphs
(A), (B), (C), (D), (E), and (F).
For purposes of paragraph (E) regarding agency notification of criminal drug convictions, DOH has designated
the following central point for receipt of such notices:
Compliance and Internal Control Officer
Office of Grants Management
WA State Department of Health
PO Box 47905
Olympia, WA 98504-7905
3. CERTIFICATION REGARDING LOBBYING
Title 31, United States Code, Section 1352, entitled "Limitation on use of appropriated funds to influence certain
Federal contracting and financial transactions," generally prohibits recipients of Federal grants and cooperative
agreements from using Federal (appropriated) funds for lobbying the Executive or Legislative Branches of the Federal
Government in connection with a SPECIFIC grant or cooperative agreement. Section 1352 also requires that each
person who requests or receives a Federal grant or cooperative agreement must disclose lobbying undertaken with
non -Federal (nonappropriated) funds. These requirements apply to grants and cooperative agreements EXCEEDING
$100,000 in total costs (45 CFR Part 93).
The undersigned (authorized official signing for the contracting organization) certifies, to the best of his or her
knowledge and belief, that:
A. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person
for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer
or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any
Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal
contract, grant, loan, or cooperative agreement.
B. If any funds other than Federally appropriated funds have been paid or will be paid to any person for influencing
or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee
of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or
cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying
2018-2028 2021 Consolidated Contract Page 12 of 17
DOH CONTRACT #: CLH18247
Activities," in accordance with its instructions. (If needed, Standard Form-LLL, "Disclosure of Lobbying
Activities," its instructions, and continuation sheet are included at the end of this application form.)
C. The undersigned shall require that the language of this certification be included in the award documents for all
subcontracts at all tiers (including subcontracts, subcontracts, and contracts under grants, loans and cooperative
agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made
or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed
by Section 1352, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty
of not less than $10,000 and not more than $100,000 for each such failure.
4. CERTIFICATION REGARDING PROGRAM FRAUD CIVIL REMEDIES ACT (PFCRA)
The undersigned (authorized official signing for the contracting organization) certifies that the statements herein are
true, complete, and accurate to the best of his or her knowledge, and that he or she is aware that any false, fictitious,
or fraudulent statements or claims may subject him or her to criminal, civil, or administrative penalties. The
undersigned agrees that the contracting organization will comply with the Public Health Service terms and conditions
of award if a contract is awarded.
5. CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE
Public Law 103-227, also known as the Pro -Children Act of 1994 (Act), requires that smoking not be permitted in
any portion of any indoor facility owned or leased or contracted for by an entity and used routinely or regularly for
the provision of health, day care, early childhood development services, education or library services to children under
the age of 18, if the services are funded by Federal programs either directly or through State or local governments, by
Federal grant, contract, loan, or loan guarantee. The law also applies to children's services that are provided in indoor
facilities that are constructed, operated, or maintained with such Federal funds. The law does not apply to children's
services provided in private residence, portions of facilities used for inpatient drug or alcohol treatment, service
providers whose sole source of applicable Federal funds is Medicare or Medicaid, or facilities where WIC coupons
are redeemed.
Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to
$1,000 for each violation and/or the imposition of an administrative compliance order on the responsible entity.
By signing the certification, the undersigned certifies that the contracting organization will comply with the
requirements of the Act and will not allow smoking within any portion of any indoor facility used for the provision
of services for children as defined by the Act.
The contracting organization agrees that it will require that the language of this certification be included in any
subcontracts which contain provisions for children's services and that all subrecipients shall certify accordingly.
The Public Health Services strongly encourages all recipients to provide a smoke -free workplace and promote the
non-use of tobacco products. This is consistent with the PHS mission to protect and advance the physical and mental
health of the American people.
6. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY
MATTERS - INSTRUCTIONS FOR CERTIFICATION
By signing and submitting this proposal, the prospective contractor is providing the certification set out below.
A. The inability of a person to provide the certification required below will not necessarily result in denial of
participation in this covered transaction. The prospective contractor shall submit an explanation of why it cannot
provide the certification set out below. The certification or explanation will be considered in connection with the
department or agency's determination whether to enter into this transaction. However, failure of the prospective
contractor to furnish a certification or an explanation shall disqualify such person from participation in this
transaction.
2018 2028 2021 Consolidated Contract Page 13 of 17
DOH CONTRACT #: CLH18247
B. The certification in this clause is a material representation of fact upon which reliance was placed when the
department or agency determined to enter into this transaction. If it is later determined that the prospective
contractor knowingly rendered an erroneous certification, in addition to other remedies available to the Federal
Government, the department or agency may terminate this transaction for cause of default.
C. The prospective contractor shall provide immediate written notice to the department or agency to whom this
contract is submitted if at any time the prospective contractor learns that its certification was erroneous when
submitted or has become erroneous by reason of changed circumstances.
D. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person,
primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the
meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You
may contact the person to whom this contract is submitted for assistance in obtaining a copy of those regulations.
E. The prospective contractor agrees by submitting this contract that, should the proposed covered transaction be
entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred,
suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless
authorized by DOH.
F. The prospective contractor further agrees by submitting this contract that it will include the clause titled
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -- Lower Tier Covered
Transaction, provided by HHS, without modification, in all lower tier covered transactions and in all solicitations
for lower tier covered transactions.
G. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier
covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered
transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency
by which it determines the eligibility of its principals. Each participant may, but is not required to, check the
Nonprocurement List (of excluded parties).
H. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to
render in good faith the certification required by this clause. The knowledge and information of a participant is
not required to exceed that which is normally possessed by a prudent person in the ordinary course of business
dealings.
I. Except for transactions authorized under paragraph 6. of these instructions, if a participant in a covered transaction
knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or
voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal
Government, DOH may terminate this transaction for cause or default.
7. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY
MATTERS - PRIMARY COVERED TRANSACTIONS
A. The prospective contractor certifies to the best of its knowledge and belief, that it and its principals:
1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded
from covered transactions by any Federal department or agency;
2) Have not within a three-year period preceding this contract been convicted of or had a civil judgment rendered
against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain,
or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of
Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
3) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal,
State or local) with commission of any of the offenses enumerated in paragraph 1. B. of this certification; and
4) Have not within a three-year period preceding this contract had one or more public transactions (Federal,
State or local) terminated for cause or default.
2018-202 2021 Consolidated Contract Page 14 of 17
DOH CONTRACT #: CLH18247
Where the prospective contractor is unable to certify to any of the statements in this certification, such prospective
contractor shall attach an explanation to this contract.
AUTHORIZED SIGNATURE REQUIRED
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
TITLE
PLEASE PRINT OR TYPE NAME:
ORGANIZATION NAME: (if applicable)
DATE
2018-2028 2021 Consolidated Contract Page 15 of 17
DOH CONTRACT #: CLH18247
Federal Assurances — Non -Construction Programs
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection
of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork
Reduction Project (0348-0040), Washington, DC 20503
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND
BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact
the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional
assurances. If such is the case, you will be notified.
As the duly authorized representative of the contractor, I certify that the contractor:
1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability
(including funds sufficient to pay the non -Federal share of project cost) to ensure proper planning, management, and
completion of the project described in this application.
2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any
authorized representative, access to and the right to examine all records, books, papers, or documents related to the
award; and will establish a proper accounting system in accordance with generally accepted accounting standards or
agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the
appearance of personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. ❑ ❑4728-4763) relating to prescribed
standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of
OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of
the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin;
(b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. 1 11681-1683, and 1685-1686), which
prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C.
1 1794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended
(42 U.S.C.- ❑ 6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment
Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive
Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended,
relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) ❑ ❑ 523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. 1 11 1 290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug
abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. 1 13601 et seq.), as amended, relating to
nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific
statute(s) under which application for Federal assistance is being made; and 0) the requirements of any other
nondiscrimination statute(s) which may apply to the application.
7. Will comply, or has already complied, with the requirements of Titles II and III of the uniform Relocation Assistance
and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of
persons displaced or whose property is acquired as a result of Federal or federally assisted programs. These requirements
apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases.
2018-2022021 Consolidated Contract Page 16 of 17
DOH CONTRACT #: CLH18247
8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. --1501-1508 and 7324-7328) which limit
the political activities of employees whose principal employment activities are funded in whole or in part with Federal
funds.
9. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C. I I 276a to 276a-7), the Copeland
Act (40 U.S.C. 11276c and 18 U.S.C. 111 1874) and the Contract Work Hours and Safety Standards Act (40 U.S.C. 1
327-333), regarding labor standards for federally assisted construction subagreements.
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the
program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and
Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of
project consistency with the approved State management program developed under the Coastal Zone Management Act
of 1972 (16 U.S.C. 1 11451 et seq.); (f) conformity of Federal actions to State (Clear Air) Implementation Plans under
Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. 1 1 7401 et seq.); (g) protection of underground
sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection
of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205).
12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. -1721 et seq.) related to protecting components
or potential components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of
1966, as amended (16 U.S.C. 1 1470), EO 11593 (identification and protection of historic properties), and the
Archaeological and Historic Preservation Act of 1974 (16 U.S.C. I I 469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related
activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. U_2131 et seq.)
pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities
supported by this award of assistance.
16. Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. - ❑4801 et seq.) which prohibits the use
of lead -based paint in construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act
Amendments of 1996 and OMB Uniform Guidance at 2 CFR 200, Subpart F.
18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies
governing this program.
AUTHORIZED SIGNATURE REQUIRED
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
TITLE
PLEASE PRINT OR TYPE NAME
ORGANIZATION NAME (if applicable)
DATE
2018-.2020 2021 Consolidated Contract Page 17 of 17
JEFFERSON COUNTY PUBLIC HEALTH
2018-2021 CONSOLIDATED CONTRACT #CLH18247
EXHIBIT A - STATEMENTS OF WORK
TABLE OF CONTENTS
DOH Program Name or Title: Division of Emergency Preparedness & Response PHEP - Effective July 1, 2020................................
DOH Program Name or Title: Infectious Disease Prevention Section (IDPS) - Effective July 1, 2020..................................................
DOH Program Name or Title: Maternal & Child Health Block Grant- Effective January 1, 2018.........................................................
DOH Program Name or Title: OICP-Promotion of Immunizations to Improve Vaccination Rates - Effective July 1, 2020 .................
