Loading...
HomeMy WebLinkAboutDepartment of HealthSON COUNTY PUBLIC HEALTH 2012 - 2014 CONSOLIDATED CONT CT CONTRACT NU . I: ER: C16893 AMENDMENT 7: ER: 14 PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as `DOH", and MASON COUNTY PUBLIC HEALTH hereinafter referred to as ` LHJ' , pursuant to the Modifications/Waivers clause, and to make necessary changes within the scope of this contract and any subsequent amendments thereto. IT IS MUTUALLY AGREED: That the contract is hereby amended as follows: 1 Exhibit A Statements of Work, attached and incorporated by this reference, are amended as follows: x n Adds Statements of Work for the following programs. Amends Statements of Work for the following programs: • EPA NEP PIC Program Competitive Award - Effective May 15, 2012 • Office of Drinking Water Group A Program - Effective January 1, 2012 • PS OSS LMP Implementation - Effective July 1, 2013 • Public Health Emergency Preparedness & Response (PHEPR) - Effective July 1, 2013 Deletes Statements of Work for the following programs: 2. Exhibit B-14 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-13 Allocations as follows: 41. n Increase of $11,000 for a revised maximum consideration of $2,170,549. Decrease of for a revised maximum consideration of No change in the maximum consideration of Exhibit B Allocations are attached only for informational purposes. 3. Exhibit C-7 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces Exhibit C-6. 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 Date Date APPROVED AS TO FORM ONLY Assistant Attorney General Page 1 of 27 t7t7C� 0000 xxxx 0000 71U:4!- zzz� 0 0 0 H H H H eyaws Pad a F:7 QS b b O h hzi O o a c 04 0 ti_ did 0 ~ t� n otvb 5)—ro N d4 0 crq0 SID 'Ptr- _ n fr.; rP1. F0 0 0 N 0 ~ C pt ,.ttrl CD "O CD fr-frJ 0 0 fr--;d r+ v 0 c' Ro 1 o O N o w b C O tiJ 0 0 CD ti O w l 1 0 5 Pr C CD r-r- C • 0 Contract Number C 16893-14 bl�� .I \-IIAICN'}-IJAX Mason County Public Health tion Name: Contract Number: C16893 Statement of Work Contract Term: 2012-2014 Local Health Jurisdi DOH Program Name or Title: Price Ci /. ipliance ecovery Act) Transparency Act) C O E" Ts a w ig Source eral Subrecipient er wL.•C Revision # (for this SOW) 6 SOW Type: Revision through December 31, 2014 N 1-1 O Et Period of Performance: +; U U cci Q 0�y a) 0 ¢ , .2 Ti 0 cct O O O 0 O P, O U G`` PH ✓' N O cn U ct 0 4. O VU' U 'ccg 5 O O U U E71 "d a) U N TS F N al Y0r wri 0 .y ° am 0 ••4. O at -4-+ _ 0 i. py 5 0 O cct U b N 0 up H. O 0 b4 O O .,N. n i N 0 0 Q °o 0 0 0 2 -0 VD C/] Y 0 0 0 0 1-1 cn cn U O0 cn N bA cn a U H 0 O 0 ). ® 4 tat a N L. N > AA H N ta2.4 ;IS a ti ® _ -'s a, > 0 P. 0 �� Total Consideration a\ N N 0 00 tn 60,000 5,000 645,779 0 645,779 O bD G O 0 O O O O .0 U 4 C O .w 580,779 60,000 5,000 ez Sa O ❑ a)Pall L.•vt U U _. ding Period f Use Only) )ate End Date 12/31/14 CA a d- d- 1 en N cm yi NN N m in in .4--• O oo O v In O — v Noo O CND U0.'1 (it N N N N N 333.66.12 m m m m m m :le CFDA # 11 P C en N m N m N LIVESTOCK MGMT AG BMP'S - NEP LLFISH PROTECTION DISTRICT -1 VD CORRECTION -1 0 format 15, 2012 ;, 2013 15,2013 2014 15 2014 ber 30, 2012 Lime r rame a) O A • • Deliverables/Out -An on, 1 ina ting 3) P t Mc And t Isl vati( gtoi Ma Ic/Activity/Description *May Support PH Standards/Measu Project Administration and M 0 z o Et o°z U ' . nI 1 Contract Number C16893-14 H rj N mut Es-7 z OCD a z H z n 0 O-, o 0 J 00o 0 y N o 0J, w' cn Hco _ cn • 0 " twoUti : w cnff% a0 >Li 6' O n n e CPR 0 _ w -w bo N O Cr CD cC (ACDOGc-.p O G 0 ; 2 _ G 0 6" 'D ` : O caio,-I 0 P W c ea C61 ❑• = - _ • - ._ U,Q CD _ �-t 00 N w b N< ® ® _ b N N y "P3' "� O O a O ® CD cap `< .'y' C 0 P Q' 00 o PO o "t O '9 O o o J co 0 0 0 a w o O N p 0) �i 0 -ci C P PD '(„ t 0 • 0 0 G N sv 0 0 H w P d P� .� w y P, 0 0 W r-i cp 0 ~ ' o `d 0 O �° ° " •• Z. ru `C° ' iit w `° w cam° H "0 p co En _ cn d 2 6, °. Cr O En o w - O CD �' o m w ro __ O .. 2 q 0 p rr 0 H �O V] a ��' `C w 0 0 CD "O n 0 n 0 w O ea. a 0' a b co r-" a c� Cn n• C41_. �q 0 _ ~ �.0 V CD °�- art bw pi t C P _ r-`e'D Ci 8' y« Clo w b CD VD O H H0 Ln O cnrjo.o els CP c� ~O • cn rr_j '0 O cn CD _ ai 0 "O a 0 cp O G. 0 g ,_ Grp • \ a a ra- O iD b b` O �C r O - O c F p _ _' O w C> c0'> __ 0 0» u' CAD _ °m N o ' 0_ • ao C a `G O_• o CZ w r O CD p. a _ R 0 o w a, _ cD 5 c • o tllhi � r� � p p. • O o P-, 0_ np ;."h �. p Z, . �'* • L/Z O ci °� °p Pi oc n a dwH o w rn dfrC _ at 5- 5 rr,p CD 0 N r� �h E. p O 0 a O P b . ' n tai 0 r-r- OQ �--( a _ cn t< ,-h.),-h.)o i. 0. 0 0 co nn __ • .--. a p - 0 LC rt ~ N ime F rt o N O 0 0 ...„ '"'* M W 0 (� 6s p e'• C O O T O D. w v m ILA m J o P� C o W 0" O 2 c 0 oo w n , 0 Yn rni .4 0s O cn O 0 Ccn D 0 O 0 [~ii V fn tin) up 0 0 up (D c rt 0 N 0 0 O O O p r"b O ,��, "G r 0 ' 3 r-" i ' W .p O � w zo® o o o o C.)C.)o¢ ¢ U U_ 0 .< et 0, o o I) cc NCn C.,o O ' O OO ke74d 2 V N U O G p `` 4 _OU UQO C O.%•w,7.pp- OUN N0 71 N E d si t:3 . cc a) d cC O cct 71_ co O O t�a Oy,U O'j O co} GE.;�. Sti ••C U = 69r4 5 s� P 5 s_ +„ Rp400 3-4 vE vr 0 "m�U,'� r-.O et • O a.) d ^l O .-• O O O ti, U ES., O ,. 42 s'g 64 �,.. 4-i co cs-i 4-e EA 4•e cn up 69 Fci W 69 U 4-11 44a ,- - .D i...cn N o, rPo no -5 w E O N U 3 ay - et pp.UM o N-a dO d N ,-G' 0 O OM+ VI -I i-)U _o M 4.2 .9 N U Of ,., cd" t.4) b0 N P 0_ O N >, N 0 �O 8 4-' _> by Z w . Po O4-4 O. O ''" O n g Q 1 bA g s� N cts N byM,,, 3 3 ,, O 5 Q 0 a_ 0 A' 0 ® T U = 0 .p ._ .Q •. �b0 r. N U O >O M -' ccdd .' ,� _ • �' �r.' f _ " U OdO O a O0oN00Q V vi At': "0 O a-, h cN crd cd NO U s, rt N cd Q Q U '� a) .a. o U O • Deliverables/Outco. '�.T�7] can ice, —1 ccd 0' W s., O O_ 0 W ,o O 1' .' to r, +' 5 ' 4co cd O O cOd s' al o ci ® co EA O. O p Pa ply 5_ O . 