HomeMy WebLinkAboutWashington State Department of Health Amendment # 06 MC Contract # 19 —�(Q
MASON COUNTY PUBLIC HEALTH
2018—2020 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH18253 AMENDMENT NUMBER: 6
PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as
"DOH", and MASON COUNTY PUBLIC HEALTH hereinafter referred to as"LHJ",pursuant to the
Modifications/Waivers clause, and to make necessary changes within the scope of this contract and any subsequent
amendments thereto.
IT IS MUTUALLY AGREED: That the contract is hereby amended as follows:
1. Exhibit A Statements of Work, attached and incorporated by this reference, are amended as follows:
❑ Adds Statements of Work for the following programs:
® Amends Statements of Work for the following programs:
• Maternal& Child Health Block Grant-Effective January 1, 2018
• Office of Drinking Water Group A Program-Effective January 1,2018
❑ Deletes Statements of Work for the following programs:
2. Exhibit B-6 Allocations,attached and incorporated by this reference, amends and replaces Exhibit B-5 Allocations as
follows:
® Increase of$26,000 for a revised maximum consideration of$699,571.
❑ 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-6 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces
Exhibit C-5.
Unless designated otherwise herein,the effective date of this amendment is the date of execution.
ALL OTHER TERMS AND CONDITIONS of the original contract and any subsequent amendments remain in full force
and effect.
IN WITNESS WHEREOF,the undersigned has affixed his/her signature in execution thereof.
MASON COUNTY PUBLIC HEALTH STATE OF WASHINGTON
DEPARTMENT OF HEALTH
4F
Date Dat
-7 APPROVED AS TO FORM ONLY
Assistant Attorney General
Page I of12
AMENDMENT#6
2018-2020 CONSOLIDATED CONTRACT
EDIT A
STATEMENTS OF WORK
TABLE OF CONTENTS
DOH Program Name or Title: Maternal&Child Health Block Grant-Effective January 1, 2018....................................................................................................3
DOH Program Name or Title: Office of Drinking Water Group A Program-Effective January 1, 2018..........................................................................................8
Exhibit A, Statements of Work Page 2 of 12 Contract Number CLH18253-6
Revised as of November 15,2018
AMENDMENT#6
Exhibit A
Statement of Work
Contract Term: 2018-2020
DOH Program Name or Title: Maternal&Child Health Block Grant- Local Health Jurisdiction Name: Mason County Public Health
Effective January 1,2018
Contract Number: CLH18253
SOW Type: Revision Revision#(for this SOW) 3 Funding Source Federal Compliance Type of Payment
_ E]Federal Subrecipient (check if applicable) ®Reimbursement
Period of Performance: January 1,2018 through September 30 2019 ❑ State ®FFATA(Transparency Act) ❑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 revise deliverable requirements for 2018-19 and add language related to allowable expenses in the Special Instructions
section.
Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period," Current Change Total
Revenue Index (LHJ,Use Only) Consideration Consideration
Start Date End Daatte
Code Code None
` '
FFY18 MCHBG LHJ CONTRACTS 93.994 333.93.99 78120281 01/01/18 09/30/18 56,115 0 56,115
FFY19 MCHBG LHJ CONTRACTS 93.994 333.93.99 78120291 10/01/18 09/30/19 67,694 0 67,694
TOTALS 123,809 0 123,809
Task Task/Activity/Descripdon *May.Support PHAB F Deliverables/Outcomes DueDate/TimeFrame Payment Information
Number Standards/Measures and/or 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 - in contract management calls. September 30,2019 actual costs,not to
and time for calls are mutually agreed upon exceed total funding
between DOH and LHJ consideration.Action
lb Report actual expenditures for October 1, Submit actual expenditures using the May 26,2018 Plan and Progress
2017 through March 31,2018 MCHBG Budget Workbook to DOH Reports must only
contract manager reflect activities paid
lc Develop 2018-2019 MCHBG Budget Submit MCHBG Budget Workbook September 5,2018 for with funds provided
Workbook for October 1,2018 through to DOH contract manager in this statement of
September 30,2019 using DOH provided work for the specified
template. funding period.