AMENDMENT # 18
........................................... 2
......................................... 11
......................................... 13
......................................... 19
Exhibit A, Statements of Work Page 1 of 20 Contract Number CLH18247-18
Revised as of September 15, 2020
Exhibit A
Statement of Work
Contract Term: 2018-2021
DOH Program Name or Title: Division of Emereencv Preparedness & Response
PHEP -Effective July I.2020
AMENDMENT # 18
Local Health Jurisdiction Name: Jefferson County Public Health
Contract Number: CLH18247
SOW Type: Revision Revision # (for this SOW) 1 Funding Source Federal Compliance T pe of Payment
® Federal Subrecipient (check if applicable) Reimbursement
Period of Performance: July I.2020 through June 30, 2021 ❑ State ® FFATA (Transparency Act) ❑ Fixed Price
❑ Other ❑ Research & Develo ment
Statement of Work Purpose: The purpose of this statement of work is to establish funding and tasks to support and sustain LHJ public health emergency preparedness as part of
statewide public health emergency preparedness and response.
Revision Purpose: The purpose of this revision is to extend the period of performance, add the remainder of the annual allocation, add an end -of -year report, revise the budget
due date, add a training and exercise task, and remove activities no longer required.
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
FFY20 PHEP BP2 LHJ Funding
93.069
333.93.06
1 31102280
07/01/20 06/30/21
20,630
13,754
34,384
TOTALS
20,630
13,754
34,394
Task
Number
Task/Activity/Description
*May Support PHAB
Staadards/Measures
Deliverables/Outcomes
Due Date/Time
Frame
Payment
Information and/or
Amount
1
Across Domains and Capabilities
Mid -year report on template
December 31, 2020
Reimbursement for
provided by DOH.
actual costs not to
Complete reporting templates as requested by
exceed total funding
DOH to comply with program and federal grant
End -of -year report on template
June 30, 2021
consideration amount.
requirements, including mid -year and end -of -year
provided by DOH.
reports.
Additional reporting may be
required if federal requirements
change.
2
Across Domains and Capabilities
DOH will maintain documentation
Upon request.
of evaluation participation.
Participate in an evaluation of LHJ response
capabilities, upon request from DOH.
Exhibit A, Statements of Work Page 2 of 20 Contract Number CLH18247-18
Revised as of September 15, 2020
AMENDMENT # 18
Task
Task/Activity/Description
*May Support PHAB
Deliverables/Outcomes
Due Datc/Time
Payment
Information and/or
Number
StaudardarMeasures
Frame
Amount
3
Across Domains and Capabilities
Budget, using template provided
o,...,..2
by DOH.
Develop a budget demonstrating how the LHJ
Upon request from
plans to spend funds during this period of
DOH.
performance, using a budget template provided by
DOH.
Note: 20% of the LHJ's annual allocation will be
withheld until this requirement is met. Failure to
meet this requirement may result in DOH
redirecting funds from the LHJ.
4
Across Domains and Capabilities
Mid -year report on template
December 31, 2020
provided by DOH.
Review and provide input to DOH on public health
emergency preparedness plans developed by DOH,
End -of -year report on template
June 30, 2021
upon request from DOH.
provided by DOH.
Input provided to DOH upon
request from DOH.
5
Domain 1 Community Resilience
Mid -year report on template
December 31, 2020
Capability 1 Community Preparedness
provided by DOH.
Participate in emergency preparedness events (for
End -of -year report on template
June 30, 2021
example, trainings, meetings, conference calls, and
provided by DOH.
conferences) to advance LHJ, regional, or
statewide public health preparedness.
Documentation of training
available upon request.
6
Domain 2 Incident Management
Mid -year report on template
December 31, 2020
Capability 3 Emergency Operations Coordination -
provided by DOH.
Training & Exercise
End -of -year report on template
June 30, 2021
Based on availability of training, participate in at
provided by DO//.
least one Foundational Public Health Emergency
Preparedness Training provided by region, DOH,
DOH -contracted partner, or DOH -approved trainer
in person or via webinar.
Notes:
• For some LHJs this training won't be available
until the next Statement of Work period,
Jan1 — June 30, 2021. DOH will work
Exhibit A, Statements of Work Page 3 of 20 Contract Number CLH18247-18
Revised as of September 15, 2020
AMENDMENT # 18
Task
Task/Activity/Description
*May Support PHAB
Deliverables/Outcomes
Due Date/Time
Payment
Information and/or
Number
Standatds/Mcasum
Frame
Amount
with regions and LHJs to customize and
schedule training(s).
• This is one or more specific trainings
coordinated by DOH. DOH will work with
LHJ to implement.
• Participation in an activation, exercise or real -
world event may be considered additional
training, but does not take the place of the
requirement to participate in at least one
training as described above.
7
Domain 2 Incident Management
LHJ performance measure data
October 30, 2020
Capability 3 Emergency Operations Coordination -
(PM 2)
Training & Exercise
Gather and submit data for LHJ performance
measure (PM) 2: Percent of public health and
medical responders who are trained on their role
during a public health response.
Note: DOH will provide additional guidance about
submitting performance measure data.
8
Domain 2 Incident Management
LERCs & RERCs -
December 31, 2020
Capability 3 Emergency Operations Coordination -
Mid -year report on template
Training & Exercise
provided by DOH.
8.1 Review LHJ public health preparedness and
End -of -year report on template
June 30, 2021
response capabilities and identify gaps, priorities,
provided by DOH.
and training needs.
8.2 Input into Regional Training &
8.2 As requested by
8.2 Provide input to Regional Emergency
Exercise Plan and Training &
RERCs.
Response Coordinators (RERCs) for Regional
Exercise Planning Workshop
Training & Exercise Plan and Training & Exercise
Guide provided to RERCs.
8.3 As requested by
Planning Workshop Guide.
DOH.
8.3 Participate in Integrated Preparedness
Planning Workshop unless cancelled.
Note: LHJ may opt to develop, update and
maintain a local Training & Exercise Plan. They
still need to participate in regional process
described above.
Exhibit A, Statements of Work Page 4 of 20 Contract Number CLH18247-18
Revised as of September 15, 2020
AMENDMENT # 18
Task
Task/Activity/Description
PH
*May Support PIIAB'
Deliverables/Outcomes
Due Date/Time
payment
Information and/or
Number
standards/measures 1'rt
es
Frame
Amount
9
Domain 2 Incident Management
LHJ performance measure data
October 30, 2020
Capability 3 Emergency Operations Coordination
(PM 3) will be due June 30, 2021.
Gather and submit data for LHJ performance
measure 3: Percent of Corrective Action Plan items
completed by due date.
Notes:
• Develop corrective action plans following the
Homeland Security Exercise and Evaluation
Program (I ISEEP).
• DOH will provide additional guidance about
submitting performance measure data.
10
Domain 2 Incident Management
LHJ performance measure data
October 30, 2020
Capability 3 Emergency Operations Coordination
(PM 1)
Gather and submit data for LHJ performance
measure 1: Amount of time (in minutes) to
mobilize a public health and medical response.
Notes:
• "Mobilize a response" is defined as the first
verbal briefing of the response team from the
initial notification to the public health
responders in the area.
• The target is to mobilize a response within 45
minutes.
• DOH will provide additional guidance about
submitting performance measure data.
11
Domain 2 Incident Management
Mid -year report on template
December 31, 2020
Capability 3 Emergency Operations Coordination
provided by DOH. Indicate that
this was done or that no response
11.1 Provide immediate notification to DOH Duty
incident occurred.
Officer at 360-888-0838 or hanalertna,doh.wa.eov
for all response incidents involving use of
End -of -year report on template
June 30, 2021
emergency response plans and/or incident
provided by DOH. Indicate that
command structures.
this was done or that no response
incident occurred
Exhibit A, Statements of Work Page 5 of 20 Contract Number CLH18247-18
Revised as of September 15, 2020
AMENDMENT # 18
Task
Number
Task/Activity/Description
*May Support PHAB
Standards/11 usures
Deliverables/Outcomes
Due Daterrime
Frame
Payment
Information and/or
Amount
11.2 Produce and provide situation reports (sitreps)
11.1 Notification to DOH Duty
documenting LHJ activity during all incidents.
Officer within 60 minutes of
Sitrep may be developed by the LHJ or another
activation.
jurisdiction that includes input from LHJ.
11.2 Sitreps submitted to DOH
Duty Officer
12
Domain 3 Information Management
Mid -year report on template
December 31, 2020
Capability 4 Emergency Public Information and
provided by DOH.
Warning - Communication
End -of -year report on template
June 30, 2021
12.1 Participate in Monthly Public Health
provided by DOH.
Communicator Call/Webinar by joining
call/webinar and/or following information on
12.3 and 12.4 Hotwash or After
Basecamp.
Action Review (AAR) OR
summary of communication
12.2 Participate in Mess ane ris# communication
activities and one sample.
drill offered by DOH
June 0 2021. Drill will occur via webinar, phone
and email. DOH will offer one in Juh,1
n,.,.... bep 31, 2020 Gird one drill between
January 31 —June 30, 2021.
12.3 Conduct a hot wash evaluating LHJ
participation in the drill.
12.4 Identifying and implementing communication
strategies in real world incident will satisfy need to
participate in drill. Conduct a hot wash or After
Action Review (AAR) evaluating LHJ
participation in communication strategies during
the incident. 1f, the real world event response is
ongoing, LHJ may opt to conduct a hot wash or
AAR evaluating communication strategies to date,
OR include a summary of communication activities
in mid -year and/or end -of year reports and one
sample of communication.
Note: Participation in a real world event may meet
the requirement for 12.2, 12.2 and 12.4.
Exhibit A, Statements of Work Page 6 of 20 Contract Number CLH18247-18
Revised as of September 15, 2020
AMENDMENT # 18
Task
Number
Task/Activity/Description
*May Support PH"
Stxuda�,as/1►leasureu
Deliverables/Outcomes
Due Date/Time
Frame
Payment
Information and/or
Amount
13
Domain 3 Information Management
LHJ performance measure data
October 30, 2020
Capability 4 Emergency Public Information and
(PM 7)
Warning
Gather and submit data for LHJ performance
measure 7: Amount of time to identify and
implement communication strategies during a
response or exercise.
Notes:
• The target is within the first six hours.
• DOH will provide additional guidance about
submitting performance measure data
14
Domain 3 Information Management
Mid -year report on template
December 31, 2020
Capability 6 Information Sharing
provided by DOH.
14.1 Maintain Washington Secure Electronic
End -of -year report on template
June 30, 2021
Communications, Urgent Response and Exchange
provided by DOH.
System (WASECURES) as primary notification
system.
.14. 1 C,9. ,.L,,.r alf 1p......,,,,, i LJ, 6h44 ,... mg LHJ
Notes:
• Registered users must log in quarterly at a
minimum.
• DOH will provide technical assistance to LHJs
on using WASECURES.