'CY 1 Q N_ O .5 s�O. +�+ ,i" ct w. '� .� , O +d O a) U Ste' U 4-' (fa J. "O Q 4O-i >' "O O a •,— 0 "d I dq o sue-. 1_ M cn • O F-' .+G' a) G4 .9 D O O U O O U O �+ (9.4) f _ ° _ a o ai.,' E_ _ o o .- tti.yy 5 E-41 a ti a' ' o -- E" p p, 0_ k b cn o Education and Outreach • • isk/Activity/Description *May Support Standards/n bA .5 O o O 5 0 .-, N a) F-' H Z 0 Z ® �, Fe U �® �� 0U ® 0 0 Z 0 _ M_ N N 0 O Vet b d N O to Co T i N 0 0 0 Co n 00 d ;k Number. 4' a Pollution Identification and Correction HON activities TION Task/Activity/Description r *May Support,] Standards/Mes Deliverables/Outcomes Due ° 0 O < C' N O• C S .• O `, O cn C' y a, fO N .- CD (}p' trz- • r • Z. a p m o CD o L) 5 z c 0 H o w o. Cm• o a fa `C CD Cn Or. O ° o 2 6, `G 5: c P m n'crqE o= p cD ccI o )-cn will be revi Sanitary sury the develop( Bay and ;e (McLane en for early ellfish grow: ;r sampling Y quality cone( s. [on problems ng the cours will be addr( Pt CD x cn 0 N 0 _ n 0 0 ~' •• °° •p Q V ao 0 -4 � C w -' o Cn cno. ad ' Cr) ¢. ct p. Oq '-t 0 rt •-s 0 r-ti 0; ct ° 0 0 0 �- - ?. E o 0. F CD `o cOj Co • A+ o n o a. •-1 0' `0 Np-to ~o -° o Z d R. w , a o o co -C - n n ( .d c�D co ? y tC, CD :o 4 cc o< C' 0 0 CD 0< w� 0 o O �o N "C o 0 cc u) t-F_ O ?a o r ra k Tr -TT Arz r ED 0 O N `CA `� G n_ C) CD •" W ai n O pq v O• '� i:�' - (07 OO C7' C` ` w W �--� rt -�. j Orn d C y C 0 O C"' 2 < ,.s a n ¢, -• N Z• Ccr- w P CD O— o• O O (n w G r n• O p R, .-� 0 n 'CS O N. 0 0 0 �7 N y ��-•' CD 0 O� s" �' w N ° m -� O r.' L.. W �' �• 'P ' .�0. ti OO CAD ?' — n �. �. C -4 --� ~ `� cn cn N w z G' CCD �. cn .;; (o c: cc o c2 z v �^ a �� ~m CC w cc ,.� `•n0 No ace 1 e In! and/ w naEra o o, WG o • o o rm gi- Ich formal Z --i Z L AM o a >, ca bO v' v) , 5 O '� c _ a -10 'c O 0 4 t) x• Q a S�, Va>_ J, H ^O Q) Ct a) to _m e/Time 1 +-� U O s O a CD O N cca b1 V N WO j O O 0 y Q bA O N .. ct 'c7 ca f(0 O • � "H +�' ra> > ,� O 0 1 ..' 5 • C0 , N w O _ •. _ NUpQcn z- 1-0 -N en -•Cc� 5 0 tO 5 '�c .O LA M at 0 3 id 1 ta It, D ' QQ cal "ci N N • — .b +_i .— �..� �..� O O o U O .5 �� O in 5 .+J O , U C O m Q = ® (- O a"i Q as of March17. 2014 0, �3 se d s +' L) ca p¢ N �, 'o b' cd a> o cd Q W 5 cn o 4-a o 0 3 o pe o t. 1 Q o 0Ti A0 re +.1 fa( 73 U O co cn cd Q L& Lie H °' o y ?' •_ �. r. p Cn O d 0 t. 0 C t •... N 74, UO 3 O 3 cn z o "5¢ N 0 cn •'O an cd •0 cd O �'' O 0 y ..� O 4] `ncm' U p `n •-1 at P P N N 'ma., • 2 ap-, cd CIO ct t z cA 4=i c ° M O 32 N cn 'd Its a) ® = C/) 2 N pbe O 1-1•-0 Ilia ) rci rti N cd U 7 o> O ,E yy o o N bA C N C) O'" U N = t 5 '=7 'C3 'O et y.. r•, t O O +�, 0 K+ 'G ® 0 Ccn0.coL O d +� +•C 0r o ata �iLco H i ci^0 - o y, 7-1 c *MaySun Standarc UQ CD J Contact Number C16893-14 Taslc Number nt7ba, �'-�+ O o ,t > d nn H O Z Z b 0 0 tc .ation of the Agrict ent Practices (BM ted in accordance l by the Dept Mier ,unty will be respo of the funds as out ask/Activity/Description Support 1 lards/Mea Deliverables/Outco '7J O g G m tar? trl 0 r- o 0 '- n b p; o cn c w Elm r ach semi-annual pri ill include the numl cation of BMPs co: progress and the tc ,ent for each report. id the total to date. • ry,p. 1-1 G *'� G• Pr-)._ _ c P E a o o 0 _ o w_ 41 tt W Flip t cn CD o n' O '-o O p �.'h w CD O CD N CD O F. �' CD m . CD H a" N7O c .I vD W 4- G g C) N O E < n M. Ca' fa. R. p aCID Op 5_ CD 0 nt and approval of the PP, update of SOPS .essary created or aunty policy. 'slcy of the Squaxin will act as the urance (QA) officer ity Assurance Project ') process with EPA. C_ z _ CD C/] w 5 P-' P_ o _ cG-r- CD O On )- a° p.a ° .. _ni-a _.__ ° W O O' LI C) p Fp CG p CD t• co P i 1 rno N Rs f p O O o o p_ w N. ~o m �vCD ell n cD xes Q' 0 o o a P r`< G ___ ' a cn co o 0 p- cp c _ w c90 1—, 1 r' �' A.�C.t.w' Da oCD a. fa 6' v) 7y � o p ti cD i4 n'� CT c� . - - co- %'. C G _. . . - - - .. CD fai v] cm w cn o cop r w me Fra: ' It o" c b N Q- Dip C' �O' O G CD 0 a w °� DID K Reimbursement of actual costs up to $60,000 Reimbursement up to S50.000 T A TrTT A Trrk Trr, o F 0 ._.. _ N 0 J 0 CD o H me] anal ART L t c U b � 4-10 03a> vi ���> o 0 ct o =� A. o cl) 'aymei formal o f� _ N II _ c�i .� .{ o •.1 ._ > II sa. II r 11 _ Cd o L O O +� 0 0 O h O O .� .9 O QJ O 00 •O� ; 0 N i 0 O a) N cd _ O c� cd vi � 5 ''"'' 'c� • O vOi �-„ �v�i dj �+ ram! i O 101 bA • g -ough 11, 2013. a 4 CO cn e/Time 1 3 U 'CS .9 or' • y _"d .4O 74 5 m One (1) data quality sumary report. m Up to 40 water quality samples Ongoin per sampling event for up to 6 Decem l events during the year. 0 WO � in 0 Q 0 2 o 3N ct __ T data quality Hance verification nples voluntary a. Deliverables/Oul ca 0 N CO 0) o p o U O N O Q *May Support PE Standards/Measu k/Activity/Description cn un "o �O vi N b4 LID r4 cd 4•. N •� O , zi '3 0O IO p c, a. _ O cO�d � r_i� ,� v OccS co 0 _.5 5 0 o � o _ 0 •`d 3 CH _ o n _ o _ o> e_ _ o 0 4-4 o o 0 . o 0 and] nnple moni ,;, 0ct 0 -ibe will Steerir h direct uality a quality all be pi ty and P i Distric manage sport fat cn �" a `n O ro , cat al _ U U _ 0 cad o "o Iwo 0 o n _ 4- PP.., in a, 'ti4 _ °' Imml o O cn T — op U O �, O co o et U ,-a ,.0 IdU� 3w a4� ct-0U >; C.)toL O 0 cn ti ® _ _ N bA ct (0 ® ® ® Q cd L Taslc Number z U (—a Contract Number C16893-14 Statements of Work LZ3 . t a2nd 0 O 0 `G 5 0 CP.. 0 n CD OQ CD CD CD n est cn cn 0 p 0 O 0 ti cn rt CD PD CD W z _ CD '10 O "' 0 0 CD O 0 1 CD o 5 2 ,• may. __)41 , o CD �-h co ra4 _ On O era', Cn cn P eat- "G w AD CD )-60 c O' 0< O C° aaa' �•<< O a) 1-1 cD w w CD r h Ocn cn r- P f• ir n O • 0 rM• < G•1 9 0 n i] C0 P CD .r 0 CD CD o to_. rmtri CD r. • CCD L CD o n, • 0 • P CO_cn 0 CD .' 