Exhibit A,Statements of Work Page 3 of 12 Contract Number C1,1418253-6
Revised as of November 15,2018
AMENDMENT#6
Task *May Support PHAB Payment Information
Task/Activity/Description - Deliverables/Outcomes Due Date/Time Frame
Number Standards/Measures and/or Amount
Id Report actual expenditures for October 1, Submit actual expenditures using the May 24,2019 See Program Specific
2018 through March 31,2019 MCHBG Budget Workbook to DOH Requirements and
contract.manager. Special Billing
Requirements.
le Develop 2019-2020 MCHBG Budget Submit MCHBG Budget Workbook September 5,2019
Workbook for October 1,2019 through to DOH contract manager
September 30,2020 using DOH provided
template.
if Report actual expenditures for October 1, Submit actual expenditures using the November 30,2018
2017 through September 30,2018 MCHBG Budget Workbook to DOH
contract manager.
MCHBG Assessment and Evaluation
2a Participate in project evaluation activities Documentation using report template September 30,2018 Reimbursement for
developed and coordinated by DOH,as provided by DOH ,September 30,2019 actual costs,.not to
requested- exceed total funding
2b Report program level strategy measure data Documentation using report template January 15,2018 consideration.
(CSHCN,UDS,ACEs). provided by DOH April 15,2018
July 15,2018 See Program Specific
October 15, 2018 Requirements and
iffwfa� 'gin" Special Billing
^--'�, ,, '^�'�" Requirements.
2c Conduct a Maternal and Child Health Submit Needs Assessment May 24,2019
(MCH)Needs Assessment. documentation to DOH contract
manager using templates provided by
DOH
MCHBG Implementation
3a Develop 2018-2019 MCHBG Action Plan Submit MCHBG Action Plan to Draft August 17,2018 Reimbursement for
for October 1,2018 through September 30, DOH contract.manager Final September 5,2018 actual costs,not to
2019 using DOH-provided template. exceed total funding
3b Report activities and outcomes of 2017-2018 Submit Action Plan monthly reports Monthly,on or before consideration.Action
MCHBG Action Plan using DOH-provided to DOH contract manager the 15t'of the following Plan and Progress
template. month Reports must only
Exhibit A, Statements of Work Page 4 of 12 Contract Number CLH18253-6
Revised as of November 15,2018
AMENDMENT#6
Task Task/Activity/Description *May Support PHAB Deliverables/Outcomes Due Date/Time Frame Payment Information
NumberStandards/Measures and/or Amount
3c Develop 2019-2020 MCHBG Action Plan Submit MCHBG Action Plan to Draft August 17„2019 reflect activities paid
for October 1,2019 through September 30, _ DOH contract manager Final-September 5,2019 for with funds provided
2020 using DOH-provided tem late. - in this statement of
3d Report activities and outcomes of 2018-2019 Submit Action Plan monthly reports Monthly,on or before work for the specified
MCHBG Action Plan using DOH-provided to DOH contract manager the 15ffi of the following funding period.
template. month
See Program Specific
Requirements and
Special Billing
Reauirementq.
Children with Special Health Care Needs(CSHCN)
4a Complete Child Health Intake Form(CHIP) Submit CH1F data into Secure File January 15,2018 Reimbursement for
using the CUT Automated System on all Transport(SIT)websitei April 15,2018 actual costs,not to
infants and children served by the CSHCN https:Hsft.wa.eov July 15,2018 exceed total funding
Program as referenced in CSHCN Program October 15,2018 consideration.Action
Manual. January 15,2019 Plan and Progress
April 15,2019 Reports must only
Ensure client data is collected on all children July 15,2019 reflect activities paid
served by CSHCN contractors,including - for with funds provided
neurodevelopmental centers,regional in this statement of
maxillofacial coordinators,and the DOH work for the specified
Newborn Screening Program. .. funding period.
4b Administer requested DOH Diagnostic and Submit completed Health Services 30 days after forms are
Treatment funds for infants and children per Authorization forms and Central completed. See Program Specific
CSHCN Program Manual when funds are Treatment Fund requests directly to Requirements and
used. the CSHCN Program as needed. Special Billing
4e n.._.;.,.rYa.e in ♦ e nacTnnT n,,,-:,,,..,T o.....,,__ S.bmit lets.«Plan„_,.,_♦Al. repept� A&nA�- en ei-b--fore Requirements.
inelt.ing_tour,.,,,,.s'_,...:,._,.1 4se4�0 ,fr♦
no Uo rF.eus o-:.ar�Fu meethTs attended to ♦ e nnU "Tenth _
hare withpartnery._.y el.etr call, ♦ the DOH eentrae
*For Information Onlv:. -
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 i)haboard ore/wo-content/uvloads/PHAB-Standards-and Measures Version 1 0 ndf
Exhibit A, Statements of Work Page 5 of 12 Contract Number CLH18253-6
Revised as of November 15,2018
AMENDMENT#6
Program Specific Requirements/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 USASpending.eov by DOH as required by P.L. 109-282.