• LHJ may choose to use another notification
system in addition to WASECURES to alert
staff during incidents.
Exhibit A, Statements of Work Page 7 of 20 Contract Number CLH 18247-18
Revised as of September 15, 2020
AMENDMENT # 18
Task
Number
Task/Activity/Description
*May Support l°I3AB
StandSupp 1'rtPH es
Deliverables/Outcomes
Due Date/Time
Frame
Payment
Information and/or
Amount
15
Domain 3 Information Management
Provide EEIs upon request.
Upon request.
Capability 6 Information Sharing
Note in the mid -year and end -of-
December 31, 2020
Provide Essential Elements of Information (EEIs)
year reports that EEIs were
during incident response upon request from DOH
provided or none were requested.
June 30, 2021
Note: DOH will request specific data elements
from the LHJ during an incident response, as
needed to inform decision making by DOH and
state leaders, as well as federal partners when
requested.
16
Domain 4 Countermeasures and Mitigation
Report progress and/or plans in
December 31, 2020
Capability 8 Medical Countermeasures Dispensing
mid -year report on template
Capability 9 Medical Countermeasures
provided by DOH.
Management and Distribution
End -of -year report on template
June 30, 2021
Update and maintain Medical Countermeasure
provided by DOH.
(MCM) Plans for LHJ and/or Region.
If there is a regional plan, provide
Notes:
input to the RERC upon request.
• MCM plans include number of local
distribution sites and number for which a
Updated MCM plans wild be due
detailed point-to-point distribution plan from
June 30, 2021.
RSS to distribution site has been jointly
confirmed by LHJ and DOH. (LHJ PM 4)
• MCM plans include number of local points of
dispensing (PODS) and number for which a
detailed point-to-point distribution plan from
local distribution site to dispensing site has been
jointly confirmed by LHJ and POD operator
(nursing home, local agency, public POD, and
independent pharmacy). (LHJ PM 5)
• LHJs are not required to maintain a hub. LHJs
may partner with other organizations to
centralize distribution. If LHJs opt to maintain a
hub, this should be included in the MCM plan.
• DOH will provide technical assistance to LHJs
on core elements of an MCM plan.
Exhibit A, Statements of Work Page 8 of 20 Contract Number CLH 18247-18
Revised as of September 15, 2020
AMENDMENT # 18
Task
Number
Task/Activity/Description
*May Support PHAB
upp
Stay Srt Standards/Measures
Deliverables/Outcomes
Due Date/Time
Frame
payment
Information and/or
Amount
• LHJ Performance Measure data will be due
October 30, 2020. DOH will gather data for
PMs 4 and 5.
17
Domain 5 Surge Management
Mid -year report on template
December 31, 2020
Capability 10 Medical Surge
provided by DOH.
Engagement with regional Health Care Coalition
End -of -year report on template
June 30, 2021
(HCC)
provided by DOH.
Participate in:
At least one regional HCC meeting, in
person or virtually.
The information sharing process during
incidents.
At least one planning process or exercise
conducted to inform on the roles and
responsibilities of public health.
Reviewing HCC plans for alignment with
local ESF8 plans.
Note: This task doesn't need to be completed until
June 30, 2021. LHJs may begin work in this
Statement of Work period, or may opt to do all the
work in the next Statement of Work period.
18
Domain 5 Surge Management
LHJ performance measure data
October 30, 2020
Capability 10 Medical Surge
(PM 8).
Gather and submit data for LHJ performance
measure 8: Percent of Critical Healthcare Facilities
whose functional status can be assessed by the
local jurisdiction in an emergency.
Notes:
• "Critical Healthcare Facilities" are hospitals,
skilled nursing facilities, blood centers, and
dialysis centers.
• DOH will provide additional guidance about
submitting rformance measure data.
Exhibit A, Statements of Work Page 9 of 20 Contract Number CLH18247-18
Revised as of September 15, 2020
AMENDMENT # 18
*For Information Only:
Funding is not tied to the revised Standards/Measures listed here. This information maybe 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:
htto://www.ohaboard.org/wo-content/uDloadsiPf AB-Standards-and-Measures-Version-1.O.odf
Program Specific Reauirements/Narrative
Any subcontract/s must be approved by DOH prior to executing the contract/s.
Deliverables are to be submitted to the ConCon deliverables mailbox at concondeliverables r wa. gov- unless otherwise WWified.
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,g`v by DOH as required by P.L. 109-282.
Restrictions on Fmkb (what fYteds can be used for which activities, not direct payments, etc)
Please reference the Code of Federal Regulations:
https://www.ecfr. gov/cgi-bin/retrieveECFRygp=1&SID=58ffddb5363a27f26e9dl2ccec462549&tv=HTML&h=L&mcrtrue&r—PART&n=ot2.1.200#se2.1.200 1439
DOH Program Contact
Tory Henderson, Contracts and Finance Specialist
Division of Emergency Preparedness and Response
Department of Health
P O Box 47960, Olympia, WA 98504-7960
Desk 360-236-4596 / Mobile 360-789-7262
tore. henderson(a)doh. wa. gov
Exhibit A, Statements of Work Page 10 of 20 Contract Number CLH18247-18
Revised as of September 15, 2020
AMENDMENT # 18
Exhibit A
Statement of Work
Contract Term: 2018-2021
DOH Program Name or Title: Infectious Disease Prevention Section (IDPSI - Local Health Jurisdiction Name: Jefferson County Public Health
Effective July 1.2020
Contract Number: CLH18247
SOW Type: Revision Revision It (for this SOW) 1 Funding Source Federal Compliance T pe of Payment
El Federal <Select One> (check if applicable) 61 Reimbursement
Period of Performance: July 1, 2020 through June 30, 2021 ® State ❑ FFATA (Transparency Act) ❑ Fixed Price
❑ Other ❑ Research & Develo ment
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: The purpose of this revision is to extend the period of performance and funding from December 31, 2020 to June 30, 2021 and add funding.
Chart of Accounts Program Name or Title
CFDA #
BARS
Master
Funding Period
Current
Change
Total
Revenue
Index
(LHJ Use Only)
Consideration
Consideration
Code
Code
1
Start Date End Date
Increase (+)
STATE DRUG USER HEALTH PROGRAM
N/A
334.04.91
12405100
1 07/01/20 06/30/21
7,500
7,500
15,000
TOTALS
7,500
7,500
159000
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
S7.500 515,000 — MI
Program (SSP)
Program (SSP) to people who use drugs
for each of the SSP deliverables.
Infectious Disease (ID)
12405100 —
(PWUD). This plan of action is directed to
Reporting Requirements
State Drug User Health
distribute syringes to communities that use drugs to
Enter SSP deliverable data into database
prevent transmission of infectious disease. SSP
for tracking SSP activities by the 15th of
S7,, 500 $15, 000 for 07/01 /20-
programs will operate during scheduled hours to
each month following service.
"4'"4 06i30i21
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 maybe 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 ohaboard orpL-contenduoloads/PHAB-Standards-and-Measures-Version-1 0 odf
Exhibit A, Statements of Work Page 11 of 20 Contract Number CLH18247-18
Revised as of September 15, 2020
AMENDMENT # 18
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 Jidv 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 Al 9-IA invoice vouchers for amounts billable to DOH under this statement of work.
All A19-IA invoice vouchers must be submitted by the 251 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
A' wd w u _: •- - Tim Candela 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 ; 3579/Fax:360-664-2216 360-236-3351/Fax:360-664-2216
Abby. Gil Iilandna doh.wa.aov
Timothy.Candela@ oh.wa.gov
Exhibit A, Statements of Work Page 12 of 20 Contract Number CLH18247-18
Revised as of September 15, 2020
Exhibit A
Statement of Work
Contract Term: 2018-2021
DOH Program Name or Title: Maternal & Child Health Block Grant -
Effective January 1.2018
AMENDMENT # 18
Local Health Jurisdiction Name: Jefferson County Public Health
Contract Number: CLH18247
SOW Type: Revision Revision # (for this SOW) 4 Funding Source Federal Compliance TRpe of Payment
® Federal Subrecipient (check if applicable) ® Reimbursement
Period of Performance: January 1.2018 through September 30.2021 El State ® FFATA (Transparency Act) El Fixed Price
❑ Other ❑ Research & Development
Statement of Work Purpose: The purpose of this statement of work is to support local interventions that impact the target population of the Maternal and Child Health Block
Grant.
Revision Purpose: The purpose of this revision is to provide additional funding, add activities and deliverable due dates, and extend the period of performance and funding from
September 30, 2020 to September 30, 2021 for continuation of MCHBG-related activities.
Chart of Accounts Program Name or Title
CFDA #
BARS
Revenue
Code
Master
Index
Code
Funding Period
(LHJ Use Only)
Start late End Date
Current
Consideration
Change
Increase (+)
Total
Consideration
FFY18 MCHBG LHJ CONTRACTS
93.994
333.93.99
78120281
01/O1/18
09/30/18
27,525
0
27,525
FFY19 MCHBG LHJ CONTRACTS
93.994
333.93.99
78120291
10/O1/18
09/30/19
36,700
0
36,700
FFY20 MCHBG LHJ CONTRACTS
93.994
333.93.99
78120292
10/01/19
09/30/20
36,700
0
36,700
FFY21 MCHBG LHJ CONTRACTS
93.994
333.93.99
1 78120293
1 10/01/20
09/30/11
0
1 36,700
1 36,700
TOTALS
100,925
1 36,700
1 137,625
Task
Task/Activity/Description
* ��
Deliverables/Outcomes
Due Date/Time Frame
Payment
Information and/or
Number
Amount
Maternal and Child Health Block Grant (MCHBG) Administration
la
Participate in calls, at a minimum of every
Designated LHJ staff will participate
September 30, 2018
Reimbursement for
quarter, with DOH contract manager. Dates and
in contract management calls.
September 30, 2019
actual costs, not to
time for calls are mutually agreed upon between
September 30, 2020
exceed total funding
DOH and LHJ
consideration.
lb
Report actual expenditures for October 1, 2017
Submit actual expenditures using the
May 26, 2018
Action Plan and
through March 31, 2018
MCHBG Budget Workbook to DOH
Progress Reports
contract manager
must only reflect
Exhibit A, Statements of Work Page 13 of 20 Contract Number CLH18247-18
Revised as of September 15, 2020
AMENDMENT # 18
Task
Task/Activity/Description
Deliverables/Outcomes
Due Date/Time Frame
Payment
Information and/or
Number
Amount
lc
Develop 2018-2019 MCHBG Budget Workbook
Submit MCHBG Budget Workbook
September 5, 2018
activities paid for
for October 1, 2018 through September 30, 2019
to DOH contract manager
with funds provided
using DOH provided template.
in this statement of
work for the
specified funding
Id
Report actual expenditures for October 1, 2018
Submit actual expenditures using the
May 24, 2019
period.
through March 31, 2019
MCHBG Budget Workbook to DOH
contract manager.
