HomeMy WebLinkAboutWashington State Department of Health Amendment # 2411/29/21
AMENDMENT #24
Exhibit A, Statements of Work Page 2 of 25 Contract Number CLH18253-24
Revised as of September 15, 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: Foundational Public Health Services (FPHS) - Effective July 1, 2021 ........................................................................................... 15
DOH Program Name or Title: Office of Drinking Water Group A Program - Effective January 1, 2018 ...................................................................................... 21
AMENDMENT #24
Exhibit A, Statements of Work Page 3 of 25 Contract Number CLH18253-24
Revised as of September 15, 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) 5 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 linguistically 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 new or revised statement of work effective Januar y 1, 2022.
Revision Purpose: The purpose of this revision is to add additional funding to FFY20 ELC EDE LHJ ALLOCATION, adjust the funding period for BITV-COVID ED LHJ
ALLOCATION- CARES from 07/01/20-12/31/21 to 07/01/20-06/30/21, moving the remaining allocation of BITV-COVID ED LHJ ALLOCATION-CARES to FFY20 ELC EDE
LHJ ALLOCATION, and update task language, DCHS-Task 1 & 2
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
BITV-COVID ED LHJ ALLOCATION-CARES 21.019 333.21.01 1897129V 07/01/20 06/30/21 351,672 -327,606 24,066
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 14,582 0 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 1897120E 01/15/21 12/31/21 657,521 477,606 1,135,127
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 12/31/21 0 0 0
COVID 19 VACCINES 93.268 333.93.26 74310229 07/01/20 12/31/21 354,803 0 354,803
TOTALS 1,672,607 150,000 1,822,607
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 activities for COVID-19.
Examples of key activities include:
• Incident management for the response
• Testing
AMENDMENT #24
Exhibit A, Statements of Work Page 4 of 25 Contract Number CLH18253-24
Revised as of September 15, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
• Case Investigation/Contact Tracing
• Sustainable isolation and quarantine
• Care coordination
• Surge management
• Data reporting
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 $1,453,222
$1,303,222 total.
$24,066 $351,672
BITV-COVID ED
LHJ
ALLOCATION-
CARES Funding
(MI 1897129V)
$1,135,127
$657,521 FFY20
ELC EDE LHJ
ALLOCATION
Funding
(MI 1897120E)
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
every 100,000 people in the jurisdiction, as
needed, based on disease rates. DOH
centralized investigations will count
towards this minimum.
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 #24
Exhibit A, Statements of Work Page 5 of 25 Contract Number CLH18253-24
Revised as of September 15, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
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.
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.
Enter all case
investigation data in
WDRS following
guidance from DOH.
AMENDMENT #24
Exhibit A, Statements of Work Page 6 of 25 Contract Number CLH18253-24
Revised as of September 15, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
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.
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.
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.
Ensure all COVID
positive test results are
entered into WDRS within
2 days of receipt
AMENDMENT #24
Exhibit A, Statements of Work Page 7 of 25 Contract Number CLH18253-24
Revised as of September 15, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
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
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
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 #24
Exhibit A, Statements of Work Page 8 of 25 Contract Number CLH18253-24
Revised as of September 15, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
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
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
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.
Quarterly performance
updates to include name,
address and capacity of
identified location that
can support isolation and
quarantine, and
confirmation of
appropriate planning and
coordination as required.
AMENDMENT #24
Exhibit A, Statements of Work Page 9 of 25 Contract Number CLH18253-24
Revised as of September 15, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
ii. Maintain ongoing census data for isolation and
quarantine for your population.
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
Maintain ongoing census
data for isolation and
quarantine for your
population.
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-
traditional provider, or vulnerable populations to develop
strategies to ensure equitable access to vaccination services
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
FFY21 COVID19
VACCINE
SERVICES-CARES
Funding
(MI 74310209)
$354,803 COVID
19 VACCINES
Funding (MI
74310229)
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)
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
December 31, Annually
AMENDMENT #24
Exhibit A, Statements of Work Page 10 of 25 Contract Number CLH18253-24
Revised as of September 15, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
progress of the reach
(template to be provided)
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)
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
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
Within 30 days of
contract amendment
execution.
AMENDMENT #24
Exhibit A, Statements of Work Page 11 of 25 Contract Number CLH18253-24
Revised as of September 15, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
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.
regional map of
sites/locations.
