HomeMy WebLinkAboutWashington State Department of Health Amendment # 11 MASON COUNTY PUBLIC HEALTH
2018-2020 CONSOLIDATED CONTRACT
MC Contract#19-I06
CONTRACT NUMBER; CLH18253 AMENDMENT NUMBER: 11.
PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred tows
"DOH",and MASON COUNTY PUBLIC HEALTH hereinafter referred to as"LHJ',puisuant 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:
l I. Exhibit A Statements of Work,attached and incorporated by this reference,,are amended as fol
® Adds Statements-of Work for;the following programs:
• Injury&Violence Prevention(IVP)-Overdose Data to Action=Effective September 1,2019
Ej Amends Statements_of Work for the:.following programs:,
• Office:of Drinking Water Group B Program -Effective January 1,2018
❑ Deletes Statements of Work for the following programs:
2. Exhibit B-1 I.Allocations,attached and:incorporated by this reference,amends and replaces Exhibit B710 Allocations
as follows:
® Increase of$50,000 for a revised maximum consideration of$1;061,117.
❑ Decrease of for a revised maximum consideration of
❑ No change in the maximum consideration of .
Exhibit B Allocations'are attached only for inforinatiotial purposes.
3. Exhibit C-1.0:Schedule of Federal Awards,attached and incorporated by this reference,amends and replaces
Exhibit C-9.
`Unless designated otherwise herein,:the effective:date Of this;aniehdmentis the:date of execution.
ALL OTHER TERMS S AND CONDITIONS of the original contract and any subsequent amendments remain in full force
and effect.
IN WITNESS WHEREOF,the undersigned has affixed llis/hersignaturein execution thereof.
MASON COUNTY PUBLIC HEALTH STATE OF WASHINGTON:
DEPARTMENT OF HEALTH
Nt 140741 •
Date to
!j/"?6` / APPROVED AS TO FORM ONLY
Assistant Attorney General
Page of7
AMENDMENT#11
2018-2020 CONSOLIDATED CONTRACT
EXHIBIT A
STATEMENTS OF WORK
TABLE OF CONTENTS
DOH Program Name or Title: Injury&Violence Prevention (IVP)-Overdose Data to Action-Effective September 1,2019 3
DOH Program Name or Title: Office of Drinking Water Group B Program -Effective January 1,2018 6
Exhibit A, Statements of Work Page 2 of 7 Contract Number CLH18253-11
Revised as of September 16,2019
.
AMENDMENT#11
Exhibit A
Statement of Work _
Contract Term: 2018-20207
DOH Program Name or Title: Injury&Violence Prevention(IVP)-Overdose Data to Local Health Jurisdiction Name: Mason County Public Health
Action-Effective September 1.2019
Contract Number: CLH 18253
SOW Type: Original Revision#(for this SOW) Funding Source Federal Compliance Type of Payment
®Federal Subrecipient (check if applicable) ®Reimbursement
Period of Performance: September 1,2019 through August 31.2020 ❑State ®FFATA(Transparency Act) ❑Fixed Price
❑Other 0 Research&Development
Statement of Work Purpose: Mason County Public Health(MCPH)will support strategy 6-Establishing Linkages to Care by collaborating and coordinating among public
health partners to establish seamless linkages to care via"warm hand-offs"between the various entities.Mason County will use existing partnerships and systems to engage the
community,including emergency medical services,emergency departments,jails,public safety,mental health and substance use treatment providers,diversion programs,courts,
and syringe exchange.It will build both client and agency awareness of existing resources,enhance those resources,and deploy technology to facilitate successful care linkage and
coordination.
Revision Purpose: N/A
Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change Total
Revenue Index (LHJ Use Only) Consideration increase(+) Consideration
Code Code Start Date End Date
FFY19 OVERDOSE DATA TO ACTION PREV 93.136 333.93.13 77520290 09/01/19 08/31/20 0 50,000 50,000
TOTALS 0 50,000 50,000
Task Task/Activity/Description "May Support PHAB Deliverables/Outcomes Due Date/Time Frame Payment Information
Number Standards/Measures . and/or Amount
1. Collect and analyze opioid response plan data. Progress Report: Report data, Quarterly progress Monthly invoices for
Conduct continuous quality improvement on the findings and analysis. reports to DOH for all actual cost
•
opioid response plan and system.Data is collected Demonstrate how data informs tasks. reimbursement will be
on all response activities in Mason County.This Mason County linkages to care submitted to DOH.
includes outreach events.trainings,naloxone and opioid response plan Due Dates:
distribution,overdoses,provider reports etc. This : activities.Demonstrate how September-November Total of all invoices
data is utilized to inform quality improvement for work aligns with Overdose due December I0,2019. will not exceed
the community referral and linkage system. : Data to Action(OD2A)logic $50,000 through
model. December-February due August 31,2020.
3. Conduct continuous community education on Progress report: list training March 10,2020. '
opioid and other substance use risks and treatment dates,locations,attendance and March-May due June 10, (See Special Billing
resources through group and individual trainings, objective of trainings;lessons 2020. Requirements below.)
outreach activities at transit center,shelters,jail, : learned and successes with
outreach,education and
Exhibit A.Statements of Work Page 3 of 7 Contract Number CLH 18253-1 1
Revised as of September 16,2019
AMENDMENT#11
Task *Mayy,Support PHAB Payment Information
Task/Activity/Description: Deliverables/Outcomes Due Date/Time
Number Standards/Measures and/or Amount
syringe exchange,mobile outreach,Quick linkages to care.Are there June-August final report
Response Team,to link individuals to care. . procedures or policies that for this funding period
MCPH has developed? due September 30,.2020.
