HomeMy WebLinkAboutWashington State Department of Health Amendment # 16MASON COUNTY PUBLIC HEALTH
2022-2024 CONSOLIDATED CONTRACT
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CONTRACT NUMBER: CLH31019 AMENDMENT NUMBER: 16
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, includes the following statements of work, which are incorporated by this reference and located on
the DOH Finance SharePoint site in the Upload Center at the following URL:
https://stateofwa.sharepoint.com/sites/doh-ofsfundingresources/sitepages/home.aspx?=e1:9a94688da2d94d3ea80ac7fbc32e4d7c
Adds Statements of Work for the following programs:
Infectious Disease-Syndemic Prevention Services-SSP - Effective January 1, 2024
Office of People Services-HR-Public Health Infrastructure Grant - Effective January 1, 2024
Amends Statements of Work for the following programs:
Foundational Public Health Services (FPHS) - Effective July 1, 2023
Office of Immunization COVID-19 Vaccine - Effective January 1, 2022
Office of Immunization-Perinatal Hepatitis B - Effective July 1, 2023
Office of Immunization-Promotion of Immunizations to Improve Vaccination Rates - Effective July 1, 2023
Zoonotic Disease Program-WNV Mosquito Surveillance - Effective June 1, 2022
Deletes Statements of Work for the following programs:
2.Exhibit B-16 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-15 Allocations as follows:
Increase of $385,195 for a revised maximum consideration of $6,814,592.
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
Signature:
{{Sig_es_:signer1:signature}}
Signature:
{{Sig_es_:signer2:signature}}
Date:
{{Dte_es_:signer1:date}}
Date:
{{Dte_es_:signer2:date}}
APPROVED AS TO FORM ONLY
Assistant Attorney General
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David WIndom (Jan 19, 2024 08:36 PST)
David WIndom
Jan 19, 2024
- nda n-i&.on (Jan 19, 2024 13:ф2 PST)
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Jan 19, 2024
EXHIBIT B-16
Mason County Public Health ALLOCATIONS Contract Number:CLH31019
Contract Term: 2022-2024 Date:December 1, 2023
Indirect Rate January 1, 2022 through December 31, 2022: 17.26%
Indirect Rate January 1, 2023 through December 31, 2023: 18.44%
BARS Funding Chart of
Federal Award Assist Revenue Period Accounts
Chart of Accounts Program Title Identification #Amend #List #*Code**Start Date End Date Start Date End Date Amount SubTotal Total
FFY23 PHEP BP5 LHJ Funding NU90TP922043 Amd 14 93.069 333.93.06 07/01/23 06/30/24 07/01/23 06/30/24 $49,342 $49,342 $133,143
FFY22 PHEP BP4 LHJ Funding NU90TP922043 Amd 7 93.069 333.93.06 07/01/22 06/30/23 07/01/22 06/30/23 $49,342 $49,342
FFY21 PHEP BP3 LHJ Funding NU90TP922043 Amd 2 93.069 333.93.06 01/01/22 06/30/22 07/01/21 06/30/22 $34,459 $34,459
FFY22 Overdose Data to Action Prev NU17CE925007 Amd 10 93.136 333.93.13 09/01/22 08/31/23 09/01/22 08/31/23 $56,938 $106,938 $144,746
FFY22 Overdose Data to Action Prev NU17CE925007 Amd 7 93.136 333.93.13 09/01/22 08/31/23 09/01/22 08/31/23 $50,000
FFY21 Overdose Data to Action Prev NU17CE925007 Amd 4 93.136 333.93.13 01/01/22 08/31/22 09/01/21 08/31/22 $2,696 $37,808
FFY21 Overdose Data to Action Prev NU17CE925007 Amd 3 93.136 333.93.13 01/01/22 08/31/22 09/01/21 08/31/22 $35,112
FFY24 CDC PPHF Ops NH23IP922619 Amd 14 93.268 333.93.26 07/01/23 06/30/24 07/01/23 06/30/24 $50 $550 $550
FFY24 CDC PPHF Ops NH23IP922619 Amd 13 93.268 333.93.26 07/01/23 06/30/24 07/01/23 06/30/24 $500
FFY24 CDC VFC Ops NH23IP922619 Amd 14 93.268 333.93.26 07/01/23 06/30/24 07/01/23 06/30/24 $560 $6,160 $6,160
FFY24 CDC VFC Ops NH23IP922619 Amd 13 93.268 333.93.26 07/01/23 06/30/24 07/01/23 06/30/24 $5,600
COVID19 Vaccines NH23IP922619 Amd 4 93.268 333.93.26 01/01/22 06/30/24 07/01/20 06/30/24 $354,803 $354,803 $354,803
COVID19 Vaccines R4 NH23IP922619 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
FFY23 PPHF Ops NH23IP922619 Amd 7 93.268 333.93.26 07/01/22 06/30/23 07/01/22 06/30/23 $500 $500 $1,000
FFY22 PPHF Ops NH23IP922619 Amd 3 93.268 333.93.26 01/01/22 06/30/22 07/01/21 06/30/22 $500 $500
