HomeMy WebLinkAboutWashington State Department of Health Amendment # 01 MASON COUNTY PUBLIC HEALTH
2022-2024 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH31019 AMENDMENT NUMBER: 1
PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH 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,located on the DOH Finance SharePoint site in the Upload Center,and incorporated by this
reference,are amended as follows:
® Adds Statements of Work for the following programs:
• COVID-19 Mass Vaccination-FEMA-Effective January 1, 2022
• Foundational Public Health Services(FPHS) -Effective January 1, 2022
• Maternal&Child Health Block Grant-Effective January 1, 2022
• Office of Drinking Water Group A Program-Effective January 1,2022
• Office of Drinking Water Group B Program-Effective January 1,2022
• Office of Immunization COVID-19 Vaccine-Effective January 1,2022
• OSS LMP Implementation-Effective January 1,2022
• Recreational Shellfish Activities-Effective January 1,2022
❑ Amends Statements of Work for the following programs:
❑ beletes Statements of Work for the following programs:
2. Exhibit B-1 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-0 Allocations as follows:
® Increase of$2,037,292 for a revised maximum consideration of$2,037,292.
❑ Decrease of for a revised maximum consideration of
❑ No change in the maximum consideration of
Exhibit B Allocations are attached only for informational purposes.
Unless designated otherwise herein,the effective date of this amendment is the date of execution.
ALL OTHER TERMS AND CONDITIONS of the original contract and any subsequent amendments remain in full force and effect.
IN WITNESS WHEREOF,the undersigned has affixed his/her signature in execution thereof.
MASON COUNTY PUBLIC HEALTH STATE OF WASHINGTON
DEPARTMENT OF HEALTH
02/18/22
Date Dale
APPROVED AS TO FORM ONLY
Assistant Attorney General
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EXHIBIT B-1
Mason County Public Health ALLOCATIONS Contract Number: CLH31019
Contract Term:2022-2024 Date: January 1,2022
Indirect Rate as of January 1,2022:12.03%
DOH Use Only
BARS Statement of Work Chart of Accounts Funding Chart of
Federal Award Assist Revenue LHJ Funding Period Funding Period Period Accounts
Chart of Accounts Program Title Identification# Amend# List#* Code** Start Date End Date Start Date End Date Amount SubTotal Total
COVID19 Vaccines R4 NH231P922619 Amd 1 93.268 333.93.26 01/01/22 06/30/24 07/01/20 06/30/24 $354,803 $354,803 $354,803
FFY22 MCHBG LHJ Contracts B0445251 Amd 1 93.994 333.93.99 01/01/22 09/30/22 10/01/21 09/30/22 $50,770 $50,770 $50,770
GFS-Group B(FO-SW) Amd 1 N/A 334.04.90 01/01/22 06/30/22 07/01/21 06/30/22 $6,469 $6,469 $6,469
Rec Shellfish/Biotoxin Amd 1 N/A 334.04.93 01/01/22 06/30/23 07/01/21 06/30/23 $5,250 $5,250 $5,250
Wastewater Management-GFS Amd 1 N/A 334.04.93 07/01/22 06/30/23 07/01/21 06/30/23 $60,000 $60,000 $75,000
Wastewater Management-GFS Amd 1 N/A 334.04.93 07/01/22 06/30/23 07/01/21 06/30/23 $15,000 $15,000
FPHS-LHJ-Proviso(YR2) Amd 1 N/A 336.04.25 07/01/22 06/30/23 07/01/21 06/30/23 $761,000 $761,000 $1,522,000
FPHS-LHJ-Proviso(YRl) Amd 1 N/A 336.04.25 01/01/22 06/30/22 07/01/21 06/30/23 $761,000 $761,000
YR24 SRF-Local Asst(15%)(FO-SW)SS Amd 1 N/A 346.26.64 01/01/22 12/31/22 07/01/21 06/30/23 $11,000 $11,000 $11,000
Sanitary Survey Fees(FO-SW)SS-State Amd 1 N/A 346.26.65 01/01/22 12/31/22 07/01/21 06/30/23 $11,000 $11,000 $11,000
YR24 SRF-Local Asst(15%)(FO-SW)TA Amd 1 N/A 346.26.66 01/01/22 12/31/22 07/01/21 06/30/23 $1,000 $1,000 $1,000
TOTAL $2,037,292 $2,037,292
Total consideration: $0 GRAND TOTAL $2,037,292
$2,037,292
GRAND TOTAL $2,037,292 Total Fed $405,573
Total State $1,6319719
*Catalog of Federal Domestic Assistance
**Federal revenue codes begin with"333". State revenue codes begin with"334".
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Signature: 81'Oftl& s �
Brenda Henrikson,Contracts Specialist(Feb 18,202214:36PST)
Email: Brenda.Hen rikson@DOH.WA.GOV