Demonstrate how work aligns.
with OD2A.;logic model.
3. Facilitate academic detailing opportunities for Progress report:list
primary care providers on safe opioid prescribing, - opportunities,#of trainings,
overdose prevention and buprenorphine-based outcomes,changes in
medication-assisted treatment(MAT). , prescribing and any new
waivered prescribers as an
outcome of these opportunities.
Demonstrate how work aligns
with OD2A.logic model.
4. Participate in quarterly calls with DOH and grant . . Collaboration with grant
partners.Share lessons learned and successes.More partners and DOH to-improve
frequent one on one calls with DOH when needed: statewide efforts to address the
opioid/all drug epidemic.
*For Information Only:.
Funding is not tied to the revised Standards/Measures listed here: This information may be helpful in discussions of how program activities might contribute to meeting a
Standard/Measure. More detail on•these and/or other Public Health Accreditation Board(PHAB)Standards/Measures that may apply can be found at:
http://www.phaboard.or�.iwp=content/uploads/PHAB-Standards-and-Measures-Version=l".0.pdf'
Special Requirements
Federal Funding Accountability and Transparency Act(FFATA)
This statement of work is supported by federal funds that require compliance'with the Federal.Funding Accountability and Transparency Act'(FFATA or the Transparency Act).
The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent
To comply with this act and be eligible to perform the"activities in this statement of work,the LHJ must have a Data Universal Numbering System(DUNS®)number.
anformation'aboutthe-LHJ and this statement of work will be made available.on USASpending.gov by DOH as required by P.L.-109-282.
Restrictions on Funds(what can,be used:for which activities,not direct payments,etc.)
• Subrecipients may not use funds for research.
• Subrecipients may not use funds for clinical care except as allowed by law.
Subrecipients may use funds only for reasonable program purposes,including personnel,travel,supplies,and"services.
• Generally,Subrecipients may not use funds to purchase-,furniture.;or equipment.
• No funds may be used for:
o Publicity or propaganda purposes,'for the preparation,distribution,or use of any material designed to support or defeat the'enactment of legislation before any
legislative"body the salary or expenses of any grant or contract recipient,or agent.acting for such recipient,related to any activity designed to influence the enactment
oflegislation,appropriations,regulation,administrative action,or Executive order proposed or pending before any legislative;body.
Exhibit A,Statements of Work Page 4 of 7 Contract Number CLH 18253-1'l
Revisedas of September 16,2019
AMENDMENT#11 -
o in accordance•with;the:United States Protecting Life in Global Health Assistance policy.all non=governmental organization(NGO)applicants acknowledge that
foreign NGOs that receive funds provided through this award,either as a prime recipient or subrecipient,are strictly prohibited,regardless of the,source of funds,
from performing abortions as a method of family planning or engaging:in any activity that promotes abortion as a method of family planning,or to provide financial
support to any other foreign nongovernmental organization,that conducts'such activities.See Additional Requirement(AR)35 for applicability
(littps'.//www cdc aov/grants%additionalredoirements?ar-35:htnil).
Program funds cannot be used°for purchasing naloxone,implementing or expanding drug''`take back'.'programs or other drug disposal"programs-(e.g:drop boxes:or disposal
bags),purchasing fentanyl test strips,or directly'funding or expanding;direct provision of substance"abuse treatment programs.Such activities are outside the scope of this
NOFO.
Monitoring Visits.(frequency,.type),
DOH:program staff may conduct site visits up to twice per funding year.
Special Billing Requirements'
Billing on an A19-1`A:invoice"voucher must be received by DOH monthly.
Special Instructions;
The following funding statement.must be used for media(publications,presentations,'manuscripts,posters,etc:)created using OD2A funding:
This publication(journal article;etc.)'was"supported by the Grant or Cooperative Agreement Number,NU17CE925007,funded bythe Centers for Disease:Control and Prevention
Its contents are solely the responsibility of the authors and:do not necessarily represent the official views of the Centers for Disease Control and Prevention or the-Department of
Health and Human Services.
'DOH Program Contact DOH Program Contact DOH Fiscal Contact
Rachel Meade. Jennifer Alvisurez Tami Davidson.
Opioid Overdose Prevention Specialist OpioidOverdose Prevention Project Manager Contracts.Coordinator
-.Rachel:Meade�n doh.wa:gov Jennifer:Alvisurez(a.doh.wa.aov Tami Davidson®doh.wa.gov
.360-236-2846 360-236-2845
Exhibit A Statements'cif Work Page 5 of 7 Contract-Number-CLI1I8253-11;
Revised as of September 16,,2019
AMENDMENT#11
Exhibit A
Statement of Work
Contract Term: 2018-2020
DOH Program Name or Title: Office of Drinking Water Group B Program- Local Health Jurisdiction Name: Mason County Public Health
Effective January.1.2018
Contract Number: CLH1.8253.