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
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
Monthly
AMENDMENT #24
Exhibit A, Statements of Work Page 12 of 25 Contract Number CLH18253-24
Revised as of September 15, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
the time period, estimated
costs for the time period,
any challenges/successes
of note, including
assistance requested.
*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 Boar d (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
Special Requirements
Federal Funding Accountability and Transparency Act (FFATA)
This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act).
The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent.
To comply with this act and be eligible to perform the activities in this statement of work, the LHJ must have a Data 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.
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 June 30 December 31, 2021 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 Marc h–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.
AMENDMENT #24
Exhibit A, Statements of Work Page 13 of 25 Contract Number CLH18253-24
Revised as of September 15, 2021
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 25th 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 Vaccination 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 outside 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.
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 associated with these activities for submission to FEMA
upon request by DOH.
Eligible costs from the timeframe of January 21, 2021 through December 31, 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 DO H. Indirect rates are not applicable to these funds.
Eligible equipment includes facility infection control measures, personal protective equipment (PPE), storage equipment, coolers, freezers, temperature monitoring devices,
portable vaccine units for transportation, supplies such as emergency medical supplies (for emergency medical care ne eds that may arise in the administration of the vaccine),
containers for medical waste, as well as proper storage as needed for canisters of liquid nitrogen or dry ice. Eligible equip ment 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 the 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 f or those working at the vaccine site; more
detailed/specific description is required for those not working at the vaccine site.
AMENDMENT #24
Exhibit A, Statements of Work Page 14 of 25 Contract Number CLH18253-24
Revised as of September 15, 2021
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 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
DOH COVID19 Vaccine Services Program Contacts (Task 3)
Tawney Harper, MPA Sonja Morris, COVID-19 Operations Supervisor
Deputy Director | Operations Manager Enhanced Influenza and COVID-19 Response
Office of Immunization and Child Profile Office of Immunization and Child Profile
Department of Health Department of Health
PO Box 47843, Olympia WA 98504-7843 PO Box 47843, Olympia, WA 98504-7843
tawney.harper@doh.wa.gov / 360-236-3525 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 #24
Exhibit A, Statements of Work Page 15 of 25 Contract Number CLH18253-24
Revised as of September 15, 2021
Exhibit A
Statement of Work
Contract Term: 2018-2021
DOH Program Name or Title: Foundational Public Health Services
(FPHS) - Effective July 1, 2021
Local Health Jurisdiction Name: Mason County Public Health
Contract Number: CLH18253
SOW Type: Revision Revision # (for this SOW) 1 Funding Source
Federal <Select One>
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Periodic
Distribution Period of Performance: July 1, 2021 through December 31, 2021
Statement of Work Purpose: The purpose of this statement of work (SOW) is to specify how state funds for Foundational Public Health Services (FPHS) will be used for the
period of performance. Per RCW 43.70.512, these funds are for the governmental public health system to deliver FPHS services statewide in the most effective, efficient and
equitable manner possible with the funds available.
The FPHS Steering Committee with input from FPHS Subject Matter Expert (SME) Workgroups and the Tribal Technical Workgroup is the decision making body for FPHS
funds. For the 2021 – 2023 biennium, the Steering Committee is using an iterative approach to decision making. Determining investments first for SFY22 (July 1, 2021 –
June 30, 2022), then for SFY23 (July 1, 2022 – June 30, 2023). This means that additional tasks and/or funds may be added to an LHJ’s FPHS SOW as these decisions are made.
These funds are to be used as directed and allocated by the FPHS Steering Committee. As the global COVID -19 pandemic and the public health response to it continues and
begins to abate, these FPHS funds can be braided with and used to supplement other short-term pandemic response funding as needed for FPHS activities during this period of
performance (07/01/21 12/31/21). Responding to pandemics, epidemics and public health emergencies are foundational services of the governmental public health system.
Note:
The total biennial funding allocation is for the period of July 1, 2021 through June 30, 2023. 2021 -2023 biennial funding allocations will be divided into four six-month
lump sum amounts that will be disbursed at the beginning of each six month period as follows: July 1, 2021; January 1, 2022; July 1, 2022; January 1, 2023. Each year,
the July payment will be disbursed upon completion of the FP HS Annual Report.