FFY19 COVID CARES NU50CK000515 Amd 2, 3 93.323 333.93.32 01/01/22 06/30/22 04/23/20 07/31/24 $65,595 $65,595 $65,595
FFY19 ELC COVID Ed LHJ Allocation NU50CK000515 Amd 3, 11 93.323 333.93.32 01/01/22 01/31/23 05/19/20 01/31/23 ($29,966)$213,061 $213,061
FFY19 ELC COVID Ed LHJ Allocation NU50CK000515 Amd 2, 11 93.323 333.93.32 01/01/22 01/31/23 05/19/20 01/31/23 $243,027
FFY20 ELC EDE LHJ Allocation NU50CK000515 Amd 7, 9 93.323 333.93.32 01/01/22 07/31/23 01/15/21 07/31/24 ($27,095)$867,729 $867,729
FFY20 ELC EDE LHJ Allocation NU50CK000515 Amd 3, 9 93.323 333.93.32 01/01/22 07/31/23 01/15/21 07/31/24 ($30)
FFY20 ELC EDE LHJ Allocation NU50CK000515 Amd 2, 9 93.323 333.93.32 01/01/22 07/31/23 01/15/21 07/31/24 $894,854
FFY23 Vector-borne T2&3 Epi ELC FPH NU50CK000515 Amd 16 93.323 333.93.32 08/01/23 09/30/23 08/01/23 09/30/23 $195 $1,395 $8,695
FFY23 Vector-borne T2&3 Epi ELC FPH NU50CK000515 Amd 12 93.323 333.93.32 08/01/23 09/30/23 08/01/23 09/30/23 $1,200
FFY22 Vector-borne T2&3 Epi ELC FPH NU50CK000515 Amd 12 93.323 333.93.32 08/01/22 07/31/23 08/01/22 07/31/23 $1,800 $4,550
FFY22 Vector-borne T2&3 Epi ELC FPH NU50CK000515 Amd 5, 12 93.323 333.93.32 08/01/22 07/31/23 08/01/22 07/31/23 $2,750
FFY21 Vector-borne T2&3 Epi ELC FPH NU50CK000515 Amd 5 93.323 333.93.32 06/01/22 07/31/22 08/01/21 07/31/22 $2,750 $2,750
FFY21 CDC COVID-19 PHWFD-LHJ NU90TP922181 Amd 15 93.354 333.93.35 07/01/23 06/30/24 07/01/23 06/30/24 $100,000 $100,000 $100,000
FFY22 PH Infrastructure Comp A1-LHJ NE11OE000053 Amd 16 93.967 333.93.96 01/01/24 12/31/24 12/01/22 06/30/25 $200,000 $200,000 $200,000
LHJ Funding Period Funding Period
Chart of AccountsStatement of Work
DOH Use Only
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EXHIBIT B-16
Mason County Public Health ALLOCATIONS Contract Number:CLH31019
Contract Term: 2022-2024 Date:December 1, 2023
Indirect Rate January 1, 2022 through December 31, 2022: 17.26%
Indirect Rate January 1, 2023 through December 31, 2023: 18.44%
BARS Funding Chart of
Federal Award Assist Revenue Period Accounts
Chart of Accounts Program Title Identification #Amend #List #*Code**Start Date End Date Start Date End Date Amount SubTotal Total
LHJ Funding Period Funding Period
Chart of AccountsStatement of Work
DOH Use Only
FFY24 HRSA MCHBG LHJ Contracts NGA Not Received Amd 14 93.994 333.93.99 10/01/23 09/30/24 10/01/23 09/30/24 $67,694 $67,694 $122,553
FFY23 HRSA MCHBG LHJ Contracts B04MC47453 Amd 14 93.994 333.93.99 10/01/22 09/30/23 10/01/22 09/30/23 ($12,835)$54,859
FFY23 HRSA MCHBG LHJ Contracts B04MC47453 Amd 7 93.994 333.93.99 10/01/22 09/30/23 10/01/22 09/30/23 $67,694
FFY22 HRSA MCHBG Special Proj B04MC45251 Amd 14 93.994 333.93.99 10/01/22 09/30/23 10/01/22 09/30/23 $22,194 $22,194 $22,194
FFY22 MCHBG LHJ Contracts B04MC45251 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 10 N/A 334.04.90 01/01/23 06/30/23 07/01/22 06/30/23 $6,469 $6,469 $12,938
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
SFY25 Drug User Health Program Amd 16 N/A 334.04.91 07/01/24 12/31/24 07/01/24 06/30/25 $92,500 $92,500 $187,500
SFY24 Drug User Health Program Amd 16 N/A 334.04.91 01/01/24 06/30/24 07/01/23 06/30/24 $92,500 $92,500
SFY24 Drug User Health Program Amd 13 N/A 334.04.91 07/01/23 12/31/23 07/01/23 06/30/24 $2,500 $2,500
State Drug User Health Program Amd 12 N/A 334.04.91 02/01/23 06/30/23 07/01/23 12/31/23 $5,000 $5,000 $5,000
State TB Control-FPH Amd 9 N/A 334.04.91 10/01/22 06/30/23 07/01/21 06/30/23 $500 $500 $500
Rec Shellfish/Biotoxin Amd 13 N/A 334.04.93 07/01/23 12/31/24 07/01/23 06/30/25 $5,250 $5,250 $10,500
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
Small Onsite Management (GFS)Amd 15 N/A 334.04.93 07/01/24 12/31/24 07/01/23 06/30/25 ($53,636)$0 $0
Small Onsite Management (GFS)Amd 13 N/A 334.04.93 07/01/24 12/31/24 07/01/23 06/30/25 $53,636
Small Onsite Management (GFS)Amd 15 N/A 334.04.93 07/01/23 06/30/24 07/01/23 06/30/25 ($45,000)$0
Small Onsite Management (GFS)Amd 13 N/A 334.04.93 07/01/23 06/30/24 07/01/23 06/30/25 $45,000