SOW Type: Revision Revision"#(for this SOW).3- Funding Source Federal Compliance Type of Payment
Federal<Select One> (check if applicable) ❑Reimbursement
Period of Performance: January 1.2018 through December 3 1.2020 ®State' ❑FFATA(Transparency Act) Flied Price
❑Other ❑Research&Development
Statement of Work Purpose: The purpose of this statemerit`of work is to provide financial support to LHJs implementing local Group B water system programs.
Revision Purpose: The purpose of this revision is to move expenditures for the February consolidated contract payment from FY2 Group B Programs for OW(FO-SW)to Op
Permit fees SRF 10%.match(FO-SW)in reference to.JV 430325261.
Chart of Accounts Program Name or Title CFDA# BARS. Master Funding Period <: Current Change Total
Revenue Index (LHJ Use Only) Consideration None Consideration
Code Code Start Date End".Date
GFS-Group B(FO-SW) N/A 334.04.90 24230103 01/01/18 :06/30/18 2,500 0 2,500
.FY2.Group B Programs for DW(FO-SW) .. ., N/A . 334.04.90 24230105 07/01/18 06/30/19 5,000 -272 4,728
GFS-.Group B(F(MW) N/A 334.04.90 24230103 07/01/19 06/30/20 2,500 0 2,500
GFS-Group B(FO-SW) N/A 334.04:90 24230103 07/01/20 12/31/20 2,50.0 0 2,500
Op PermitFees(FO-SW) N/A 334.04.90 24234600 02/01/19 02/28/19 0 :272 272
TOTALS 12,500 0 12,500.
Task '''*,Ma,Su ortPHAB- Payment'
y Pp Memorandum of
Task/Activity/Description Deliverables/Outcomes Information and/or
Number Standards/Measures., Agreement Number Amount
1 Implement a partial.Group B water system ,An executed joint plan of Reference=DOH JPR# Lump sum payment
program. responsibility(JPR)with DOH CLN20495 (See Special Billing.
identifying responsibilities of a Requirements)
. partial:Group B program.
'*For Information Only:
'Fundingis not tied to:the revised?Standards/Measures listed here. This information:may be helpful in discussions of how program':activities might contribute to meeting a
Standard/Measure. More detail`on these and/or other Public Health.Accreditation Board(PHAB)Standards/Measures that may apply can be found at
http://wwv phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-l.0.pdf
Exhibit A,Statements of Work Page 6 of 7 Contract Nurriber CLH 18253-11
Revised as of September 16,2019
AMENDMENT#11
Program Specific Requirements/Narrative
Special Billing Requirements
For January 1,-2018—June 30,2019,'the'LHJ shall submit three:semi-annual invoices as follows::$2;500.in;the frst.half of each calendar year(no'later than May 15)and$2,500 in
the second half:of each calendar wear:(no.later than November 15).Payment cannot exceed a maximum cumulative:fee of$5,000;per year.
For July 1,2019—December.31,2020;the LHJ shall submit two invoices as follows:$2,500 between July 1,2019—June 30,2020'(no later.than.May 15,2020)'and$2,500
between July 1,2020—December 31,2020.Payment cannot exceed the amounts indicated during the•time periods above.
DOH Program Contact DOR'fiscal.Contae
Denise Miles "Karena McGovern
Southwest Regional Office 'DOH.Office of Drinking-Water
DOH Office of Drinking Water 243 Israel Rd SE
243.Israel Rd SE Tumwater,WA 98501'
Tumwater;WA'98501 Karena.Mcgovern@doli.wa.gov
Denise:Miles@doh Wa.gov '(360)236-3094,
(360)236-3028
Exhibit A,Statements—of fWork Page 7 of 7 contract Number,CLH 18253:11
Revised as of September 16.2019
EXHIBIT B=11.
Mason County:Public Health ALLOCATIONS Contract Number: CLH18253
Contract Tenn:2018-2020 Date: September 16,2019..
Indirect'Rate as-of January 2018:113.71*
Indirect Rate as of January 2019i 14.553% G DOH Use On I) 4.
