HomeMy WebLinkAboutWashington State Department of Health Amendment # 22MASON COUNTY PUBLIC HEALTH
2018 -2021 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH18253 AMENDMENT NUMBER: 22
PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEAL TH hereinafter referred to as
"DOH", and MASON 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: That the contract is hereby amended as follows:
1.Exhibit A Statements of Work, attached and in�,0rporated by this reference, are amended as follows:,,.·� Adds Statements of Work for the following programs:
•Office of Immunization & Child Profile Perinatal Hepatitis B - Effective July 1, 2021•Recreational Shellfish Activities -Effective July 1, 2021
� Amends Statements of Work for the following programs:
•COVID-19 Coordinated Response -Effective July 1, 2020•Emergency Preparedness & Response COVID-19 Local CARES - Effective March 1, 2020•Office of Drinking Water Group A Program -Effective January 1, 2018
0 Deletes Statements of Work for the following programs:
t
2.Exhibit B-22 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-21 Allocations
as follows:
� Increase of $28,250 for a revised maximum consideration of $5,058,047.
□Decrease of for a revised maximum consideration of __
0 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.
IN WITNESS WHEREOF, the undersigned has affixed his/her signature in execution thereof.
MASON COUNTY PUBLIC HEALTH
Date
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
APPROVED AS TO FORM ONLY
Assistant Attorney General
Page 1 of27
Date
08/10/21
AMENDMENT #22
Exhibit A, Statements of Work Page 2 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
2018-2021 CONSOLIDATED CONTRACT
EXHIBIT A
STATEMENTS OF WORK
TABLE OF CONTENTS
DOH Program Name or Title: COVID-19 Coordinated Response - Effective July 1, 2020 ........................................................................................................................................ 3
DOH Program Name or Title: Emergency Preparedness & Response COVID -19 Local CARES - Effective March 1, 2020 .................................................................................. 16
DOH Program Name or Title: Office of Drinking Water Group A Program - Effective January 1, 2018 ................................................................................................................. 19
DOH Program Name or Title: Office of Immunization & Child Profile Perinatal Hepatitis B - Effective July 1, 2021 ........................................................................................... 24
DOH Program Name or Title: Recreational Shellfish Activities - Effective July 1, 2021 ......................................................................................................................................... 26
AMENDMENT #22
Exhibit A, Statements of Work Page 3 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
Exhibit A
Statement of Work
Contract Term: 2018-2021
DOH Program Name or Title: COVID-19 Coordinated Response -
Effective July 1, 2020
Local Health Jurisdiction Name: Mason County Public Health
Contract Number: CLH18253
SOW Type: Revision Revision # (for this SOW) 3 Funding Source
Federal Subrecipient
State Other
Federal *Contractor
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price Period of Performance: July 1, 2020 through December 31, 2021
Statement of Work Purpose: The purpose of this statement of work is to provide supplemental funding for the LHJ to ensure adequate culturally and lingui stically responsive
testing, investigation and contact tracing resources to limit the spread of COVID-19
NOTE: Pending execution of a new consolidated contract term or an extension to the 2018 -2021 consolidated contracts which currently end December 31, 2021, DOH plans to
continue the task activities and funding as noted in the task(s) below in a n ew or revised statement of work effective January 1, 2022.
Revision Purpose: The purpose of this revision is to revise deliverable due dates, correct the BARS Revenue Code, move a portion of the funding to COVID-19 VACCINES, add
a link for allowable activities under Program Specific Requirements, and update DOH Program Contact information for COVID -19 Vaccine Services-Task 3; update DOH Fiscal
Contact information and add special language for DCHS COVID-19 Response-Task 1 and 2; and extend the funding period from April 20, 2021 to July 20, 2021 for MASS
VACCINATION FEMA 100%-Task 4. This revision also includes a task funding guide for all tasks under Program Specific Requirements.
Chart of Accounts Program Name or Title CFDA # BARS
Revenue
Code
Master
Index
Code
Funding
(LHJ Use
Start Date
Period
Only)
End Date
Current
Consideration
Change
None
Total
Consideration
BITV-COVID ED LHJ ALLOCATION-CARES 21.019 333.21.01 1897129V 07/01/20 12/31/21 351,672 0 351,672
FEMA-75 COVID LHJ ALLOCATION 97.036 333.97.03 1897129W 07/01/20 12/30/20 0 0 0
FFY21 COVID19 VACCINE SERVICES-CARES 93.268 333.93.26 74310209 07/01/20 12/31/21 369,385 -354,803 14,582
FFY21 COVID GFS LHJ REGIONAL N/A 334.04.92 1897211G 12/31/20 06/30/21 0 0 0
FFY20 ELC EDE LHJ ALLOCATION 93.323 333.93.32 1897120D 01/15/21 12/31/21 657,521 0 657,521
FFY19 ELC COVID ED LHJ ALLOCATION 93.323 333.93.32 1897129G 01/01/21 12/31/21 294,029 0 294,029
*MASS VACCINATION FEMA 100% 97.036 333.97.03 934V0200 01/21/21 07/20/21 0 0 0
COVID 19 VACCINES 93.268 333.93.26 74310229 07/01/20 12/31/21 0 354,803 354,803
TOTALS 1,672,607 0 1,672,607
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
Participate in public health emergency preparedness and response activities for COVID -19. This may include surveillance, epidemiology, laboratory capacity, infection control,
mitigation, communications and or other preparedness and response acti vities for COVID-19.
Examples of key activities include:
Incident management for the response
AMENDMENT #22
Exhibit A, Statements of Work Page 4 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
Testing
Case Investigation/Contact Tracing
Sustainable isolation and quarantine
Care coordination
Surge management
Data reporting
Previous funding provided by DOH for COVID response (federal Crisis Cooperative Agreement funding, state Disaster Recovery Account funding) must be fully u tilized before
these funds can be accessed. The total state funding consideration is for the period of December 31, 2020 through Ju ne 30, 2021.
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, mitigation, communications, community engagement, and other public health preparedness and response activities for COVID -19.
DCHS COVID-19 Response - Tasks 1 and 2 – Unspent ELC funding can be carried forward into new contract term effective January 1, 2022.
1 Establish a budget plan and narrative to be submitted to the
Department of Health (DOH) Contract Manager. DOH will
send the “Budget narrative Template”, “Budget Guidance”
and any other applicable documents that may be identified.
DOH does recognize the public health response goes
beyond December 2021 and authorizes local health
jurisdictions the ability to maximize funding streams
available to them by using short term funding first to
have longer term funding available to continue to
support the local health jurisdiction response activities
beyond December 2021 as applicable.
Submit the budget plan
and narrative using the
template provided.
Within 30 days of
receiving any new
award for DCHS
COVID-19 Response
tasks.
Reimbursement of
actual costs
incurred, not to
exceed $1,303,222
total.
$351,672 BITV-
COVID ED LHJ
ALLOCATION-
CARES Funding
(MI 1897129V)
$657,521 FFY20
ELC EDE LHJ
ALLOCATION
Funding
(MI 1897120D)
Funding end date
7/31/2023
$294,029 FFY19
ELC COVID ED
LHJ
ALLOCATION
Funding
(MI 1897129G)
Funding end date
10/18/2022
2 1) LHJ Active monitoring activities. In partnership with
WA DOH and neighboring Tribes, the LHJ must ensure
adequate culturally and linguistically responsive testing,
investigation and contact tracing resources to limit the
spread disease. LHJs must conduct the following
activities in accordance with the guidance to be provided
by DOH.
a. Allocate enough funding to ensure the following
Contact Tracing and Case Investigation Support:
Hire a minimum of 1.0 data entry FTE to assure
system requirements for task 2.1.a.
i. Contact tracing
1. Strive to maintain the capacity to surge a
minimum of five (5) contact tracers for
Data collected and
reported into DOH
systems daily.
Enter all contact tracing
data in CREST following
guidance from DOH.
Enter performance
metrics daily into DOH
identified systems
Quarterly performance
reporting updates
AMENDMENT #22
Exhibit A, Statements of Work Page 5 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
every 100,000 people in the jurisdiction, as
needed, based on disease rates. DOH
centralized investigations will count
towards this minimum.
2. Have staff that reflect the demographic
makeup of the jurisdiction and who can
provide culturally and linguistically
competent and responsive services. In
addition, or alternatively, enter into an
agreement(s) with Tribal, community-
based and/or culturally-specific
organizations to provide such services.
DOH centralized investigations will count
towards this minimum.
3. Ensure all contact tracing staff are trained
in accordance with DOH investigative
guidelines and data entry protocols.
4. Coordinate with Tribal partners in
conducting contact tracing for Tribal
members.
5. Ensure contact tracing and case
investigations activities meet DOH case
and Contact Tracing Metrics. (Metrics to
be determined collaboratively by DOH,
LHJs and Tribes.) Work with DOH to
develop a corrective action plan if unable
to meet metrics.
6. Perform daily monitoring for symptoms
during quarantine period of contacts
ii. Case investigation
1. Strive to maintain the capacity to surge a
minimum of five (5) case investigators and
contact tracers for every 100,000 people in
the jurisdiction, as needed, based on
disease rates. DOH centralized
investigation will count toward this
minimum.
2. Enter all case investigation and outbreak
data in WDRS following DOH guidance.
Enter all case
investigation data in
WDRS following
guidance from DOH.
AMENDMENT #22
Exhibit A, Statements of Work Page 6 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
a) Strive to enter all case investigation
and outbreak data into CREST as
directed by DOH.
b) Ensure all staff designated to utilize
WDRS have access and are trained in
the system.
c) Include if new positive cases are tied
to a known existing positive case or
indicate community spread.
d) Conduct case investigation and
monitor outbreaks.
e) Coordinate with Tribal partners in
conducting case investigations for
tribal members.
3. Ensure contact tracing and case
investigation activities meet DOH Case
and Contact Tracing Metrics. (Metrics to
be determined collaboratively by DOH,
LHJs, and Tribes.) Work with DOH to
develop a corrective action plan if unable
to meet metrics.
b. Testing
i. Work with partners and Tribes to ensure
testing is available to every person within the
jurisdiction meeting current DOH criteria for
testing and other local testing needs.
ii. Work with partners and Tribes to ensure
testing is provided in a culturally and
linguistically responsive manner with an
emphasis on making testing available to
disproportionately impacted communities and
as a part of the jurisdiction’s contact tracing
strategy.
iii. Maintain a current list of entities providing
COVID-19 testing and at what volume.
Provide reports to DOH on testing locations
and volume as requested.
c. Surveillance FTE support at a minimum of .5 FTE
Epidemiologist to support daily reporting needs
below.