The disbursement of funds scheduled for January 1, 2022, July 1, 2022 and January 1, 2023 and deliverable due dates after Dec ember 31, 2021 are included in this
statement of work for informational purposes only and will be carried forward into a new statement of work in the new consolidated contract term beginning January 1,
2022.
FPHS funds must be spent in the state fiscal year (SFY) in which they are appropriated by the legislature, allocated, and dis bursed. Legislative appropriations lapse at
the end of each state fiscal year (RCW 43.88.140).
Spending and spending projections must be reported as required by the FPHS Steering Committee. Funds that are projected to b e unspent by the close of the state
fiscal year must be reallocated per the process developed by the FPHS Steering Committee to assure that all funds appropriated by the legislature can be spent by the
governmental public health system to deliver FPHS within the year that the funds are appropriated. Unspent funds revert to t he state treasury and must be returned to
DOH by July 15th of each year for return to the Office of Financial Management (OFM).
2021-2023 Biennium:
SFY22 (July 1, 2021-June 30, 2022)
SFY23 (July 1, 2022-June 30, 2023)
Revision Purpose: The purpose of this revision is to revise language and add funding and tasks for FFY22.
AMENDMENT #24
Exhibit A, Statements of Work Page 16 of 25 Contract Number CLH18253-24
Revised as of September 15, 2021
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
FPHS-LHJ-PROVISO (YR1) N/A 336.04.25 99202111 07/01/21 12/31/21 202,891 558,109 761,000
Note: Total Consideration is for SFY22 (07/01/21-06/30/22). 0 0 0
TOTALS 202,891 558,109 761,000
BARS
Expenditure.
Code 562.xx
FPHS Tasks / Activities / Short Description
Funds to provide FPHS in:
SFY22 SFY23 21-23
BIENNIUM Your
jurisdiction
Other
jurisdictions
10-17,
20, 21, 23-29
40-53, 93
All – CD,
EPH, CCC,
Assessment
Reinforcing Capacity (Assessment, CD, EPH, CCC) X 235,000 235,000 470,000
10 Assessment CHA/CHIP X 30,000 30,000 60,000
20, 21, 23-29,
93 CD Communicable Disease (CD) X 162,000 162,000 324,000
24 CD Hepatitis C X 103,000 103,000 206,000
40-53, 93 EPH Environmental Public Health (EPH) X 231,000 231,000 462,000
TOTAL $761,000 $761,000 $1,522,000
Task
Number Task/Activity/Description Deliverables/Outcomes
Due
Date/Time
Frame
Payment Information and/or
Amount
0 FOUNDATIONAL PUBLIC HEALTH FUNDING – ALL In coordination with FPHS Steering Committee
and Subject Matter Expert (SME) workgroups:
• Increase delivery of FPHS services in each
jurisdiction and statewide as measured via
through FPHS annual reporting, indicators,
from all agencies receiving FPHS funds,
metrics and other data compiled and
analyzed by contractors, DOH and Subject
Matter Expert (SME) Workgroups. All of
which is included as part of Results are
published in the annual FPHS Investment
Report. FPHS indicator metrics are
available here.
• Routine reporting of spending and
spending projections. Process and
reporting template TBD and provided by
the FPHS Steering Committee via DOH.
Funds are available beginning
July 1, 2021. Half of the annual
allocation will be disbursed each
July upon receipt completion of
the FPHS Annual Report for the
previous state fiscal year and the
second half will be disbursed each
January.
Note: Funds must be spent in
the state fiscal year (SFY) in
which they are appropriated by
the legislature, allocated, and
disbursed. Unspent funds must
be returned to DOH by
July 15th of each year for return
to OFM.
AMENDMENT #24
Exhibit A, Statements of Work Page 17 of 25 Contract Number CLH18253-24
Revised as of September 15, 2021
Task
Number Task/Activity/Description Deliverables/Outcomes
Due
Date/Time
Frame
Payment Information and/or
Amount
• FPHS annual reporting (template provided
by the FPHS Steering Committee via
DOH)
o For SFY22 (07/01/21–06/30/22)
FPHS annual reporting (template
provided by DOH)
o For SFY23 (07/01/22–06/30/23)
By 08/15/22
By 08/15/23
1. Reinforcing Capacity
These funds are to each LHJ to deliver FPHS in their own jurisdiction – In coordination with the FPHS Steering Committee and Subject Matter Expert (SME)
Workgroups, provide FPHS Communicable Disease (CD), Environmental Public Health (EPH), Assessment (Surveillance & Epidemiology) and / or any or all of the
other FPHS Cross-cutting Capabilities (CCC) as defined in the most current version of the FPHS definitions.