BARS Statement of Work Chart of Aceounts `z Funding Chart of
Federal-Award Revenue Funding Period, Funding Period . Period ;Accounts
Chart of-Accounts Pro ram"Title ..Identification. -. , , . ,..Anicnd# "-:CFDA* .Code** Start_Date End Date Startr ,a"tciEn l Date, Amount: Sub-Total Total
•NEP`a 6 Onsite Sewage Management '00J88801: Amd 2,8 66.123 .333 6612 01/01/IS; 06/i0119 1(1/01/14 /3l 08 /19 $.10;904 $85,330 $85.330
NEP 5-6 0nsite:Sevtale•Management: 00J88801 NIA,Amd'S. 66.123 333.66.12 01/01/18 06130/1'9 ,10/01/a4""0S/31/19 t" $74,425
PS SSI 15 0SS:Task:4 01718001 Anid 2,.8' 66.123 333 66 12 01/01/18` 0640119 07l01/.17 06/30/19`I- ($13 337) $86 541 $86,541
:PS'SSI I a OSS Task 4 ;01J13001 N/A;.AnidB' 6G 1.,23� �3�66_I...;01/O1/18; 06/30/19 107/01l17y 06/30/l9 $99:578
FFYI7EPR PHI P BPI L1dJ Funding• NU901P921889-.01+ Amd 2 93:069 333:93:06 01/01/18: 06/30/18 107/01/17 07/02/13 $9,062 $28.979 $28,979
FAY I7 EAR.PIIEP"BPI,L..HJFunding NU90TP9218S9-01 N/A• 93..069 33393:06 01/01/18-•`06/30/18 j 07/01%17 07/02/18 •; $19.917
FFY18 EAR PREP BP1.Supp:LHJ Funding NU90TP921889-01. •Amd`5 93:069 333 93;06: 07/01/18; 06/30/19. '07/01/1S 06/30/19, $SSS $49;341, $49 341
FFY18 EAR PLIEP BPI`Supp"LHJ:Funding NU90TP921889-01 ,Aim 4 93.069 333.93 06'"07/01/IS 06/30/19 07/01/18 06/30/19 .`. $48;453
FFY..19PHEP BP1'LHJ Funding 190TP922043. Amd•10 93:069 333 93 06 07/01/19` 06/30/20 07/0n1/19 06/4,0/20 ?•: .$49,342' $49 342: $49,342
Tn'I9 Overdose Data tci Action Prey i\U17CE925007. •-AmdI1' 93,13C, .333.93.13 09/01/19',_08/31/20 09/01/19 0S/3112O $5,0,000 $50.000: $503100
FFYIS,Prescri tionDru OD-Su NW7CE002734:P � PP AmdS '91136 '33.3 93 13_09/Ot/IS- 03/31719 S 09/Oa(1S OS(4/19 _ $35;000• $110000 $173,027
FFY1S Prescription Drug OD Supp NU17CE002734 Anid-4 93.136 333193 /3 09/01/1.8= 08131/19 09/01/18 08/31119. $75.000
FFY17Prescription Drug OD',Supp U17CE002734 Arad 2. :93:136 333 93.13;.01/01/18" 08/31/18 09/01/17 08/3.1115-,- $29,627 '$63 027
FFY17 Prescription Drug OD-Supp U17CE002734 N/A 93.136 333;93:13 01/0,1/1.$,.08/31/1.3 09/0 ""1/17" -08/3'1/18; $33,400
FFY17►ncreasing Immunization Rates NH231P000762 01 097/0118 06/ 0t19,4 3 307/ J /3l 0 $5,600 $S;G00' $5,600
FI'Y20PPHF Ops NH2310922619 Amd.9 93.268 333.93 26 07/01/19 06/30/20 07/01/•19 06/30/20" $500 $500= $1,000
FFY:17'PPHF Ops NH23IP000762 Amd 3,4 -93,268 333 93 26 07/p1/1s, 06/30/19 07/01I18 06la0/19,gig $500. $a00
FFY1231700s 5NH231P000762-0540 N/A 93268 333.93.26;01/01/18" 06130/18 04/01117 0610Y15 $1,423 $1,42 . $1;423
.FFYI7'AFIX 5NH23IP000762-05=00 N/A 93268 333 9.26' 01/01%I8•. 06/30/,15,04/0I/17 O6/v0%1S°; $4:293 $4.293 $4,293
FFY2OVFC Ops NH231P922619 .Amd 9. 93,168. 333.9316, 07/01/19. 06/3.0/20,07/0 U,19 06/3O/20 j. $5,600 $5,600 $7,828
FFYI7 VFC Ops :5NH231P000762-05-00 N/A :93268 333 9326. 01/01/18 06/3.0/18 4 04/01/17 06/30/18j $2;228 $2 228
FPY20 MCHBG:LHJ Contracts B0414C'.32578;_ Amd'70 ,93.994. 333 93 99`�70/01/19, 09/30/_0 10/01/10 09/j0/20;1 $67 694' J67;694 $.194503
FFY19-MCHBG'LHJ Contracts B04MC32578 Arad,4 93.994 33.E 93 99: 10/01/1,8 09/30/19 10/01/18 091a01_19 $(,7,694 $67,694
rFY18(:MCHI3G'LHJ Contracts. .B04MC31a24 Amd-2 91994: 333.9.,99%i01/01/18;`' 091.0%t8 10/01/17 09/3071; : $5;344 $56,115
f1�Y1S'MC11BG LHJ Contracts 'B04MC31524 N/A 93,994 333 93 99 01/01/:18 09/30/I8 10/01/1±7 09/.3t1/lb $50:771
1z32 'roupBS•Progrrinis:forD\1(FO SW,1)' Amd'"i1 \/:\ " 33-tt1t90 ''07/01/18 06/30/19 07101/17 Z72 2 06la0/19 , (`$'�-,) 54;728 S4,7_8
:FY2,:Group B Programs=for DW(FO=SW) Amd.3 N/A, 33404.90 90 `07/01/1S. 06.'30/19 07/01/1 06 '0/19 i, $5;000
Page'I of 3
EXHIBIT 13-1 1 -
Mason Conn ty.Public Health
'AL1,0CATIONS: Contract Number:- CL1110,253
'
Conttnet Term:2018-2029 Date: Septariber 16,2019
Indirect Rate as Of January 21118:,13'.7.31/0,
"•"- :
IndirectRatens 4 "Fiitafilse'Q!ilY
ofJanuary2019:.14:a
Funding -Chart of
BARS , Statem-en-t,i4,Wor,,k,-;,-,cIart,f,Niceci,..(yiuonii,...,, i
Period• Acconnts
. .