Maintain a current list of
entities providing
COVID-19 testing and at
what volume. Provide
reports to DOH Contract
manager on testing
locations and volume as
requested.
AMENDMENT #22
Exhibit A, Statements of Work Page 7 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
i. Ensure all COVID positive lab test results from
LHJ are entered in to WDRS by 1) entering data
directly in to WDRS, 2) sending test results to
DOH to enter, or 3) working with DOH and
entities conducting tests to implement an
electronic method for test result submission.
ii. Maintain records of all COVID negative lab test
results from the LHJ and enter into WDRS when
resources permit or send test results to DOH.
iii. Collaborate with Tribes to ensure Tribal entities
with appropriate public health authority have
read/write access to WDRS and CREST to
ensure that all COVID lab results from their
jurisdictions are entered in WDRS or shared
with the LHJ or DOH for entry.
d. Tribal Support. Ensure alignment of contact tracing
and support for patients and family by coordinating
with local tribes if a patient identified as American
Indian/Alaska Native and/or a member of a WA
tribe.
e. Support Infection Prevention and control for high -
risk populations
i. Migrant and seasonal farmworker support.
Partner with farmers, agriculture sector and
farmworker service organizations to develop
and execute plans for testing, quarantine and
isolation, and social service needs for migrant
and seasonal farmworkers.
ii. Congregate care facilities: In collaboration
with the state licensing agency (DSHS),
support infection prevention assessments,
testing. Infection control and isolation and
quarantine protocols in congregate care
facilities.
iii. High risk businesses or community-based
operations. In collaboration with state
licensing agencies and Labor and Industries,
partner with food processing and
manufacturing businesses to ensure adequate
Quarterly performance
updates related to
culturally and linguistic
competency and
responsiveness, tribal
support, infection
prevention and control for
high-risk populations,
community education and
regional active monitoring
activities. Performance
update should include
status of all projects
listed.
AMENDMENT #22
Exhibit A, Statements of Work Page 8 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
practices to prevent COVID-19 exposure,
conduct testing and respond to outbreaks.
iv. Healthcare: Support infection prevention and
control assessments, testing, cohorting, and
isolation procedures. Provide educational
resources to a variety of healthcare setting
types (e.g., nursing homes, hospitals, dental,
dialysis).
v. Non-healthcare settings that house vulnerable
populations: In collaboration with state
corrections agency (DOC) and other state
partners, support testing, infection control,
isolation and quarantine and social services
and wraparound supports for individuals living
or temporarily residing in congregate living
settings, including detention centers, prisons,
jails, transition housing, homeless shelters,
and other vulnerable populations.
vi. Schools: In collaboration with OSPI and local
health jurisdictions, support infection
prevention and control and outbreak response
in K-12 and university school settings.
f. Ensure adequate resources are directed towards h28
H2A housing facilities within communities, fishing
industries and long-term care facilities to prevent
and control disease transmission. Funds can be used
to hire support staff, provide incentives or facility-
based funding for onsite infection prevention
efforts, etc.
g. Community education. Work with Tribes and
partners to provide culturally and linguistically
responsive community outreach and education
related to COVID-19.
h. Establish sustainable isolation and quarantine
measures.
i. Have at least one (1) location identified and
confirmed through contract/formal agreement
that can support isolation and quarantine
adequate to the population for your jurisdiction
Quarterly performance
updates to include name,
address and capacity of
identified location that
can support isolation and
quarantine, date of
AMENDMENT #22
Exhibit A, Statements of Work Page 9 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
with the ability to expand; alternatively,
establish with an adjacent jurisdiction a formal
agreement to provide the isolation and
quarantine capacity adequate to the population
for your jurisdiction with the ability to expand.
ii. Conduct at least one (1) exercise per year with
the identified isolation and quarantine site to
include a minimum of: confirmation of wrap
around services (food service/delivery, laundry
service, water/septic, garbage, ambulance
service, cleaning/sanitation), facility intake and
discharge procedures, transport procedures,
and staffing.
iii. Planning must incorporate transfer or receipt of
isolation and quarantine patients to from
adjacent jurisdictions or state facilities in the
event of localized increased need.
iv. Planning must incorporate triggers and
coordination to request state isolation and
quarantine support either through mobile teams
or the state facility to include site identification
and access
exercise to be conducted
and confirmation of
appropriate planning and
coordination as required.
COVID-19 Vaccine Services - Task 3 – will be extended through June 30, 2022 in new contract term effective January 1, 2022. Any unspent funds may be carried
forward.
3.A Identify activity/activities to support COVID vaccine
response in your community, using the examples below as a
guideline.
Example 1: Develop and implement communication
strategies with health care providers, community, and/or
other partners to help build vaccine confidence broadly and
among groups anticipated to receive early vaccination, as
well as dispel vaccine misinformation. Document and
provide a plan that shows the communication strategies used
with health care providers and other partners and the locally
identified population anticipated to reach.
Example 2: Engage in other vaccination planning activities
such as partnership development, provider education,
vaccination point of dispensing (POD) planning, tabletop
exercises, engagement with communities, leaders, non-
Summary of the
engagement strategies to
be used with health care
providers and other
partners, and the locally
identified population to be
reached.
January 31, Annually Reimbursement of
actual costs
incurred, not to
exceed:
$14,582 $369,385
FFY21 COVID19
VACCINE
SERVICES-CARES
Funding
(MI 74310209)
$354,803 COVID 19
VACCINES Funding
(MI 74310229)
AMENDMENT #22
Exhibit A, Statements of Work Page 10 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
traditional provider, or vulnerable populations to develop
strategies to ensure equitable access to vaccination services
3.B Implement the communication strategies or other activities,
working with health care providers and other partners to
reach the locally identified population, support providers in
vaccination plans, and support equitable access to
vaccination services.
Mid-term written report
describing
activity/activities and
progress made to-date and
strategies used (template
to be provided)
March 31 June 30,
Annually
3.C Catalog activities and conduct an evaluation of the strategies
used
Final written report,
showing the strategies
used and the final
progress of the reach
(template to be provided)
June 30 December 31,
Annually
Regional Incident Management Team (IMT) Mass Vaccination Clinics – Task 4
*NOTE: Task 4 activities for Mass Vaccination Clinics
in this statement of work are NOT CONSIDERED
SUBRECIPIENT but are as a CONTRACTOR of DOH.
DOH reimbursement provided for local mass
vaccination clinic (see definition below) planning,
implementation and operations in coordination between
Unified Command and the Regional IMT to administer
the vaccine as efficiently, quickly, equitably, and safely
in all regions of Washington State. State Supported,
Regionally Coordinated, Locally Implemented.
Definition: Mass vaccination clinics defined as those
outside of the usual healthcare delivery. method such as
pop-up clinics, mobile clinics, non- clinical facility
(fairgrounds, arenas, etc.).
Leaders Intent about this work from DOH is included as an
attachment.
Guidance on vaccination protocols must be followed as
provided by DOH and CDC.
*Reimbursement of
eligible costs.
MASS
VACCINATION
FEMA 100%
Funding
(MI 934V0200)
(See Program
Specific
Requirements for
Mass Vaccination
Task 4 below)
AMENDMENT #22
Exhibit A, Statements of Work Page 11 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
4.A Local health jurisdiction (LHJ) will coordinate planning and
implementation of mass vaccination clinics/sites provided
within the county(s) with a regional incident management
team/organization as approved by DOH.
Request for regional IMT should be submitted through the
normal process through WebEOC.
Local health jurisdiction is the coordinating agency for the
mass vaccination plan within the county.
Regional IMT will be under the delegation authority of
DOH and they are to provide support and coordination for
all efforts around vaccine planning, resource support and
general guidance and information sharing in order to
regionally coordinate efforts. Local jurisdictions will
maintain all decisional authority around vaccination
planning and execution within their jurisdiction/district.
Provide any information as requested by the regional IMT.
Submit to DOH a mass
vaccination plan
including:
type of site,
site locations,
throughput,
considerations
made to ensure
equity to
historically
marginalized
populations,
and to the extent
possible a
regional map of
sites/locations.
Within 30 days of
contract amendment
execution.
4.B Funding for eligible Mass Vaccination activities are
reimbursed on actual costs as outlined in the DOH guidance
to provide the services and to carry out the mission. Funding
will be dependent on full participation in the LHJ and IMT
processes and all documentation will be required to be
provided to fully close out funding requests by the end of
the mission period of performance.
Allowable costs include expenses such as facility rentals,
staff to conduct planning, management, support and
operation of the site, medical personnel for vaccinations, site
security personnel, wrap around services for staff (meals,
travel, lodging), equipment (which must be pre-approved by
IMT/DOH if it exceeds $5,000 each), supplies for
vaccinations and site operation. LHJs should provide
narratives to help assist IMT and DOH finance know what
expenditures were necessary to carry out the mission.
Submit estimated budget
for the mass vaccination
plan.
Monthly Cost Summary
Spreadsheet to the
IMT/IMO by the fifth of
the following month.
Within 30 days of
contract amendment
execution.
Monthly
AMENDMENT #22
Exhibit A, Statements of Work Page 12 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
4.C Vaccination data – will be maintained according to current
state and federal requirements.
Vaccine Registration Systems – If a local jurisdiction or
region does not have a registration system(s) the include
internet based, phone option and other methods to ensure
equitable registration, the state PrepMod system and tools
will be available for use.
Submission of vaccine
use into WA IIS database
within 24hrs of use.
Jurisdiction/Regions will
ensure a fair and equitable
process for registration of
eligible Washingtonians
across all available
modalities.
Daily
4.D Regularly report on vaccinations sites and operational
activities (number of vaccinations, personnel to operate the
site, challenges, successes to share for learning across the
public health system).
Provide monthly situation
report to IMT/IMO on
status of implementation
of mass vaccination plan,
or more frequently if that
is the LHJ procedure.
Sites operating for the
time period, vaccines
administered by site for
the time period, estimated
costs for the time period,
any challenges/successes
of note, including
assistance requested.
Monthly
*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 app ly can be found at:
http://www.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf
Special Requirements
Federal Funding Accountability and Transparency Act (FFATA)
This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Trans parency 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 Univers al Numbering System (DUNS®) number.
Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. 109-282.
