HomeMy WebLinkAboutWashington State Department of Health Amendment # 17YY�C Q Wt ack t0 - O%
MASON COUNTY PUBLIC HEALTH
2018 — 2020 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLII18253
AMENDMENT NUMBER: 17
PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HF,ALTI-I hereinafter referred to as
"DOH", and MASON COUNTY PUBLIC HEALTH hereinafter referred to as "LI-IJ", pursuant to the
Modifications/Waivers clause, and to make necessary changes within the scope of this contract and any subsequent
amendments thereto.
I'I' 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:
• Disease Control & Health Statistics BITV Cl/CT - COVID-19 - Effective July 1, 2020
• Division of Emergency Preparedness & Response PI-IEP - Effective July 1, 2020
• Emergency Preparedness & Response COVID-19 Local CARES - Effective March 1, 2020
• Injury & Violence Prevention (1VP) Overdose Data to Action - Effective September 1, 2020
Amends Statements of Work for the following programs:
• Foundational Public Health Services (FPHS) - Effective July 1, 2019
Deletes Statements of Work for the following programs:
2. Exhibit B-17 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-16 Allocations
as follows:
■
■
Increase of $2,142,659 for a revised maximum consideration of $3,545,031.
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-13 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces
Exhibit C-12.
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 1-HEALTH STATE OF WASI-IINGTON
DEPAR'I'MEN'I' OF I-IEAL'I'I-1
• • 13rend Gv FteLnr Batt. 1 /04 20
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Date Date
APPROVED AS TO FORM ONLY
Assistant Attorney General
Page 1 of 27
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Payment
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Establish a budget plan and narrative to be submitted to the Submit the budget plan Within 30 days of Reimbursement of
Department of Health (DOH) Contract Manager. DOH will and narrative using the receiving this award. actual costs
send the "Budget narrative Template", "Budget Guidance" template provided. incurred, not to
and any other applicable documents that may be identified. exceed $351,672
This statement of work includes FEMA funding as part of Provide the requested Upon request
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these costs to provide to FEMA for a reimbursement costs for FEMA
request. Further instructions on the necessary documents reimbursement reporting.
and timeline for providing these will be shared.
NOTE: The purpose of this agreement is to supplement
existing funds for local health jurisdictions to carry out
surveillance, epidemiology, case investigations & contact
tracing, laboratory capacity, infection control,
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AMENDMENT #16
Date: July 15, 2020
01 /01 /2018-12/31 /2020
CONTRACT PERIOD:
Federal Grant Award Name
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NGA Not Received
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Department of the Treasury
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VERIZON WORKSHEET - OCTOBER 4 2020 INVOICE
150.000000.100.000.562.20.542010.0000.00
360-490-0051
360-490-8728
360-490-2381
WINDOM, Dave
Dr. Daniel Stein
MI-FI / NOT A PHONE
150.000000.200.000.562.20.542010.0000.00
360-463-2238
360-490-3235
360-545-5701
360-490-1556
360-490-3070
360-490-2345
360-490-2558
360-463-3736
360-463-6516
360-490-3622
360-463-7949
$26.43
$52.85
Mi-Fi $27.32
SUB TOTAL• $106.60
GARDNER, Abe
GARDNER, Abe Mi-Fi
FULLING, Joy
BUCHHEIT, Lydia
BUCHHEIT, Lydia Mi-Fi
CUSTIS, Elizabeth
CUSTIS, Elizabeth Mi-Fi
HEALTH SPARE
O'CONNOR, AUDREY
MULLER-SHINN, Christina Mi-Fi
MULLER-SHINN, Christina
150.000000.300.000.562.50.542010.0000.00
360-463-0622 HAMME, Kayla
360-401-9772 MATHEWS, Wendy
360-463-0660
360-463-6818
360-490-8381
360-490-8630
360-463-7736
WILMOTH, Jeffery
THOMPSON, Rhonda
TRACY, Ian
CENCULA, Luke
PAYSSE, Alex
SUB TOTAL•
SUB TOTAL•
164.000000.100.000.564.10.542010
360-490-9867 JOHNSON, Ben
*Different fund, not included in total
$52.85
$27.32
$52.85
$52.85
$27.32
$52.85
$27.32
$52.85
$52.85
$27.32
$52.85
$479.23
F2005-93959E
F2005-93959B
F1246-93994C
F1246-93994C
F1705-93136A
F1705-93136A
$52.85
$52.85 51226-0310B
$52.85
$52.85 F1711-66123E
$52.85 F1711-66123E
$52.85
$52.85
$369.95
64/647
64/647
88/883
88/883
12/120
25/250
25/250
88/883
88/883
64/646
64/646
56/560
53/300
54/540
60/603
60/600
54/540
15/150
$52.85 F1403-93243A 64/641
$52.85
TOTAL PUBLIC HEALTH VERIZON BILL:
$955.78
me co racle to- oqt
MASON COUNTY PUBLIC HEALTH
2018 — 2020 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLI118253 AMENDMENT NUMBER: 17
PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTFI 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.
1'I' 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:
• Disease Control & Health Statistics BITV Cl/CT - COVID-19 - Effective July 1, 2020
• Division of Emergency Preparedness & Response PFIEP - Effective July 1, 2020
• Emergency Preparedness & Response COVID-19 Local CARES - Effective March 1, 2020
• Injury & Violence Prevention (IVP) Overdose Data to Action - Effective September 1, 2020
Amends Statements of Work for the following programs:
• Foundational Public I-Iealth Services (FPHS) - Effective July 1, 2019
Deletes Statements of Work for the following programs:
2. Exhibit B-17 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-16 Allocations
as follows:
Increase of $2,142,659 for a revised maximum consideration of $3,545,031.
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-13 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces
Exhibit C-12.
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
STOW
Date Date
8f^ESZflev fiEiZf^(.iGfrUf2 11/04/20
APPROVED AS '1'O FORM ONLY
Assistant Attorney Genet al
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AMENDMENT #16
Date: July 15, 2020
MASON COUNTY HEALTH SERVICES-SWV0001893-04
CONTRACT CLH18253-Mason County Public Health
01 /01 /2018-12/31 /2020
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