' Funi '. hrtg ,
Federal Award Revenue :- . .d •••nff Period Func,, .-: :-..jute i Amount. Sub Total ...
Total.
Chart of Accounts Program Title , •Identification#:.... „ ..-•: •'AMend tr. CELIA* .tode**:1,StariDniettid Date....
tart,iBateEn7,,,
,5 ' $7,
GFS7Groun B(FO-SW) 'Aincl;10 N/A 334.04.96:::67/0)/2 6:1.2/31/20-L07/0 I/19 °6„1-A,..,90,7,...,
$2 00 .S.2.500 500
GFS-Group B(F Amd 10,O-SW) N/A .334.04.90.07/01/.19 l06/30P0 r 07/01/19 0q3 /21 $2,500 $2 500
GFS Group p(FO N/A-SW) N/A 334.04.90.oligo 06/30/iS 10 7/01/17' 06130/1 S.2.5bo $2.500
9'1
' ,/„"1/19: (/2/.--)Sil 9 07/4/11 06/30/19 I 272 -S271 ,, . .
$21;74
$ .--
.„
4
'):
Op Permit Pecs(p0-SW,
-... .• ...,• .• .... .
$1,370 $1.370 .$1,370
Amd lb
iiealthy Communities N/A' 334.04.91' 07/0.11f9 ,06/30/2011, .07/01/19 Q6/,..30/.21,,
'
SFY/,Lead Environments: of Children Amd, 4 N/A '334.04.93••.'04/01/1$ 06/..:10/19,!07/01/1$. 06"/309 SI.Sbo $i.sob $43oo'
$1,500 :0,000
.Anu12
SFY1 Lead Enviranments of Chil dren, N/A* 334.049-3 '.01/01/1$: 06/.30/18 107/01,,./.117.•,0A:i30/,/11:4.
N/A ,33404.9.3:„.0 I/01/18 :06/3;W18':137/(1/17 i
SPY]Lead Environments of qhildren. Amd.1 $1,500
ice S'Iilfi's11/1iiotoxitt Amd 9. N/A 334.04.93-07/01/19. .06/30120:1 07/01/19•-06130/:.)1 $3.500 '$3.500 $11.000
'. ,
Rec ShellfishiBioto N/A xin 4 0493 01/01/1$ 06/30/191,07/01/17' 06/30/1 9 $7500 $7 5001,
Wastewater'Management-CFS
Amd 9 N/A •33404.93 97.4O ip0,.:,•'1 2/31,.-:a 107.../01/19 -01)64"1- .-S3C1°°C) .$30,000 $120,000
Wastewater Management-CPS Amd 9 N/A 3.34,0493:1'07/91!1.9. 06/30/20 i 07/01/19 00.130/21.1; $30:000 S30.000'.
WaSteWater-Managem&i: t-GFS 'Amd 5 N/A '334.04.93.207/01/18 06/30/19 .0'-‘7/0-1/17 ":-..,06/3.0/..19i'•... $41274)
$16$43 274 726
Wastewatet'Management-GFS ,
Anid 5 N/A 334.0493; 01/01/1$ 06/30/1$.,[1.'07/0-f/17 06/30/19,;=, ($4,1
.... -,,-74
•
Wastewater Management=CPS N/A.Amd 5- N/A 334.04.93'' 01/01/1 r$ ,06/30/181,,,03/01/17. 06,,....,,/3,,,,0/19 S60.,000,
. -
,..;'-' ' ' 66):40/21'' $42.>000 $126000
M ]0
FPHS Funding:for LH.ls N/A 336..0'1.25.--.07101/20: 1.4/3,1/2 0;07,101119,, ,S42;000
9 $42,000,
Amd-I0
FPI-IS Funding for LFDs 16:(1.4,71i: Cri/ 1/19, 06/30/20,,07/0,1S/1 ;:';'06/30/2 1-,. -$
s44,4000000.;
N/A -.........._.._....,"`,_. 9.. ... . . ...,. -.,-,-,- - ..1..--7-,,,,-6,4.-.!..„, .., '$42,000
Aind 3
FPHS,Furiding for,L1-1.1s Dir N/A .336.04'.25)07/Ci1/18, 06/30/19 i,07491i! ,y74,5f!. „1,,,,
•
-
YR,20 SAF-tOcal.Asst(15%)(FS)-SS Amd 3 :1;11//A 4.6 4 i/0 A i3,.46,:22 66"..66 4 1:100,110 11//1 1 1738,. 1 /:1i 311/;8 6 8L:0 7"n,i/i0,il iiil;7 72: :,112/32",:::1;,
1;8 $
'8.,:i.,.. ..1,2 0.
, $0'
.: 0...0.