AMENDMENT #22
Exhibit A, Statements of Work Page 13 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
Program Specific Requirements/Narrative
DCHS COVID-19 Response - Tasks 1 and 2
BITV-COVID ED LHJ ALLOCATION-CARES
FFY19 ELC COVID ED LHJ ALLOCATION
FFY20 ELC EDE LHJ ALLOCATION
COVID-19 Vaccine Services - Task 3 FFY21 COVID 19 VACCINE SERVICES-CARES
COVID 19 VACCINES
Regional Incident Management Team (IMT) Mass Vaccination Clinics – Task 4 MASS VACCINATION FEMA 100%
DCHS COVID-19 Response - Tasks 1 and 2
Restrictions on Funds: Indirects are NOT allowable for CARES funding from September 2, 2020 forward – LHJ can charge administrative activities as direct costs but not
incur indirects from September 2, 2020 through December 30, 2020 for activities funded with CARES funds (COVID LOCAL CARES - COVID LHJ OFM
ALLOCATION-CARES, BITV-COVID ED LHJ ALLOCATION-CARES, FEMA-75 COVID LHJ ALLOCATION)
o Since the federal guidance was not updated until September 2, 2020, DOH understands that indirects could be charged from March–August 2020.
Payment: Upon approval of deliverables and receipt of an invoice voucher, DOH will reimburse for actual allowable costs incurred. Bil lings for services on a monthly fraction of
the budget will not be accepted or approved.
Submission of Invoice Vouchers: The LHJ shall submit correct monthly A19-1A invoice vouchers for amounts billable under this statement of work to DOH by the 25 th of the
following month or on a frequency no less often than quarterly.
COVID-19 Vaccine Services - Task 3 – allowable activities https://www.doh.wa.gov/Portals/1/Documents/9240/AllowableUseFedOpsFunds.pdf
Mass Vaccination – Task 4
Program Manual, Handbook, Policy References
Emergency Response Plan (or equivalent)
Medical Countermeasure/Mass Vaccinat ion Plan
Restrictions on Funds (what funds can be used for which activities, not direct payments, etc.):
Non-mass vaccination efforts are not allowable through this funding stream.
Duplication of billing (sending request for reimbursement) to entities o utside of this agreement is prohibited.
Indirect rates are not applicable to these funds.
Special References (RCWs, WACs, etc.)
County Health Emergency Documentation if applicable
Monitoring Visits (frequency, type):
Occasional visits from DOH or IMT/IMO personnel for the purpose of monitoring and surveillance of mass vaccination activities may be expected.
AMENDMENT #22
Exhibit A, Statements of Work Page 14 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
Definitions
Mass vaccination clinic are those outside of the usual healthcare delivery methods such as pop -up clinics, mobile clinics, non-clinical facility clinics (i.e., fairgrounds, arenas, etc.).
Special Billing Requirements:
Monthly invoices must be submitted timely to the regional IMT/Organization for review/approval prior to submission to DOH for reimbursement.
Contract (MI) Code: 934V0200 General Mass Vaccination
BARS Revenue Code: 333.97.03 Mass Vaccination Reimbursement
Special Instructions:
The LHJ is considered a CONTRACTOR of DOH not a subrecipient for this portion of the statement of work. An allocation of funds is not provided as these FEMA funds are only
available as reimbursement of costs associated with implementation of the mass vaccination plan.
Detailed documentation must be maintained as directed by the regional IMT/Organization and DOH to substantiate costs associat ed with these activities for submission to FEMA
upon request by DOH.
Eligible costs from the timeframe of January 21, 2021 through April 20, 2021 July 20, 2021 include facility rentals, medical and support staff for planning, management, support,
and operations; as well as wrap-around services for staff (i.e., meals, travel, lodging). Regular and overtime pay associated with this project is allowable for all staff working under
this project and must be billed as a direct charge; timesheets are required documentation and must be available upon request by DOH. Indirect rates are not applicable to these
funds. Eligible equipment includes facility infection control measures, personal protective equipment (PPE), storage equipmen t, coolers, freezers, temperature monitoring devices,
portable vaccine units for transportation, supplies such as emergency medical supplies (for emergency medical care needs that may arise in the administration of the vaccine),
containers for medical waste, as well as proper storage as need ed for canisters of liquid nitrogen or dry ice. Eligible equipment purchase costs should not exceed $5,000 per piece.
Equipment over $5,000 a piece must be preapproved by the IMT and should be leased rather than purchased. Any diversion from t he list of pre-approved expenses will require a
narrative on the purchase rationale and will be subject to IMT approval prior to reimbursement. Timesheets are required documentation for all activities related to this project. Staff
time-in / time-out must be recorded, as well as a brief description of their activities. A general description of activities is acceptable for those working at th e vaccine site; more
detailed/specific description is required for those not working at the vaccine site.
DOH Program Contact
Alyssa Lavin, LHJ Contract Manager
DOH, PHOCIS
1610 NE 150th St, Shoreline, WA 98155
alyssa.lavin@doh.wa.gov / 360-236-3273
DOH BITV-COVID ED LHJ Allocation-CARES Fiscal Contact (Tasks 1 and 2)
Sheri Spezze
DOH, Office of Program Financial Management
PO Box 47840, Olympia, WA 98504-7841
Ph: 360-236-4447 / Fax: 360-664-2216 / sheri.spezze@doh.wa.gov
DOH BITV-COVID ED LHJ Allocation-CARES and DOH ELC Allocation Fiscal Contact (Tasks 1 and 2)
Christie Durkin
DOH, Office of Program Financial Management
PO Box 47840, Olympia, WA 98504-7841
Ph: 360-236-4235 / christie.durkin@doh.wa.gov
AMENDMENT #22
Exhibit A, Statements of Work Page 15 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
DOH COVID19 Vaccine Services Program Contacts (Task 3)
Tawney Harper, MPA Misty Ellis, Project Manager Sonja Morris, Program Manager COVID-19
Deputy Director | Operations Manager CDC Public Health Advisor Operations Supervisor
Office of Immunization and Child Profile Office of Immunization and Child Profile Enhanced Influenza and COVID-19 Response
Department of Health Department of Health Office of Immunization and Child Profile
PO Box 47843, Olympia WA 98504-7843 PO Box 47843, Olympia WA 98504-7843 Department of Health
tawney.harper@doh.wa.gov / 360-236-3525 misty.ellis@doh.wa.gov / 360-236-3675 PO Box 47843, Olympia, WA 98504-7843
sonja.morris@doh.wa.gov / 360-236-3545
DOH General Mass Vaccination Program and Fiscal Contact (Task 4)
Patrick Plumb Janice Baumgardt
COVID FEMA Project Management Analyst Financial Operations Manager
Washington State Department of Health Washington State Department of Health
Office of Financial Services Office of Financial Services
111 Israel Road SE, Tumwater, WA 98501 111 Israel Road SE, Tumwater, WA 98501
patrick.plumb@doh.wa.gov / (360) 236-4291 janice.baumgardt@doh.wa.gov / (360) 236-4505
AMENDMENT #22
Exhibit A, Statements of Work Page 16 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
Exhibit A
Statement of Work
Contract Term: 2018-2021
DOH Program Name or Title: Emergency Preparedness & Response COVID-19 Local
CARES - Effective March 1, 2020
Local Health Jurisdiction Name: Mason County Public Health
Contract Number: CLH18253
SOW Type: Revision Revision # (for this SOW) 2 Funding Source
Federal Subrecipient
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
One-Time
Distribution Period of Performance: March 1, 2020 through December 31, 2021
Statement of Work Purpose: The purpose of this statement of work is to provide additional funding to suppl ement existing funds for LHJs to prevent, prepare for, and respond
to the COVID-19 disease outbreak.
Revision Purpose: The purpose of this revision is to extend the period of performance from July 31, 2021 to December 31, 2021, extend the e nd of the funding period from
June 30, 2021 to December 31, 2021, and add report (deliverables) due dates.
Chart of Accounts Program Name or Title CFDA # BARS
Revenue
Code
Master
Index
Code
Funding
(LHJ Use
Start Date
Period
Only)
End Date
Current
Consideration
Change
None
Total
Consideration
COVID LHJ OFM Allocation-CARES 21.019 333.21.01 934E0200 03/01/20 12/31/21 1,389,600 0 1,389,600
TOTALS 1,389,600 0 1,389,600
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
1 Federal Funds
Participate in public health emergency
preparedness and response activities for
COVID-19. This may include surveillance,
epidemiology, laboratory capacity, infection
control, mitigation, communications, and or other
preparedness and response activities for
COVID-19.
The CARES Act (Coronavirus Relief Fund)
provides that payments from the Fund may only be
used to cover costs that:
1. Are necessary expenditures incurred due to the
public health emergency with respect to the
Coronavirus Disease 2019 (COVID–19);
Complete Federal Funding
Certification (provided by
DOH).
Activity report(s) on template
to be provided DOH.
September 30, 2020
September 30, 2020
October 31, 2020
November 30, 2020
December 31, 2020
January 30, 2021
February 28, 2021
March 31, 2021
April 30, 2021
May 31, 2021
June 30, 2021
July 31, 2021
August 31, 2021
Reimbursement for
actual costs not to
exceed total funding
consideration amount.
AMENDMENT #22
Exhibit A, Statements of Work Page 17 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
2. Were not accounted for in the budget most
recently approved as of March 27, 2020 (the
date of enactment of the CARES Act) for the
State or government; and;
3. Were incurred during the period that begins on
March 1, 2020 and ends on June 30, 2021
December 31, 2021.
The guidance on the Department of the Treasury’s
interpretation of these limitations on the
permissible use of Fund payments can be found at
this link:
https://home.treasury.gov/policy-issues/cares/state-
and-local-governments
Coronavirus Relief Fund | U.S. Department of the
Treasury
DOH will provide additional guidance and
technical assistance.
Note:
The purpose of this agreement is to supplement
existing funds for local health jurisdictions to
carry out surveillance, epidemiology, case
investigations and contact tracing, laboratory
capacity, infection control, mitigation,
communications, community engagement, and
other public health preparedness and response
activities for COVID-19.
Existing funds for COVID-19 public health
response activities may not be displaced by these
funds and reallocated for other organizational
expenses. No funds from this agreement shall be
used to supplant existing federal, state or local
funds nor any funding allocations or
commitments made before August 31, 2020.
DOH does recognize the public health response
goes beyond December 2020 and authorizes
local health jurisdictions the ability to maximize
funding streams available to them by using
short term funding first to have longer term
funding available to continue to support the
local health jurisdiction response activities
beyond December 2020 as applicable.
September 30, 2021
October 31, 2021
November 30, 2021
December 31, 2021
Final Report:
July 30, 2021
January 31, 2022.
This report will reflect
costs incurred through
December 31, 2021. No
billable costs are allowed
after December 31, 2021.