Program Manual,Handbook,Policy References
Children with Special health Care Needs Manual-http://www.doh.wa.eov/Portals/l/Documents/Pubs/970-209-CSHCN-Manual pdf
Health Services Authorization(HSA)Form
hM://www doh.wa.gov/Portals/I/Documents/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 healthcare needs.,[Social Security Law, See. 505(a)(3)].
2. 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)].
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 at least one every quarter,and annual site visit.
Special Billing Requirements -
Payment is contingent upon DOH receipt and approval of all deliverables and an acceptable A19-1A 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 monthly by the 30th of each month
following the month 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.
Exhibit A, Statements of Work Page 6 of 12 Contract Number CLH18253-6
Revised as of November 15,2018
AMENDMENT#6
Special Instructions
Contact DOH contract manager below for approval of expenses not reflected in approved budget workbook
DOH Program Contact .
Mary Dussol,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:360-236-3781/Fax: 360-236-3646
Email: Marv.Dussol9—doh.wa gov
Exhibit A, Statements of Work Page 7 of 12 Contract Number CLH18253-6
Revised as of November 15,2018
AMENDMENT#6
Exhibit A
Statement of Work
Contract Term: 2018-2020
DOH Program Name or Title: Office of Drinking Water Group A Program- Local Health Jurisdiction Name:. Mason County Public Health
Effective January 1,2018
Contract Number: CLH18253
SOW Type: Revision. Revision#(for this SOW) 2 Funding Source Federal Compliance Type of Payment
Z Federal Contractor (check if applicable) ❑Reimbursement
Period of Performance: January 1,2018 through December 31,2020 ® State ❑FFATA(Transparency Act) ®Fixed Price
❑ Other ❑Research&Development
Statement of Work Purpose: The purpose of this statement of work is to provide funding to the LHJ for conducting sanitary surveys and providing technical assistance to small
-community and non-community Group A water systems.
Revision Purpose: The purpose of this revision is to change end date in Funding Period from 12/31/18 to 12/31/19,increase Total Consideration,and revise Special Billing
Requirements and Special Instructions.
Chart of Accounts Program Name or Title CFDA# BARS Master i Funding Period ;' Current Change Total
Revenue Index (LHJ Use Only) '': Consideration Consideration
Increase
Code Code (+)
`�'�StarfDate'EndsDate,�.
Yr20SRF-Local Asst 15%o S SS N/A 346.26.64 24139220 01/01/I8 12/31/18 0 0 0
Sanitary Survey Fees O-S SS-State N/A 346.26.65 24232522 01/01/18 12/31/19 12,000 12,000 24,000
Yr20SRF-Local Asst 15% S TA N/A 34626.66 24139220 01/01/18 12/31/18 0 0 0
Yr21 SRF-Local Asst 15% (ITS) SS N/A 34626.64 24139221 01/01/18 12/31/19 12,000 12,000 24,000
Yr 21 SRF-Local Asst 15%u S TA N/A 346.26.66 24139221 O1/01/18 12/31/19 2,000 2,000 41000
TOTALS 26,000 26,000 52,000
Task Task/Activity/Description *May Support PHAB Deliverables/Outcomes Due Date/Time payment Information andlor Amount
Number Standards/Measures Frame
1 Trained LHJ staff will conduct - - - Provide Final* Sanitary Final Sanitary Upon ODW acceptance of the Final
sanitary surveys of small community -. Survey Reports to ODW Survey Reports Sanitary Survey Report,the LHJ shall be
and non-community Group A water - Regional Office. Complete must be received by paid$400 for each sanitary survey of a non-
systems identified by the DOH Office Sanitary Survey Reports the ODW Regional community system with three or fewer
of Drinking Water(ODW)Regional shall include: Office within 30 connections.
Office. 1. Cover letter identifying calendar days of
significant deficiencies, conducting the Upon ODW acceptance of the Final
See Special Instructions for task significant findings, sanitary survey. Sanitary Survey Report,the LHJ shall be
activity. observations, aid$800 for each sanita
ry ary survey of a non-
recommendations,and community system with four or more
referrals for further connections and each community system.
ODW follow-u .