0 0 0c Y co0-1 n 0 C p •L pi Cn AD• CD P I o I •0 CD O G. CrQ ca 0 P Ph)JN Cr r ,r*.• O 0 CD CL O O • - 0 n 'z ace C < w �• I 0 O vi n _ O .1 AD c n. p CD P 0 w. C a 0 0D 1 O cn ed (4 ER 0) Cia ram'+ 0.-• n n (-Z+ • Cl. 0 • N j n c, CD 0 5. r t1 < Oco '5' o' PO w << 0 7 ccDD CL CD • a R w Q cn 0 O. Pcn "J m G O M c O L Imo p `7G-'� 0- Contract Number C 16893 -14 OQ cn y n %, 0 5 The subrecipient will take the ne H steps to update the Oakland Bay [ON Plan and Matrix, and present it t( the Oakland Bay Clean Water D Advisory Committee, County Bic Directors, and the public at large the county website. C n h-y 1 b-cjcn 1 p 1 r-1 1 cn r p 1 ml AD E. o N n f '<'" _ 0 a Q' _ c c2 p8' CD tt `�' O n up�� "4 < N �'. rn'P 2 (7 0 r, O �� _ C w ask/Activity/Description CD O rm CD tj P �. rr+ O qt 0� CD 0-13 CD n G C4 W O O CD O n N- CD Ufa D �. * G °_ CD tj CD 0 a p� ._. O n )-o ; 1 P R. 0 C _ral o _ va A. R. a-1 CM t< h Da = cn P 0 rn f. 0 n 0It'll R. G < w p_, V) O CD O 0 • 'to • 1 ,or-e _ n O up _. 0 0 cn 'O` '-- Qq F' O 0 •~�- G n cD Cfa q _ 0 aCD �� cD 5_1:74L r• W 0 0 0 5 N 1) *May Support:PHAB Standards/Measures Deliverables/Outco] "d '-a C/D J o 5 b _ t� _ yw 0 n CID o CD 0 CD [ft updated Oakland Bay Plan and Matrix al Oakland Bay Action P1 [atrix orn o co� cn 51 cn 0 n p H cD p ,.; cD PCn 0 w0 0 O o o O Q. 0 Cam!] D, O cD CD CCDD ".0cn N CZ 0'.n Ft _ ct O la. V N n a ~ 0 O 1-1 CD 0 d o'9 0 _ 0 0 n O &} 5 _ _ 0- .. -- n _ L. Cr ei AT,z, tr-rt.rt , 'c3 cD Ua NJ OW cn R. _ n ber 31, 2013 31, 2014 ..S r4- .-: O 1-1 O0-1 n CD 0 ¢ ON o 0 o w "Li_ w 0 '04 r ,-,. w!-� h 0 n NJU' O .-+ ^ C < P_ 0 Pa e Info and/o .p 1.. cn }"+> rt- O OFo 69 69 69 i �. o` w CD 0 '41CD -P v, CD cam°, E NP, o '1 CD o O ' p O < O w N •• cn cn 'a A C cn G O G' t _ CN 1 AMEN L _ENT # 14 O O YL. 4.4 U o P.' O _ o'� U ,.2 0 O TPCi b U 1-0 0 • bA r� .5 y N CD a0 O "U .? CO 0 C c cOC W L cale«V 0 U s 0 0 Rd Tri • o a^1' o Cn C/] Ittl 1) cp 0 o 'U. 764 � a W g 1_ L SSO U U U Q N N N U • a U 0 ice O O w cnn 0 O 0 a sni 0 PI U_ P� N by 0 • "d O U +.4b0n U 00 V o U r O < O NPy N N ea U v O CID Pa • 1 4 0 U 0 0 y'O 0 0 • • > "3 -1••, U 0 a4 g O U N 'd I' O 0 ) 0 Pi a . o N O :1 '0 O 0 0• 0 D d • "0 • cnn 0 • > _• iF p O ClIeN P CO Eel tta 0 CIDAn( LID A. > bA • 0 W745 "a O C• t Z tri O U N 0 _ • b bO dra O 3 U U a) • O � o O 0 0 d o t in• "! CC: O ¢, P N O 0 4P 0 rn Pti cd CZ P Cit • Ct U will be determined and scheduled in W 0 by . 5 sic 'd aas O t• ad L) 'd 0 U 0 0 (4- 0 0 . 5 Z7 cn • ti 0 0 a:0 U itin N O '' ai AaN = • 3 _ o 0 ni 1' 0cc U 0 Lzig er O • P. o cu Q o 0 O0.4 O o U b4 O N 4� 0 N g o 'o O.q o cd 0 O' N O N 4-4 Q "d rA • T7 Yid O b0 0 'G O • bA tAH U O 014 (24 O O 0 .knacks .. gib • • 0 Inn 0 O U O d IN 1-0 •4 M O N In n 0 U O M co Inn 0 r M N N N O Inn lec N N ra UO a▪ ^U �0 0 SznO Ne • ' _O O N N ) Cgt 0 — • CO)te Pa Administrative Conditions U ctin Ota cn 0 azt O 2.4 cd cn 0 0 0 0 0 w 0 o U 264 N a) > O 0 rid g o 4 .. o 121 It C Hczt bo O 0 O 2 1 a) 0 o O "top .0 c+AW o p a) cH N r N E5 U ¢ o V1 O co N N M N N M U U U -< N N N fG O U 0 4-. 0 O a1 int CA F-^ •O • 0 b bA • ct "d ct N 0 ) cn • QD 0 CD 0 • rci 7.. TS t O op o O O 0 O• cn sac c) O o a N P-( ct bq o O U L( 0 O 0 U _ o ▪ b N cn ° cn .... P-, fit Organizations, if applicable. P-4 0 z 'd vi r 0 0 0 0 0 (Ii 0 Cut CIO 4-y 0 M U Pal • 0 tl 0 0 5i 5 0 cm 78 8 r1 •H Cle PIO a) Contract Number C16893-14 Contract Number C16893-14 0 n o cn � 0 n cn cn 0 . O O w 4-4 a. 0 0" n w 0 FA a n Y. p O CD 0 56) ct' U.) • w 0 cD rt- 14 a, 0 C/D 0 0 cn n w n n CD 0) GO CD n O CD 171 0 n a CD w egulations (CFR) Title 40 Part 36 at cn o' • CD CD G•5 CD CD '6 • cn • 0 CD 0 0 0- 0 0 n w 0 O AD 0) C/D 0 0 CD 0 '0• F'. P 0 0 uc w • -. 4) 0 CCD 02 �o 1.4 CD w 0 cn Orr O up )10 n tai nco co a O . �co t• _ � CD En 'n. cD 0 P y a N a n n CS o Hit t7co On" w cd 0 n w 0 `< CD cn n . n o _ CD 0 an 0m 0= 0 0, CD cc) P cp ,H 2 This tern and condition supersedes EPA Form 5 O O n 0 n O crp era UQ w ° • CCDD n O CD 20 a f . O n o n a.up a0Q cn 5 n 0" g O O 0 GrP P "o • CD a o. N cn CD cn 0- CD 1- n » o ,_d CD ' CD Ca H. v, AD N c n P 4 n cn w a rs an U, 0 'u 2 O 6• n• a a pCI) W UQ •N Cd cn 0 n _ CD w 0 cn CD cn r" � 0• up CIA o o w 0 0 C' ` a L0 Oq n w O "t 0' 0 O a, CD ! C_ AD CL '0 c O .. CD 0.ga- 6 w 0 n < O n Cip ''rLai. • <' 0 0 4cent) td a - nap w a E. N O C ' Co O UQ o o .. n o C N n a 0• O "CP CD o0 C CD O CD 0. Dn _ CD 0. P CDC a w• c. CD 0I. CD w n CD 0. �cn ' 0 ✓ n a a N 40) c CDN 0 n g•' - F4). n <' � �' o w '•o CD cn g N. O" 0 a= c) CD CD a Lobbying and Litigation Oo b a a. cA 0 n 0 O C `< O Cn n 05 O 22. �.y o` T _ o 2oto O ' cap 52' w y ^� n 0 rs- _ 0 o� l y. o°° "t 5. P cn . ' 0 0 Cn C L �„t an co1-0 O N O 0 o ncn r` 0 O O w a O CD O O 0" ti r+ O"t 0 H. cn O 72 � w 0 w N a 'tea a n o� 0 C UQ w UQ p. E• CDD n n R C 0 C r"t• 1‘-4• N 0 O oQ �. w O n 0v 5• O CD 0) r AD n aLH CD 0 OP CD N "P co < CD CD °. 0 0 0 n O c iept cn n a C Cn CD 6' n n CD C 0 CD 7' 0 'OE tnd?IJD 0170141 sjua!doau o£ aaed CD 0 0 0 w ° w CD n w. a A 0 0 n 0 0 n r+ O n CD -' CD C St n Cr H. UP cn CD CD ag cn CD o w g. w � 0 0 a °" 0 aog 0 O cn 0 g ,_, n n. cn cn O_Ci a 0 n O_ "O 0 ' 0 a a 0 G CD cn 0 0 CD < n w w n 0 c pepo n Y�`< as co a a G HJ a bp co COD Oozi w O Cn p 0 "CS C CD 0 �0o_ _ 2.• C O 0• n op CD c CD f CD a n o a <. O a' O 0• r' (Ft, o O (J..) n CD O n L" n 2 0• 6 o. ati 0' AD CD 4-4 CD CD na.� P CD Q' CD n G• n a O w 0 w n. w o w _ cn o a Y o4 CD CD 0 . 