Frequency and due dates
of reports may change
based on federal
requirements. DOH will
notify LHJ of any changes
via email.
A final activity report is
required prior to DOH
releasing the final amount
of funding.
AMENDMENT #22
Exhibit A, Statements of Work Page 18 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
*For Information Only:
Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how pro gram activities might contribute to meeting a
Standard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at:
http://www.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf
Program Specific Requirements/Narrative
Deliverables are to be submitted to the ConCon deliverables mailbox at concondeliverables@doh.wa.gov
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 Trans parency 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 Univers al Numbering System (DUNS®) number.
Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. 109-282.
Restrictions on Funds (what funds can be used for which activi ties, not direct payments, etc)
Please reference the Code of Federal Regulations:
https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=58ffddb5363a27f26e9d12ccec462549&ty=HTML&h=L&mc=true&r=PART&n=pt2.1.200#se2.1.200_1439
Allowable Activities
See information about allowable activities at US Department of the Treasury – CARES Act Provides Assistance for State, Local, and Tribal Governments: Coronavirus Relief
Fund:
https://home.treasury.gov/policy-issues/cares/state-and-local-governments
Coronavirus Relief Fund | U.S. Department of the Treasury
DOH Program Contact
Tory Henderson, Contracts & Finance Specialist
Department of Health
P O Box 47960, Olympia, WA 98504 -7960
Mobile 360-789-7262/ tory.henderson@doh.wa.gov
AMENDMENT #22
Exhibit A, Statements of Work Page 19 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
Exhibit A
Statement of Work
Contract Term: 2018-2021
DOH Program Name or Title: Office of Drinking Water Group A Program -
Effective January 1, 2018
Local Health Jurisdiction Name: Mason County Public Health
Contract Number: CLH18253
SOW Type: Revision Revision # (for this SOW) 9 Funding Source
Federal Contractor
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price Period of Performance: January 1, 2018 through December 31, 2021
Statement of Work Purpose: The purpose of this statement of work is to provide funding to the LHJ for conducting sanit ary surveys and providing technical assistance to small
community and non-community Group A water systems.
Revision Purpose: The purpose of this revision is to move unspent funding for Sanitary Survey and Technical Assistance from Yr 22 to Yr 23; to provide additional Sanitary
Survey and Technical Assistance funding in Year 23; revise previous Amendment distribution between Yr 23 SS and SS State; and revise Special Billing Requirements and
Special Instructions.
Chart of Accounts Program Name or Title CFDA # BARS
Revenue
Code
Master
Index
Code
Funding
(LHJ Use
Start Date
Period
Only)
End Date
Current
Consideration
Change
Increase (+)
Total
Consideration
Yr 20 SRF - Local Asst (15%) (FS) SS N/A 346.26.64 24139220 01/01/18 12/31/18 0 0 0
Sanitary Survey Fees (FO-SW) SS-State N/A 346.26.65 24232522 01/01/18 12/31/20 34,200 23,200 57,400
Yr 20 SRF - Local Asst (15%) (FS) TA N/A 346.26.66 24139220 01/01/18 12/31/18 0 0 0
Yr 21 SRF - Local Asst (15%) (FS) SS N/A 346.26.64 24139221 01/01/18 06/30/19 11,200 0 11,200
Yr 21 SRF - Local Asst (15%) (FS) TA N/A 346.26.66 24139221 01/01/18 06/30/19 0 0 0
Yr 22 SRF - Local Asst (15%) (FO-SW) SS N/A 346.26.64 24239222 01/01/19 12/31/20 23,000 -11,200 11,800
Yr 22 SRF - Local Asst (15%) (FO-SW) TA N/A 346.26.66 24239222 01/01/19 12/31/20 4,000 -4,000 0
Yr 23 SRF - Local Asst (15%) (FO-SW) SS N/A 346.26.64 24239223 01/01/21 12/31/21 22,400 12,000 34,400
Yr 23 SRF - Local Asst (15%) (FO-SW) TA N/A 346.26.66 24239223 01/01/21 12/31/21 2,000 6,000 8,000
TOTALS 96,800 26,000 122,800
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time
Frame Payment Information and/or Amount
1 Trained LHJ staff will conduct
sanitary surveys of small community
and non-community Group A water
systems identified by the DOH Office
of Drinking Water (ODW) Regional
Office.
Provide Final* Sanitary
Survey Reports to ODW
Regional Office. Complete
Sanitary Survey Reports
shall include:
Final Sanitary
Survey Reports
must be received by
the ODW Regional
Office within 30
calendar days of
Upon ODW acceptance of the Final
Sanitary Survey Report, the LHJ shall be
paid $400 for each sanitary survey of a non-
community system with three or fewer
connections.
AMENDMENT #22
Exhibit A, Statements of Work Page 20 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time
Frame Payment Information and/or Amount
See Special Instructions for task
activity.
1. Cover letter identifying
significant deficiencies,
significant findings,
observations,
recommendations, and
referrals for further
ODW follow-up.
2. Completed Small Water
System checklist.
3. Updated Water
Facilities Inventory
(WFI).
4. Photos of water system
with text identifying
features
5. Any other supporting
documents.
*Final Reports reviewed
and accepted by the ODW
Regional Office.
conducting the
sanitary survey.
Upon ODW acceptance of the Final
Sanitary Survey Report, the LHJ shall be
paid $800 for each sanitary survey of a non-
community system with four or more
connections and each community system.
Payment is inclusive of all associated costs
such as travel, lodging, per diem.
Payment is authorized upon receipt and
acceptance of the Final Sanitary Survey
Report within the 30-day deadline.
Late or incomplete reports may not be
accepted for payment.
2 Trained LHJ staff will conduct
Special Purpose Investigations (SPI)
of small community and non-
community Group A water systems
identified by the ODW Regional
Office.
See Special Instructions for task
activity.
Provide completed SPI
Report and any supporting
documents and photos to
ODW Regional Office.
Completed SPI
Reports must be
received by the
ODW Regional
Office within 2
working days of the
service request.
Upon acceptance of the completed SPI
Report, the LHJ shall be paid $800 for each
SPI.
Payment is inclusive of all associated costs
such as travel, lodging, per diem.
Payment is authorized upon receipt and
acceptance of completed SPI Report within
the 2 working day deadline.
Late or incomplete reports may not be
accepted for payment.
AMENDMENT #22
Exhibit A, Statements of Work Page 21 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time
Frame Payment Information and/or Amount
3 Trained LHJ staff will provide direct
technical assistance (TA) to small
community and non-community
Group A water systems identified by
the ODW Regional Office.
See Special Instructions for task
activity.
Provide completed TA
Report and any supporting
documents and photos to
ODW Regional Office.
Completed TA
Report must be
received by the
ODW Regional
Office within 30
calendar days of
providing technical
assistance.
Upon acceptance of the completed TA
Report, the LHJ shall be paid for each
technical assistance activity as follows:
Up to 3 hours of work: $250
3-6 hours of work: $500
More than 6 hours of work: $750
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
under tasks 1, 2 and 3 must have
completed the mandatory Sanitary
Survey Training.
See Special Instructions for task
activity.
Prior to attending the
training, submit an
“Authorization for Travel
(Non-Employee)” DOH
Form 710-013 to the ODW
Program Contact below for
approval (to ensure that
enough funds are available).
Annually LHJ shall be paid mileage, per diem,
lodging, and registration costs as approved
on the pre-authorization form in accordance
with the current rates listed on the OFM
Website
http://www.ofm.wa.gov/resources/travel.asp
*For Information Only:
Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how pro gram activities might contribute to meeting a
Standard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at:
http://www.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf
Program Specific Requirements/Narrative
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 per forming work. See special instructions under Task 4, below.
AMENDMENT #22
Exhibit A, Statements of Work Page 22 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
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 $90,800 $114,800 for Task 1, and $6,000 $8,000 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 ab ove. 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 WS Name, ID #, Amount Billed, Survey Date and Letter Date that you are requesting p ayment.
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 A19-1A Invoice
Voucher to the DOH Grants 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 Surve y 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 facil ities and controls; monitoring, reporting and data
verification; system management and operation; and certified operator compliance. If a system is more complex than anticipat ed 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 28 surveys of non-community systems with four or more connections and all community systems to be completed betwe en 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 29 surveys of non-community systems with four or more connections and all community systems to be completed between January 1, 2019 and
December 31, 2019.
No more than 14 surveys of non-community systems with three or fewer connections to be completed between January 1, 2020 and December 31, 2020.
No more than 21 surveys of non-community systems with four or more connections and all community systems to be completed between January 1, 2020 and
December 31, 2020.
No more than 8 18 surveys of non-community systems with three or fewer connections to be completed bet ween January 1, 2021 and December 31, 2021.
No more than 24 49 surveys of non-community systems with four or more connections and all community systems to be completed between January 1, 2021 and
December 31, 2021.
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 deta il 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 Office must authorize in advance any technical assistance provided by the LHJ to a water system.
AMENDMENT #22
Exhibit A, Statements of Work Page 23 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
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 . LHJ 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 W orkshop, and are expected to attend the Regional ODW LHJ Drinking Water Meetings.
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 t asks, the
LHJ staff person may, with ODW approval, substitute other training activities to be determined by ODW. Such substitute activi ties 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.gov/Portals/1/Documents/Pubs/331 -486.pdf
DOH Program Contact DOH Fiscal Contact
Denise Miles Marcea Kato
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.Miles@doh.wa.gov Marcea.Kato@doh.wa.gov
(360) 236-3028 (360) 236-3094
AMENDMENT #22
Exhibit A, Statements of Work Page 24 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
Exhibit A
Statement of Work
Contract Term: 2018-2021
DOH Program Name or Title: Office of Immunization & Child Profile Perinatal
Hepatitis B - Effective July 1, 2021
Local Health Jurisdiction Name: Mason County Public Health
Contract Number: CLH18253
SOW Type: Original Revision # (for this SOW) Funding Source
Federal Subrecipient
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price Period of Performance: July 1, 2021 through December 31, 2021
Statement of Work Purpose: The purpose of this statement of work is to define required Perinatal Hepatitis B activities, deliverables, and funding.
Revision Purpose: N/A
Chart of Accounts Program Name or Title CFDA # BARS
Revenue
Code
Master
Index
Code
Funding
(LHJ Use
Start Date
Period
Only)
End Date
Current
Consideration
Change
Increase (+)
Total
Consideration
FFY22 PPHF OPS 93.268 333.93.26 74310216 07/01/21 12/31/21 0 500 500
TOTALS 0 500 500
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time
Frame
Payment
Information and/or
Amount
The total funding allocation for this statement of work is intended to cover the time period of July 1, 2021 through June 30, 2022. A new statement of work will be
included in the next consolidated contract term beginning January 1, 2022 through June 30, 2022. Any unspent funds will be carried forward into that new contract
term.