2. Assessment – CHA/CHIP (FPHS definitions G.3)
These funds are to each LHJ to deliver FPHS in their own jurisdiction – In coordination with the FPHS Steering Committee and Subject Matter Expert (SME)
Workgroups, conduct and complete a comprehensive community health assessment and identify health priorities arising from that assessment, including analysis of
health disparities and the social determinants of health as defined in the most current version of the FPHS definitions.
• Conduct a local and/or regional comprehensive community health assessment (CHA) every three to five years in conjunction with community partners.
• Develop a local and/or regional community health improvement plan (CHIP) in conjunction with community partners.
These funds can be used for any CHA/CHIP activity or service (e.g., data analysis, focus groups, report writing, process faci litation) and may be used to contract
with other LHJs for staff time or services.
3. Communicable Disease (CD) (FPHS definitions C.1, 2, 3, 4, 6)
These funds are to each LHJ to deliver FPHS in their own jurisdiction – In coordination with the FPHS Steering Committee and Subject Matter Expert (SME)
Workgroups, provide FPHS CD services as defined in the most current version of the FPHS definitions. These funds can (and actually are i ntended to) be braided
with temporary pandemic emergency funding such that when those funds run out, FPHS funds can be used to retain staff there were hired wit h pandemic emergency
funds if the jurisdictions desires to retain them and/or to hire additional staff if needed, and/or contract with other LHJs for staff time or services for delivering FPHS
CD. As the pandemic response wains, staff funded with FPHS funds are to shift focus to providing some or all or the FPHS CD services. This includes maintaining
access to and use of data systems created during the pandemic and others under development and case investigation and contact tracing for sexually transmitted
disease and other communicable and notifiable conditions within the mandated timeframes. Emphasis should be placed on addressing syphilis and gonorrhea cases.
Provide timely, statewide, locally relevant and accurate information statewide and to communities on prevention and control of communicable disease and
other notifiable conditions.
Identify statewide and local community assets for the control of communicable diseases and other notifiable conditions, develop and implement a prioritized
control plan addressing communicable diseases and other notifiable conditions and seek resources and advocate for high priority prevention and control
policies and initiatives regarding communicable diseases and other notifiable conditions.
Promote immunization through evidence-based strategies and collaboration with schools, health care providers and other community partners to increase
immunization rates.
Ensure disease surveillance, investigation and control for communicable disease and notifiable conditions in accordance with local, state and federal
mandates and guidelines.
AMENDMENT #24
Exhibit A, Statements of Work Page 18 of 25 Contract Number CLH18253-24
Revised as of September 15, 2021
Task
Number Task/Activity/Description Deliverables/Outcomes
Due
Date/Time
Frame
Payment Information and/or
Amount
4. Communicable Disease – Hepatitis C (FPHS definitions C.4.o-p)
These funds are to select LHJs to deliver FPHS in their own jurisdictions – In coordination with the FPHS Steering Committee and Subject Matter Expert (SME)
Workgroups, address Hepatitis C cases in the jurisdiction per guidance developed by the statewide FPHS Communicable Disease Workgroup, including, but not
limited to: shared priorities, standardized surveillance, minimum standards of practice, common metrics and staffing models. The allocation of these funds is based
on burden of disease using the most current Hepatitis C data. Allocations will be revised biennially using updated data.
The priorities for the 2021-2023 biennium (July 2021 – June 2023):
• Surveillance – entering labs into Washington Disease Reporting System (WDRS), enter acute cases into WDRS.
• Investigation – focus on acute cases: people aged 35 or younger, newly diagnosed, pregnant women, people seen in the ED/inpatient, Black, In digenous and
People of Color or other historically marginalized population, and incorporate Hepatitis B work.