6 w Oa" P v) n a O r+ CD- 5 CD O G O up 0 0 t a CD O CD 'U n H L7• 0 _b w 0 0 CD c ° c 0 w �,0 0+ o n H 0 CD eat - co n O tat rF n M •~ CD CD aCO P a 'a cn 0• m 045 O C CD 4 cD w cn CD a cn ' CIO a 'z N CCDD CNII . ;I' w o 0- a') cn a O o O (1• go w 0 0 n V ocn 0 O ...0 0 n cD 0- cn O O G� to - CD r+ Pr r-r 0 W '- _ cn p a n CD W d 0.4 w 2 0 0 O 0 cD 4-0 N CDP. N O w COD Aa CD e n O 0 cn a) 4-4 ce U b7l 0 0 • .,1 ‘.t cn O cn N 0 45.1 4- Y `Ly O c22 ro U WD 0 • l O p 0i-I 0 a) r O `n Cd rg . _ 0 ct c 0 0 • 11 -0 44 0 cn 0 U O . 5 0 Lo U c O 41) a) `n Pro cN t n ca • 0• ai Sat N O byct 4.J 1' ct O NY .0 0 >, 5 5 ct 0 ri a) o O a 0 N • + U O R3 cd .40 cn cn O ' b Na.) • P • N O i0.1 O P. 0 N 0 Cd CH 0 tta N O E N LJ 0 -04 FL, a) . up O • 4-4 cn 0 4▪ -4 O a 1 "O cd ▪ N 0 C 0 -0 4-4 O > 0• tad ci . 0 UQ cd LH • • Lo to X "0 a) 4-0 • •.L O O 0 cd 44-4 • "O 'Li 4-4 4a 0 0 O a) cn O U 0 4° • N .Q. U a) a) 10. Trafficki 0 Y g ct cd cd ct rsD ct C 0 cn cn a) U • Y U x. 4-0 C0� aa)) • U CU 421 V1 4y 0 0 0 von 444+44 .153 4-45 cn • 4-4 0 0 un • .40 • U 0 '-1 0 0 }-I • Subrecipient may not make a subward to any entity unless the entity has provided its D z0 G� O U O 4-4 4-4 0 0 N 0 O 0 O O U O cycn 745 0 U 0 .F 2 "o 0 c) 0 PLI c 0 -0 LU E O a) d C � PO 0 w '_ O > O terprises in procurement under assistance O 0 .134 rat K z sac 0 '71- o U• ro o (1) R1 a0i .45 FIZ C o et a) ct CZ 0 U `O et_ b CZ Cepct K) 0 0 tai 4+1 N ct up up cn [bp 0 1-0 cp 0 O H C7 1 0 F-� E-+ W U cG V1 0 'tS O Sal Y 4-4 O 0 O • 0 O U 0 U b4 • 4 _ • 4i 0-0at 0 ominercial goods or services for the 0 4-4 0 'O^ eTh O_ 0 0 'O 0 S•7 ca rn Q 0 U .a en ct ^ CC w LYd a3 P d onditions which flow down in the LJ cs cn cn L4 con O N a) 40 > ct UvrIt bq 45 . ) R O � > O O 0 > . 5 b ct O Ch N O C N • .0 ct ct O N .. 0 • ct O _ v7 ° 0 U 3 i cn 0 • o Y a) ai 04 cid cn Cd O 'a Cr) C � • • ct tn N O Om O L' a) 0 w U C O d" O 0 ct rcs O O U0 •H 0 • p, 1 ct 0 0 01 O > N 0 i31 O bb. 0 0 • .5 O• 'd �,J Alt 0 0 C' O ct 0 rti TS • cd 4-0 4D c) bO 0etP2ct0., Y ro E • cd O _ O .O c.w L9w L900 Contract Number C16893-14 N 44 0 a) a 0� O c-1-, NP ct o 4-4 c O cn "O cn Contract Number C16893-14 r1 CD a .0 • b ocD•� C 0 al o '_ pCD"fl°st- cn a G G gin° G'o,•� 0 0 a a 400 o. y F. Ho HCo n rt C1-d Ht-,1 0 w 00+ 0 p. Cna I-S• rTh O o a g 0 y__ W 0 0 o 0 n o 0 E. a t. 0 h w o CC*D c 'a A. Ea- 8 • •0_ '0 h• CD wH. o oa G • 0 O CD CD pia. ty a 0 a"" O CD P I npip _ _ ro P rt O t G "O CD _ 0 y w co w G• N or c < CO _aCn_ 0 X 0 o H o w cin 0CD0H.� h• 0 0 • a ti7 O • _ 0oa la�'y O 0 Y CD CD )arz CD HO . a 0 H G 0 - o �. * 0 0• ado_ 'ao CD a CD d ~r O S O 0 r+, CD m� 0 0 0 o 0 p O too o w 0 c� P g CD raL 8 0 0 P �D ° "Di 0 QD G < �+ _C CDX a CD FL G G m,Q Oa nX • O P 0 C CD 0 X 0 250 o w o �• 5_ d O 0 O 1no • w� 0 o 0 • 0 8 O 0 t7 1 i, w rno �a CO Cn r 0 oCD CD w o. 5 0 o PH, Ht 0 rnH , 0 O CD aX 0' b HS "CS a LH. CD 0 p, 0 a 0 . o o Em CD O _ Ht- p x CD pi CD CD Prl n00 -. v 0 0 DD W CD CD a' N 0 cn �._ 0 CD �n U o a 0 � cn �• � o) � cm o 0 r* O G n g 0. 0 0 cip H. "0 CD c, 0 CD • 9 0 C)CD CD PD O 0 < P p o a 0 0 0 a CCP 0"0 cp 0 0 o _ a ap C cn °< co o rs.2 cn o5� b p got. • < OG 0 CD 111 0 0 0at•o a0 • 0" ¢, co o b doo° O x n ' 0 _ cn _ cn _ P N N CM CD < OD o 'EFE. 0 CD 0 a-c O Ca Hi- tt: • r CD CD 'HS 0 0' 0 O O P cn cn �° 0 Cm 0 0 P ( • w • Cl4 G r Him d O da O C rh CD C. • x co cm eC co et r` till 2 o<< e err z.*7 o. o et- n o r+ oy o 0 4 ca ota 0 < @ O eur- rDCs' ti G n Lon co o n oos mo 0 )0 'CD Ht o" o ro XL) A: 74 m O 0 tHi CD n Clot o a o 5 rD rir- 0 G. n O CCDD o "4 G nD .y ICoD ro ra- rei iptA 0 0 n 0 G up up 0 0 co 0 0 It tTi H. n X0' 0 ro XL O 1 _ n n rn o ccn o 0 Hi 0 a a- a r w 1-3 o m H < zh J 1j 't H la. h G n, z m a a cn o rip- a �_ G CID 0 0 C CO 0 0 0 0 P t. C7 0 CD ry O 0 „'BSI-1 11Od MOI. NEN SS3OEN .ION OQ'ma z b 0 m 0 m 2 0 Oi i09Z£f00-3dJN ca "0 n0 O O oattp CD cn G G P CID) a 0 0 . aa 0 0 0 0 0 a CD < 0 O 0 cn w ra O 1, 0 0 a. 0 a C X• cn rjr CD 0 CD 0 E. 0 00 0 CD hi 0 5 5 . CD p 1• 13 Oa a `° ▪ at it H CD • ao 0 o y 0 0 0 CD ° o co m O "'+' a Pit n a C" o CD H, 01 w CD CD CD 0 X° 0 0 0 o 1 CD H Cn 2 0 L ILL r 0 40. � o P.k p H w O °X < .0.� CIr a CD P CD G 0 O 0 O N w 0 t-C r* 0' O 0x O , P o aq 0 0 per) 0 p• a Ica, X CID w m 5' CD 0 co w CD 0 .� 0 o' p N tat CD 0 O co 0 cn CD O CD 0 0 0' 172 CID a 0 0 0 00 w 0 1 0 0 CD 0 0 cn CD 0 0 0 0 0 0 XL a `< 0 0 Jab 0 0 c 0 rga UQ "O CD 0 H. G C cD cin C0 0 a0 aCD 0"< oG o up '� Pi'• � VD Leci O G G "" • o ~ omt a 0 o op w tO _ a• 0" � c0 w rt-• Hn HJ.� w 0 0 co c Eimj "a 0 0X4Xcn F, CD o 0 n p' G a 0 o• 0 00 0 X O CD ko 0 a En 0 cX CD w o En up P u. a �° H. 0 1 O I-n 0 0 Cn 0 H 0 o✓ 0 O co O 0 0 0 0 tH- "0 O W O O 0 W +U+ O tin 0 b.bA N U 0 O U CCS bn W O cn U a%'O cEct o cn g ��o at .L" � a ✓ W can z O 0.' W -W • U z a).� O gz Ra 7-1 rn 0 yO G p U 'C Ct r:Q un L N ® O •1 rti p v 0 C 0 W 0 O W Go cn 1-4 rQ O z ''O ri14 w O w as 0 o O o� f:4 124 CW/) CW/D 01 Q • U P-t GO 171" 0 0 O O O 0 o Q Q U U tt • • 0 a) cn U bq cn Ct a) ▪ aa E O aa C ca 0 cn • CA 0) U c U O U b.() icn cd • ct bA • p 'N O p ch N P -43 .p" �, U Uct ct • N cn • U at .'. cat 1) U v)D ct cn• n O .0A) cn 4~ nl • PI O • p U U O ,' ® c E > a, N cn O 4O 1-1 0 N • W m U r0 O O O a) O 0 Cd U Cd O VI N ¢` • f bA • U N 6. Name/Addrc Contractor or V 5. Type of Product or Services * (Enter Code) Lase DD/YY ue of irement 2. Business Enterprise (checic box) tv 1 Women 1. Procurement Made By (checic box) Recipient Subreeipient Prime MP IM4 • 3 = Services 1 = Construction F pr( 023 O Can b cAN "O 'O AtC bA 0 O O U a' w 1) E-1 tad tut ct 414 c E v) Z Q w 1) U U O O Ssa v O C3 Ww �' cC 0 r 0U 0 U ct ct F • go 1 46 �1 .1 b .1 • • O • • • • .1 lib 415 •1 4.1 466 lb 1 •.1 • n lo • .1 .1 • .1 1 Contract Number C16893-14 N 0 N U a LZJU > I °Red Contract Number C 16 8 93 -14 Vas d LHJ staff ys of small ci [unity Group fled by DOF (DOH) Reg pecial Instru, Y. lc/Activity/Description PHIP cal. Deliverables/Outcomes Due Dal sures. 