1 1. In coordination with hospitals, health care
providers, and health plans (if applicable),
conduct activities to prevent perinatal hepatitis
B infection in accordance with the Perinatal
Hepatitis B Prevention Program Guidelines,
including the following:
Identification of hepatitis B surface
antigen (HBsAG)-positive pregnant
women and pregnant women with
unknown HBsAg status.
Reporting of HBsAg-positive women and
their infants.
Case management for infants born to
HBsAg-positive women to ensure
administration of hepatitis B immune
Enter information for each case
identified into the Perinatal
Hepatitis B module of the
Washington Immunization
Information System
By the last day of each
month
Reimbursement for
actual costs incurred,
not to exceed total
funding consideration
amount.
AMENDMENT #22
Exhibit A, Statements of Work Page 25 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time
Frame
Payment
Information and/or
Amount
globulin (HBIG) and hepatitis B vaccine
within 12 hours of birth, the completion of
the 3-dose hepatitis B vaccine series, and
post vaccination serologic testing.
2. Provide technical assistance to birthing
hospitals to encourage administration of the
hepatitis B birth dose to all newborns within
12 hours of birth, in accordance with Advisory
Committee on Immunization Practices (ACIP)
recommendations.
3. Report all perinatal hepatitis B investigations,
including HBsAg-positive infants, in the
Perinatal Hepatitis B Module of the
Washington State Immunization Information
System.
*For Information Only:
Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how pro gram activities might contribute to meeting a
Standard/Measure. More detail on these and/or other Public Health Accredita tion Board (PHAB) Standards/Measures that may apply can be found at:
http://www.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf
Program Specific Requirements/Narrative
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 fed eral 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 Univers al Numbering System (DUNS®) number.
Information about the LHJ and this statement of work will be made available on USASpending.gov by DOH as required by P.L. 109-282.
DOH Contract Manager DOH Program Manager
Tawney Harper, MPA Anna McAllister
Deputy Director | Operations Manager Perinatal Hepatitis B Coordinator
Office of Immunization and Child Profile Vaccine Preventable Diseases
Department of Health Department of Health
PO Box 47843, Olympia WA 98504-7843 1610 NE 105th Street, Shoreline, WA 98155
tawney.harper@doh.wa.gov, 360-236-3525 anna.mcallister@doh.wa.gov, 360-489-4214
AMENDMENT #22
Exhibit A, Statements of Work Page 26 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
Exhibit A
Statement of Work
Contract Term: 2018-2021
DOH Program Name or Title: Recreational Shellfish Activities -
Effective July 1, 2021
Local Health Jurisdiction Name: Mason County Public Health
Contract Number: CLH18253
SOW Type: Original Revision # (for this SOW) Funding Source
Federal <Select One>
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price Period of Performance: July 1, 2021 through December 31, 2021
Statement of Work Purpose: The purpose of this statement of work is to provide funds for shellfish harvesting safety.
Revision Purpose: N/A
Chart of Accounts Program Name or Title CFDA # BARS
Revenue
Code
Master
Index
Code
Funding
(LHJ Use
Start Date
Period
Only)
End Date
Current
Consideration
Change
Increase (+)
Total
Consideration
Rec. Shellfish/Biotoxin N/A 334.04.93 26402600 07/01/21 12/31/21 0 1,750 1,750
TOTALS 0 1,750 1,750
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
1 Biotoxin Monitoring
Collect samples on schedule according to
Department of Health (DOH) Biotoxin
Monitoring Plan, coordinate deviations from the
schedule with DOH, notify DOH in advance if
samples cannot be collected.
Post / remove recreational shellfish warning
and / or classification signs on beaches and
restock cages as needed.
This may also include recruiting, training, and
coordination of volunteers, and fuel
reimbursement funds for volunteer biotoxin
monitoring.
Submit report on DOH approved
format of activities for the year,
including the number and names
of beaches posted for
classification.
Email Report to DOH by:
December 31, 2021
(See Special Instructions
below.)
$1,600
2 Outreach
Staff educational booths at local events.
Distribute safe shellfish harvesting information.
Submit report including the
number of events staffed, and
amount of educational materials
distributed.
Email Report to DOH by:
December 31, 2021
(See Special Instructions
below.)
$150
AMENDMENT #22
Exhibit A, Statements of Work Page 27 of 27 Contract Number CLH18253-22
Revised as of May 14, 2021
*For Information Only:
Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how pro gram activities might contribute to meeting a
Standard/Measure. More detail on these and/or other Public Health Accreditati on Board (PHAB) Standards/Measures that may apply can be found at:
http://www.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf
Program Specific Requirements/Narrative
Program Manual, Handbook, Policy References
Department of Health’s Biotoxin Monitoring Plan
Special References (RCWs, WACs, etc)
Chapter 246-280 WAC
http://www.doh.wa.gov/CommunityandEnvironment/Shellfish/RecreationalShellfish
http://www.doh.wa.gov/AboutUs/ProgramsandServices/EnvironmentalPublicHealth/EnvironmentalHealthandSafety/ShellfishProgram/Bio toxins
Special Instructions
Report for work done the previous year must be submitted via email to Liz Maier by December 31, 2021.
The report format will be provided by DOH and may be modified throughout the period of performance via email announcement.
DOH Program Contacts:
Liz Maier, Office of Environmental Health and Safety, PO Box 47824, Olympia WA 98504 -7824; 360.236.3308; liz.maier@doh.wa.gov
Kristy Warner, Office of Environmental Health and Safety, PO Box 47824, Olympia WA 98 504-7824; 360.701.7537; kristy.warner@doh.wa.gov
DOH Fiscal Contact: Taylor Warren, Office of Financial Management; PO Box 47850, Olympia, WA 98504 -7850; 360.236.3348; taylor.warren@doh.wa.gov
EXHIBIT B-22
Mason County Public Health ALLOCATIONS Contract Number:CLH18253
Contract Term: 2018-2021 Date:May 14, 2021
Indirect Rate as of January 2018: 13.71%
Indirect Rate as of January 2019: 14.53%
BARS Funding Chart of
Federal Award Revenue Period Accounts
Chart of Accounts Program Title Identification #Amend #CFDA*Code**Start Date End Date Start Date End Date Amount Sub Total Total
BITV-COVID Ed LHJ Allocation-CARES NGA Not Received Amd 19, 22 21.019 333.21.01 07/01/20 12/31/21 07/01/20 12/31/21 $263,754 $351,672 $351,672
BITV-COVID Ed LHJ Allocation-CARES NGA Not Received Amd 17, 19, 22 21.019 333.21.01 07/01/20 12/31/21 07/01/20 12/31/21 $87,918
COVID LHJ OFM Allocation-CARES NGA Not Received Amd 17, 19, 22 21.019 333.21.01 03/01/20 12/31/21 03/01/20 12/31/21 $1,389,600 $1,389,600 $1,389,600
SS Community Outreach PN NGA Not Received Amd 18, 21 21.019 333.21.01 07/01/20 06/30/21 07/01/20 06/30/21 $20,000 $20,000 $20,000
NEP 5-6 Onsite Sewage Management 00J88801 Amd 2, 8 66.123 333.66.12 01/01/18 06/30/19 10/01/14 08/31/19 $10,904 $85,330 $85,330
NEP 5-6 Onsite Sewage Management 00J88801 N/A, Amd 8 66.123 333.66.12 01/01/18 06/30/19 10/01/14 08/31/19 $74,426
PS SSI 1-5 OSS Task 4 01J18001 Amd 2, 8 66.123 333.66.12 01/01/18 06/30/19 07/01/17 06/30/19 ($13,337)$86,541 $86,541
PS SSI 1-5 OSS Task 4 01J18001 N/A, Amd 8 66.123 333.66.12 01/01/18 06/30/19 07/01/17 06/30/19 $99,878
FFY17 EPR PHEP BP1 LHJ Funding NU90TP921889-01 Amd 2 93.069 333.93.06 01/01/18 06/30/18 07/01/17 07/02/18 $9,062 $28,979 $28,979
FFY17 EPR PHEP BP1 LHJ Funding NU90TP921889-01 N/A 93.069 333.93.06 01/01/18 06/30/18 07/01/17 07/02/18 $19,917