SFY25 Wastewater Management-GFS Amd 15 N/A 334.04.93 07/01/24 12/31/24 07/01/23 06/30/25 $53,636 $53,636 $173,636
SFY24 Wastewater Management-GFS Amd 15 N/A 334.04.93 07/01/23 06/30/24 07/01/23 06/30/25 $45,000 $45,000
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
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 6 N/A 336.04.25 07/01/22 06/30/23 07/01/21 06/30/23 $1,266,000 $1,266,000 $1,603,116
FPHS-LHJ-Proviso (YR2)Amd 7 N/A 336.04.25 07/01/22 06/30/23 07/01/21 06/30/23 ($761,000)$0
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
FPHS-LHJ-Proviso (YR1)Amd 9 N/A 336.04.25 01/01/22 06/30/22 07/01/21 06/30/23 ($423,884)$337,116
FPHS-LHJ-Proviso (YR1)Amd 1 N/A 336.04.25 01/01/22 06/30/22 07/01/21 06/30/23 $761,000
SFY24 FPHS-LHJ-Funds-GFS Amd 14 N/A 336.04.25 07/01/23 06/30/24 07/01/23 06/30/25 $832,000 $2,098,000 $2,098,000
SFY24 FPHS-LHJ-Funds-GFS Amd 13 N/A 336.04.25 07/01/23 06/30/24 07/01/23 06/30/25 $1,266,000
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EXHIBIT B-16
Mason County Public Health ALLOCATIONS Contract Number:CLH31019
Contract Term: 2022-2024 Date:December 1, 2023
Indirect Rate January 1, 2022 through December 31, 2022: 17.26%
Indirect Rate January 1, 2023 through December 31, 2023: 18.44%
BARS Funding Chart of
Federal Award Assist Revenue Period Accounts
Chart of Accounts Program Title Identification #Amend #List #*Code**Start Date End Date Start Date End Date Amount SubTotal Total
LHJ Funding Period Funding Period
Chart of AccountsStatement of Work
DOH Use Only
YR 25 SRF - Local Asst (15%) SS Amd 15 N/A 346.26.64 01/01/24 12/31/24 07/01/23 06/30/25 $13,800 $13,800 $37,800
YR 25 SRF - Local Asst (15%) SS Amd 14 N/A 346.26.64 01/01/23 12/31/23 01/01/23 12/31/23 $800 $11,600
YR 25 SRF - Local Asst (15%) SS Amd 11 N/A 346.26.64 01/01/23 12/31/23 01/01/23 12/31/23 $10,800
YR24 SRF - Local Asst (15%) (FO-SW) SS Amd 7 N/A 346.26.64 01/01/22 12/31/22 07/01/21 06/30/23 $1,400 $12,400
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
Sanitary Survey Fees SS-State Amd 15 N/A 346.26.65 01/01/22 12/31/24 07/01/21 12/31/24 $13,800 $37,800 $37,800
Sanitary Survey Fees SS-State Amd 14, 15 N/A 346.26.65 01/01/22 12/31/24 07/01/21 12/31/24 $800
Sanitary Survey Fees SS-State Amd 11, 15 N/A 346.26.65 01/01/22 12/31/24 07/01/21 12/31/24 $10,800
Sanitary Survey Fees SS-State Amd 7, 11, 15 N/A 346.26.65 01/01/22 12/31/24 07/01/21 12/31/24 $1,400
Sanitary Survey Fees SS-State Amd 1, 11, 15 N/A 346.26.65 01/01/22 12/31/24 07/01/21 12/31/24 $11,000
YR 25 SRF - Local Asst (15%) TA Amd 11 N/A 346.26.66 01/01/23 12/31/23 01/01/23 12/31/23 $1,000 $1,000 $2,000
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
TOTAL $6,814,592 $6,814,592
Total consideration:$6,429,397 GRAND TOTAL $6,814,592
$385,195
GRAND TOTAL $6,814,592 Total Fed $2,645,802
Total State $4,168,790
*Catalog of Federal Domestic Assistance
**Federal revenue codes begin with "333". State revenue codes begin with "334".
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Exhibit A, Statement of Work Page 1 of 6 Contract Number CLH31019-Amendment 16
Exhibit A
Statement of Work
Contract Term: 2022-2024
DOH Program Name or Title: Foundational Public Health Services (FPHS) -
Effective July 1, 2023
Local Health Jurisdiction Name: Mason County Public Health
Contract Number: CLH31019
SOW Type: Revision Revision # (for this SOW) 2 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, 2023 through June 30, 2024
Statement of Work Purpose: Per RCW 43.70.512, Foundational Public Health Services (FPHS) funds are for the governmental public health system: local heal th jurisdictions,
Department of Health, state Board of Health, sovereign tribal nations and Indian health programs. These funds ar e to build the system’s capacity and increase the availability of
FPHS services statewide.
Revision Purpose: Correcting BARS expenditure code typo and updating Master Index Code Chart of Accounts Title to match the title in the new 2025 biennium chart of
accounts.