1. Provide inspe DOH Region the water syst Reports shall a. Cover let b. Small Ws checklist. c. Updated Inventor) d. Photos of e. Any othe documen C0_-5 CD cn < '7' 'CS n 0 E5,Lic0 r O o -9 w 0 = 0 0 0 �• Cn 0 0 0-nP PD cn 1 O. O OD CD CD 0 O 0 �-h 0 r cl- Ci 0 r a00opO__ OD CD µ3-4 me°_ ti ti Cra . CD O0 O QO G W O it Cn O gift 29" (D a' O N Cr O �< GCoo Cr O 0 N › oW ) CD , _ O'HP 0 �. 0 r+w cn c-F c.n CC CD 0 N y*( �. ra- 0- 0 _ CD O 0 o o P C) cnrL P n Drinking Water Group A - TA Drinking Water Group A — SS State IDrinking Water Group A - TA Drinking Water Group A SS State IOTA] pA-SS pA-SS Name or Title CFDA # BARS lY Revenue Ir Code C zzzzzz w 346.26.65 346.26.64 w w w CT N O\ Cn CT OCTCT N CT 01 01 N CT 01 IA N CT O\ A P 2421252C a N N N N -P N -h N CO N CO Ni, a N a C.) d e O J O O J O O J O O O O O O O • • W W w N N N 12/31/14 06/30/13 01 CD O O W t•JW fr--f a w w J N 4,000 22,1 N N 1 O O _ Cn O vi O O O O O i N -2,000 CA O LA O O 0 O hange ecrease (—) ® ® N O 0 0 H N 1,000 OS/2I I V1 O V1 O J V1 N CO 0 0 Con O pp _ CD f (4- d ro 0 Q.. ce o " uc roq co 0 O CD ro o pot° Ps, coo C CD 0 coo P o CO CD y w C.)0 G0 'U N G 1-1 >t O� O N G •0 O' 0 ri0y O 0 0 CD CD CD 0 0 p 0 0 faa cp O • a CD C/] CD CD C) uJ va 0 O 0 CD Coo - C/D 0 0 _ 0Q Cn zr cn cn 0 CD r-r CD 0 m CD 0 CD cD O w ON O c • 0 11 0 a 0 N W 0 CD ti 0 0 G a cra ceD cap. 0 a providing technical assistance to small Revision # (for this SOW) _ [tiding Source Federal Vendor State Other *i rD _ t 't r Epliance . covery Act) Transparency Act) X LEI se111enL Price CD n CD O N DOH Program Name or Title: Local Health Jurisdi n nemt- e g K pFh N O w N o IfrfrzeL O .A. :dogumw pua;uoj 0 , CO C1 W tion Name: Mason County Public Health AMENL . ,ENT # 14 cn 0 T. _ J _ o ca-i O O Ct 03 • "O V °8 >s ct ��', -+ .Q raj "O at a� ® C R as S. 7U 4) O Pc .a; N Ucc formal > .> Cn CID b0 O O cd a) L CZ "d •" �✓ • • O ® O 0 L Cd pt Ct v "d �.' =ma _ etCJ CIO�" Q EA EA EA cC U a bA C o Q 1' O" bA N w, V • ;0 �d _ __a_� i CF-1 co) co, ea n • •gm.. v UaU E iQ ° E4 UU UU XQN cci U "d U qa Acct d r �O an 'C im °® � o . c PY O Ll U .f6) E a) "d 0 Umml cci O O O U' ate-+ tit( a) co 0 U N v a) c—' a) a) cad a) a) 'd W 4-1 N cct 5 U . y.� - - cd 4-+ -w U ran 4-i 0 to ¢+ O `n O O E .1_, U 0 O ^d , -' O 0 'd ,'-' O .., O O t O _ 0 Cr) Cr) m Cr) rn V U o 0 E O ,_ rn O n-4 M �" M «i 5 d" +-' O N GB cu aa U 0 5 U et N c..) �-I cC N N U O t U 'Q U ® �Nt "O t�, a� "O A+ 0 i--� s-I �, i-. N a� .O y..1 N N Due Dal �O U tarn �'-� U >i n O Q O V >, ® i, ~' Q Q co O S Fes+ z a) • Cal (` � ' O Q� O ° ^ - D 1 re 0 H 0 ti p _ _ _ _ 0-1 a -cc 3 5.,0cif) Q 3.5 a• 3 O ati¢ti0 0N oati ti0 O a a� .d o Cid bI3 l Q W CII 0 o ~ -- Qa :d N •' Q 'd g y Cd on -0 N WO a-1 U U >, E r-, >, y�_i "d N Yea +a "o N 'd O Deliverables/Oul w b4 ' " • 0o bU4 O O ." p aJ �. E ,3 N E 'O U 4-� > „, , 0 �' 'O a4 MI N OU •d U C •i'' E g O 'd p-' ai O "d Gl. 0 O P-1 �i cd U a) . v) E O • �y d 5 "d n _ >~ t +� v a) _ ,- cd a, 6 _ _ 'd _ cd U cd Q) g ' 'd n U CD U >, 1--1rid � o 6' 1-4 CI) O b0 a)i - 12 �N .3 QU • � 'P �' • O F"">-� j E O J' U 'N cad 3 N c cd 'O cc:r��n 5 cn a>., , >, O 'c7 �, O" '; OU 0 UQ en 6' e> ro Q -1 0 U 0 O +U+ „in V] g, O U d • rn ccn U - p UQ �+ 3 O cUj 1-1 ro U ct Q W UOigU cO NOOU Clea) 9w0-dr� O d r;0-drw cd ci >aQ4- .9 • .9 a) •H U a> N C/] "d ^' N *May Suppo State and Standards/M lc Task/Activity/Description ber _ _ (., 0 5p v r. E0 O U O 'dteE'Q • ++ Oa., N V.p N vN O "0 _� Q o � bpcn�° >WU o y o a d E °>' _ p F _ .0 4.a __ � E Cd ~ `o' a 0 o x __ CI Q 0 0 E 'g � d ) • H 0 ai ccd �t ,> cn t 0 E U a--' fj1 up O co o • cd 3 >, CO ,.._, • i' P, a, 0 0 _ 1 o 174 0 3 ' c>, cd 0 on .,5 N n E O ,.d rt -. .E U U O Q. 'aU-+ OCL) -•�' +'' �. c. ct ®Q�49 _ 2 H°-a u 8 U_ - . � csn cc N Contract Number C16893-14 N N 0 1-1 U ct Contract Number C16893-14 o o CD 0 . O 0 CD • CD ri Ca) DID • 7• 474 o w w 0 O n a n IC-Pg O CD rnt CD 'C CD 0 O N 0 O N 01 CD o,'3 o 0 COD -t _ 0 o CD O 0 O CD 'D a CD t< CD O cn 0 -I 0, 0 O O C\ .' V CD ✓ CD CP R CO O 0-r, H 0 cn r PLD M O " •t A. 4-G ® O� cn w O < O n o cn • -t y N CD a a CD » 5 W 0 < 0 O O CD CD • n CD o n. fa. n 0 C Q\� CD 0 O w 5. r O 0 • a CA • 0 < 0 (D .G Gam' 0 0� 0 1 CD O 0 0 00 CD R. co 0. G O "G U 0 CL 0 CD r O p ,O_, 0Oi C • CD CD OS' 0-, cn _ 0 cn r CD w cn CD cn C rt O '-; n O 0 5' X 0 R cn r < 0 CD En w n $,-c o cn W n. • n O ct I P cn • CD Go n o g LRL cn w CT 0 9 zn P as 5 CD QQ cn CD 5• a CD cn 0-1 0 0 1 CD p, 0 0 O �-A 0 d O C 0 a O O 0 0 0 O a 0 0 P. • co co cA .O cn 0 co a O 70 G CID s •CD 0 CD a. 0 c 0 u 0 F. 9.< co P cn o n, c/p a DI n, :o 0 _ ▪ W Q. CL CD O 0 O cn O O CD O ▪ �t fn cn Cr• 0 Q+ n C C/D C°D n d ,313 C r• � • CD • P _ w S. 0 O_ a_ p, < `< CD 2 cn '-CD C 0') n . c 0 n PSI cap_ < 0 O O O OQ 0 otai O 0CD 0 0 0 cro 0 11) 0 V 1.4 1L1\1.1Y\R_EN J/\10 AMI-1NL MKT # Instructions .5 0 a) 0 0 • Cd N 11 a Ch V) 0 Cdd Q a) a) 9 a0j cc! ct 0" '0 ^O 0 ct ct 0 0. O U bA 0. .0et 0 c Y O vi _ O0. O 0 O O U bA c0 g4 ct 0 4" 2 O a.)0 F2,0 a) 0 ._ act0. g 0. &a cd 0 0 Y a) N • U U a) d O .� 0 O wai 0. 