$o
1/11.*0'SRF=;Local Asst(15%)(FS).-.SS .N/A;Amd 3
Amd 10 01/01/18 o6.136/19-1,79749.1qT .'••...,,,-; .„..,f.'.i $1 I 200; $11;200
YR 7I•SRF Local Asst115%)(rS)S$
YR"1;SRF-.1'...66i1 A it'(15%)(FS)SS Amd 7,110 1N/A‘1/1. 3463:4°1266664;I/11R)1/.1'8 :06::.';30;;9:4:(;;;O:Itlt:';' ilo673o6/74499 ,'.:. '(:::$1986po°00°,)
YR/I SRF-LtiealAsst(15%)(FS)--,SS Amd 6.'.10 N/A 346.26...640 1/0 11//11,8,, 012/6/330::11919 ,,.0077:0011/,/:11:,-:'00661.3/:0://21.91-.. ,
$12000
Yil,1 f,SRF'-'1.:ocal A§st.(15%)(FS)-'SS' Amd 3,10 N/A 346.26.64:01/0 1/1 (1.6/3 0/19.-'07/01?1 7 '0 6/30/19...',..,
„ . 1".:3 600, ,S13,600 $13.600
..._ .. .
"4616 644 01/0 .., 1
Ylt//•SR.17"-local Asst(15%)(FO-SW)SS Amd 10 N/A -, - • ,' ., , :,,.. ..••• ,., '... ,,,,,,,,,,,.,:,,.',J',',41.i:.'' '-.,. $800 $/4:800 $24,/300
SanitarySurveyTeeS(TO SW) SS Slate Midi. 717''12/31/19,- •.„N/A 346.-26.65'4 0y01/18 '-12/31/1.9.07/01 ,...:.„.,. , i/
$12,goo'
Amd 6
Sanitary,Survey FcteS,(PC/7SW)-.SS,Stan, N/A 346.26..65, 01/01/1$ 12/31/19:',.07101117-•-142/,.,0"1/1?,,,.,
•
Sanitary Survey Fees(00.-SW)-SS'Statc 'N/A,Amd 3.6 N/A 3,16.26..6.5'01A/1/18 :12/31/19..„07/0 I/1,7"-:1..'i/31/19. S12;000
•
Page 2 6.1'3
________ ........ ......._......... ...:____
EXHIBIT 13-11 -
Mason County Public health ALLOCATIONS Contract Number: 04118253.. •
Con tractTeriM2018"=2020 Date: :Sentember1.6,:2019
Indirect Rate as,Of'January 2018:-1371%:
Indirect Rate as'Of4anpary.2019:.14,531Y0 ;.i' 50.#V461:04711
BARS iStatement.of70V.,Orit4,.,(Itall.tjl'ACc0t1,. . Funding ,Chart of
.., , ..
Accounts
:Federal Award, Itevenue.'',.,.Tniiding.PeriOd., '.::::.iiiiiiiiiiiierikV. Period
Chart of Accounts Program Title Identification ik• -.,.. : ..-: Amend if CFDA*- Code** -8iiittlfiaie--kndljaieStartItattEnttLilate,, Amount Sub TOtal
YR'20•SRF=.Local Asst.(1.5%)(FS)-TA Anut'S N/A 346.26.66'..:pf/01412(7.iiiis,,ponpiuri::,.,)2/31/18.: ($2,000) $0. $0
YR.20 SRF=Local Ast.(I 5°%0)(PS)r TA 14/A.Amd.3 N/A, 346,26.66,:ofioji,i v.12/31,41v.07/0/11,:;:,!24,10 -• .$2.000
. ......:::::.: ..' ,,-1'1. .g:1,.1:..1 •'. 1
'YR 2.I SRF-LOeil.As§t(t *(FS)TA Arnd:10 'N/A 34676.66,!idt)61lig,, o0/3o40•i,pvp)/17Q...qp,Oil?: ($4.000.) so $0
YR 21 SRF-u.. iii:Aiit.(15°4)(FS),-TA .AnitliG,' ib' -N/A 346.26.-66t01V0140A60404.1. 4::0719147:k3,:-Ipor $2;,009 ,
YR-21 SRF-tOCalAiSt(15%).(FS):-TA /kind 3,10` N/A 3462666 014-.,f/1 :,:.....iciOdif0-•:r64/11)1/.iIVq/SOzi 9:4:: s2,000
YR:22 SRF-.Local.Asst(fsix).(ro-sw)tA Arad 10 N/A 3406.66,,01/0.1/219', 1.2/31,1119`.'?01/01/19,:0,613,0/2.1 j: $2.600 $2,000 82000
... ...
TOTAL $1.',06I,177 $1,061,117
•
Total consideration: SI;011;177 GRAND TOTAL
$50;000 S1;061,177
GRAND TOTAL $1,061,177 Total Fed .S734;207
Total State S326;970
*Catalog-of Federal,DOme.itic Assistance
:1!*Fedeial.feyenne eodesl:eain with"333". Staterevcnnercodes liegin with''334":
, .
. . •
'Page 3'ne3
- ,.... , .
Exhibit C-10:Schedule:of Federal Awards AMENDMENT ill
,.
Date:September 16,2019-
-,,,, -• . . • , ., . . ,• ..
MASON COUNTY=HEALTH SERVICES-SWV0001893-04
.. , .
cONTRACT;CLH18253-MisoK County?Uwe Health
CONTRACT PERIOD: 01/01/2018-12131/2020=
DOH; Total Amt Allocation Period ,. •-
• •Federal Federal Start End — • , - ' • - Federal AWard „
Chart of Accounts'Program Title ;BARS - 'Contract Amt 'CFDA= CFDA Program title Federal Agency Name
Ate Identification Number Faderal(3radr Award Name
, •
Pugut Sound Action Agendor
Technical Investigations and- • .PUGET‘SOUNDSHELLFISH"
PS SS11-5 OSS,TASK-4 333.66.12 08102/16 $5,000,000 01/01/18-.06/30/19 S86,541 66.121 EnVirahmental Protection Agency 0i..118631
Implementation Assistance Region 10 .STRATEGIC INMATIVE LEAD
. . . „
.„ . . ... Program
- • '•
• • , • - • -,'. Pt Sound Action Agenda: •
... ,. . .