5. Environmental Public Health (EPH) (FPHS definitions B.3 & 4)
These funds are to each LHJ to deliver services in their own jurisdiction In coordination with the FPHS Steering Committee and Subject Matter Expert (SME)
Workgroups, these funds are for each LHJ to deliver FPHS EPH services for which fees cannot be charged in their jurisdiction as defined in the most current version
of the FPHS definitions and specifically for:
• Develop, implement and enforce laws, rules, policies and procedures for maintaining the health and safety of retail food service inspections and shellfish
monitoring, that address environmental public health concerns. (B.3.b)
• Develop, implement and enforce laws, rules, policies and procedures for ensuring the health and safety of wastewater and facilities, including onsite septic
design and inspections, wastewater treatment and reclaimed water, that address environmental public health concerns. (B.3.e)
• Develop, implement and enforce laws, rules, policies and procedures for ensuring the health and safety of solid waste and facilities, including hazardous
waste streams (e.g. animal waste, solid waste permitting and solid waste inspections), that address environmental public heal th concerns. (B.3.f)
• Develop, implement and enforce laws, rules, policies and procedures for ensuring the health and safety of schools, including through education and plan
review that address environmental public health concerns. (B.3.g)
These funds can be used to retain, hire and/or contract with other LHJs for staff time or services and for staff training as needed to provide the following FPHS EPH
services that are not appropriately funded with fees. Each LHJ will be responsible to report on their progress on FPHS deliv erables even if contracted with other
LHJs (FPHS funds are intended to build capacity and not intended to justify the reduction of existing fee revenue):
• Food Safety (FPHS definitions B.3.b.) – Respond to food safety concerns that are not appropriately funded such as foodborne illness threats, requests for
technical assistance and addressing new and emerging business models. Every local jurisdiction in Washington is expected to respond to foodborne illness
outbreaks, food safety inquiries and provide preventative education for the general public and technical assistance.
• Sewage Safety (FPHS definitions B.3.e-f) – Respond to sewage concerns and public health threats and provide technical assistance that are not
appropriately funded to ensure that sewage is handled appropriately to limit potential exposure to sewage. Every local jurisdiction in Washington is
expected to ensure sewage is properly managed. On-Site Septic (OSS) permitting, enforcement and providing technical assistance and education to OSS
owners are fee funded activities and should be funded through fees or local government who sets the fees. These FPHS funds provide resources to support
activities for which a fee cannot be charged such as: responding to OSS failures, surfacing sewage, OSS safety concerns, and similar issues. These funds
can also be used for concerns related to large on-site sewage systems, other OSS-related concerns that do not involve locally permittable systems, and other
sewage-related issues, regardless of whether they are related to a fee-for-service activity. Examples of activities FPHS funds can be used for:
o Work with partners to educate and inform public on OSS monitoring and maintenance
o Work with the public, policy makers and partners to assess needs and develop plans and solutions for wastewater management in their communities.
o Respond to complaints, act as needed, and assure that failing OSS are identified and promptly repaired.
AMENDMENT #24
Exhibit A, Statements of Work Page 19 of 25 Contract Number CLH18253-24
Revised as of September 15, 2021
Task
Number Task/Activity/Description Deliverables/Outcomes
Due
Date/Time
Frame
Payment Information and/or
Amount
o Conduct Pollution Identification and Correction (PIC) investigations where water quality is impaired to identify failing septic systems and other
pollution sources.
o Ensure that sewage from both OSS and other sources is adequately handled to create barriers to potential exposure to sewage.
o Adequate qualified staff to evaluate proposals, inspect new installations and repairs, assess cause of OSS failure, and comply with requirements in state
law.
• Schools Safety (FPHS definition B.3.g) – Assure safe and effective learning environments for children attending K-12 schools – public, private and
parochial. Every local jurisdiction in Washington is expected to work collaboratively with DOH, ESDs and local school districts and use the model program
to assure consistency to regularly evaluate each K-12 for health and safety concerns and provide mandated services per WAC 246-366. Initial priorities
include:
o Build partnerships with school officials, local boards of education, parent teacher associations, education service districts, and other school focused
entities.
o Participate with statewide public health groups to standardize school program implementation.