See Program
Specific
Requirements and
le
Develop 2019-2020 MCHBG Budget Workbook
Submit MCHBG Budget Workbook
September 5, 2019
Special Billing
for October 1, 2019 through September 30, 2020
to DOH contract manager
Requirements.
using DOH provided template.
if
Report actual expenditures for October 1, 2017
Submit actual expenditures using the
November 30, 2018
through September 30, 2018
MCHBG Budget Workbook to DOH
contract manager.
lg
Participate in DOH sponsored MCHBG fall
Designated LHJ staff will attend
September 30, 2020
regional meeting.
regional meeting.
lh
Report actual expenditures for October 1, 2018
Submit actual expenditures using the
December 6, 2019
through September 30, 2019
MCHBG Budget Workbook to DOH
contract manager.
li
Develop 2020-2021 MCHBG Budget Workbook
Submit MCHBG Budget Workbook
September 6, 2020
for October 1, 2020 through September 30, 2021
to DOH contract manager
using DOH provided template.
1 j
Report actual expenditures for the six month
Submit actual expenditures using the
May 22, 2020
period from October 1, 2019 through March 31,
MCHBG Budget Workbook to DOH
2020
contract manager.
Exhibit A, Statements of Work Page 14 of 20 Contract Number CLH18247-18
Revised as of September 15, 2020
AMENDMENT # 18
Task
Number
Task/Activity/Description
*Maysapport PHAB
$tandtirda/Measures
Deliverables/Outcomes
Due Date/Time Frame
Payment
Information and/or
Amount
Ik
Report actual expenditures for October 1, 2019
Submit actual expenditures using the
December 4, 2020
through September 30, 2020
MCHBG Budget Workbook to DOH
contract manager
11
Report actual expenditures for the six month
Submit actual expenditures using the
May 21, 2021
period from October 1, 2020 through Match 31,
MCHBG Budget Workbook to DOH
2021.
contract manager.
Im
Develop 2021-2022 MCHBG Budget Workbook
Submit MCHBG Budget Workbook
September 10, 2021
for October 1, 2021 through September 30, 2022
to DOH contract manager
using DOH provided template.
MCHBG Assessment and Evaluation
2a
Participate in project evaluation activities
Documentation using report
September 30, 2018
Reimbursement for
developed and coordinated by DOH, as
template provided by DOH
September 30, 2019
actual costs, not to
requested.
September 30, 2020
exceed total funding
September 30, 2021
consideration.
2b
Report program level strategy measure data
Documentation using report
January 15, 2018
(CSHCN, UDS, ACES).
template provided by DOH
April 15, 2018
See Program
July 15, 2018
Specific
October 15, 2018
Requirements and
2c
Conduct a Maternal and Child Health (MCH)
Submit Needs Assessment
May 24, 2019
Special Billing
Needs Assessment.
documentation to DOH contract
Requirements.
manager using templates provided
by DOH
2d
Explore health equity approaches to maternal and
Include health equity plan in 2020-
Draft August 16, 2020
child health and develop implementation plan
2021 MCHBG Action Plan using
Final September 6, 2020
DOH- provided template.
MCHBG Implementation
3a
Develop 2018-2019 MCHBG Action Plan for
Submit MCHBG Action Plan to
Draft August 17, 2018
Reimbursement for
October 1, 2018 through September 30, 2019
DOH contract manager
Final- September 5,
actual costs, not to
using DOH -provided template.
2018
exceed total funding
3b
Report activities and outcomes of 2017-2018
Submit Action Plan monthly reports
Monthly, on or before
consideration.
MCHBG Action Plan using DOH- provided
to DOH contract manager
the 151 of the following
Action Plan and
template.
month
Progress Reports
Exhibit A, Statements of Work Page 15 of 20 Contract Number CLH18247-18
Revised as of September 15, 2020
AMENDMENT # 18
Task
Number
Task/Activity/Description
*May Support $
Deliverables/Outcomes
Due Datc/Time Frame
Payment
Information and/or
Amount
3c
Develop 2019-2020 MCHBG Action Plan for
Submit MCHBG Action Plan to
Draft August 17, 2019
must only reflect
October 1, 2019 through September 30, 2020
DOH contract manager
Final- September 5,
activities paid for
using DOH -pro ided template.
2019
with funds provided
3d
Report activities and outcomes of 2018-2019
Submit Action Plan monthly reports
Monthly, on or before
in this statement of
MCHBG Action Plan using DOH- provided
to DOH contract manager
the 151 of the following
work for the
template.
month
specified funding
3e
Develop 2020-2021 MCHBG Action Plan for
Submit MCHBG Action Plan to
Draft August 16, 2020
period.
October 1, 2020 through September 30, 2021
DOH contract manager
Final September 6, 2020
usin DOH -provided template.
See Program
317
Report activities and outcomes of 2019-2020
Submit Action Plan monthly reports
Monthly, on or before
Specific
MCHBG Action Plan using DOH- provided
to DOH contract manager
the 151 of the following
Requirements and
template.
month
Special Billing
3g
Report activities and outcomes of2020-21
Submit Action Plan reports to DOH
October 15, 2020
Requirements.
MCHBG Action Plan using DOH -Provided
contract manager
January 15, 2021
template.
April 15, 2021
July 15, 2021
3h
Develop 2021-2022 MCHBG Action Plan for
Submit MCHBG Action Plan to
Draft August 20, 2021
October 1, 2021 through September 30, 2022
DOH contract manager
Final September 10,
using DOH -Provided template.
2021
Children and Youth with Special Health Care Needs (CYSHCN)
4a
Complete Child Health Intake Form (CHIF)
=
Submit CHIF data into Secure File
January 15, 2018
Reimbursement for
using the CHIF Automated System on all infants
raxspe"'�' T) Access Washington
April 15, 2018
actual costs, not to
and children served by the CYSHCN Program as
website: ""-""- : 'w
July 15, 2018
exceed total funding
referenced in CYSHCN Program 4&mwl
his://secureaccess.wa.Qov
October 15, 2018
consideration.
guidance.
January 15, 2019
Action Plan and
Ensure client data is collected on all children
April 15, 2019
Progress Reports
served by CYSHCN contractors,Aneludinig
July 15, 2019
must only reflect
regional
October 15, 2019
activities paid for
maxillofacial coordinators, and the DOH
January 15, 2020
with funds provided
Newborn Screening Program.
April 15, 2020
in this statement of
July 15, 2020
work for the
October 15, 2020
specified funding
January 15, 2021
period.
April 15, 2021
July 15, 2021
See Program
4b
Submit completed Health Services
30 days after forms are
Specific
Authorization forms and Central
completed.
Requirements and
G YSHC-N o......_. a,.,,. ...u.... fund- ,...,,a
Treatment Fund requests directly to
Special Billing
m ual are
the CYSHCN Program as needed.
Requirements.
Identify unmet needs for CYSHCN on Medicaid,
and refer to DOH CYSHCN Program for
Exhibit A, Statements of Work Page 16 of 20 Contract Number CLt118247-18
Revised as of September 15, 2020
AMENDMENT # 18
Task
Task/Activity/Description
*
Deliverables/Outcomes
Due Date/Time Frame
Payment
Information and/or
Number
StandardaMeasura
Amount
approval to access Diagnostic and Treatment
fiords to meet the need.
*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 he found at:
http://www phaboard orgJmT-content/ut)loads/PHAB-Standards-and-Measures-Version-1 0 1df
Program Specific Rea uirements/Narrative
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 USASMnding aov by DOH as required by P.L. 109-282.
Program Manual, Handbook, Policy References
Children and Youth with Special Health Care Needs Manual -
https://www doh wa gov/ForPublicliealthandHealthcareProviders[PublicHealthSystemResourcesandServices/Loca]HealthResourcesandTools/MatemalandChildHealthBlockGrant/
Chi ldrenandYouthW ithSpecialHealthCareNeeds
Health Services Authorization (HSA) Form
htti)://www.doh.wa.gov/Portals/i /Doc uments/Pubs/910-002-ApprovedHSA. docx
Restrictions on Funds (what funds can be used for which activities, not direct payments, etc.)
1. At least 30% of federal Title V funds must be used for preventive and primary care services for children and at least 30% must be used services for children with
special health care needs. [Social Security Law, Sec. 505(a)(3)].
Funds may not be used for:
a. Inpatient services, other than inpatient services for children with special health care needs or high risk pregnant women and infants, and other patient services approved by
Health Resources and Services Administration (HRSA).
b. Cash payments to intended recipients of health services.
c. The purchase or improvement of land, the purchase, construction, or permanent improvement of any building or other facility, or the purchase of major medical
equipment.
d. Meeting other federal matching funds requirements.
e. Providing funds for research or training to any entity other than a public or nonprofit private entity.
f. payment for any services furnished by a provider or entity who has been excluded under Title XVIII (Medicare), Title XIX (Medicaid), or Title XX (social services block
grant).[Social Security Law, Sec 504(b)].
Exhibit A, Statements of Work Page 17 of 20 Contract Number CLH18247-18
Revised as of September 15, 2020
AMENDMENT # 18
3. If any charges are imposed for the provision of health services using Title V (MCH Block Grant) funds, such charges will be pursuant to a public schedule of charges; will not
be imposed with respect to services provided to low income mothers or children; and will be adjusted to reflect the income, resources, and family size of the individual
provided the services. [Social Security Law, Sec. 505 (1) (D)].
Monitoring Visits (frequency, type)
Telephone calls with contract manager needed.
Special Billing Requirements
Payment is contingent upon DOH receipt and approval of all deliverables and an acceptable Al9-1A invoice voucher. Payment to completely expend the "Total Consideration"
for a specific funding period will not be processed until all deliverables are accepted and approved by DOH. Invoices must be submitted menth4 quarterly by the 30th of each
month following the month quarter in which the expenditures were incurred and must be based on actual allowable program costs. Billing for services on a monthly fraction of the
"Total Consideration" will not be accepted or approved.
Special Instructions
Contact DOH contract manager below for approval of expenses not reflected in approved budget workbook.
MCHBG funds may be expended on COVID-19 response activities that align with maternal and child health priorities. Examples may include:
• Providing support in educating the MCHpopulation about COVID-19 through partnerships with other local agencies, medical providers, and health care organizations.
• Working closely with state and local emergency preparedness staff to assure that the needs of the MCH population are represented.