NEP 5,6 ONSITE SEWAGE MANAGEMENT 339 .66.1-23 m',Technfcal investigations and Environental Protection Agency''.= 06.1680=1:,"•i':,,-..' - ", PUGET SOUND RESTORATION.-•,•' ,.
, 6612 ,01/69/11.-= S2,490,0610 01/01/18 60/36/19 585,330: ,,i :::--„ . ,=Implementation Aasistance, Region 10 .. :',i.:.;,-'".' •.:-:";_. •=',.:"• ... '''.,"=:: ' .: •":2.PROJECT• ..' ::'-'••'-''',;:.==,',;',
.. , . .... Department of Heaittrand Fir/man .PUBLIC HEALTH EMERGENCY
FFYI9 PHEP BP1 Lit)FUNDING 333.93.06 06/29/19 $11,307,904 07/01/19 '06/30/20 $49.342, sioss. Publie Health Emergency.
Services Centers for Disease Control 51119070022043' PREPAREDNESS.(PHEP)
Preparedness' .
and Prevention COOPERATIVE AGREEMENT
. . , .., •
..•, . '•HOSPITAL PREPAREDNESS
...•; •.;,,
, , ,. Department IN ealth and Hthitan,„ ;-=',",', :•-; -`:
--,PROGRAMAND
FFY18 EPR PHEP'BP.1'SUFP Lk/FUNDING " 333:91106 -..08/04118:•' 511,662.78 07031/18=''66/20/19 -: $4.9.34,1 .-,6-.056- Pub0c Health Emergency,,, . Services Centers for Disease Control'NU9OTP921889-01 ."'
. „:Preparedness -':....::,.. = EMERdENCY PREPAREDNESS
.,. . . • ,.
„
" .:"..'"'; -- '..:. . . HPP• AND PHEP COOPEFTAMV. E
, . „ ... .
r recta n COOPERATIVE AGREEMENT
FFY17 EPR PHEPBP1.L14.1 FUNDING: 33363.06 07/18117.' S11.062.782 01/61/18 ,06/30/18 P s28.979 93.059, . ubk Health Emergency Department of Health and Human
Services Centers for Disease Control NU9OTP921889•01
''Preparednese . AGREEMENT '—
and prevention,
,— . . . „ . . . .. .....,- .„.:,•:, - ... :: ' . - .- • '-= = • . .•'''-. •''Injury Preven5on and'Donk& ' DopaoenofHllh sod Human ,.
-,"" -, ' -• .-' WASHINGTON STATE DEPARTMENT
PFY19pvERnosp DATA TO ACTION PREV • ,' 333.93.13==,,,08/12/19, 54,390.280:09/01/19:08131120,•, ='• =.850.000';',.93,136':'Research and State and:',-: •' .„.Servicea-Centers, ... . ,for Disease Control- ..
NU17CE925007 ..."- -. OF HEATLH OVERDOSE DATA TO
. - - - -. ' -and Prevention-Naticinal Center for• • '
. . . . . ACTION
- ,
Injury Prevention and Control Department of Health and Human_._. __... . .
PRESCRIPTION DRUG OVERDOSE
FFY18 PRESCRIPTION DRUG OD-SUPP 033.83,13 05131/17 50.223.62.3 ()biotite oariiiis stiocoo- 63:13e Reseaith and State and „Services Centdrs for Disease Control U•17CE002734
• • „: • •FOR STATES
Commanity Based Programs and Prevention • . . ,..
.. .
-• ,.. ..' ,
.-... : - ,• - -..-.;•,'Injury Preventionand Control Department of Health and Hurnan,==;„,- .„'=,;„.;:..• , „. •- - •' -'•- -' ' • - „ .
FFY17 PRESCRIPTION DRUG OD4UPP ;.333,93.13 03/16/16 54.031,632 01/01/18 06/31/18-= . 563.027 '93.136''Research and State and - Services Centers for Disease Control ,U17CE062734',,,'"''' . PpESCRIPTIONpRuG OVERDOSE
..„ . —' ', STATES ' '' •''— • ,';
Community Based Programs and Prevention=' - ..•' ;'' - •---- ;•' • .,--• • •i . . , . ;: .. :-'. -- -
. . ,
. . . . . . . . .. . . ,
. .
IniniunizatIon CooperaMie Deportment of Health'and Human •
IMMUNIZATION GRANTAND
FFY20 yFc OPS 333.93.26. '07/01/19 S9,234.835 07/01/19 '06/30/20 55.600 93.268 Services Centers for Disease Control NH23IP922619
Agreements VACCINES FORCHILDREN PROGRAM
.andPrevention
. .IMMUNIZATION GRANTAND
•FPY20?0410 oi,s;••-.;•.;::I.,/ • ...., :•••:;3i3.93.25,', ",07/0i/19:-";„:',$9,234,835'07/61/19='denorie: . ...:.ssoa. 93.268 'mmunizaton Cooperative,, .= .