o Focus on schools that have not previously been inspected to assess current conditions
o Focus on existing elementary schools for first phase of inspections program
▪ Indoor Air Quality
▪ Classroom
▪ Healthy cleaning and indoor environments
▪ Playground
▪ Drinking water (lead)
Program Specific Requirements/Narrative
Special References (RCWs, WACs, etc)
Link to RCW 43.70.512 – RCW 43.70.512: Public health system—Foundational public health services—Intent. (wa.gov)
Link to RCW 43.70.515 – RCW 43.70.515: Foundational public health services—Funding. (wa.gov)
FPHS Definitions
https://wsalpho.box.com/s/qb6ss10mxbrajx0fla742lw6zcfxzohk
All FPHS Resources
www.doh.wa.gov/fphs or FPHS | Powered by Box
Special Instructions
There are two different BARS Revenue Codes for “state flexible funds” to be tracked separately and reported separately on your annual BARS report. These two BARS Revenue
Codes and definitions from the State Auditor’s Office (SAO’s) are listed below along with a link to the BARS Manual. 336.04.25 is the new BARS Revenue Code to use for the
Foundational Public Health Services (FPHS) funds included in this statement of work.
336.04.24 – County Public Health Assistance
Use this account for the state distribution authorized by the 2013 2ESSB 5034, section 710. The local health jurisdictions are required to provide reports regarding expenditures
to the legislature from this revenue source.
AMENDMENT #24
Exhibit A, Statements of Work Page 20 of 25 Contract Number CLH18253-24
Revised as of September 15, 2021
336.04.25 – Foundational Public Health Services
Use this account for the funding designated for the local health jurisdictions to provide a set of core services that government is responsible for in all communities in the WA
state. This set of core services provides the foundation to support the work of the broader public health system and community partn ers. At this time the funding from this
account is for delivering ANY or all of the FPHS communicable disease services (listed above) and can also be used for the FP HS capabilities that support FPHS communicable
disease services as defined in the most current version of FPHS Definitions.
Public Health Budgeting, Accounting and Reporting System (BARS) Resources
www.doh.wa.gov/lhjfunding
Deliverables are to be submitted to Marie Flake at marie.flake@doh.wa.gov
DOH Program Contact
Marie Flake, Special Projects, Foundational Public Health Services
Washington State Department of Health
PO Box 47890, Olympia, WA 98504-7890
Mobile Phone 360-951-7566 / Fax 360.236.4024 / marie.flake@doh.wa.gov
AMENDMENT #24
Exhibit A, Statements of Work Page 21 of 25 Contract Number CLH18253-24
Revised as of September 15, 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) 10 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 sanitary surveys and providing technical assistance to small
community and non-community Group A water systems.
Revision Purpose: The purpose of this revision is to correct distribution of Sanitary Surveys and Technical Assistance between years January 1, 2018 thru December 31, 2021
assigned in previous Revisions.
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
Decrease (–)
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 12/31/21 57,400 -22,400 35,000
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 1,600 12,800
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 07/01/19 12/31/20 11,800 -1,600 10,200
Yr 22 SRF - Local Asst (15%) (FO-SW) TA N/A 346.26.66 24239222 07/01/19 12/31/20 0 0 0
Yr 23 SRF - Local Asst (15%) (FO-SW) SS N/A 346.26.64 24239223 01/01/21 12/31/21 34,400 -22,400 12,000
Yr 23 SRF - Local Asst (15%) (FO-SW) TA N/A 346.26.66 24239223 01/01/21 12/31/21 8,000 -6,000 2,000
TOTALS 122,800 -50,800 72,000
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:
1. Cover letter identifying
significant deficiencies,
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 #24
Exhibit A, Statements of Work Page 22 of 25 Contract Number CLH18253-24
Revised as of September 15, 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.
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.
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.
AMENDMENT #24
Exhibit A, Statements of Work Page 23 of 25 Contract Number CLH18253-24
Revised as of September 15, 2021
Task
Number Task/Activity/Description *May Support PHAB
Standards/Measures Deliverables/Outcomes Due Date/Time
Frame Payment Information and/or Amount
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 app ly 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 performing work. See special instructions under Task 4, below.
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 $114,800 $70,000 for Task 1, and $8,000 $2,000 for Task 2, Task 3 and Task 4 combined during the contracting period,
to be paid at the rates specified in the Payment Method/Amount section above. When invoicing for sanitary surveys, bill half to BARS Revenue Code 346.26.64 and hal f 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 payment.
When invoicing for Task 2-3, submit the list of WS Name, ID #, TA Date and description of TA work performed, and Amount Billed.
When invoicing for Task 4, submit receipts and the signed pre-authorization form for non-employee travel to the ODW Program Contact below and a signed A19-1A Invoice
Voucher to the DOH Grants Management, billing to BARS Revenue Code 346.26.66 under Technical Assistance (TA).