• Funding infrastructure that supports the response to COVID-19. For example, Public Health Nurses who are routinely supported through the Title V program may be
able to be mobilized, using Title V funds or separate emergency funding, to support a call center or deliver health services.
• Partnering with parent networks and health care providers to provide accurate and reliable information to all families.
• Engaging community leaders, including faith -based leaders, to educate communitv members about strategies for preventing illness
Restrictions listed above continue to apply.
DOH Program Contact
Kara Seaman, Community Consultant
Office of Family and Community Health Improvement
Washington State Department of Health
Street Address: 310 Israel Rd SE, Tumwater, WA 98501
Mailing Address: PO Box 47848, Olympia, WA 98504
Telephone: 360-236-3963/ Fax: 360-236-3646
Email: kara.seamangdoh.wa.flov
Exhibit A, Statements of Work Page 18 of 20 Contract Number CLH18247-18
Revised as of September 15, 2020
Exhibit A
Statement of Work
Contract Term: 2018-2021
DOH Program Name or Title: OICP-Promotion of Immunizations to Improve
Vaccination Rates - Effective July 1.2020
AMENDMENT # 18
Local Health Jurisdiction Name: Jefferson County Public Health
Contract Number: CLH18247
SOW Type: Revision Revision # (for this SOW) 1 Funding Source Federal Compliance T pe of Payment
® Federal Subrecipient (check if applicable) Reimbursement
Period of Performance: July 1.2020 through June 30.2021 ❑ State ® FFATA (Transparency Act) El 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: The purpose of this revision is to extend the period of performance and funding from 12/31/20 to 06/30/21, add funds, and modify the statement of work.
Chart of Accounts Program Name or Title
CFDA #
BARS
Master
Funding Period
Current
Change
Total
Revenue
Index
(LIJ Use Only)
Consideration
Increase (+)
Consideration
Code
Code
..Start Date End Date
FFY21 VFC Ops
93.268
333.93.26
74310202
07/01/20 06/30/21
2,800
2,800
5,600
TOTALS
2,800
2,800
5,600
Task
Task/Activity/Description
"May Support PHAB
Deliverables/Outcomes
Due Date/Time
Payment
Information and/or
Number
Standardstm4msum
Frame
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
March 31, 202/
in the plan (template will be
provided)
3
Perform data collection necessary to enable a
Final written report, including a
June 15, 2021
comparison of immunisation rates from the start of
report showing ending
the project.
immuncation rates for the target
population (template will he
provided)
Exhibit A, Statements of Work Page 19 of 20 Contract Number CLH18247-18
Revised as of September 15, 2020
AMENDMENT # 18
*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:
him//www.Dhaboard.ore/wo-content/uoloads/PHAB-Standards-and-Measures-Version-1.0.pdf
Program Specific Reguirements/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 USASpendina. 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
Tawney Harper, MPA
Deputy Director I Operations Manager
Office of Immunization and Child Profile
Department of Health
PO Box 47843, Olympia WA 98504-7843
tawney.barpert7a doh.wa.gov, 360-236-3525
DOH Program Contact
Misty Ellis, Project Manager
CDC Public Health Advisor
Office of Immunization and Child Profile
Department of Health
PO Box 47843, Olympia WA 98504-7843
misty. ellisnadoh.wa.gov, 360-236-3675
Exhibit A, Statements of Work Page 20 of 20 Contract Number CLH18247-18
Revised as of September 15, 2020
EXHIBIT B-19
Jefferson County Public Health
ALLOCATIONS
Contract Term:2019-2021
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
Federal Award
Revenue
Funding Period
Chart of Accounts Program Title
Identification #
Amend #
CFDA• Code—
Start Date End Date
FFY21 USDA WIC Program Mgnt CSS
NGA Not Received
Amd 15
10.557
333.10.55
10/0120 12/31/20
FFY21 USDA WIC Program Mgnt CSS
NGA Not Received
Amd 6
10.557
333.10.55
10/01/20 12/31/20
FFY21 USDA WIC Program Mgnt CSS
NGA Not Received
N/A
10.557
333.10.55
10/0120 12/31/20
FFY20 USDA WIC Program Mgnt CSS
207WAWA7W 1003
Amd 15
10.557
333.10.55
10/01/19 09/30/20
FFY20 USDA WIC Program Mgnt CSS
207WAWA7W 1003
Amd 10
10.557
333.10.55
10/O1/19 09/30/20
FFY20 USDA WIC Program Mgnt CSS
207WAWA7W I003
Amd 8
10.557
333J0.55
10/01/19 09/3020
FFY20 USDA WIC Program Mgm CSS
207WAWA7W 1003
Amd 6
10.557
333.10.55
10/01/19 09/30/20
FFY20 USDA WIC Program Mgm CSS
207WAWA7W 1003
N/A
10.557
333.10.55
10/O1/19 09/30/20
FFY19 CSS USDA WIC Program Mgnt
187WAWA7W I003
Amd 10
10.557
333.10.55
10/01/18 09/30/19
FFY19 CSS USDA WIC Program Mgnt
187WAWA7W 1003
Amd 9
10.557
333.10.55
10/01/18 09/30/19
FFYl9 CSS USDA WIC Program Mgnt
187WAWA7W 1003
Amd 8
10.557
333.10.55
10/01/18 09/30/19
FFY19 CSS USDA WIC Program Mgnt
187WAWA7W I003
Amd 6
10.557
333.10.55
10/O1/18 09/30/19
FFYl9 CSS USDA WIC Program Mgnt
187WAWA7W I003
Amd 5
10.557
333.10.55
10/O1/18 09/30/19
FFYI9 CSS USDA WIC Program Mgnt
187WAWA7W I003
N/A
10.557
333.10.55
10/01/18 09/30/19
FFY18 CSS USDA WIC Program Mgnt
187WAWA7W 1003
Amd 3
10.557
333.10.55
01/01/18 09/30/18
FFYI8 CSS USDA WIC Program Mgnt
187WAWA7W I003
Amd 2
10.557
333.10.55
01/01/18 09/30/18
FFY18 CSS USDA WIC Program Mgnt
187WAWA7W 1003
Amd 1
10.557
333.10.55
01/01/18 09/30/18
FFY18 CSS USDA WIC Program Mgnt
187WAWA7WI003
N/A
10.557
333.10.55
01/01/18 09/30/18
FFY21 USDA WIC Client Svs Contracts
NGA Not Received
Amd 15
10.557
333.10.55
10/01/20 12/31/20
FFY20 USDA WIC Client Svs Contracts
207WAWA7W 1003
Amd 16
10.557
333.10.55
10/01/19 09/30/20
FFY20 USDA WIC Client Svs Contracts
207WAWA7W 1003
Amd 15
10.557
333.10.55
10/O1/19 09/30/20
FFY20 USDA WIC Client Svs Contracts
207WAWA7W 1003
Amd 12
10.557
333.10.55
10/O1/19 09/3020
FFY20 USDA WIC Nutrition Ed
207WAWA7WI003
Amd 17
10.557
333.10.55
10/O1/19 09/30/20
FFY20 USDA FMNP Prog Mgmt
207WAWA7Y8604
Amd16
10.572
333.10.57
10/01/19 09/30/20
FFY19 CSS USDA FMNP Prog Mgnt
197WAWA7Y8604
Amd8
10.572
333.10.57
01/O1/19 09/30/19
FFY 18 CSS USDA FMNP Prog Mgnt
187WAWA7Y8604
Amd2
10.572
333.10.57
01/01/18 09/30/18
FFY16 Cascades USDA WIC Prog Mgm-MIS
16157WAWA6W522
Amd 6, 8
10.578
333.10.57
10/01/19 09/30/19
FFY19 MIS Tech Grant
197WAWAIGS212
Amd 8
10.578
333.10.57
10/01/19 09/30/20
BITV-COVID Ed LHJ Allocation -CARES
NGA Not Received
Amd 17
21A19
333.21.01
07/0120 12/3020
COVID LHJ OFM Allocation -CARES
NGA Not Received
Amd 17
21.019
333.21.01
03/0120 12/30/20
Page 1 of 5
Contract Number: CLHIS247
Date: September 15, 2020
Amount
Funding
Period
Sub Total
Chart of
Accounts
Total
($24,250)
$0
$191,346
$4,820
$19,430
($102,402)
$0
$640
$2,381
$21,661
$77,720
$780
$106,856
$200
$6,515
$17,111
$4,530
$77,720
$2,800
$74,490
$4,700
$8,700
$58,290
$24,250
$24,250
$129,182
$260
$104,932
$102,402
$2,270
$1,295
$1,295
$1,295
$481
$481
$1,483
$502
$502
$500
$500
$845
$845
$845
$790
$790
$790
$43,161
$43,161
$43,161
$639,000
$638,000
$638,000
Jefferson County Public Health
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
Award
Chart of Accounts Program Tide Identification #
Amend #
EXHIBIT B-18
ALLOCATIONS
Contract Term: 2018-2021
..
BARS Statement of Work
Revenue .Funding Per' o-=
dFederal
CFDA* Code** Start Date En
Contract Number:
Date:
Funding
Period
Amount Sub Total
CLH18247
September 15, 2020
Chart of
Accounts
Total
PS SSI 1-5 BEACH Task 4
OIJ18001
Amd 13
66.123
333.66.12 03/01/20
10/31/20 - -
$10,000
$10,000
$32,400
PS SSI 1-5 BEACH Task 4
OIJ18001
Amd 9
66.123
333.66.12 03/01/19.
10/31/19
$2,000
$12,200
PS SSI 1-5 BEACH Task 4
OIJ18001
Amd 7
66.123
333.66.12 03/01/19
10/31/19 �1,F' _
$10,200
PS SSI 1-5 BEACH Task
OIJ18001
Amd 1
66.123
333.66.12 03/01/18
10/31/18
$10,200
$10,200
PS SSI 1-5 OSS Task 4
OIJ18001
Amd 12
66.123
333.66.12 05/01/19
12/31/20 -;
$300,000
$300,000
$300,000
PS SSI 1-5 Subaward Process Task 4
01119001
Amd 12
66.123
333.66.12 05/01/19
12/31/20
($30Q,000)
$0
$0
PS SSI I-5SubawardProcess Task 4
OIJ18001
Amd9
6.