DOH Chart of Accounts Master Index Title
Master
Index
Code
Assistance
Listing
Number
BARS
Revenue
Code
LHJ Fund
Start Date
ing Period
End Date
Current
Allocation
Allocation
Change
None
Total
Allocation
SFY24 FPHS-LHJ FUNDS-GFS 99210840 N/A 336.04.25 07/01/23 06/30/24 2,098,000 0 2,098,000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 2,098,000 0 2,098,000
Task
# Activity Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
1 FPHS funds to each LHJ – See below in Program Specific
Requirements – Activity Special Instructions for details
See below in Program Specific
Requirements - Deliverables
See below in Program Specific
Requirements - Deliverables $629,000
2 Assessment Reinforcing Capacity – See below in Program Specific
Requirements – Activity Special Instructions for details
See below in Program Specific
Requirements - Deliverables
See below in Program Specific
Requirements - Deliverables $60,000
3 Assessment – CHA/CHIP – See below in Program Specific
Requirements – Activity Special Instructions for details
See below in Program Specific
Requirements - Deliverables
See below in Program Specific
Requirements - Deliverables $30,000
4
Lifecourse - NEW SFY 24 Full Lifecourse Workforce Capacity – See
below in Program Specific Requirements – Activity Special Instructions
for details
See below in Program Specific
Requirements - Deliverables
See below in Program Specific
Requirements - Deliverables $384,000
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Exhibit A, Statement of Work Page 2 of 6 Contract Number CLH31019-Amendment 16
Task
# Activity Deliverables/Outcomes Due Date/Time Frame
Payment
Information and/or
Amount
5
CD - NEW SFY 24 Immunization Outreach, Education & Response
– See below in Program Specific Requirements – Activity Special
Instructions for details
See below in Program Specific
Requirements - Deliverables
See below in Program Specific
Requirements - Deliverables $75,000
6
EPH - NEW SFY 24 Fully fund Environmental Public Health Policy
& Leadership Capacity – See below in Program Specific Requirements
– Activity Special Instructions for details
See below in Program Specific
Requirements - Deliverables
See below in Program Specific
Requirements - Deliverables $125,000
7
FC - NEW SFY 24 Strengthening Local Finance Capacity – See
below in Program Specific Requirements – Activity Special Instructions
for details
See below in Program Specific
Requirements - Deliverables
See below in Program Specific
Requirements - Deliverables $62,000
8 FC - NEW SFY 24 Public Health Communications – See below in
Program Specific Requirements – Activity Special Instructions for details
See below in Program Specific
Requirements - Deliverables
See below in Program Specific
Requirements - Deliverables $200,000
9
Lifecourse - NEW SFY 24 Illicit Substance Use and Overdose
Response – See below in Program Specific Requirements – Activity
Special Instructions for details
See below in Program Specific
Requirements - Deliverables
See below in Program Specific
Requirements - Deliverables $150,000
10
EPR - NEW SFY 24 Emergency Preparedness & Response –
Capacity and Capability – See below in Program Specific
Requirements – Activity Special Instructions for details
See below in Program Specific
Requirements - Deliverables
See below in Program Specific
Requirements - Deliverables $195,000
11 CD – Hepatitis C – See below in Program Specific Requirements –
Activity Special Instructions for details
See below in Program Specific
Requirements - Deliverables
See below in Program Specific
Requirements - Deliverables $103,000
12 CD – Case Investigation Capacity – See below in Program Specific
Requirements – Activity Special Instructions for details
See below in Program Specific
Requirements - Deliverables
See below in Program Specific
Requirements - Deliverables $85,000
DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site. Questions related to this SOW, or any other
finance-related inquiry, may be sent to finance@doh.wa.gov.
FPHS staff from DOH and the Washington State Association of Local Public Health Officials (WSALPHO) will coordinate and commu nicate together to build and assure common
systemwide approaches per FPHS Steering Committee direction and the FPHS framework inten t.
• For LHJ questions about the use of funds:
o Chris Goodwin, FPHS Policy Advisor, WSALPHO – cgoodwin@wsac.org, 564-200-3166
o Brianna Steere, FPHS Policy Advisor, WSALPHO – bsteere@wsac.org, 564-200-3171
The intent of FPHS funding is outlined in RCW 43.70.512.
Foundational Public Health Services Definitions and related information can be found here: www.doh.wa.gov/fphs.
Stable funding and an iterative decision -making process – The FPHS Steering Committee’s roles and responsibilities are outlined in the FPHS Committee & Workgroup
Charter The Steering Committee is the decision making body for FPHS and operates under a consensus-based decision making model, outlined here. The Steering Committee use
an iterative approach to decision making meaning additional tasks and/or funds may be added to a local health jurisdiction’s (LHJ) FPHS Statement of Work (SOW) as funding
decisions are made.
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Exhibit A, Statement of Work Page 3 of 6 Contract Number CLH31019-Amendment 16
Spending of FPHS funds – FPHS funds do not require pre-approval or pre-authorization to spend. FPHS funds are to assure FPHS services are available in each jurisdiction based
on the FPHS Definitions (link) and as reflected in the SOW. Assurance includes providing FPHS as part o f your jurisdiction's program operations, contracting with another
governmental public health system partner to provide the service, or receiving the service through a new service delivery mod el such as cross-jurisdictional sharing or regional
staff. FPHS funds are eligible starting at the beginning of each state fiscal year (July 1) regardless of when funds are received by the LHJ, even if the expenditure
occurred before the LHJ’s contract was signed.
These funds are not intended for fee-based services such as select environmental public health services. As state funding for FPHS increases, other funds sources (local revenue,
grants, federal block grants) should be directed to the implementation of additional important services and local/state priorities as determined by each agency/jurisdiction.
Annual Allocations – The legislature appropriates FPHS funding on an annual basis and the FPHS Steering Committee allocates funds annually through the FPHS Concurrence
Process for the State Fiscal Year (SFY): July - June.