AMENDMENT #24
Exhibit A, Statements of Work Page 24 of 25 Contract Number CLH18253-24
Revised as of September 15, 2021
Special Instructions
Task 1
Trained LHJ staff will evaluate the water system for physical and operational deficiencies and prepare a Final Sanitary Survey Report which has been accepted by ODW. Detail ed
guidance is provided in the Field Guide for Sanitary Surveys, Special Purpose Investigations and Technical Assistance (Field Guide). The sanitary survey will include an
evaluation of the following eight elements: source; treatment; distribution system; finished water storage; pumps, pump facilities and controls; monitoring, reporting and data
verification; system management and operation; and certified operator compliance. If a system is more complex than anticipated or other significant issues arise, the LHJ may
request ODW assistance.
• No more than 0 surveys of non-community systems with three or fewer connections to be completed between January 1, 2018 and December 31, 2018.
• No more than 28 surveys of non-community systems with four or more connections and all community systems to be completed between January 1, 2018 and
December 31, 2018.
• No more than 10 surveys of non-community systems with three or fewer connections to be completed between January 1, 2019 and December 31, 2019.
• No more than 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 11surveys of non-community systems with three or fewer connections to be completed between January 1, 2020 and December 31, 2020.
• No more than 21 20 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 18 10 surveys of non-community systems with three or fewer connections to be completed between January 1, 2021 and December 31, 2021.
• No more than 49 25 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 th e cause of positive coliform samples or the cause of
other emergency conditions. SPIs may also include sanitary surveys of newly discovered Group A water systems. Additional detail about conducting SPIs is described in the Field
Guide. The ODW Regional Office must authorize in advance any SPI conducted by LHJ staff.
Task 3
Trained LHJ staff will conduct Technical assistance as assigned by ODW. Technical Assistance includes assisting water system personnel in completing work or verifying work
has been addressed as required, requested, or advised by the ODW to meet applicable drinking water regulations. Examples of technical assistance activities are described in the
Field Guide. The ODW Regional Office must authorize in advance any technical assistance provided by the LHJ to a water system .
Task 4
LHJ staff assigned to perform activities under tasks 1, 2, and 3 must be trained and ap proved 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 Workshop, and are expected to attend the Regional ODW LHJ Drinki ng 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 tasks, 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.
AMENDMENT #24
Exhibit A, Statements of Work Page 25 of 25 Contract Number CLH18253-24
Revised as of September 15, 2021
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
EXHIBIT B-24
Mason County Public Health ALLOCATIONS Contract Number:CLH18253
Contract Term: 2018-2021 Date:September 15, 2021
Indirect Rate as of January 2018: 13.71%
Indirect Rate as of January 2019: 14.53%
Indirect Rate as of January 2021: 12.03%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 24 21.019 333.21.01 07/01/20 06/30/21 07/01/20 06/30/21 ($327,606)$24,066 $24,066
BITV-COVID Ed LHJ Allocation-CARES NGA Not Received Amd 19, 22, 24 21.019 333.21.01 07/01/20 06/30/21 07/01/20 06/30/21 $263,754
BITV-COVID Ed LHJ Allocation-CARES NGA Not Received Amd 17, 19, 22, 24 21.019 333.21.01 07/01/20 06/30/21 07/01/20 06/30/21 $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
FFY21 PHEP BP3 LHJ Funding NU90TP922043 Amd 23 93.069 333.93.06 07/01/21 12/31/21 07/01/21 06/30/22 $29,605 $29,605 $128,289
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
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
FFY21 Overdose Data to Action Prev NU17CE925007 Amd 23 93.136 333.93.13 09/01/21 12/31/21 09/01/21 08/31/22 $50,000 $50,000 $150,000
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
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 NH23IP922619 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-24
Mason County Public Health ALLOCATIONS Contract Number:CLH18253
Contract Term: 2018-2021 Date:September 15, 2021
Indirect Rate as of January 2018: 13.71%
Indirect Rate as of January 2019: 14.53%
Indirect Rate as of January 2021: 12.03%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 NH23IP922619 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 24 93.323 333.93.32 01/15/21 12/31/21 01/15/21 12/31/21 $477,606 $1,135,127 $1,135,127
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