6123
333.66.12 05/01/19
12/31/20 a
$300,000
FFY20 Swim Beach Act Grant IAR (ECY-NEP)
CE-OIJ65401
Amd 15
66.456
333,66.45 03/01/20
10/31/20 �} _�
$2,315
$2,315
$2,315
FFY19 Swimming Beach Act Grant IAR (ECY)
OIJ49701
Amd 7
66.472
333.66.47 03/01/19
10/31/19
$2,000
$2,000
$4,000
FFY18 Swimming Beach Act Grant IAR (ECY)
OOJ75501
Amd 1
66.472
333.66.47 03/01/19
10/31/18 J 1'
$2,000
$2,000
FFY17 EPR PHEP BPI LHJ Funding
NU90TP921889-01
Amd 2
93.069
333.93.06 01/01/18
06/30/18
$1,145
$15,024
$15,024
FFY17 EPR PHEP BPI LHJ Funding
NU90TP921889-01
N/A
93.069
333.93.06 01/01/18
06/30/18
$13,879
FFYI8 EPR PHEP BPI Supp LIU Funding
NU90TP921889-01
Amd 5
93.069
333 93 06 07/01/18
06/30/19 ":
$619
$34,384
$34,384
FFY18 EPR PHEP BPI Supp LHJ Funding
NU90TP921889-01
Amd 4
93.069
333.93.06 07/01/18
06/30/19 111 1$
$33,765
FFY20 PHEP BP2 LHJ Funding
NU90TP922043
Amd 18
93.069
333.93.06 07/01/20
06/30/21
$13,754
S34,384
$68,768
FFY20 PHEP BP2 LHJ Funding
NU90TP922043
Amd 17, 18
93.069
333.93.06 07/01/20
06/30/21
$20,630
FFY19 PHEP BPI LHJ Funding
NU90TP922043
Amd 10
93.069
333 93 06 07/01/19
06/30/20
z g $
$34,384
$34,384
FFY19 Family Planning Title X
FPHPA006462
Amd 8, 12
93.217
333.93.21 04/01/19
06/30/19 :,
$26,467
$26,467
$65,099
FFY18 Family Planning Tide X
FPHPA006359
Amd 4
93.217
333 93 21 09/01/18
03/31/19 _.'�
$19,048
$19,048
FFY17 Family Planning Title X
FPHPA106286
Amd 3
93.217
333 93 21 01/01/18
08/31/18
$13,603
$19,584
FFY17 Family Planning Title X
FPHPA106286
N/A, Amd 3
93.217
333.93.21 01/01/18
O8/31/18
iAj
$5,981
FFY17 317 Ops
5NH231P000762-05-00
N/A
93.268
333.93.26 01/01/18
06/30/18
$333
$333
$333
.. _
'..
FFY17AFIX
5NH231P000762-05-00
N/A
93.268
333.93.26 01/01/18
06/30/18
$1,113
$1,113
$1,113
FFY17 Increasing Immunization Rates
NH231P000762
Amd 3, 4
93.268
333.93.26 07/01/18
06/30/19
$5,600
$5,600
$5,600
15
93.268
333.93.26 07/01/19
06/30/20 -
($500)
$0
$500
FFY20 PPHF Ops
NH231P922619
Amd
FFY20 PPHF Ops
NH231P922619
Amd 9
93.269
333.93.26 07/01/19
06/30/20 .<. -
$500
FFY17 PPHF Ops
NH231P000762
Amd 3, 4
93.268
333.93.26 07/01/18
06/30/19 , ; -,
$500
$500
Page 2 of 5
Jefferson County Public Health
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
Federal Award
Chart of Accounts Program Title Identification #
Amend #
EXHIBIT B-18
ALLOCATIONS
Contract Term: 2019-2021
BARS Statement of Work 4"
Revenue Funding Period
CFDA* Code** Start Date End Date
Contract Number:
Date:
Funding
Period
Amount Sub Total
CLH18247
September 15, 2020
Chart of
Accounts
Total
r
FFY21 VFC Ops
NH23IP922619
Amd 18
93.268
333.93.26
07/01/20
06/30/21 F_,.
$2,900
$5,600
$11,757
FFY21 VFC Ops
NI423IP922619
Amd 16,18
93.268
333.93.26
07/01/20
06/30/21 _ t
-
$2,800
FFY20 VFC Ops
NH231P922619
Amd 9
93.268
333.93.26
07/01/19
06/30/20
$5,600
$5,600
FFY17 VFC Ops
5NH231P000762-05-00
N/A
93.268
333.93.26
01/01/18
06/30/18
$557
$557
FFY19 COVID CARES
NUSOCK000515
Amd 16
93.323
333.93.32
06/01/20
12/31/20
$57,656
$57,656
$57,656
FFY20 CDC COVID-19 Crisis Resp LHJ-Tribe
NU90TP922069
Amd 14
93.354
333.93.35
01/20/20
IV31/20
$78,522
$78,522
$78,522
FFY21 MCHBG LHJ Contracts
NGA Not Received
Amd 18
93.994
333.93.99
10/01/20
09/30/21 ':
$36,700
$36,700
$137,625
FFY20 MCHBG LHJ Contracts
B04MC32578
Amd 10
93.994
333 93.99
10/01/19.
09/30/20
$36,700
$36,700
FFY19 MCHBG LI-U Contracts
B04MC32578
Amd 4
93.994
333.93.99
10/01/18
09/30/19
$36,700
$36,700
FFY18MCHBGLHJContracts
B04MC31524
N/A
93.994
333.93.99
01/01/18
09/30/18
$27,525
$27,525
FEMA-75 COVID LHJ Allocation
NGA Not Received
Amd 17
97.036
333.97.03
07/01/20
12/30/20
$129,483
$129,483
$129,483
SFY21 Family Planning Cost Share
Amd 17
N/A
334.04.91
07/01/20
12/31/20 �� < _
$45,814
$45,814
$306,909
SFY20 Family Planning Cost Share
Amd 17
N/A
334.04.91
12/01/19
06/30/20
($45,814)
$53,449
SFY20 Family Planning Cost Share
Amd 12,17
N/A
334.04.91
12/01/19
06/30/20
$99,263
SFY20 Family Planning Cost Share
Amd 16
N/A
334.04.91
12/01/19
06/30/20
$16,545
$16,545
SFY20 Family Planning Cost Share
Amd 8,12
N/A
334.04.91
07/01/19
11/30/19
$36,250
$46,011
SFY20 Family Planning Cost Share
Amd 4,12
N/A
334.04.91
07/01/19
11/30/19 1. "
$9,761
SFY19 Family Planning Cost Share
Amd 7
N/A
334.04.91
09/01/18
03/31/19 fi-�
$5,589
$5,589
SFY19 Family Planning Cost Share
SFY19 Family Planning Cost Share
Amd 8
Amd 4
N/A
N/A
334.04.91
334.04.91
09/01/18
09/01/18
06/30/19
06/30/19
$1,393
$48,803
$50,196
SFY19 Family Planning Cost Share
Amd 3
N/A
334.04.91
07/01/18
08/31/18r
$16,311
$16,311
SFY18 Family Planning Cost Share
Amd 1
N/A
334.04.91
01/01/18
06/30/18
$56,987
$72,994
SFY18 Family Planning Cost Share
N/A, Amd 1
N/A
334.04.91
01/01/18
06/30/18 _I
�e
$16,007
Zoonotics-GFS
Amd 9
N/A
334.04.91
07/01/19
06/30/20
$4,029
$4,029
$5,000
Zoonotics-GFS
Amd 9
N/A
334.04.91
06/01/19
06/30/19 f
$971
$971
State Drug User Health Program
Amd 18
N/A
334.04.91
07/01/20
06/30/21
$7,500
$15,000
$30,000
State Drug User Health Program
Amd 16, 18
N/A
334,04.91
07/01/20
..
06/30t21 _
$7,500
State Drug User Health Program
Amd 9
N/A
334.04.91
07/01/19
06/30/20
$15,000
$15,000
FY20/21 COVID-1 9 Disaster Response Acct
Amd 14
N/A
334.04.92
01/20/20
12/31/20-
$71,478
$71,478
$71,478
SFYI Lead Environments of Children
Amd 1
N/A
334.04.93
01/01/18
06/30/18 -; °;
$2,000
$2,000
$2,000
Page 3 of 5
Jefferson County Public Health
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
Federal Award
Chart of Accounts Program Title Identification N
Amend N
EXHIBIT B-13
ALLOCATIONS
Contract Term: 2018-2021
t -
BARS Statement of Work v
Revenue Funding Period
CFDA• Code- Start Date End Date
Contract Number:
Date:
Funding
Period
Amount Sub Total
CLH18247
September 15, 2020
Chart of
Accounts
Total
Rec Shellfish/Biotoxin
Amd 16
N/A
334.04.93
07/01/19
12/31/20
$3,500
$10,000
$19,750
Rec ShellfishBiotoxin
Amd 9,16
N/A
334,04.93
07/01/19
12/31/20
$6,500
Rec ShellfishBiotoxin
N/A
N/A
334.04.93
01/01/18
06/30/19 ' +, ','.
$9,750
$9,750
ve �
Small Onsite Management (ALEA)
Amd 9
N/A
334.04.93
07/01/19
06/30/20
$45,000
$45,000
$79,948
Small Onsite Management (ALEA)
Amd 9
N/A
334.04.93
07/01/18
06/30/19 _
$4,948
$13,616
Small Onsite Management (ALEA)
Amd 5
N/A
334.04 93
07/01/18
06/30/19'0'0
$8,668
Small Onsite Management (ALEA)
Amd 5
N/A
334.04.93
01/01/18
06/30/18 i
(S8,668)
$21,332
Small Onsite Management (ALEA)
N/A, Amd 5
N/A
334.04.93
01/01/18
06/30/18
$30,000
Wastewater Management-GFS
Wastewater Management-GFS
Amd 9
Amd 9
N/A
N/A
334.04.93
334.04.93
07/01/20
07/01/19
12/31/20
06/30/19m-. -
$30,000
($4,948)
$30,000
$25,052
$55,052
Wastewater Manageent-GFS
N/A
N/A
334.04.93
07/01/18
06/30/19 �� �.
$30,000
et
FFY20 Swim Beach Act Grant IAR (ECY-ALEA)
Amd 15
N/A
334.04.96
03/01/20
10/31/20
$1,685
$1,685
$1,685
FPHS Funding for LHJs
Amd 17
N/A
336.04.25
07/01/20
12/31/20
$58,000
$100,000
S242,000
FPHS Funding for LHJs
Amdll
N/A
336.04.25
07/01/20
12/31/20 9
($4,238)
FPHS Funding for LHJs
Amd 10
N/A
336.04.25
07/01/20
12/31/20
$46,238
FPHS Funding for LHJs
Amd 17
N/A
336.04.25
07/01/19
06/30/20
$58,000
$100,000
FPHS Funding for LHJs
Amd 11
N/A
336.04.25
07/01/19
06/30/20
($4,238)
FPHS Funding for LHJs
Amd 10
N/A
336.04.25
07/01/19
06/30/20
$46,238
FPHS Funding for LHJs Dir
Amd 3
N/A
336.04.25
07/01/19
06/30/19
$42,000
$42,000
YR 20 SRF -Local Asst (15 % xF5) - SS
Amd 1
N/A
346.26.64
01/01/18
12/31/18 . I`F
($2,200)
$0
$0
YR 20 SRF - Local Asst (I5%)(FS) - SS
N/A
N/A
346.26.64
01/01/18
12/31/18 � -!