The Legislature appropriates FPHS funding amounts for each fiscal year of the biennium. This means that funds must be spent within that fiscal year and cannot be carried
forward. Any funds not spent by June 30th each year must be returned to the State Treasury. Funding allocations reset and begin again at the start of the next fiscal year (July 1).
This Statement of Work is for the period of July 1, 2023-June 30, 2024 and may be included in multiple Consolidated Contracts (ConCons) which are based on the calendar year
and renewed every three years.
Disbursement of FPHS funds to LHJs – Unlike other ConCon grants, FPHS bill-back to DOH is NOT required. Half of the annual FPHS funds allocated by the Steering
Committee to each LHJ are disbursed each July and January. The July payments to LHJs and access to FPHS allocation for all o ther parts of the governmental public health
system occur upon completion of the FPHS Annual Assessment.
Deliverables – FPHS funds are to be used to assure FPHS services statewide. The FPHS accountability process measures how funds are spent, along with changes in system
capacity through the FPHS Annual Assessment, system performance indicators, and other data. DOH, SBOH and local health jurisdictions have agreed to complete:
1. Reporting of spending and spending projections. Process timelines and reporting template are provided by the FPHS Steering Committee via FPHS Support Staff.
2. FPHS Annual Assessment is due each July to report on the previous state fiscal year. Process and reporting template are provi ded by the FPHS Steering Committee via
FPHS Support Staff. System results are published in the annual FPHS Investment Report available at www.doh.wa.gov/fphs.
BARS Revenue Code: 336.04.25
BARS Expenditure Coding – provided for your reference.
562.xx BARS Expenditure Codes for FPHS activities: see below
10 FPHS Epidemiology & Surveillance
11 FPHS Community Health Assessment
12 FPHS Emergency Preparedness & Response
13 FPHS Communication
14 FPHS Policy Development
15 FPHS Community Partnership Development
16 FPHS Business Competencies
17 FPHS Technology
20 FPHS CD Data & Planning
21 FPHS Promote Immunizations
23 FPHS Disease Investigation – Tuberculosis (TB)
Page 7 of 33
Exhibit A, Statement of Work Page 4 of 6 Contract Number CLH31019-Amendment 16
24 FPHS Disease Investigation – Hepatitis C
25 FPHS Disease Investigation – Syphilis, Gonorrhea & HIV
26 FPHS Disease Investigation – STD (other)
27 FPHS Disease Investigation – VPD
28 FPHS Disease Investigation – Enteric
29 FPHS Disease Investigation – General CD
40 FPHS EPH Data& Planning
41 FPHS Food
42 FPHS Recreational Water
43 FPHS Drinking Water Quality
44 FPHS On-site Wastewater
45 FPHS Solid & Hazardous Waste
46 FPHS Schools
47 FPHS Temporary Worker Housing
48 FPHS Transient Accommodations
49 FPHS Smoking in Public Places
50 FPHS Other EPH Outbreak Investigations
51 FPHS Zoonotics (includes vectors)
52 FPHS Radiation
53 FPHS Land Use Planning
60 FPHS MCH Data & Planning
70 FPHS Chronic Disease, Injury & Violence Prevention Data & Planning
80 FPHS Access/Linkage with Medical, Oral and Behavioral Health Care Services Data & Planning
90 FPHS Vital Records
91 FPHS Laboratory – Centralized (PHSKC Only)
92 FPHS Laboratory
Special References (i.e., RCWs, WACs, etc.):
FPHS Intent - RCW 43.70.512
FPHS Funding – RCW 43.70.515
FPHS Committee & Workgroup Charter
FPHS Steering Committee Consensus Decision Making Model
Activity Special Instructions:
Investments to Each LHJ:
1. FPHS Funds to Each LHJ
These funds are allocated to be used to provide any programs and services within all of the FPHS Definitions. Each LHJ is empowered to prioritize where and how to use
these funds to maximize equitable, effective and efficient delivery of FPHS to every community in Washington.
Use BARS expenditure codes from the list above that most closely align with expenditure made.