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
FFY22 MCHBG LHJ Contracts B0445251 Amd 23 93.994 333.93.99 10/01/21 12/31/21 10/01/21 09/30/22 $16,924 $16,924 $276,121
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
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 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 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-24
Mason County Public Health ALLOCATIONS Contract Number:CLH18253
Contract Term: 2018-2021 Date:September 15, 2021
Indirect Rate as of January 2018: 13.71%
Indirect Rate as of January 2019: 14.53%
Indirect Rate as of January 2021: 12.03%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 23 N/A 334.04.93 07/01/21 12/31/21 07/01/21 06/30/23 $15,000 $15,000 $165,000
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
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-LHJ-Proviso (YR1)Amd 24 N/A 336.04.25 07/01/21 12/31/21 07/01/21 06/30/23 $558,109 $761,000 $1,208,782
FPHS-LHJ-Proviso (YR1)Amd 23 N/A 336.04.25 07/01/21 12/31/21 07/01/21 06/30/23 $202,891
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
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 24 N/A 346.26.64 01/01/18 06/30/19 07/01/17 06/30/19 $1,600 $12,800 $12,800
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)
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
Page 3 of 4
EXHIBIT B-24
Mason County Public Health ALLOCATIONS Contract Number:CLH18253
Contract Term: 2018-2021 Date:September 15, 2021
Indirect Rate as of January 2018: 13.71%
Indirect Rate as of January 2019: 14.53%
Indirect Rate as of January 2021: 12.03%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 22 SRF - Local Asst (15%) (FO-SW) SS Amd 24 N/A 346.26.64 01/01/21 12/31/21 09/01/20 12/31/21 ($1,600)$10,200 $10,200
YR 22 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)
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
YR 23 SRF - Local Asst (15%) (FO-SW) SS Amd 24 N/A 346.26.64 01/01/21 12/31/21 09/01/20 12/31/21 ($22,400)$12,000 $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 $12,000
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 24 N/A 346.26.65 01/01/18 12/31/21 07/01/17 12/31/21 ($22,400)$35,000 $35,000
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
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 24 N/A 346.26.66 01/01/21 12/31/21 09/01/20 12/31/21 ($6,000)$2,000 $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
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 $6,029,776 $6,029,776
Total consideration:$5,372,467 GRAND TOTAL $6,029,776
$657,309
GRAND TOTAL $6,029,776 Total Fed $4,430,245
Total State $1,599,531
*Catalog of Federal Domestic Assistance
**Federal revenue codes begin with "333". State revenue codes begin with "334".
Page 4 of 4
Exhibit C-20 Schedule of Federal Awards AMENDMENT #24
Date: September 15, 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 06/30/21 $24,066 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
FFY21 PHEP BP3 LHJ FUNDING 333.93.06 05/27/21 $11,574,298 07/01/21 12/31/21 $29,605 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
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
FFY21 OVERDOSE DATA TO ACTION PREV 333.93.13 07/29/21 $4,390,240 09/01/21 12/31/21 $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
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
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-20 Schedule of Federal Awards AMENDMENT #24
Date: September 15, 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
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 07/01/21 $1,961,462 07/01/21 12/31/21 $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 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 03/31/21 $60,234,086 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
NH23IP922619 CDC-RFA-IP19-1901 IMMUNIZATION
AND VACCINES FOR CHILDREN
FFY20 ELC EDE LHJ ALLOCATION 333.93.32 01/14/21 $438,300,928 01/15/21 12/31/21 $1,135,127 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
Page 2 of 3
Exhibit C-20 Schedule of Federal Awards AMENDMENT #24
Date: September 15, 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
FFY19 ELC COVID ED LHJ ALLOCATION 333.93.32 01/01/21 $177,231,546 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
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
FFY22 MCHBG LHJ CONTRACTS 333.93.99 10/13/21 $1,555,601 10/01/21 12/31/21 $16,924 93.994 Maternal and Child Health Services
Block Grant to the States
Department of Health and Human
Services Health Resources and
Services Administration
B0445251 MATERNAL AND CHILD HEALTH
SERVICES BLOCK GRANT
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 $4,430,245
Page 3 of 3
Signature:
Email:
Brenda Henrikson, Contracts Specialist (Nov 29, 2021 09:43 PST)
Brenda Henrikson, Contracts Specialist
Brenda.Henrikson@DOH.WA.GOV