$2,200
YR 21 SRF - Local Asst (15%) (FS) SS
Amd 10
N/A
346.26.64
01/01/18
06/30/19 w
($2,000)
$0
$0
YR 21 SRF - Local Asst (15%) (FS) SS
Amd 6, 10
N/A
346.26.64
01/01/19
06/30/19 : ,.
$2,000
YR 22 SRF - Local Asst (15%) (FO-SW) SS
Amd 12
N/A
346.26.64
01/01/19
12/31/20 r
$3,000
$4,800
$4,800
YR 22 SRF - Local Asst (15%) (FO-SW) SS
Amd 10,12
N/A
346.26.64
01/01/19
12/31/20 _
$1,800
Sanitary Survey Fees (FO-SW) SS State
Sanitary Survey Fees (FO-SW) SS State
Amd 12
Amd 10, 12
N/A
N/A
346.26.65
346.26.65
01/01/18
01/01/19
12/31/20 .�
CZ
12/31/20,;
$3,000
($200)
$4,800
$4,800
Sanitary Survey Fees (FO-SW) SS State
Sanitary Survey Fees (FO-SW) SS -State
Amd 6,12
Amd I
N/A
N/A
346.26.65
346.26.65
01/01/19
01/01/18
12/31/201,
12/3,1/18 s
$2,000
($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
Page 4 of 5
EXHIBIT B-18
Jefferson County Public Health ALLOCATIONS Contract Number: CLH18247
Contract Term: 2018-2021 Date: September 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
Federal Award
Ch.- of A. .mr. V.v .— TM. id.nl:froHnn a
YR 20 SRF - Local Asst (15%) (FS) TA
YR 20 SRF - Local Asst (15%) (FS) - TA
YR 21 SRF - Local Asst (15%) (FS) TA
YR 21 SRF - Local Asst (15%) (FS) TA
YR 21 SRF - Local Asst (15%) (FS) TA
YR 22 SRF - Local Asst (15%) (FO-SW) TA
YR 22 SRF - Local Asst (15%) (FO-SW) TA
YR 22 SRF - Local Asst (15%) (FO-SW) TA
TOTAL
Total consideration: $2,706,722
$60,754
GRAND TOTAL $2,767,476
*Catalog of Federal Domestic Assistance
**Federal revenue codes begin with "3331. State revenue codes begin with "334".
BARS Statement of Work
Revenue Funding Perm
Amend # CFDA* Code" StartDate End Dad
Amd 3
N/A
346.26.66 01/01/18
12/31/18
N/A
N/A
346.26.66 01/01/18
12/31/18
Amd 10
N/A
346.26.66 01/01/18
06/30/19
Amd 6, 10
N/A
346.26.66 01/01/18
06/30/19
Arad 3, 6, 10
N/A
346.26.66 01/01/18
W30/19
Amd 15
N/A
346.26.66 01/01/19
12/31/20
Amd 12
N/A
346.26.66 01/01/19
12/31/20
Amd 10, 12
N/A
346.26.66 01/01/19
12/31/20
Page 5 of 5
Amount
Funding
Period
Sub Total
Chart of
Accounts
Total
($2,000)
$0
$0
$2,000
($3,627)
$373
$373
$2,000
$2,000
($1,000)
$3,000
$3,000
$2,000
$2,000
$2,767,476
$2,767,476
GRAND TOTAL
$2,767,476
Total Fed
$1,940,681
Total State
$826,795
Exhibit C-18 Schedule of Federal Awards
AMENDMENT #18
Date: September 16, 2020
JEFFERSON COUNTY PUBLIC HEALTHSWV0002430-07
CONTRACT CLH18247Jeffamon County Pudic
Health
CONTRACT PERIOD: 0110112018-1213112021
DOH
Total Amt Allocation Period
Federal
Federal Start End
Contract
Federal Award
Chart of Accounts Program Title
BARS
Award Date
Award Date Data
CFDA CFDA Program Title
And
Federal Agency Name
Identification Number
Federal Grant Award Name
FFY2I USDA WIC CLIENT SYS CONTRACTS
333.10.55
NGA Not
NGA Not
1=120 12/31/20
Special Supplemental Nutrition
$24.250 10,557 Program for Warren. Manta. and
Doprhrrrt MAgrealtire Food and
NGA Not Received
NGA Not Received
...,
Recehed
Received
.: ...
Children
Nutrition Service
FFY20 USDA WIC PROGRAM MGMT CSS
333,10.55
100/119
$6.181,312 10A1119 O97J0f2O
Special Sup"A" nal Nutrition
3104,932 10.557 Program for Woman. Rants. and
DaPMwdofApiallra Foodand 7
20WAWA7WI003
WOMEN, INFANTS AND CHILDREN
Children
Nutrition Service
_.......
-
Special Supplemental Nutrition
Department of Agriculture Food and..
N
INFANTS AND CHILDREN
FFY20 USDA WIC NUTRITION ED
333.10.55
10101119
$6.161,312 IM1119 09/30/20
h
$1.295 10,557 Program for Woman. Innta, and
Nutrition Service 207WAWA7W1003
WOMEN,
Children
...
,...
..... ..
....
SpedY Supplemental Nutrition
Din ahem ofAynaltre Food and
FFYI9 CSS USDA WIC PROGRAM MOMT
333.10.55
1010IM7
S40.Im,357 10A1118 OW"9
$100.866 10SV Program for Women, Marts, and
Nutraon Ssrvke 1B7WAWA7W1003
WOMEN,INFANTS AND CHILDREN
Chid—
..
....
,..
SPedal Supplemental Nutrition
Departmentof Agriculaure Food and
ADMIN
FFY19 CSS USDA WIC PROGRAM MONT
333.10.65
10A2/17
$27.576,710 0IM1118 09r"18
$74,490 10SV Program for Woman, ntanta and
Nutrition Service 187WAWA7W1W3
USDMWIC
Children
FFY20 USDA FMNP PROD MGMT
333.10,57
I0A1119
$129.791 10001119 090020
s461 10.572 WIC Famers' Mutt Nutrition
DspaMrt ofA9rio It food and 207Va1WA7Y8W4
COMMODITY ASSISTANCE PROGRAM
Program (FMNP)
Nu99ion Samoa
FFYI9 CSS USDA FMNP PROG MONT
333.10S7
10A7/18
$130,973 DIM1119 DQW19
f502 t0.572 WIC Farmers' Market Nutrition
Deparnend of Agnoltrafood and'97WAWA7ySSO4
COMMODITY ASSISTANCE PROGRAM
Program (FMNP)
Nutrition Service
FFYI9 Call USDA FMNP PROfi MGNT
333.70.57
IOAt/17
f88,117 01A7/18 OB/JMB
$500 10.572 WIC Famere' Marlat Nutrition
DopaMwt MAgniollue Food and 1S7WAWA7ySK4
Nutrition Sawisa
COMMODITY ASSISTANCE PROGRAM
ProW m(FMNP)
FFYI9 MIS TECH GRANT
333,10,57
0128/19
$2,209,026 1000IM9 09/3020
$790 10.578 WIC Giants to States(WGS)
DeparmentofAgnouth—Foodand 197WAWAIG5212
WIC CONTINGECY
Nutrition Service
DapaMwt ofAaralhre Food and
WOMEN,INFANTSAND CHILDREN
FFYI9 CASCADES USDA WIC PROG MGMT-UM
333.%57
03/11/16
$2.224.476 1001118 09/JM9
Sa45 10.578 WIC Gnarls to StaW(WGS)
IIn57WAWA&Wl22
Nutrition Service
WIC SAM PROJECTS
COVID L W OFM ALLOCATION -CARES
333 21 01
NGA Not
NGA Not 030120 12/J020
$638 000 21 019 Commvhus Relief Fund
Department of Bar Treasury NGA Not Reariveo
NGA Not Received
Received
Received
BITVCOVID ED LW ALLOCATION -CARES
333.21.01
NGA Not
NGA Not 07A/20 12/3020
$43.161 21.019 Commina Relief Fund
DapartamMitoftha Treaury NGA Not Raciw*d
NGA Not Received
Received
R—hied
.........
.., .
Puget Sound Acton Agenda:
,.,. ..
fi6.123 Technical lmea0gations and
Envkonaintal Protection Agency O1J18001
PUGET SOUND SHELLFISH
PS SSIId OSS TABKI
333.B8.12
0&O2h6
$S,000,OW 05A7/19 12lJ720
$300.000
Implamntation Assistance
Region 10
STRATEGIC INITIATIVE LEAD
.. Program... .
...
_.
... ....
......
,......
Puget Sound Action Agenda:
Technical lmestgatoe and
Em11 lion Agency OIJI800I
PUGETSOUNb SHELLFISH
PS SSI I.6 BEACH TASK 4
333.66.12
01MOVIS
$9,20D,000 0300IM8 100120
$32,40D 65.123
Implementation Aeaietanos
Region to
STRATEGIC INITIATIVE LEAD
Pro
FFY20 SWAM BEACH ACT GRANT U1R (ECY-MEP)
333.65,47
0113120
S49.000 0340120 10/3120
$2,315 66A72 Beech Montomg and Notifioibn
Program hnplermn etion Grams
Emtomental Protamon Agency CE-01J65401
Office of Water
PUGET SOUND PARTNERSHIP
NATIONAL ESTUARY PROGRAM
Page 1 of 3
Exhibit C-18 Schedule of Federal Awards
JEFFERSON COUNTY PUBLIC HEALTH-SWVW024304
CONTRACT CLH18247.1eBerson County Pudic Health
CONTRACT PERIOD: 01/01/201842/3U2021
AMENDMENT #18
Date: September 15, 2020
DOH
Total Amt Allocation Period
Federal
Federal Start End
Contract
Federal Award
Chart of Accounts Program Title
BARS
Award Dab
Award Data Dale
_.......