Page 8 of 33
Exhibit A, Statement of Work Page 5 of 6 Contract Number CLH31019-Amendment 16
Targeted Investments to Each LHJ:
2. Assessment Reinforcing Capacity (FPHS definition G.2)
Support LHJ assessment capacity with flexible funds to meet locally identified needs. BARS expenditure codes: 562.10 or 11
3. Assessment – CHA/CHIP (FPHS definitions G.3)
Support any CHA/CHIP activity or service (e.g., data analysis, focus groups, report writing, process facilitation) and may be used to contract with other agencies for staff
time or services. Use BARS expenditure codes: 562.11
4. Lifecourse - NEW SFY 24 Full Lifecourse Workforce Capacity (FPHS definitions D, E, F)
Infrastructure and workforce investments to each LHJ to meet fundamental needs in three areas: Maternal/Child/Family Health; Access/Linkage with Medical, Oral and
Behavioral Health Services; and Chronic Disease, Injury and Violence Prevention. Use BARS expenditure codes: 562.60, 562.70, and/or 562.80
5. CD - NEW SFY 24 Immunization Outreach, Education & Response (FPHS definition C.3)
Promote immunization education and use of the statewide immunization registry through evidence-based strategies. Funding can also be used to support vaccine-
preventable disease response. BARS expenditure codes: 562.21 and/or 562.27
6. EPH - NEW SFY 24 Fully fund Environmental Public Health Policy & Leadership Capacity (FPHS definitions B.2, A.C, J.1 -3, K.1-2, L.1)
These funds are to be used for staffing costs for environmental health responsibilities and functions (that are not directly fee-based) within leadership, policy development,
foundational public health services implementation, evaluation, or administration, including (but not limited to) Environmental Health Directors. Examples of funded
roles include work relating to general policy, statewide and/or system-wide, and/or cross-jurisdictional work, legislation, and rulemaking, SBOH engagement, leadership
support and/or development, workforce development, leadership within health equity, climate, and environmental justice. Use BARS expenditure codes: 562.14, 562.40 –
562.53
7. FC - NEW SFY 24 Strengthening Local Finance Capacity (FPHS definitions L.2-4, L.6, L.8)
Capacity and infrastructure to assure fiscal management and contract and procurement policies and procedures are effectively implemented to support programs and
services. Use BARS expenditure codes: 526.16 562.16
8. FC - NEW SFY 24 Public Health Communications (FPHS definitions I.1 -2)
Capacity to enhance the frequency, accuracy, and accessibility of public health communications to diverse populations via var ious media to support programs and
services. Use BARS expenditure codes: 526.13 562.13
9. Lifecourse - NEW SFY 24 Illicit Substance Use and Overdose Response (FPHS definitions D.1 -2, D.4, F.1-3, G.1-3, I.1-2, J.1-J.3, K.1-2)
Capacity and infrastructure related to addressing overdose crisis. This includes but is not limited to: Overdose response tra inings, convening stakeholders or coordination
groups, data analysis, and community education. Use BARS expenditure codes: 562.13, 562.14, 562.15, 562.60, 562.70, 562.80
10. EPR - NEW SFY 24 Emergency Preparedness & Response – Capacity and Capability (FPHS definitions H. 1-4)
Capacity and infrastructure to support and enhance the local delivery of FPHS Emergency Preparedness and Response services and activities across critical subject matter
areas. Use BARS expenditure codes: 562.12
Page 9 of 33
Exhibit A, Statement of Work Page 6 of 6 Contract Number CLH31019-Amendment 16
Targeted Investments to Select LHJs – Assuring FPHS Available in Own Jurisdiction:
11. CD – Hepatitis C (FPHS definitions C.4.o-p)
Address Hepatitis C cases per guidance developed by the FPHS CD SME Workgroup and DOH’s Hepatitis C Prioritization document with particular emphasis on lab
surveillance and investigation of acute cases. Use BARS expenditure codes: 562.24.
12. CD – Case Investigation Capacity (FPHS definitions C.2, C. 4)
Support LHJ communicable disease capacity to conduct case investigation and follow up to reduce gaps and meet locally identified needs that address notifiable
conditions responsibilities. Use BARS expenditure codes: 562.23-29.
Page 10 of 33
Exhibit A, Statement of Work Page 1 of 9 Contract Number CLH31019-Amendment 16
Exhibit A
Statement of Work
Contract Term: 2022-2024
DOH Program Name or Title: Infectious Disease-Syndemic Prevention Services-
SSP - Effective January 1, 2024
Local Health Jurisdiction Name: Mason County Public Health
Contract Number: CLH31019
SOW Type: Original Revision # (for this SOW) Funding Source
Federal <Select One>
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price Period of Performance: January 1, 2024 through December 31, 2024
Statement of Work Purpose: The purpose of this statement of work (SOW) is to provide Syndemic Prevention Services for infectious diseases (HIV, STI, and Adult Viral
Hepatitis), supporting the Office of Infectious Disease (OID) within Department of Health (DOH). Awarded through OID's 2024 Syndemic RFA.
Revision Purpose: N/A
DOH Chart of Accounts Master Index Title
Master
Index
Code
Assistance
Listing
Number
BARS
Revenue
Code
LHJ Fund
Start Date
ing Period
End Date
Current
Allocation
Allocation
Change
Increase (+)
Total
Allocation
SFY24 DRUG USER HEALTH PROGRAM 12405140 N/A 334.04.91 01/01/24 06/30/24 0 92,500 92,500
SFY25 DRUG USER HEALTH PROGRAM 12405150 N/A 334.04.91 07/01/24 12/31/24 0 92,500 92,500
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 0 185,000 185,000
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
1 Syringe Services Programs (SSP): Support for Operations
Provide comprehensive SSP to people who use drugs
(PWUD). This plan of action is directed to distribute
syringes to communities that use drugs to prevent
transmission of infectious disease. SSPs will operate during
scheduled hours to provide all required harm reduction
supplies, naloxone, and syringes to prevent transmission of
disease and overdose. SSPs will offer referrals to address
social determinants of health.
Priority populations for Syringe Services Programs include
people who use drugs, with a focus on:
SSP operations outcomes include delivering
services and tracking:
• number of sterile syringes distributed
• number of naloxone kits distributed
• number of participant encounters
• number of referrals to health and social
services
Enter deliverable data into the
DOH/OID issued database for
tracking SSP activities by the
15th of each month following
service.
Reimbursement of
actual costs incurred,
not to exceed $185,000
based on funding split
below.
$92,500 for
1/1/24-6/30/24
$92,500 for
7/1/24-12/31/24
Page 11 of 33
Exhibit A, Statement of Work Page 2 of 9 Contract Number CLH31019-Amendment 16
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
• People systemically marginalized and underserved
due to racism – Black/African American,
Latino/Latina/Latine/Latinx, American
Indian/Alaska Native people and other
communities for whom there are documented
health disparities in your region.
• People who are unhoused or unstably housed.
• People engaged in sex work.
• People involved in the criminal legal system.
• Gender expansive/transgender individuals.
• Gay, bi, and other men who have sex with men.