Exhibit A, Statements of Work Page 8 of 12 Contract Number CLH18253-6
Revised as of November 15,2018
AMENDMENT#6
Task Task/Activity/Description *May Support PHAB Deliverables/Outcomes Due Date/Time payment Information and/or Amount
Number Standards/Measures Frame
2. Completed Small Water Payment is inclusive of all associated costs
DOH will provide a tablet and GPS System checklist. such as travel,lodging,per diem.
unit for the LHJ to gather source data - 3. Updated Water
during a routine sanitary survey.DOH Facilities Inventory Payment is authorized upon receipt and
expects the LHJ to commit to using (WFl). acceptance of the Final Sanitary Survey
the tablet and GPS for a five-year 4. Photos of water system Report within the 30-day deadline.
period. with text identifying
- features Late or incomplete reports may not be
5. Any other supporting accepted for payment.
documents,
*Final Reports reviewed
and accepted by the ODW
Regional Office.
The LHJ surveyor will
record at least two(2) GPS
data points,for each source,
into the preloaded Excel _
template on the tablet and
submit that data file with the
associated sanitary survey.
2_ Trained LHJ staff will conduct Provide completed SPI Completed SPI Upon acceptance of the completed SPI
Special Purpose Investigations(SPI) Report and any supporting Reports must be Report,the LHJ shall be paid$800 for each
of small community and non- documents and photos to received by the SPI.
community Group A water systems ODW Regional Office. ODW Regional
identified by the ODW Regional Office within 2 . Payment is inclusive of all associated costs
Office. working days of the such as travel,lodging,per diem.
service request.
See Special Instructions for task Payment is authorized upon receipt and
activity. acceptance of completed SPI Report within
the 2 working day deadline.
Late or incomplete reports may not be
accepted for payment.
Exhibit A, Statements of Work Page 9 of 12 Contract Number CLH18253-6
Revised as of November 15,2018 -
AMENDMENT#6
Task Task/Activity/Description *May SupporarePHAB Deliverables/Outcomes Due Date/Time Payment Information and/or Amount
Number Standards/Measures Frame y
3 Trained LHJ staff will provide direct Provide completed TA Completed TA Upon acceptance of the completed TA
technical assistance(TA)to small Report and any supporting Report must be Report,the LHJ shall be paid for each
community and non-community documents and photos to received by the technical assistance activity as follows:
Group A water systems identified by ODW Regional Office. ODW Regional • Up to 3 hours of work: $250
the ODW Regional Office. Office within 30 e 3-6 hours of work: $500
calendar days of . More than 6 hours of work: $750
See Special Instructions for task providing technical
activity. assistance. Payment is inclusive of all associated costs
such as consulting fee,travel,lodging,per
diem.
Payment is authorized upon receipt and
acceptance of completed TA Report within
the 30-day deadline.
Late or incomplete reports may not be
accepted for payment.
4 LHJ staff performing the activities - Prior to attending the Annually LHJ shall be paid mileage,per diem,
under tasks 1,2 and 3 must have training, submit an lodging,and registration costs as approved
completed the mandatory Sanitary "Authorization for Travel on the pre-authorization form in accordance
Survey Training. - (Non-Employee)"DOH with the current rates listed on the OFM
Form 710-013 to the ODW Website
See Special Instructions for task -, Program Contact below for http://=.ofm.wa.gov/resources/travel.asi)
activity. _ - approval(to ensure that
enou h funds are available .
*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:
hW://www phaboard ore/n-content/ui)loads/PHAB-Standards-and-Measures Version 1 0 pdf
Program Specific Rea uirements/Narrative
Special References(RCWs,WACs,etc)
Chapter 246-290 WAC is the set of rules that regulate Group A water systems. By this statement of work,ODW contracts with the LHJ to conduct sanitary surveys(and SPIs,and
provide technical assistance)for small community and non-community water systems with groundwater sources. ODW retains responsibility for conducting sanitary surveys(and
SPIs, and provide technical assistance)for small community and non-community water systems with surface water sources,large water systems,and systems with complex
treatment. -
LHJ staff assigned to perform activities under tasks 1,2,and 3 must be trained and approved by ODW prior to performing work. See special instructions under Task 4,below.
Exhibit A, Statements of Work Page 10 of 12 Contract Number CLH18253-6
Revised as of November 15,2018
AMENDMENT#6
Special Billing Requirements
The LHJ shall submit quarterly invoices within 30 days following the end of the quarter in which work was completed,noting on the invoice the quarter and year being billed for.
Payment cannot exceed a maximum accumulative fee of$2-0;000$48,000 for Task 1,and$1,,000$4,000 for Task 2,Task 3 and Task 4 combined during the contracting period,
to be paid at the rates specified in the Payment Method/Amount section above. When invoicing for sanitary surveys bill half to BARS Revenue Code 346 26 64 and half to BARS
Revenue Code 346.26.65.