FFY18 EPR PHEP BP1 Supp LHJ Funding NU90TP921889-01 Amd 5 93.069 333.93.06 07/01/18 06/30/19 07/01/18 06/30/19 $888 $49,341 $49,341
FFY18 EPR PHEP BP1 Supp LHJ Funding NU90TP921889-01 Amd 4 93.069 333.93.06 07/01/18 06/30/19 07/01/18 06/30/19 $48,453
FFY20 PHEP BP2 LHJ Funding NU90TP922043 Amd 18 93.069 333.93.06 07/01/20 06/30/21 07/01/20 06/30/21 $19,737 $49,342 $98,684
FFY20 PHEP BP2 LHJ Funding NU90TP922043 Amd 17, 18 93.069 333.93.06 07/01/20 06/30/21 07/01/20 06/30/21 $29,605
FFY19 PHEP BP1 LHJ Funding NU90TP922043 Amd 10 93.069 333.93.06 07/01/19 06/30/20 07/01/19 06/30/20 $49,342 $49,342
FFY20 Overdose Data to Action Prev NU17CE925007 Amd 17, 19 93.136 333.93.13 09/01/20 08/31/21 09/01/20 08/31/21 $50,000 $50,000 $100,000
FFY19 Overdose Data to Action Prev NU17CE925007 Amd 11 93.136 333.93.13 09/01/19 08/31/20 09/01/19 08/31/20 $50,000 $50,000
FFY18 Prescription Drug OD-Supp NU17CE002734 Amd 8 93.136 333.93.13 09/01/18 08/31/19 09/01/18 08/31/19 $35,000 $110,000 $173,027
FFY18 Prescription Drug OD-Supp NU17CE002734 Amd 4 93.136 333.93.13 09/01/18 08/31/19 09/01/18 08/31/19 $75,000
FFY17 Prescription Drug OD-Supp U17CE002734 Amd 2 93.136 333.93.13 01/01/18 08/31/18 09/01/17 08/31/18 $29,627 $63,027
FFY17 Prescription Drug OD-Supp U17CE002734 N/A 93.136 333.93.13 01/01/18 08/31/18 09/01/17 08/31/18 $33,400
FFY17 Increasing Immunization Rates NH23IP000762 Amd 3, 4 93.268 333.93.26 07/01/18 06/30/19 07/01/18 06/30/19 $5,600 $5,600 $5,600
FFY22 PPHF Ops NGA Not Received Amd 22 93.268 333.93.26 07/01/21 12/31/21 07/01/21 12/31/21 $500 $500 $2,000
FFY21 PPHF Ops NH23IP922619 Amd 18 93.268 333.93.26 07/01/20 06/30/21 07/01/20 06/30/21 $250 $500
FFY21 PPHF Ops NH23IP922619 Amd 16, 18 93.268 333.93.26 07/01/20 06/30/21 07/01/20 06/30/21 $250
FFY20 PPHF Ops NH23IP922619 Amd 9 93.268 333.93.26 07/01/19 06/30/20 07/01/19 06/30/20 $500 $500
FFY17 PPHF Ops NH23IP000762 Amd 3, 4 93.268 333.93.26 07/01/18 06/30/19 07/01/18 06/30/19 $500 $500
FFY17 317 Ops 5NH23IP000762-05-00 N/A 93.268 333.93.26 01/01/18 06/30/18 04/01/17 06/30/18 $1,423 $1,423 $1,423
Chart of Accounts
Funding Period
Statement of Work
Funding Period
DOH Use Only
Page 1 of 4
EXHIBIT B-22
Mason County Public Health ALLOCATIONS Contract Number:CLH18253
Contract Term: 2018-2021 Date:May 14, 2021
Indirect Rate as of January 2018: 13.71%
Indirect Rate as of January 2019: 14.53%
BARS Funding Chart of
Federal Award Revenue Period Accounts
Chart of Accounts Program Title Identification #Amend #CFDA*Code**Start Date End Date Start Date End Date Amount Sub Total Total
Chart of Accounts
Funding Period
Statement of Work
Funding Period
DOH Use Only
FFY17 AFIX 5NH23IP000762-05-00 N/A 93.268 333.93.26 01/01/18 06/30/18 04/01/17 06/30/18 $4,293 $4,293 $4,293
FFY21 COVID19 Vaccine Services-CARES NH23IP922619 Amd 22 93.268 333.93.26 07/01/20 12/31/21 07/01/20 12/31/21 ($354,803)$14,582 $14,582
FFY21 COVID19 Vaccine Services-CARES NH23IP922619 Amd 20 93.268 333.93.26 07/01/20 12/31/21 07/01/20 12/31/21 $354,803
FFY21 COVID19 Vaccine Services-CARES NH23IP922619 Amd 19, 20 93.268 333.93.26 07/01/20 12/31/21 07/01/20 12/31/21 $14,582
COVID19 Vaccines NGA Not Received Amd 22 93.268 333.93.26 07/01/20 12/31/21 07/01/20 12/31/21 $354,803 $354,803 $354,803
FFY21 VFC Ops NH23IP922619 Amd 16 93.268 333.93.26 07/01/20 12/31/20 07/01/20 06/30/21 $2,800 $2,800 $10,628
FFY20 VFC Ops NH23IP922619 Amd 9 93.268 333.93.26 07/01/19 06/30/20 07/01/19 06/30/20 $5,600 $5,600
FFY17 VFC Ops 5NH23IP000762-05-00 N/A 93.268 333.93.26 01/01/18 06/30/18 04/01/17 06/30/18 $2,228 $2,228
FFY19 COVID CARES NU50CK000515 Amd 16, 19 93.323 333.93.32 06/01/20 12/31/21 06/01/20 12/31/21 $65,595 $65,595 $65,595
FFY19 ELC COVID Ed LHJ Allocation NU50CK000515 Amd 20 93.323 333.93.32 01/01/21 12/31/21 01/01/21 12/31/21 $294,029 $294,029 $294,029
FFY20 ELC EDE LHJ Allocation NU50CK000515 Amd 20 93.323 333.93.32 01/15/21 12/31/21 01/15/21 12/31/21 $657,521 $657,521 $657,521
FFY20 CDC COVID-19 Crisis Resp LHJ-Tribe NU90TP922069 Amd 14, 19, 20 93.354 333.93.35 01/20/20 12/31/21 01/01/20 12/31/21 $130,871 $130,871 $130,871
FFY21 MCHBG LHJ Contracts B0440169 Amd 18 93.994 333.93.99 10/01/20 09/30/21 10/01/20 09/30/21 $67,694 $67,694 $259,197
FFY20 MCHBG LHJ Contracts B04MC32578 Amd 10 93.994 333.93.99 10/01/19 09/30/20 10/01/19 09/30/20 $67,694 $67,694
FFY19 MCHBG LHJ Contracts B04MC32578 Amd 4 93.994 333.93.99 10/01/18 09/30/19 10/01/18 09/30/19 $67,694 $67,694
FFY18 MCHBG LHJ Contracts B04MC31524 Amd 2 93.994 333.93.99 01/01/18 09/30/18 10/01/17 09/30/18 $5,344 $56,115
FFY18 MCHBG LHJ Contracts B04MC31524 N/A 93.994 333.93.99 01/01/18 09/30/18 10/01/17 09/30/18 $50,771
FEMA-75 COVID LHJ Allocation NGA Not Received Amd 19 97.036 333.97.03 07/01/20 12/30/20 07/01/20 12/30/20 ($263,754)$0 $0
FEMA-75 COVID LHJ Allocation NGA Not Received Amd 17 97.036 333.97.03 07/01/20 12/30/20 07/01/20 12/30/20 $263,754
FY2 Group B Programs for DW (FO-SW)Amd 11 N/A 334.04.90 07/01/18 06/30/19 07/01/17 06/30/19 ($272)$4,728 $4,728
FY2 Group B Programs for DW (FO-SW)Amd 3 N/A 334.04.90 07/01/18 06/30/19 07/01/17 06/30/19 $5,000
GFS-Group B (FO-SW)Amd 10 N/A 334.04.90 07/01/20 12/31/20 07/01/19 06/30/21 $2,500 $2,500 $7,500
GFS-Group B (FO-SW)Amd 10 N/A 334.04.90 07/01/19 06/30/20 07/01/19 06/30/21 $2,500 $2,500
GFS - Group B (FO-SW)N/A N/A 334.04.90 01/01/18 06/30/18 07/01/17 06/30/19 $2,500 $2,500
Op Permit Fees (FO-SW)Amd 11 N/A 334.04.90 02/01/19 02/28/19 07/01/17 06/30/19 $272 $272 $272
Healthy Communities Amd 12 N/A 334.04.91 07/01/19 06/30/20 07/01/19 06/30/21 ($1,370)$0 $0
Healthy Communities Amd 10 N/A 334.04.91 07/01/19 06/30/20 07/01/19 06/30/21 $1,370
Page 2 of 4
EXHIBIT B-22
Mason County Public Health ALLOCATIONS Contract Number:CLH18253
Contract Term: 2018-2021 Date:May 14, 2021
Indirect Rate as of January 2018: 13.71%
Indirect Rate as of January 2019: 14.53%
BARS Funding Chart of
Federal Award Revenue Period Accounts
Chart of Accounts Program Title Identification #Amend #CFDA*Code**Start Date End Date Start Date End Date Amount Sub Total Total
Chart of Accounts
Funding Period
Statement of Work
Funding Period
DOH Use Only
FY20/21 COVID-19 Disaster Response Acct Amd 14, 19 N/A 334.04.92 01/20/20 06/30/21 01/01/20 06/30/21 $119,129 $119,129 $119,129
FFY21 COVID GFS LHJ Regional Amd 20 N/A 334.04.92 12/31/20 06/30/21 12/31/20 06/30/21 ($175,000)$0 $0
FFY21 COVID GFS LHJ Regional Amd 19 N/A 334.04.92 12/31/20 06/30/21 12/31/20 06/30/21 $175,000
FPH Lead Case Mgmt-FPH Amd 12 N/A 334.04.93 07/01/19 06/30/20 07/01/19 06/30/20 $1,370 $1,370 $1,370
SFY2 Lead Environments of Children Amd 4 N/A 334.04.93 07/01/18 06/30/19 07/01/18 06/30/19 $1,500 $1,500 $4,500
SFY1 Lead Environments of Children Amd 2 N/A 334.04.93 01/01/18 06/30/18 07/01/17 06/30/18 $1,500 $3,000
SFY1 Lead Environments of Children Amd 1 N/A 334.04.93 01/01/18 06/30/18 07/01/17 06/30/18 $1,500
Rec Shellfish/Biotoxin Amd 22 N/A 334.04.93 07/01/21 12/31/21 07/01/21 12/31/21 $1,750 $1,750 $16,250
Rec Shellfish/Biotoxin Amd 19 N/A 334.04.93 07/01/19 06/30/21 07/01/19 06/30/21 $1,750 $7,000
Rec Shellfish/Biotoxin Amd 16, 19 N/A 334.04.93 07/01/19 06/30/21 07/01/19 06/30/21 $1,750
Rec Shellfish/Biotoxin Amd 9, 16, 19 N/A 334.04.93 07/01/19 06/30/21 07/01/19 06/30/21 $3,500
Rec Shellfish/Biotoxin N/A N/A 334.04.93 01/01/18 06/30/19 07/01/17 06/30/19 $7,500 $7,500
Wastewater Management-GFS Amd 19 N/A 334.04.93 01/01/21 06/30/21 07/01/19 06/30/21 $30,000 $30,000 $150,000
Wastewater Management-GFS Amd 9, 19 N/A 334.04.93 07/01/20 06/30/21 07/01/19 06/30/21 $30,000 $30,000
Wastewater Management-GFS Amd 9, 19 N/A 334.04.93 07/01/20 06/30/21 07/01/19 06/30/21 $30,000 $30,000
Wastewater Management-GFS Amd 5 N/A 334.04.93 07/01/18 06/30/19 07/01/17 06/30/19 $43,274 $43,274
Wastewater Management-GFS Amd 5 N/A 334.04.93 01/01/18 06/30/18 07/01/17 06/30/19 ($43,274)$16,726