0 baCt cat 1 OO a) o rI U • y 4 U ' __ cnai U 0 0 cn O_ 0.4 p.;9 o O c 7. _ -0 O • +voi Cd a`di 8 wai :U.. } _ "0 -40 cn O "4 ct y 0 O p _ a) o ,cd Imoa) 0. c O bD C®1 H a-1 ) cd No more than 47 surveys to be completed between January 1, 2012 and June 30, 2013. No more than 3-0 29 surveys to be completed between July 1, 2013 and December 31, 2013. 0 cn -01 0 0 U N O Cd ti a)) U d- a) O N _ 0-4 0 0 0 ,n o N a) � F -01 0 �. Sal O U a) o _ o • 0 U O0 U 0) 0 0 imma 3 .3 a O 0 0 o 0 a) 0 0 0 M ct Cd 0rE tog 0 o p Q) Z Z H H Ki 1-073 • 0 U a) 0 a) 0 ct O 0 - a) O o 0 0 0 N C _ 0 0 .4 0 .0 N •ti aa) t U a _ 0 O .d at U 0y ct 0-0 � 0 ct O 01.2 go 0 N cd 5 a) a) U O j I. ct .5 9 N-4 cn •cn ocid � U .1 0 thH 0 U w Ob • O 0 0. O ba0 o X8 N O 0. 0 O .� +� 0 0 2 bA cA 0 5 O 0 d 0 0 up up O O b cn U 5 as 0 O ro U g bA O 6.' N 0 N 5. 0 O > cn a) ch 0 O QD 0 U U cn 0 0 U O • cu a) 0 0, 0 O 0. p LU 'b V) LP VI CJI O U 0 0 bA l , 0 U O -••1 oni 0) CD o O 77 0.1 ,O ct aca .a;• cd 0. z °y' O v 0 a�) dW N Cd H 0 0 c 0 0 U 0 0 O y1) i (i 0 a) • crl bA rn • "CI 77 din 0 U 0 0 U 0 cn 0) 0 0 a7 7 c0 a) U 0 a) U U 0 'c3 0 • ti a) cu 0.4 bA a cn 1-0 ct 73 O _ • U O 0 0 ¢ O 0 va 0 ."4 0 Ov 0, oO O 74 bD 0 O ' 0 o ul 0 01 O U • 0 ct 0" O40 N 0. O O 0. 4 0 cn 0 it 5 0 a) a)-0 co 0 0 N a) O O174 o 'ct: 40 cn d Si" O N N O cat cat 0 0 ttta 0-4 0 0 CID 0 bA N bA U 0 O -ct Y N d" a) O ct 0 U Ti O P 1 00 U 'j) 0 0 U ccd a) •-% 0 0 b • a) U •cn cn cid • •0 a) ct ch 0 0.4 at 0 0 0 0 O 0 0 U ,cD 0 ti 0 N O U 0) O 5 0 0 U a) 0 l x 0 0 (44 V) 0 0.4 0. d 0 C!] bb O a) bD O a) 0 0 cc cn g cp cat d• o 0 O ct)4- 0. 1 v] cn _ �O" U C! 78 N a) 6' 0 1' id O ct 1-1 d ct 0 ct by bD ._ .5 R4 .5 O ct_ E. O 0 O ater regulations and sound bq • a) 21 ct N U 0 bbD U .5 0. 0 cn m U U a) F." 0 0 0 U 0 bD .5 0 o o ° a) U O c N Ct (I)O o o _ 3 ,:0 3C bD bA 0 bA O o 0 0 r 7,4 c, rn .`n. . .`n. O N li •�. d � d 0 O o 40 0 0 N Contract Number C16893-14 O o cch N O Q Ct Ca ContractNumber C16893-14 Perform joint quality control surveys with DOH. DOH will issue a Notice of Violation (NOV) with an offer for a Bilateral Comp] responsive system. If the Purveyor is still uncooperative and refuses the survey, LHJ will notify DOH by including the non resin. information in the 2nd quarterly report. If the Purveyor is uncooperative and refuses the survey, LHJ will notify DOH information in the 1st quarterly report. Prior to sending inspection report to purveyor, DOH will revie significance of any findings and (if needed) provide additional will be returned to LHJ via email within 5 days. am DO (B [c completed; schedule new assignments; re -negotiate contract and discuss concerns or rnd process. `red above to the purveyor and DOH. E' their survey requirement. navment [ion (unless ] ODW. Lion per the Si; to ensure the d rcement could [er (SHO). bw 1 LHJ X X X X X X X XXXX 0OCD 0 `�'d c7) x N C J c) co co LID w W O O O �. O co �CC < 0 G A W CD salon fH'I Pun HOG 0® g Z\1INCY ENV �a Contract Term: aarN� aJ-e U_ a O U Cfl Ct cts I1 4 O CN 00 U Contract Number: Price Cc 1/ .pliance v H La a b �¢w ;EMILi nding Source Federal Subrecipient State Other w►HOC Revision # (for this SOW) 1 M ti b4 O 1-1 cn N ri ti O U O U .c7D tit 1-1 troma Sag rip pa O-i W O O O O. ct En N a) b4 0 W 1 MN U a 0 cn Ct bA "C▪ S N .O • ti cn O 0 0 0 a) Q) cn 0 0 0 0 a) d O R O O N ® t14 0 ON U M O N O 0 O~ 0 0 CZ U "d a) cn b4 0 Q) 0 SZLI d) • 0 Q. O I--3 N 0 0 ccs cn cn • a4 r O O 9) En • 0 U) LD 0 ni En ALI con ideration 00S`£ 82,417 3,500 85,917 N co Change Increase (+) 0 00 M at leration 82,417 0 U bS Funding Period (LHJ Use Only) Start Date End Date -- O M O O M O M M .-1 ,-1 O O o s, 0 Cn 14 O o0 .. _Ct) kCP O /00 2S enue le O 333.93.88 M • M M CFDA # rn 0 M. me rn 00 M. [NG PR HC SYSTEMS - PREP fame or 7 fluent `ion and/or count Reimbursement fbr costs, not to exceed total funding consideration amount. keiml ;osts, total 1 onsic rime ] FFY13 PHEPR HC SYSTEMS — PREP (HPP) O M O G (PHEP) As requ - Submit completed work plan. 03/] Submityear-endprogress report summarizing activities. Submit completed templates. Deliverables/Oul k/Activity/Description *May Support Standards/Mea Provide preparedness training and educational opportunities to staff and partners. 2014-20] eml emc Develop work plan for 1 cycle. U O Admin 1 Admin 2 HPP 1 Contract Number C16893-14 N W 0 N N g m "5 o cs 0 co O = E O _- .O U w F • Z AN U a.) E co .G r O d' U k 0- d' 0- d' d' d' 0- d- d- ki. _ 0 0 0 0 0 0 0 y m 0 \ O m O en o M O m VD� O Cr) O 0 m O 0 m o 0 rn o 0 \ O 0 \ o E� '0 -o -d b -a 'd -o -0 -d -d b Exhibit A, S' 1nents of Worlc Page 2n of 27 Revised as t arch 17.2014 CD N O N O N CD N N CD0 N N N N N N 0 N AB Deliverables/Outcomes 1 res N N N N N N N N N N N N—� tit completed reporting ates. Lit mid -year and year-end ess reports summarizing ties. ait mid -year and year-end :ess reports summarizing ities. .t mid -year and year-end ss reports summarizing ies. t mid -year and year-end :ss reports summarizing ies. 1-year and year-end ports summarizing and year-end summarizing l-year and year-end worts summarizing lid -year and year-end reports summarizing it mid -year and y ass reports sunnn ties. t mid -year and ss reports sum [es. 1-year anc ports sum = t ca OO =4 -'^C .. � et t q Cd _ .' ... cn 10.3 Update of resource list to our Alternative Care Facility (ACF) cache. b0 to Update of our Alternative Care Facility (At Plan. N N �a.ct 3 U z N UO cd 4"ri W C.) O ias �+ O C3 Ct U d 4-4 50 cd O U as .r,1-4 W .I) FP O as .� P.. n U 0 r F." m 41a >. 0 .r" ., om.' r. W cn °' b N p -- U d s. •° _ O P..