, SeriticeaCenters for Disease Control=;ri1H2315;92201.6:..:::.
' '....'•.,,i:, ',VACCINES FOR CHILDREN PROGRAM
„ .. . Department of Health and Human IMMUNIZATIONGRANTANd
_
FFY17 vAo,ops 333.9326 03/03/17 ...51.2.01.505 olietna 06130/18 $2.228 93=268, Ininiunizatio'6 Cooperative'
Services Centers for Disease Control 5NH23IP000762-05-00 VACCINES FOR,CHILOREN'S
... Agreements
and Prevention., , , ..
'PROGRAM
Department of Health and Human IMMUNIZATION GRANT AND
.FFyiipri.HF oin:,,-" ,, •• "' '•'-,-.1';333.93.25:.::.-• 06/29118 ": ; Services Centers for Disease Control''N11.231P000762:,': '";''VACCINES FOR CHILDREN'S;S3 834 51.2'07031/10;f06/30/19--= :, ',..seed.-g126Ei., Immuntzabon Cooperative•.•.. ' 'Department of Health and Human IMMUNIZATION GRANT AND
.. •:... •linmunization CoopeiatNe
FFY17 INCREASING IMMUNIZATION RATES 333.9326 66/29/18 S1.722.443 07/01/18 66/30/19 $56 -.600 93268 Services Centers for Disease Control NH23114000762 VACCINES FOR CHILDREN'S
Agreements
and prevention. PROGRAM
. -
,,,,, ,• - :,,,, ., --••, •,,-•---- , ••' •- •- - '•,-..:- „• ' -;;•:1- •. ti Coo- • „,.„-,•.. Deportment of Health and Human;:',:-,•.; .-• . ..•,,;,IMMUNIZATION GRANT AND.;,-,.., :-...,
FPY17AFIX,, ''',;','=" • 333:9326:''„..03/03/17.-.•51:67:2=256 oliIithe,•-66Ociiii,.:- - ,.'s4.ie3- :'si,'2.ia'.,,nmunim'Joerat!ve"
•=.",,=','Services,Ceiiters1or Disea.se Control/5NH2S1P00.0762:05:00' ::,,VACCINES FOR CHILDfiSNSi','.:1''''''''•
.•,, , •,,:. ..;, .-.;• .' ,r,..•, . ,„-:,-..; ,,„„' ", .„•.;:.•,:,, ,,,•. -.,:.• , .,.. ." ',, ,., • - ., ',Agreements''''':. .•'.•:-;" ,d Prevention, "'-,%, -,-•,,., -,,,,;. , , ....--, ,, -PROGRAM . - - ,-, .''',... ',",•.'
_.... .. . .. ... . .
„ „ Department of Health and Human' IMMUNIZATION GRANT AND -
FFY17 317 OPS 333.9326 03/63/17 5575,969 01/61/18 °th $1.423 90.268 efts Immunization Cooperative
- • ' - Services Centers for Disease'Control 5NH23IP00076245-00 VACCINES FOR CHILDREN'S
Agreements '
and Prevention.
,OFY2C1MCI•lio iit.i61intiiiAtrs•'' '-'''''' ,333.S3.99- :' 11114/18''''="52225077' loteltio- esriorio-:". -"s,66i :•.•63 994-....:maternal and Chrld Health Services, - .- . „,-n •- ',•; . , .:.MTERNALAND CHILD HEALTH ;...;":
Servic.es Healtn Resourtos and:i •-5104MC3267.8"... SERVICES BLOCK GRANT- ---"' '
—
Page;1,of 2
. -
• ---- --- -
Exhibit C-1.0 Schedule'of Federal:Awards AMENDMENT#11
Date:September 16;2019
MASON COUNTY HEALTH SERV[CESSWV0001893-04'
CONTRACT CLH18253-Mason County Publ c•Heattft'
CONTRACT PERIOD: 01/0112018-12/31/2020
DOH Total Atnt Allocation Period,
Federal Federal Start 'End .Federal Award.
Chart of Accounts Program Title' l3ARS ContractAmt CFDA CFDA Program Titre Federal Agency Name. Federal Grant Award Nettie
Award Date Award.,.•- 'Date ' :Date Identification Number
Department of Health,and Human
FFY19 MCHBG LHJ CONTRACTS, '333.93.99 t t/14l18 52.225,977 101011tti 09l30f19: .967,694 93.994 Maternal an I thilii Health Services MATERNAL AND CHILD HEALTH
Block Grant to the States Services Health Resources and' •604MC32578
Services Administration
SERVICES BLOCK GRANT
, ,„ •: . •. , - Department ti}Health.end Human-?M
... _ .,10R0/17
Maternal,andChiltfHealthServiees, MATERNALANDCHILDHEALTH•
FFYI8MCHBG'LHJ,CONTRACTS; „ 33393,99 51650,52801J01/18:.09130l18'.i 556,115 93:99A SerylcesHeaithResoureesand <,804MC31524 - ,.
: -. :. ervices dminlstration I.. .... > - .-.•. ,. ,i.. � B�ock:Grantio.the§wtes�.' �. S ,A -'SERVICES
TOTAL 5734,207 ,
•
•Page2of2