NOTE: See Special Requirements, Terms and
Conditions – Section 4 Syringe Services Programs:
Support for Operations Program Requirements for
additional task information.
Syringe Services Programs: Clinical Services
Provide direct access to clinical services to improve the
health and well-being of people who use drugs. At
minimum, services must include onsite, low-barrier access
to wound care, infectious disease testing, STI and hepatitis
C treatment, and medications for opioid use disorder.
Additional services can include mental health services,
sexual and reproductive health care, and other primary care
and psychosocial support services.
NOTE: See Special Requirements, Terms and
Conditions – Section 5 Syringe Services Program,
Clinical Services Requirements for additional task
information.
SSP Clinical services outcomes may include,
but are not limited to, delivering services and
tracking:
• Number of wound care sessions
• Number of infectious disease tests
conducted (hepatitis C, HIV, gonorrhea-
chlamydia, syphilis)
• % positive of infectious disease tests
(hepatitis C, HIV, gonorrhea-chlamydia,
syphilis)
• Number of participants started on
hepatitis C treatment
• Number of participants inducted on
medications for opioid use disorder
DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site. Questions related to this SOW, or any other
finance-related inquiry, may be sent to finance@doh.wa.gov.
Program Specific Requirements
Special Requirements, Terms and Conditions
1. Definitions
a. ANONYMOUS SERVICES- HIV Prevention services including condom distribution, outreach and light touch.
b. CAPACITY BUILDING- The process by which individuals and organizations obtain, improve, and retain the skills, knowledge, tools, equipment, and other
Page 12 of 33
Exhibit A, Statement of Work Page 3 of 9 Contract Number CLH31019-Amendment 16
resources needed to do their jobs competently.
c. CONTRACTOR – For the purposes of this Statement of Work Only, the entity receiving funds directly from Washington State Department of Heal th (DOH) for
client services to prevent or treat conditions named in the statement of work will be referred to as contractor.
d. HARM REDUCTION - Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.
e. INTEGRATED TESTING- For the purpose of this Statement of Work, Integrated Testing includes Human Immunodeficiency Virus (HIV), Gonorrhea (GC),
Chlamydia (CT), Syphilis, Hepatitis C (HCV) and Hepatitis B (HBV).
f. SOCIAL DETERMINANTS OF HEALTH - Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn,
work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
g. YOUTH- For purposes of this agreement, the term “youth” applies to persons under the age of 18.
2. Submission of Invoice Vouchers
a. On a monthly basis, the CONTRACTOR shall submit complete and correct A19 invoice vouchers with amounts billable to DOH under this statement of work and the
corresponding OID Expense Summary backup form. All A19 invoice vouchers must be submitted by the 25th of the following month. Prior approval is required for a
different frequency of billing.
i. The CONTRACTOR must provide all backup documentation as required based on the assigned risk level and/or as identified by DOH program staff to determine
allowability of billed expenses. Risk assessments are completed at the beginning of a new contract for all sub-recipient contracts. Contact your contract manager
if you are unaware of your assigned risk level.
ii. DOH may ask for additional backup information to pay invoices based on the needs of the funding sources supporting the work.
b. The CONTRACTOR shall submit all final claims for payment for costs due and payable under this statement of work by July 31, 2 025. DOH will pay belated claims at its
discretion, contingent upon the availability of funds.
3. Program Organization – CONTRACTOR must
a. The CONTRACTOR must provide a full updated organizational chart, including Board of Directors with contact information if applicable, and staffing plan referencing
positions described in the budget narrative.
b. The CONTRACTOR must provide job descriptions for any new or changed positions in the updated organizational chart.
i. Any new positions funded through the original contract funds, must have prior DOH approval.
c. The CONTRACTOR must notify their DOH contract manager within 30 days of any staff vacancies related to contracted positions and provide an updated budget.
i. Any new fiscal staff responsible for invoicing on this contract will need to meet with the assigned OID Contract Manager with in 60 days for DOH invoice
overview and training.
4. Syringe Services Program: Support for Operations Program Requirements
a. Operate for a minimum of 8 hours per week and 2 days per week.
b. Provide mobile and/or street outreach (note: programs must have a vehicle for mobile outreach.)
c. Offer safer injection supplies (see list of required safer injection supplies below).
d. Submit monthly SSP data in accordance with DOH standards.
e. Attend required capacity building/training opportunities provided by DOH.
f. Participate in annual site visits with DOH staff.
g. Demonstrate structure for receiving and incorporating participant feedback about services.
h. Partner with relevant local agencies to ensure effective outreach and service provision. (See Scope of Work narrative below f or details on MOUs required.)
i. Develop and maintain a Universal Precautions and Sharps Handling policy and procedure, including clear, written policies on handling biohazardous waste, avoiding
unnecessary handling of sharps, and potential needle stick injuries to staff, volunteers, and participants. Programs should follow the universal precaution guidelines
established by the CDC and OSHA. SSPs may need to adapt those precautions to accommodate the circumstances of their work (e.g ., mobile and outreach settings).
Programs should also anticipate the potential of needlestick injury and have a “post-exposure-prophylaxis” protocol included in this document.
j. All staff and volunteers working directly with participants/clients must complete CPR certification within the first 3 months after contract start date (if not already
complete).
Page 13 of 33
Exhibit A, Statement of Work Page 4 of 9 Contract Number CLH31019-Amendment 16
5. Syringe Services Program, Clinical Services Requirements
a. Includes all requirements for Syringe Service Program operations (see above)
b. Must have clinical staff licensed to practice in the state of Washington to provide clinical services (e.g., RN, PA, ARNP, LCSW).
c. If providing advanced level clinical services (e.g., PA, ARNP, CNM), programs must have appropriate clinical oversight.