� O j b.0 PL r. GO �, Q. 4 4 c_d aj � y U^ O 'Rib Lit 0 0 _ U 0 '� O U U X N O U U O O W a CD ° w h a4ro co ct to O D_ co v' CI) N N 'd NCD a o, — cd cd r U' .Ua vP. ' w CO,0 � W N a O Cc�OdU a)^d0, cta. U flO O O 0 dc �M! .s i ct a, ^Ct i-1 'I-O a) 4..A Q.)Pe ,n a. L.) `JD � ., el a,. `� C^ N �., Q) U P O U cu a ^ ! ^"' as O. g � a) O aJ g �, t 0OtiO wU -O ,+ ad W co > . 0 b-0N a r o U a) da a) O e 4.a lei }" �O • r- O '. bO 'b *' ai b a0: gy 'd U; U O .r. (LE) '.N ap.0NN G(L. M 0 ,p'O N «: ? .t CJ] 0 ,y�4O o cn O _ O O o O a r, N O_ ( O _ cdb ,cd U UU+O ® O U OP�1P-io P, U Q W d Q-, .N as W ® P-< as , &. ., ea m O E O E* O 4 N d N r-, N on.-4 N M ® O r" —1 m m m CO C® C 'ment ion and/or tount and 06/30/14 and 06/30/14 and 06/30/14 and 06/30/14 and 06/30/14 and 06/30/14 3 and 06/30/14 [lime 1 12/20/1: O N N 0 N N O N N 0 N N 0 N N CI) _ A O N N Oa E © C3 [-year and year-end ports summarizing Submit mid -year and year-end progress reports summarizing activities. [-year and year-end ports summarizing t 0 Submit mid -year and progress reports sum activities. [-year and ports sum ]-year and ports sum - ----- ?orts sum Ct L *May Support ] Standards/Mca It/Activity/Description bag" to go with the Front Desk he case of a building evacuation. c 'rofessi i Coun1 anteers ;ommunicati pate in quart /7. Continue u ;ontinue bi-am d community ] health 24/7. cians a; oups id Update the Epidemiolol Policy and Procedure M gency 3f Volt to reg rve Cc re dep] N cif? N N .- — 1 cd b0 . 5 vni O 0 . 'y 0 U b. bq a) N U a 0 0 0 cn '▪ L3 • .) 0 re 0 cd up N .i: 'O U • rn d) U CCS C3 U ca • N 0 0 0 • cn � LU ,-O 0 0 0 a CS t cn cd Ci "S U cn N 0 O 0 0 0 O rzi 0 0 a) en en sourceCatalog/Standards.aspx and Tran w Cr) 02) '0't cr i rda 0 � _ CID Y H H Act (FFATA or the Transparency Act). U 0 • O al 011 E—t N "c 1 u) -( b, I N O CH U 0 O bn• 0 CD wLI) 3-+ U U C w� U iny 1-0 • a) •• • 3 U t N O Cd o • t O et ._ CS• ' tU O immt a-+ P ca .b c� 1-1 1 O O r }' �.c 4 U U Q 0 2.1 cn Sal cd cip o H • 4-4 0 a� 0 • 0 vp by Contract Number C16893-14 N W 0 M N b Pr( Ktt- 1-1 AM I-I;NDM PINT to & Contract Number C 16893-14 A 98504-7890 . 41 00 0 Cm) L O lla al NSZ z dt w oz Uv O • rani mittt ra Nod rill s. tso Jszie 0 O ima M I w O V1 Local Health Jurisdi Con a) U CD 0 E4 O N 0) N 1 0 C/D a; 0 mai z > a H Q cip Price E* s Lpliance deral Co': applicab ending Source 1 Federal <Select One> State Other G4❑..❑ Revision # (for this SOW) 1 0 N i rip N ti Period of Performance: 00 U 0 Ct 54 U 0.0 0 cn O 0) 0 Q) T a) bA cn as z 0 a) 0 0 0 N O cn • „So4-0 0 0) N .Li 4-4 0 a] 0 H L AO O Cn 0 isze( O 0 on is to add work and funding to Task 5. Revision Purpose: The purpose of this revi Lai nsideration O O O N N 67,000 10,000 77,000 Change Increase (+) 0 0 0 O ❑ O O 00 N it .w d G "O bS Funding Period (LHJ Use Only) Start Date End Date M N M Imml N O s. w a� U 0 O 0 N N V cip)Ca A O U w0 BARS revenue ;ode 334.04 zz •0 ameor] Ct 0 a) E a cn cn 0 00 a N a\ formal 'or Am lie dates: $14 r 31, 2013 ,014 r 31, 2014 'ngoing throughout ct period EA 5 0 14 bh O Le/Time I enV b gCel 0 O o N N bfJ .O — o 0. M M a) O be O 0 N 0 U le `li .. a-. :enance and educational Rep ders will be sent to 18,000 Dec n owners. Postcards will be July 3 2,000 proprietary system Dec rs Tas1 the h P4 Q Q H CO 5 0 () m cip 14 . , .,.. w cn a) s. t 31 pc 1 as 40 7.3 ppo nd. s/M k/Activity/Description Operation & Maintenance Notification to Homeowners On -Site Education Educational Presental N ,---1 Contract Number C16893-14 N 4. 0 N a) 0.0 0 0 ct N 0 N U 03 t e � \ co \ \ \ dt \ d 2 / a a « ti 0 1 -oughout 0 be bb cn 3 \ 2 J \ 2 2 \ 2/ t t .. t c o m m a .0 2 c o g m N « .0 = e » m m » .o �/22 IN �^3e '0\ \ 0_ 0_ \ en oIcT »®ow ®t _ ©^ © [ 8 _ = 2 m< [ 0 0.c. = z r a Deliverables/Outcomes Due f \\%ƒ\�\\%ƒ \\%ƒ \\�\ "�® 3/ .\/ aE •c4• EE \S»8 no-o agxo _ o @ 0 @ 0 _ @ /Q/Q 0 0- 0 0 0- o 0 0 @ 0 /0JQ DJ aeQ @aa0J/ @3 @3 articipate in all eting and confer ored by the DOl copies of progre I be submitted locuments used or grant activitie tnagerent plan Das( ate( jorl .nd tall n sIJ e fc `y8( lase rtnn lllo' nsa ho m IL :o m Sri Tta tt( t ec g& E Q 2& S» b J& 2 a *May SupportPHIP State and Local Standards/Measures ;lc/Activity/Description Enhance GIS On -site Sewage Data Layer Follow-up for Unsatisfactory Maintenance Reports anel site visits to complete record drm(iings for Lots that do not have a record 6 Administration gem( as m e Contract Number C 16 893 -14 uents of Work AMRNL isNT # 14 *For Information Onl 0 at bA 0 ni 0 O O >O O• G c O E U _ b a) ro 'O ,.0 U C.) ¢ E L� cd U COC >> V] 7-4 CCt cn 'O d) L Eop ct 4 .E "O Hct cf) S-1 _ al a) V] .T. 40 a c N ;• -1 aco y 'a 0 O 0 OCtfl cn_ " '0 O U, Ca u 0 .CD u v r o > ro nn U y c3 1.40 b0 • • W Z. nIPart_nershpPI-1_IP/R uirements/Narrative 0 4.4 F r ca 0 • 0 0 at 0 0 b0 O 0 re 0 ct U cfp 0 0 Sal 0 ' a) U c 0 0 0 U 0 U "0 b. bA O • 'o O a> lam( 1 0 0 0 U C3 cnn • j U U O a) • 0 v; 0 by • ate-+ 5A N TJ U id U cin o cri tr 4O 0 Z 0 cn U cn cop C w c O ad �O cn cd 0 m Z ct 4-i 0 0 • 'e3 0 0 z 0 3 O N 0be 0 .00 t7 0 0 N by O 3 0 0 0 0 0 0 u by Y rd 1' a) 0 a Li " ,24 _ 0 a) U .0 up 0 O U [d a) g _ 0 0 O _ egi _ 5 ' N O O a�•0 N d _ PO bA . 0 y 3.