When invoicing for Task 1,submit the list of W S Name,1D#,Amount Billed, Survey Date and Letter Date that you are requesting'payment.
When invoicing for Task 2-3,submit the list of WS Name,ID#,TA Date and description of TA work performed, and Amount Billed.
When invoicing for Task 4,submit receipts and the signed pre-authorization form for non-employee travel to the ODW Program Contact below and a signed A194A Invoice
Voucher to the DOH Giants Management,billing to BARS Revenue Code 346.26.66 under Technical Assistance(TA).
Special Instructions
Task 1
Trained LHJ staff will evaluate the water system for physical and operational deficiencies and prepare a Final Sanitary Survey Report which has been accepted by ODW.Detailed
guidance is provided in the Field Guide for Sanitary Surveys, Special Purpose Investigations and Technical Assistance(Field Guide).The sanitary survey will include an
evaluation of the following eight elements: source;treatment; distribution system;finished water storage;pumps,pump facilities and controls;monitoring,reporting and data
verification; system management and operation, and certified operator compliance. If a system is more complex than anticipated or other significant issues arise,the LHJ may
request ODW assistance. '
• No more than 0 surveys of non-community systems with three or fewer connections to be completed between January 1,2018 and December 31,2018.
• No more than 30 28 surveys of non-community systems with four or more connections and all community systems to be completed between January 1,2018 and
December 31,2018.
• No more than 10 surveys of non-community systems with three or fewer connections to be completed between January 1, 2019 and December 31, 2019.
• No more than 27surveys ofnon-community systems with four or more connections and all community systems to be completed between January 1, 2019 and
December 31, 2019.
The process for assignment of surveys to the LHJ,notification of the water system,and ODW follow-up with unresponsive water systems; and other roles and responsibilities of
the LHJ are described in the Field Guide.
Task 2
Trained LHJ staff will perform Special Purpose Investigations(SPIs)as assigned by ODW. SPIs are inspections to determine the cause of positive coliform samples or the cause of
other emergency conditions. SPIs may also include sanitary surveys of newly discovered Group A water systems.Additional detail about conducting SPIs is described in the Field
Guide.The ODW Regional Office must authorize in advance any SPI conducted by LHJ staff.
Task 3
Trained LHJ staff will conduct Technical assistance as assigned-by ODW.Technical Assistance includes assisting water system personnel in completing work or verifying work
has been addressed as required,requested,or advised by the ODW to meet applicable drinking water regulations. Examples of technical assistance activities are described in the
Field Guide.The ODW Regional Offige must authorize in advance any technical assistance provided by the LHJ to a water system.
Task 4
LHJ staff assigned to perform activities under tasks 1,2,and 3 must be trained and approved by ODW prior to performing work.L14J staff performing the activities under tasks 1,
2 and 3 must have completed,with a passing score,the ODW Online Sanitary Survey Training and the ODW Sanitary Survey Field Training.LHJ staff performing activities under
tasks 1,2,and 3 must attend the Annual ODW Sanitary Survey Workshop,and are expected to attend the Regional ODW LHJ Drinking Water Meetings.
Exhibit A, Statements of Work Page 11 of 12 Contract Number CLH18253-6
Revised as of November 15,2018'
AMENDMENT#6
If required trainings,workshops or meetings are not available,not scheduled,or if the LHJ staff person is unable to attend these activities prior to conducting assigned tasks,the
LHJ staff person may,with ODW approval,substitute other training activities to be determined by ODW. Such substitute activities may include one-on-one training with ODW
staff,co-surveys with ODW staff, or other activities as arranged and pre-approved by ODW.LHJ staff may not perform the activities under tasks 1,2,and 3 without completing
the training that has been arranged and approved by ODW.
Program Manual,Handbook,Policy References
http://www.doh.wa.2ov/Portals/l/Documents/Pubs/331-486.1)d
DOH Program Contact DOH Fiscal Contact
Denise Miles Karena McGovern
DOH Office of Drinking Water DOH Office of Drinking Water
243 Israel Rd SE 243 Israel Rd SE
Tumwater,WA 98501 Tumwater,WA 98501 _
Denise.Milcs@ oh.wa.gov Karena.McGovemt7adohwa.g_oy
(360)236-3028 (360)236-3094
Exhibit A, Statements of Work Page 12 of 12 Contract Number CLH18253-6
Revised as of November 15,2018