CFDA CFDA Program Title
And
Federal Agency Name
Identification Number
Federal Grant Award Name
_......
r
Beach Montbing and NotTdibn
and
EmbanrnrmW PreMcsam Agary
MARINE SWIMMING BEACH
FFY/9 SWIMMING BEACH ACT GRANT R(ECY)
SWIMMINGU
333.98.47
2Q
1 1/18
f91,991 0301/19 IW1119
f2.00D 88.472 Program npbvnGrano
Off of Water
970
clJ/1
MONITORING AND PUBLIC
NOTIFICATION
B-ah Monitoring and Notirmiton
Emiromemal Protection Agency
MARINE SWIMMING BEACH
FFV186NAMMING BEACH ACT GRANT UR(CCV)
333.%.17
12I15/77
$91,990 03A7/18 707JIH8
E2,000 88.472
Program tnpenemation Gr-M
Office of Water
OOJ7C�501
MONITORING AND PUBLIC
NOTIFICATION
-...
EmergencySaioes
Departs 9 of Heats art Huron
PUBLIC HEALTH EMERGENCY
FFV20 PHEP BP2 LNJ FUNDING
333.93.08
08H2J10
f11,385.797 07mOi20 OB(J027
$34,384 93.OB9Publicg�c
Camara for Daeaas
NU90TP822043
PREPAREDNESS(PREP)
CoreW and Prevent-
COOPERATIVE AGREEMENT
Public Heath Emergency
Department f H-eh nd Huma
oan
PUBLIC HEALTH EMERGENCY
FFYI9 PREP B%LHJ FUNDING333.93.08
0629H8
f11.3D7.904 WR71/19 OB(J020
$34.384 93.OW Public
Services Canon for0-a-
NU90TP922D43
PREPAREDNESS(PHEP)
Control and Pmwrem
COOPERATIVE AGREEMENT
-... -..
-.....
-.-...... .,
Department of HeWft and Huron
HOSPITAL PREPAREDNESS
FFV19 EPR PHEP BPI SUPP LHJ FUNDING
333.93.08
owllis
$11.082,782 07,OIN8 08r"9
Public Health Emergency
f34.384 93.009Services
Cents for Di.--
NU90TP9218W-01
PROGRAM AND PUBLIC HEALTH
Prapredeas
Comm)and Prevention
EMERGENCY PREPAREDNESS
-..-.......
- -....
-.... -....
-...
COOPERATIVE AGREEMENT -.
Pudk Hearth Ert ,W-y
f H
Deparbront W Heath and Hann
D p rim
HPP AND PHEP COOPERATIVE
FFY17 EPR PHEP BPI LHJ FUNDING
333.93.06
07/18/17
$11,062,782 01,01/18 06r"18
$15,024 93.069
PraPredness
Ct
far Oiasa-
NlXa7fP921B89-01
AGREEMENT
Control and Prevention
FFY19 FAMILY PLANNING TITLE X
333.93.21
032SMS
f4,100,000 04/01/19 0813019
$26,497 93.217 Family PYnmip S-Ac-
Department of HeWM and Huron
FPHPAOM462
TITLE X FAMILY PUNNING SERVICES
Services OR of P"Wation ARus
FFVI8 FAMILY PLANNING TITLE %
333.93.21
09/12fl8
$2.783.000 09,01/18 03/31/19
$19.048 93.217 Famly PlannhI; Senv'roes
DeParmem of H-8h and Huron
FPHPA008359
TITLE X FAMILY PLANNING SERVICES
Services Office of Population AfNts
FFY17 FAMILY PLANNING TITLE X
333.93.21
03f"7
11.940.000 OVOUI8 0B13IA8
$19.584 93.217 Famly Planning_ Services
Depwirrmtof Heath and Hymn
Services Office
FPHPA108298
TITLE X FAMILY PLANNING SERVICES
GRANT
of Population All-
_... .,...
...
Inmuninton Cooperative
Depar men of Health and Human
....
IMMUNIZATION GRANT AND
FFWN VFC OPS
333.83.26
07r0120
E8,082,252 07,01202 0 OB/J1
E5.800 93.288
Agra—na
ery
SicesDiseaseDiseaseOie
NH231P922618
VACCINES FOR CHILDREN PROGRAM
._..
.3..
reventi
Control and P—ion
-....
-,
-..
,..
OlA1/19
.......
1i7r01A9 0li/JMlIt
$5,800 93.288 Irnmuohreliyls, Cower""
Department of Hea ft and Huron
Savloes Cane for
NH23ffV22818
ON GRANT AND
FfYfO VFC OPS
..
333.93.28
fB234,B36
Die-ae
Conbol and Prevaation
,.... _..
VACCINESIMMUNIZA
VACCINES FOR CHILDREN PROGRAM
-....
Department of H-ln and Human
IMMUNIZATION GRANT AND
FFY17 VFC OPS
333.93,26
03,03/17
E1,201.805 01,01/18 OSM18
Irmeriation Cooperative
$557 93.268
-n forAgreements SarvkCmbDu- es
SNH231POOD762-05-00
VACCINES FOR CHILDRENSS
_.._...
Control and Prevention
PROGRAM
,., .. .
-..
.....
- ... _.....
Department (Health and Huron
-.,... -. .. ..
IMMUNIZATION GRANT AND
FFVI7 PPHF OPS
333.93.28
082w18
f3,834,512 07A7/18 OB/JO119
f50D 83288 Ym�a.m.ftrm CaoPeraYM
Sautes Gemara far Dena-
NH231POD0762
VACCINES FOR CHILDRENS
_.
--...
Coro" and Preventon
-......
PROGRAM
.... ,.
-.....
Deperbrent of H-tih and Huron '...
IMMUNIZATION GRANT AND
FFY771NCREASING IMMUNIZATION RATES
333.932E
0829/18
$1.722.443 07001/18 OSW19
$5,600 93.288 b Caoparatve
Sarvic-Cadea f r Dia-es
NH231POD0762
VACCINES FOR CHILDRENS
AgmemeControl
and Prevention
PROGRAM
.._.
�.- .,..
,.,..
.....
_ .
Departrontof Healfuand Hu-n
..,
IMMUNIZATION GRANT AND
FFVI7 AFIX
333.93.25
03Wi7
$1.672.209 01001/18 08r"S
f1,113 93.288 Inm�ala'I"_oen Co'P"K-
Sauk - Gemara for Dese-
5NH231POOD762-05-00
VACCINES FOR CHILDRENS
Conbol and Prevamon
PROGRAM
Page 2 of 3
Exhibit C-18 Schedule of Federal Awards
AMENDMENT #18
Date: September 16, 2020
JEFFERSON COUNTY PUBLIC HEALTH$W V0002430-07
CONTRACT ClH78247-Jetlenon County Pudic Health
CONTRACT PERIOD: 0110112018-12J3 V2021
DOH
Total Aml Allocation Period
Chart of Accounts Program Title
BARS
Federal
Federal Start End
Contract CFDA
CFDA Program Title Federal Agency Name
FWaral Award
Federal Grant Award Name
_.. .
......
Award Dale
_.
Award Date Dale
Amt _......
Identlflcatlon Number
j..rmurimUon
Deparbrerd of Health and Human
IMMUNIZATION GRANT AND
FFY17317 OPS
333.93,26
C31XW7
S575.969 01A1H8 Oar"S
f333 93.268
CoaPentive.
Servieas Camara for Disease
SNH231POOD762-05-00
VACCINES FOR CHILDREN5
Ageemena
CorNol and Prevention
PROGRAM
......
.,
... . _.....
_ ...
Epdaniobgy and Laboratory .. _..
_ ......
_......O
EPIDEMIOLOGY 5 LABORATORY
Cepadly for kdaame D'— Department HaIR1 and Huron
CAPACITY FOR INFECTIOUS
CAPACITY
FFY19 COND CARES
333.93.32
012320
322581,789 050120 120120
f57,�8 93.323
re
(ELC)eukbp and Sbengli—V SMvias Csrldn D
NUSOCK000515
DISEASES (ELC)-BUILDING 5
....
Conbol and Prevention
Epidrrlbbgy, Lb -,I -and .....
"
..
STRENGTHENING EPIDEMIOLOGY,
'... ..
,....
Public Heats Emergency
CDC COOPERATIVE AGREEMENT
Deparbront of Health and Human
Response: Coops bve Agreemem
RESPONSE:
FFY20 CDC COVID-19 CRISIS RESP LHJ-TRIBE
333,93.35
03riS20
$13,230.799 012020 12O 20
f78.522 93354
Serviws Camara far Disease
for Emergency Response: Public
NUDOTP922009
P BLIC HEALTH C
PUBLIC HEALTH CRISIS RESPONSE
.
Control and Prevention
Health Crisis Reaporoe
CDC-RFA.TP18-1802 ..
NGA Not
NGA Not
Mabamai and Chid HeatsDepatrant M Swoons of Hsaand Human...
RereNed
NGA Not Received
FFY21 MCXBG LHJ CONTRACTS
333.83.99
Reosived
Reosivad 100120 OBTJ021
3.,.
$36,700 93.eB1
Block Gram b the Saks $arvioas Hwlth Resources and
NGA Not
Sambas AOrirttration
,._ .
.
..,
...,
....
Dep.MmeM of Health aM Huron
Matenel and Chid Health Services
MATERNAL AND CHILD HEALTH
FFY20 MCHBG LIU CONTRACTS
333,93,99
11/14118
$2,225.977 10,01/19 09133W
f36700 93.994
S—i— H-M Rasourcea and
Back Grad b Oe Sans
B04MC32578
SERVICES BLOCK GRANT
Snbse Adniniatration
..
,...
.. ...
.....
... ... ealth and Hunan
Deparbrord of Heart,cea
Maternal end Chid Heats Swvcm
MATERNAL AND CHILD HEALTH
FFY19 MCHEIG LIM CONTRACTS
33393.99
11114n8
$2,225,977 1001ne 094"S
f38,700 93.999
BarvbN�fHand
Back Grardbthe StelesIm
B04MC32578
SERVICES BLOCK GRANT
......_...
,.
............. _..
...
_..
DepererweorHwlmamHen.n
of 1,
Maternal and Chid Health SwWcsa
MATERNAL AND CHILD HEALTH
FFYI8 MCHBG LHJ CONTRACTS
333,9399
10r"7
$1.650.528 DUMAS OVM18
$27.525 93.994
Services Resources and
&rentb the Sass
804MC31521
SERVICES
Services Adrrirastratbn
FEMA-75 COVID LHJ ALLOCATION
333.97.03
NGA Not
NGA Not 0710120 12IJ020
f12B,4B3 97.038
D"'edrrana-
GPub" Asaebrlcs Dare epnsmofNorrehnd Seeuity
NGANot Received
NGA Not Received
Racaivad
Reosivad
(Preeldenbatiy Dedwed Disaebrs)
TOTAL
$1,0401"1
Page 3 of 3