^F ri ) fl _ _ 0 0 0 O L �;/c a) on 3 a, o 0 O 0 4 ct O p-' \a, o• 0 bO ct a4 o d o bi O O O 0 U a) a) U N O 0 c, 0 .7-44 •5 U O' cad O g O Cd :L O H C.) U bbf 'C ct "0up ctL bA g .5 O U up VU 0 • .4i O 'i O y rn 0 a� i • 0 En N A U o o cat bA tee chn .5 O-' N 0 0 0 p 6-4 U N L O b 0 O cd 0• o vs O HO 0 bA I 8 9.2 b s 0 " U E O O ct O 1-4 U E rg N Ct V 'a et d- 0 N •al v 1 d 0 N O _, N 0 1 d O � U N cct 0 0 0 '0 0 0 O a 0 al cct 0) O • N 0 Q O Q � 0� ro cz 0 cccr ra O bO • aSacct P gN te 'do o _ d; vNi tej O M 0 v f, Igisowd „1_, o N 0 0 0 c Ga Q LJ O O czs co M ccp U � .p M N Z cn ✓E Ct �rN ^ frog CYO O � O co pt 0, as •� MS C:14 E O N Sir 71- Ts O Pt pc) tin U 0 H y_ ay it bn ct 6) tn C 12 ea 0 C a. O U L ct bA O O L. ra Contract Number C16893-14 EXHIBIT B-14 0 ALLOCATIONS Mason County Public Health March 17, 2014 0 0 0 Efi O trIn 69 N O\ NC- N Cn 7 7 M N \O CO O 6S 69 6S Ern 00 00 69 N CXC 6S 00 O 65 V \ Nn 1-1 0 0 f,S Contract Term: 2012-2014 E Q • 0 G Code* Start Date End Date Amendment Chart of Accounts Program Title 0 0 O 0 O ttln 613 N 7-1 rmwi en cn enenm en 0 O O 0 0:70 O 0 O- O O 0 O-.0 :O O. r � N. �. O O 9 0 O O._O 0 333.66.12 05/15/12 Livestock Mgmt AG BMP's - NE M O O N gv4 - !PP O 0 1/40 en cm z en M O O O n fie O N O\ . O 7 ti • NO O 69 69 69 64 O 0 O 0 N [ 64 6S O O ti O N O cn M rn M 1D ER • 6S 69 GS N :M' •71- ". N M N -.M M 7 ` N cc) m 7N. ..... co M M Vr N N 7 1 \Q 1. 7 D11 O\ O O\ O N >O V.")M V'O � O 7 7 Q 7 N N 7 ("cad: 9 64 6S 6S 6S 6S bS 69 li O' C1 O. O - O O '. 0 ,n ;-N-N NFN N N.`". N:N. N,N ' N N-.N N .0` .-i N M _,.N M 0 O N 6S O.,O.O O O 0-0 O O 040 O 0 7 7 7 a a a zzz 4.3 071 0• 00 R ea co • 0 CC• D CD bC co coco • ES ES &D .0� 0 0 - .N .N 1-1 N N _ 0 O N N rwl VD 1/40 Cr; cri M M M m 7 cn V'1 0 O rn M M 0 O N N_ 10 VD Vr Cr) Cr) M M M M M m cn cn M N-( .N-1 .NN -i . 1-1 \O 1/46 \C 0 otd 0 0 0 ection - NEP ection - NEP U G crddo 1-4 0 0 O O a a zz 00 U 0 O 0 r( r U U 68 000 P. aoaa 7 rn 333.66.12 08/01/13 cn _ O Shellfish Protection District - NEP CJ C] O O Cr); Cr; O1 Cr; M Cr) Cr; M z°' 333.93.06 07/01/13 bb1) SIP b ab00 a a a f r H a a a a N_ m_ n-. w 0 0 M m a• U M M M M \O N N cr.) 1 O1 D\ M M M M cn M m en cm N M D\ M m CO CO O CO N N N N M M cn M U O D1 N M M • r \ \ N N N N M M M M 4 Cl C\ Q\ rn M M m m cn en cn cn cn cn M CO CO CO O 1/40 VD \O 1/40 NNNN M M M M O\ a1 O\ a1 Nen en N N VD N N M M D\ D> Cr) m cn en m cn 1/40 N Cr) O1 C1 m 1/40 N CN M O co O co \ NINNN K7 M M Cr; \ D\ 01 O\ VD 'd FFY12 PPHF•Public Health Reimbursement a EXh1.,IT B-14 M 01 00 14-4 z Q U O 0 O U ALLOCATIONS Mason County Public Health March 17, 2014 CO Contract Term: 2012-2014 Statement of Work ACZ ct Start Date End Dat Amendment Chart of Accounts Prog O O O O CO O O O 1f, M ac EA EA EA O O O O CO O O - c O M GS Ge N M EA ER O Eta O 01 O O c+') O a, O M M 0 O M 00 M - N M a!1 4 EA EA EA EA EA , <Y N N M mot- N M M.- h 00 CO 1p :10 1/40 1/40- M :M M M Cr) 01 O O OO O O. O O O O.O O N N : O O en O Cn en O cn M h in M M O1 C1 M M Cr; M M 0 a> M M In v1 M M 0 0 N Q1 no -to cu rt ¢� FFY12 PPHF VTrckS-IIS Interface FFY12 PPHF VTrckS-IIS Interface . r IT. :� �:: 1--1 0--I i--a H O O O 0 O • O O CZ) CZ) O O O O O O O O O O O H N M 00 EA 00 M 01 7 GS ER CO (11 00 00 00 00 00 CO M M M O1 O, O1 M M (+1 M M M M M M O1 00 00 00 00 M M M Cl 00 00 00 00 00 00 cn cn • ch O O d 7 O O en M 01 0 O O LJ O .r .--+ .i r+ .r 01 a> a1 D1 O1 0 C\ 01 O1 O\ 01 0C 1 01 01 M M M Cr; M Cr; Cr; Cr; c+1 M O1 01 O1 O1 Q, O1 01 O1 C. 0 Cr; M Cr; M CK1 Cr; Cr; M Cr; M M M M M M M M M M M M M M M M M M M M M Q\ 01 O1 Q\ a1 Cr; Cr; M Cr; Cr; M Cr; Cr; O 0 0 0 O1 01 O> O1 E FFY11 RW Base Contracts 1-1 FFY12 RW Base Contracts FFY12 RW Base Contracts b ¢� FFY13 RW Base Contracts FFY14 RW Base Contracts FFY14 MCHBG CBP ConCon FFY14 MCHBG CBP ConCon FFY1 I MCHBG HCO ConCon Federal FFY12 MCHBG HCO ConCon Federal FFY12 MCHBG HCO ConCon Federal EA TOM O O 0 0 O CO 0 41 0 a, M M 01 M M Cr) M Cr) M FFY13 MCHBG OHC ConCon Federal FFY13 MCHBG OHC CouCon Federal N 00 0 CT ' O\ 01 00 ' N M M M EA M M M EA EA EA M 1/40 O M O N en O EA Cr)ON zzzzz FFY13 PPPO MCHBG Operations a ro ro et et n n n U U U U U U U U 0 a CR CR V) VD V) 0 0 0 0 0 0 0 cti 0 ab N rr e E P Implementation 01/01/12 06/30/13 0 c) O cn O 00 00 00 EA O 0 00 EA 334.04.93 07/01/13 12/31/14 Q zz March 17, 2014 ontract Number: GS 7 N V1 r N co EPS M c Ewe EXHIBIT B-14 Mason County Public Health E U G .� = O �i 0- u a> @ Pm(M n U 0 . W H 4.1 "O A : L _'4'a Statement of Worlc 0 0 Zia bD ea G fa( U es A °O CID Amendment Chart of Accounts Program Title N 0 O CO 00 \O O V1 00 00 N O M O t M M CO 7 69 ES ES 69 be O co co O O C O V) co V1 V1 Vi O r O r M N O 7 M 7 • 69 69 E5 Elj 69 O O O CD O O O O O O O O O O 0 69 E,9 69 6q 69 ES rEEE CD CD O ' O N 0 O Cr) Cr) VD 0 O O O N O O 0 0 0 O O 0 O 7 O 7 en �..�.--.Lep -- - .r-+._ O -:0 O \O --O O O. O O .\O -O O -:: O O O O O .O 01 re)menenenrn M en co co ca V \O -' O kt LO' VD 10 - \O CO kr-) Vr :"\O \ - \O 10 0 0 0 0 0 0 O -O O O. O O 0 0 0 0 c 0 O. .. CI CO - O O ;O •..O 0 ...0 O O. _O O ' 0 0 : 0 CO O _O r_r. r rr r:'r r r.r rj Cr) 0 'O CD CD CD CD CD 0 0:0 O O CD 0 O. 0 0 0 VD O co Vr N l.6 7 M rr) N 7• co 1/46 N Cr) 7 7 Cr)EEE EPPE Cr) VD N 7 M 0 O O M 0 M CO N O O ' M 7 4 4 Cr) Cr) N N Q @ @ @ <@ @ @ @ @ z z z z z z z z z z z ZZZZZ Youth Tobacco Prevention rn Youth Tobacco Prevention 7 M r 'D "d 'b < a 0 0 z @"¢ Blue Ribbon Local Health Funds Blue Ribbon Local Health Funds Blue Ribbon Local Health Funds V] V] @ ft 0 o_ co 0 - 4-4 ^� 0 0 co CO CO V] Va V) CD VD @ @ @ a a o o _ U • 0 0 N V V• ippo H H l z 4 O 0 0 0 0 C • iaaPEE • s s COO CI) V] VD VDV] VD CO VD DO CO CO V1 Cr) CO V] CO ' IIII @ @ @ @ @ a o. n. a. a o o _o 0 _o o C. cp 0 0 0 0 L U i bp°t0bD bDbD 7^ '^�\ ^ /°� Q p. Q 5 Q E. Cr) IEEE cJ O VD VD Cr) 0 en 0 0 N N O O O O 0 CD N 0 Cr) M 0 O N rEE O vo co co vo cc; v3 N N 0 7 7 Cr) Cr) r O rn 1-1 O M O O Q Q Q < @ zzzzzzz z b 0 p CC Ca‘4 b .d r 0 cro b 0 r GS z Total consideration: Fa Tot H z Total State 0 p 0 0 0 Fol 0 u• U M m g y rt N cn • 3 CD v 0 0 a o ,v0 O o • 0 0 • a Po a w > 0 • Ec o (15 4) * *