Wastewater Management-GFS N/A, Amd 5 N/A 334.04.93 01/01/18 06/30/18 07/01/17 06/30/19 $60,000
FPHS Funding for LHJs Amd 17, 19 N/A 336.04.25 07/01/20 06/30/21 07/01/19 06/30/21 $160,891 $202,891 $447,782
FPHS Funding for LHJs Amd 10, 19 N/A 336.04.25 07/01/20 06/30/21 07/01/19 06/30/21 $42,000
FPHS Funding for LHJs Amd 17 N/A 336.04.25 07/01/19 06/30/20 07/01/19 06/30/21 $160,891 $202,891
FPHS Funding for LHJs Amd 10 N/A 336.04.25 07/01/19 06/30/20 07/01/19 06/30/21 $42,000
FPHS Funding for LHJs Dir Amd 3 N/A 336.04.25 07/01/18 06/30/19 07/01/17 06/30/19 $42,000 $42,000
YR 20 SRF - Local Asst (15%) (FS) - SS Amd 3 N/A 346.26.64 01/01/18 12/31/18 07/01/17 12/31/18 ($12,000)$0 $0
YR 20 SRF - Local Asst (15%) (FS) - SS N/A, Amd 3 N/A 346.26.64 01/01/18 12/31/18 07/01/17 12/31/18 $12,000
YR 21 SRF - Local Asst (15%) (FS) SS Amd 10 N/A 346.26.64 01/01/18 06/30/19 07/01/17 06/30/19 ($13,600)$11,200 $11,200
YR 21 SRF - Local Asst (15%) (FS) SS Amd 7, 10 N/A 346.26.64 01/01/18 06/30/19 07/01/17 06/30/19 $800
YR 21 SRF - Local Asst (15%) (FS) - SS Amd 6, 10 N/A 346.26.64 01/01/18 06/30/19 07/01/17 06/30/19 $12,000
YR 21 SRF - Local Asst (15%) (FS) - SS Amd 3, 10 N/A 346.26.64 01/01/18 06/30/19 07/01/17 06/30/19 $12,000
YR 23 SRF - Local Asst (15%) (FO-SW) SS Amd 22 N/A 346.26.64 01/01/21 12/31/21 09/01/20 12/31/21 ($11,200)$11,800 $11,800
YR 22 SRF - Local Asst (15%) (FO-SW) SS Amd 15 N/A 346.26.64 01/01/19 12/31/20 07/01/19 06/30/21 ($1,800)
YR 22 SRF - Local Asst (15%) (FO-SW) SS Amd 12 N/A 346.26.64 01/01/19 12/31/20 07/01/19 06/30/21 $11,200
YR 22 SRF - Local Asst (15%) (FO-SW) SS Amd 10, 12 N/A 346.26.64 01/01/19 12/31/20 07/01/19 06/30/21 $13,600
Page 3 of 4
EXHIBIT B-22
Mason County Public Health ALLOCATIONS Contract Number:CLH18253
Contract Term: 2018-2021 Date:May 14, 2021
Indirect Rate as of January 2018: 13.71%
Indirect Rate as of January 2019: 14.53%
BARS Funding Chart of
Federal Award Revenue Period Accounts
Chart of Accounts Program Title Identification #Amend #CFDA*Code**Start Date End Date Start Date End Date Amount Sub Total Total
Chart of Accounts
Funding Period
Statement of Work
Funding Period
DOH Use Only
YR 23 SRF - Local Asst (15%) (FO-SW) SS Amd 22 N/A 346.26.64 01/01/21 12/31/21 09/01/20 12/31/21 $12,000 $34,400 $34,400
YR 23 SRF - Local Asst (15%) (FO-SW) SS Amd 20 N/A 346.26.64 01/01/21 12/31/21 09/01/20 12/31/21 $22,400
Sanitary Survey Fees (FO-SW) SS-State Amd 22 N/A 346.26.65 01/01/18 12/31/21 07/01/17 12/31/21 $23,200 $57,400 $57,400
Sanitary Survey Fees (FO-SW) - SS State Amd 15, 22 N/A 346.26.65 01/01/18 12/31/21 07/01/17 12/31/21 ($1,800)
Sanitary Survey Fees (FO-SW) - SS State Amd 12, 22 N/A 346.26.65 01/01/18 12/31/21 07/01/17 12/31/21 $11,200
Sanitary Survey Fees (FO-SW) - SS State Amd 7, 12, 22 N/A 346.26.65 01/01/18 12/31/21 07/01/17 12/31/21 $800
Sanitary Survey Fees (FO-SW) - SS State Amd 6, 12, 22 N/A 346.26.65 01/01/18 12/31/21 07/01/17 12/31/21 $12,000
Sanitary Survey Fees (FO-SW) - SS State N/A, Amd 3, 6, 12, 22 N/A 346.26.65 01/01/18 12/31/21 07/01/17 12/31/21 $12,000
YR 20 SRF - Local Asst (15%) (FS) - TA Amd 3 N/A 346.26.66 01/01/18 12/31/18 07/01/17 12/31/18 ($2,000)$0 $0
YR 20 SRF - Local Asst (15%) (FS) - TA N/A, Amd 3 N/A 346.26.66 01/01/18 12/31/18 07/01/17 12/31/18 $2,000
YR 21 SRF - Local Asst (15%) (FS) TA Amd 10 N/A 346.26.66 01/01/18 06/30/19 07/01/17 06/30/19 ($4,000)$0 $0
YR 21 SRF - Local Asst (15%) (FS) - TA Amd 6, 10 N/A 346.26.66 01/01/18 06/30/19 07/01/17 06/30/19 $2,000
YR 21 SRF - Local Asst (15%) (FS) - TA Amd 3, 10 N/A 346.26.66 01/01/18 06/30/19 07/01/17 06/30/19 $2,000
YR 22 SRF - Local Asst (15%) (FO-SW) TA Amd 22 N/A 346.26.66 01/01/19 12/31/20 01/01/19 06/30/21 ($4,000)$0 $0
YR 22 SRF - Local Asst (15%) (FO-SW) TA Amd 12 N/A 346.26.66 01/01/19 12/31/20 01/01/19 06/30/21 $2,000
YR 22 SRF - Local Asst (15%) (FO-SW) TA Amd 10, 12 N/A 346.26.66 01/01/19 12/31/20 01/01/19 06/30/21 $2,000
YR 23 SRF - Local Asst (15%) (FO-SW) TA Amd 22 N/A 346.26.66 01/01/21 12/31/21 09/01/20 12/31/21 $6,000 $8,000 $8,000
YR 22 SRF - Local Asst (15%) (FO-SW) TA Amd 20 N/A 346.26.66 01/01/21 12/31/21 09/01/20 12/31/21 $2,000
TOTAL $5,058,047 $5,058,047
Total consideration:$5,029,797 GRAND TOTAL $5,058,047
$28,250
GRAND TOTAL $5,058,047 Total Fed $4,183,716
Total State $874,331
*Catalog of Federal Domestic Assistance
**Federal revenue codes begin with "333". State revenue codes begin with "334".
Page 4 of 4
Exhibit C-18 Schedule of Federal Awards AMENDMENT #22
Date: May 14, 2021
DOH Total Amt
Chart of Accounts Program Title BARS Federal
Award Date
Federal
Award
Start
Date
End
Date Contract Amt CFDA CFDA Program Title Federal Agency Name Federal Award
Identification Number Federal Grant Award Name
SS COMMUNITY OUTREACH PN 333.21.01 NGA Not
Received
NGA Not
Received 07/01/20 06/30/21 $20,000 21.019 Coronavirus Relief Fund Department of the Treasury NGA Not Received NGA Not Received
COVID LHJ OFM ALLOCATION-CARES 333.21.01 NGA Not
Received
NGA Not
Received 03/01/20 12/31/21 $1,389,600 21.019 Coronavirus Relief Fund Department of the Treasury NGA Not Received NGA Not Received
BITV-COVID ED LHJ ALLOCATION-CARES 333.21.01 NGA Not
Received
NGA Not
Received 07/01/20 12/31/21 $351,672 21.019 Coronavirus Relief Fund Department of the Treasury NGA Not Received NGA Not Received
PS SSI 1-5 OSS TASK 4 333.66.12 08/02/16 $5,000,000 01/01/18 06/30/19 $86,541 66.123
Puget Sound Action Agenda:
Technical Investigations and
Implementation Assistance
Program
Environmental Protection Agency
Region 10 01J18001 PUGET SOUND SHELLFISH
STRATEGIC INITIATIVE LEAD
NEP 5-6 ONSITE SEWAGE MANAGEMENT 333.66.12 01/09/11 $2,490,000 01/01/18 06/30/19 $85,330 66.123
Puget Sound Action Agenda:
Technical Investigations and
Implementation Assistance
Program
Environmental Protection Agency
Region 10 00J88801 PUGET SOUND RESTORATION
PROJECT
FFY20 PHEP BP2 LHJ FUNDING 333.93.06 06/12/20 $11,365,797 07/01/20 06/30/21 $49,342 93.069 Public Health Emergency
Preparedness
Department of Health and Human
Services Centers for Disease Control
and Prevention
NU90TP922043
PUBLIC HEALTH EMERGENCY
PREPAREDNESS (PHEP)
COOPERATIVE AGREEMENT
FFY19 PHEP BP1 LHJ FUNDING 333.93.06 06/29/19 $11,307,904 07/01/19 06/30/20 $49,342 93.069 Public Health Emergency
Preparedness
Department of Health and Human
Services Centers for Disease Control
and Prevention
NU90TP922043
PUBLIC HEALTH EMERGENCY
PREPAREDNESS (PHEP)
COOPERATIVE AGREEMENT
FFY18 EPR PHEP BP1 SUPP LHJ FUNDING 333.93.06 08/01/18 $11,062,782 07/01/18 06/30/19 $49,341 93.069 Public Health Emergency
Preparedness
Department of Health and Human
Services Centers for Disease Control
and Prevention
NU90TP921889-01
HOSPITAL PREPAREDNESS
PROGRAM AND PUBLIC HEALTH
EMERGENCY PREPAREDNESS
COOPERATIVE AGREEMENT
FFY17 EPR PHEP BP1 LHJ FUNDING 333.93.06 07/18/17 $11,062,782 01/01/18 06/30/18 $28,979 93.069 Public Health Emergency
Preparedness
Department of Health and Human
Services Centers for Disease Control
and Prevention
NU90TP921889-01 HPP AND PHEP COOPERATIVE
AGREEMENT
FFY20 OVERDOSE DATA TO ACTION PREV 333.93.13 11/06/20 $4,390,240 09/01/20 08/31/21 $50,000 93.136
Injury Prevention and Control
Research and State and
Community-Based Programs
Department of Health and Human
Services Centers for Disease Control
and Prevention
NU17CE925007
WASHINGTON STATE DEPARTMENT
OF HEATLH OVERDOSE DATA TO
ACTION
FFY19 OVERDOSE DATA TO ACTION PREV 333.93.13 08/12/19 $4,390,240 09/01/19 08/31/20 $50,000 93.136
Injury Prevention and Control
Research and State and
Community-Based Programs
Department of Health and Human
Services-Centers for Disease Control
and Prevention-National Center for
Injury Prevention and Control
NU17CE925007
WASHINGTON STATE DEPARTMENT
OF HEATLH OVERDOSE DATA TO
ACTION
FFY18 PRESCRIPTION DRUG OD-SUPP 333.93.13 05/31/17 $6,223,623 09/01/18 08/31/19 $110,000 93.136
Injury Prevention and Control
Research and State and
Community Based Programs
Department of Health and Human
Services Centers for Disease Control
and Prevention
U17CE002734 PRESCRIPTION DRUG OVERDOSE
FOR STATES
FFY17 PRESCRIPTION DRUG OD-SUPP 333.93.13 03/16/16 $4,031,632 01/01/18 08/31/18 $63,027 93.136
Injury Prevention and Control
Research and State and
Community Based Programs
Department of Health and Human
Services Centers for Disease Control
and Prevention
U17CE002734 PRESCRIPTION DRUG OVERDOSE
FOR STATES
FFY22 PPHF OPS 333.93.26 NGA Not
Received
NGA Not
Received 07/01/21 12/31/21 $500 93.268 Immunization Cooperative
Agreements
Department of Health and Human
Services Centers for Disease Control
and Prevention
NGA Not Received NGA Not Received
Allocation Period
MASON COUNTY HEALTH SERVICES-SWV0001893-04
CONTRACT CLH18253-Mason County Public Health
CONTRACT PERIOD: 01/01/2018-12/31/2021
Page 1 of 3
Exhibit C-18 Schedule of Federal Awards AMENDMENT #22
Date: May 14, 2021
DOH Total Amt
Chart of Accounts Program Title BARS Federal
Award Date
Federal
Award
Start
Date
End
Date Contract Amt CFDA CFDA Program Title Federal Agency Name Federal Award
Identification Number Federal Grant Award Name
Allocation Period
MASON COUNTY HEALTH SERVICES-SWV0001893-04
CONTRACT CLH18253-Mason County Public Health
CONTRACT PERIOD: 01/01/2018-12/31/2021
FFY21 VFC Ops 333.93.26 07/01/20 $9,082,252 07/01/20 12/31/20 $2,800 93.268 Immunization Cooperative
Agreements
Department of Health and Human
Services Centers for Disease Control
and Prevention
NH23IP922619 IMMUNIZATION GRANT AND
VACCINES FOR CHILDREN PROGRAM
FFY21 PPHF OPS 333.93.26 07/01/20 $9,082,252 07/01/20 06/30/21 $500 93.268 Immunization Cooperative
Agreements
Department of Health and Human
Services Centers for Disease Control
and Prevention
NH23IP922619 IMMUNIZATION GRANT AND
VACCINES FOR CHILDREN PROGRAM
FFY21 COVID19 VACCINE SERVICES-CARES 333.93.26 01/15/21 $68,807,053 07/01/20 12/31/21 $14,582 93.268 Immunization Cooperative
Agreements
Department of Health and Human
Services Centers for Disease Control
and Prevention
NH23IP922619 IMMUNIZATION GRANT AND
VACCINES FOR CHILDREN PROGRAM
FFY20 VFC OPS 333.93.26 07/01/19 $9,234,835 07/01/19 06/30/20 $5,600 93.268 Immunization Cooperative
Agreements
Department of Health and Human
Services Centers for Disease Control
and Prevention
NH23IP922619 IMMUNIZATION GRANT AND
VACCINES FOR CHILDREN PROGRAM
FFY20 PPHF OPS 333.93.26 07/01/19 $9,234,835 07/01/19 06/30/20 $500 93.268 Immunization Cooperative
Agreements
Department of Health and Human
Services Centers for Disease Control
and Prevention
NH23IP922619 IMMUNIZATION GRANT AND
VACCINES FOR CHILDREN PROGRAM
FFY17 VFC OPS 333.93.26 03/03/17 $1,201,605 01/01/18 06/30/18 $2,228 93.268 Immunization Cooperative
Agreements
Department of Health and Human
Services Centers for Disease Control
and Prevention
5NH23IP000762-05-00
IMMUNIZATION GRANT AND
VACCINES FOR CHILDREN'S
PROGRAM
FFY17 PPHF OPS 333.93.26 06/29/18 $3,634,512 07/01/18 06/30/19 $500 93.268 Immunization Cooperative
Agreements
Department of Health and Human
Services Centers for Disease Control
and Prevention
NH23IP000762
IMMUNIZATION GRANT AND
VACCINES FOR CHILDREN'S
PROGRAM
FFY17 INCREASING IMMUNIZATION RATES 333.93.26 06/29/18 $1,722,443 07/01/18 06/30/19 $5,600 93.268 Immunization Cooperative
Agreements
Department of Health and Human
Services Centers for Disease Control
and Prevention
NH23IP000762
IMMUNIZATION GRANT AND
VACCINES FOR CHILDREN'S
PROGRAM
FFY17 AFIX 333.93.26 03/03/17 $1,672,289 01/01/18 06/30/18 $4,293 93.268 Immunization Cooperative
Agreements
Department of Health and Human
Services Centers for Disease Control
and Prevention
5NH23IP000762-05-00
IMMUNIZATION GRANT AND
VACCINES FOR CHILDREN'S
PROGRAM
FFY17 317 OPS 333.93.26 03/03/17 $575,969 01/01/18 06/30/18 $1,423 93.268 Immunization Cooperative
Agreements
Department of Health and Human
Services Centers for Disease Control
and Prevention
5NH23IP000762-05-00
IMMUNIZATION GRANT AND
VACCINES FOR CHILDREN'S
PROGRAM
COVID19 VACCINES 333.93.26 NGA Not
Received
NGA Not
Received 07/01/20 12/31/21 $354,803 93.268 Immunization Cooperative
Agreements
Department of Health and Human
Services Centers for Disease Control
and Prevention
NGA Not Received NGA Not Received
FFY20 ELC EDE LHJ ALLOCATION 333.93.32 01/14/21 ##########01/15/21 12/31/21 $657,521 93.323
Epidemiology and Laboratory
Capacity for Infectious Diseases
(ELC)-Building and Strengthening
Epidemiology, Laboratory and
Health Information Systems
Department of Health and Human
Services Centers for Disease Control
and Prevention
NU50CK000515
EPIDEMIOLOGY AND LABORATORY
CAPACITY FOR INFECTIOUS
DISEASES (ELC)-BUILDING AND
STRENGTHENING EPIDEMIOLOGY,
LABORATORY AND HEALTH
FFY19 ELC COVID ED LHJ ALLOCATION 333.93.32 01/01/21 ##########01/01/21 12/31/21 $294,029 93.323
Epidemiology and Laboratory
Capacity for Infectious Diseases
(ELC)-Building and Strengthening
Epidemiology, Laboratory and
Health Information Systems
Department of Health and Human
Services Centers for Disease Control
and Prevention
NU50CK000515
EPIDEMIOLOGY & LABORATORY
CAPACITY FOR INFECTIOUS
DISEASES (ELC)-BUILDING &
STRENGTHENING EPIDEMIOLOGY,
LABORATORY & HEALTH
FFY19 COVID CARES 333.93.32 04/23/20 $22,581,799 06/01/20 12/31/21 $65,595 93.323
Epidemiology and Laboratory
Capacity for Infectious Diseases
(ELC)-Building and Strengthening
Epidemiology, Laboratory and
Health Information Systems
Department of Health and Human
Services Centers for Disease Control
and Prevention
NU50CK000515
EPIDEMIOLOGY & LABORATORY
CAPACITY FOR INFECTIOUS
DISEASES (ELC)-BUILDING &
STRENGTHENING EPIDEMIOLOGY,
LABORATORY & HEALTH
Page 2 of 3
Exhibit C-18 Schedule of Federal Awards AMENDMENT #22
Date: May 14, 2021
DOH Total Amt
Chart of Accounts Program Title BARS Federal
Award Date
Federal
Award
Start
Date
End
Date Contract Amt CFDA CFDA Program Title Federal Agency Name Federal Award
Identification Number Federal Grant Award Name
Allocation Period
MASON COUNTY HEALTH SERVICES-SWV0001893-04
CONTRACT CLH18253-Mason County Public Health
CONTRACT PERIOD: 01/01/2018-12/31/2021
FFY20 CDC COVID-19 CRISIS RESP LHJ-TRIBE 333.93.35 03/16/20 $13,230,799 01/20/20 12/31/21 $130,871 93.354
Public Health Emergency
Response: Cooperative Agreement
for Emergency Response: Public
Health Crisis Response
Department of Health and Human
Services Centers for Disease Control
and Prevention
NU90TP922069
CDC COOPERATIVE AGREEMENT FOR
EMERGENCY RESPONSE: PUBLIC
HEALTH CRISIS RESPONSE CDC-RFA-
TP18-1802
FFY21 MCHBG LHJ CONTRACTS 333.93.99 02/08/21 $2,662,201 10/01/20 09/30/21 $67,694 93.994 Maternal and Child Health Services
Block Grant to the States
Department of Health and Human
Services Health Resources and
Services Administration
B0440169 MATERNAL AND CHILD HEALTH
SERVICES BLOCK GRANT
FFY20 MCHBG LHJ CONTRACTS 333.93.99 11/14/18 $2,225,977 10/01/19 09/30/20 $67,694 93.994 Maternal and Child Health Services
Block Grant to the States
Department of Health and Human
Services Health Resources and
Services Administration
B04MC32578 MATERNAL AND CHILD HEALTH
SERVICES BLOCK GRANT
FFY19 MCHBG LHJ CONTRACTS 333.93.99 11/14/18 $2,225,977 10/01/18 09/30/19 $67,694 93.994 Maternal and Child Health Services
Block Grant to the States
Department of Health and Human
Services Health Resources and
Services Administration
B04MC32578 MATERNAL AND CHILD HEALTH
SERVICES BLOCK GRANT
FFY18 MCHBG LHJ CONTRACTS 333.93.99 10/20/17 $1,650,528 01/01/18 09/30/18 $56,115 93.994 Maternal and Child Health Services
Block Grant to the States
Department of Health and Human
Services Health Resources and
Services Administration
B04MC31524 MATERNAL AND CHILD HEALTH
SERVICES
TOTAL $4,183,716
Page 3 of 3
Signature:
Email:
Brenda Henrikson, Contracts Specialist (Aug 10, 2021 17:33 PDT)
Brenda Henrikson, Contracts Specialist
Brenda.Henrikson@DOH.WA.GOV