Note: Clinical services can be provided through sub-contractor arrangement or MOU with a Federally Qualified Health Center or other clinical partner if there
is a justification the relationship will support efforts to reach people who use drugs and provide onsite and/or mobile clinical services. Clinical services can also
be provided using telemedicine services with appropriate description of why in -person services cannot be provided and who the telemedicine partner(s) will be.
NOTE: Funds from this contract may not be used to purchase basic safer injection supplies (listed below) – Instead, DOH will provide Contractors with supplies.
Below is the list of required supplies for SSP to be provided to Contractors by DOH:
1) Syringes (1 cc 27 gauge 1/2", 28 gauge 1/2", and 29 gauge 1/2"; 1 cc 30 gauge 5/16"; 3 cc 25G 1" and 1.5")
2) Alcohol pads
3) Non-latex tourniquets
4) Sterile water
5) Sterile saline
6) Cookers
7) Cottons and/or cellulose filters
8) Bandages/gauze
9) Sharps containers (1 quart and 2 gallon for distribution, 8 gallon for program use)
10) Naloxone
11) Amber bags
The exceptions to these supplies are vendor or manufacturer supply shortages. If a program expects to run out of one of these items, please contact DOH immediately.
6. Performance Objectives & Work Plan:
a. Funded Syndemic Prevention Services agencies are required to submit Performance Objectives and Work Plan that provides both a high-level overview of the period of
performance and a detailed description of the first year of the contract period. The work pla n should incorporate related program strategies and activities. Applicants
should propose specific, measurable, achievable, realistic, and time-based (SMART) process and/or outcome objectives for each activity aligned with performance
outcomes. The work plan should include training, capacity building, and TA needs to support the implementation of the funded services. Proposed wo rk plan activities
may be adjusted in collaboration with OID staff to better address the overarching goals of the funded services. OID will provide a template that must be used in
developing the work plan.
b. The applicant should address the following outline in their work plan:
i. Contract Year 1 Detailed Work Plan (For each funded service category)
ii. Program strategies and activities
iii. Outcomes aligned with program strategies and activities
iv. SMART objectives aligned with performance targets
v. Activities aligned with program outcomes
vi. Timeline for implementation (including staffing of the proposed program, training, etc.)
vii. Anticipated capacity building or technical assistance needs.
c. Performance Objectives & Work Plans should be submitted by July 1, 2024.
d. OID staff are available to support in developing Performance Objectives & Work Plans in collaboration with funded agencies.
e. Performance Objectives & Work Plans will be reviewed between OID staff and funded agencies at least quarterly. Performance Ob jectives & Work Plans can be adjusted
throughout the period of performance.
Page 14 of 33
Exhibit A, Statement of Work Page 5 of 9 Contract Number CLH31019-Amendment 16
7. Participation in program evaluation activities – The Contractor is expected to participate in program evaluation activities, including evaluation planning, and collecting and
reporting qualitative and quantitative program data, as deemed necessary by OID staff.
8. Participation in Capacity Building and Technical Assistance Activities designed to increase efficacy of Syndemic Services
a. Opportunities for capacity building and technical assistance for contractor will be offered throughout the contract year by W A DOH and other regional or national
capacity building organizations.
b. Contractors will be expected to meet with WA DOH OID staff on an annual basis to discuss training and will work with DOH to track shared completion of Capacity
Building Needs
c. All contracted staff will be required to complete training in respect to their role. DOH staff and contracted staff will work together to track completion of required
trainings.
9. CLAS Standards – The CONTRACTOR will comply with the National Standards for Culturally and Linguistically Appropriate Services (CLAS) standard s (1, 5-9). National
Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care (allianceforclas.org)
10. Participation in Program Monitoring Activities –
a. DOH will conduct semi-annual or annual performance site visits in the following areas:
i. Integrated testing
ii. Syndemic service navigation
iii. PrEP Housing
iv. Syringe Service Programs
v. Mail-order naloxone distribution programs
vi. Fiscal Monitoring – To be scheduled by the DOH Fiscal Monitoring Unit
b. Corrective Action Plans – DOH may exercise the following options if the CONTRACTOR does not come into compliance or resolution with programmatic and/or fiscal
monitoring corrective action plan by the due date(s) identified in the CAP. i. § 200.339 Remedies for noncompliance.
If a non-Federal entity fails to comply with the U.S. Constitution, Federal statutes, regulations or the terms and conditions of a Fed eral award, the Federal awarding
agency or pass-through entity may impose additional conditions, as described in § 200.208. If the Federal awarding agency or pass-through entity determines that
noncompliance cannot be remedied by imposing additional conditions, the Federal awarding agency or pass-through entity may take one or more of the following actions,
as appropriate in the circumstances:
(a) Temporarily withhold cash payments pending correction of the deficiency by the non-Federal entity or more severe enforcement action by the Federal
awarding agency or pass-through entity.
(b) Disallow (that is, deny both use of funds and any applicable matching credit for) all or part of the cost of the activity or action not in compliance.
(c) Wholly or partly suspend or terminate the Federal award.
(d) Initiate suspension or debarment proceedings as authorized under 2 CFR part 180 and Federal awarding agency regulations (or in the case of a pass-through
entity, recommend such a proceeding be initiated by a Federal awarding agency).
(e) Withhold further Federal awards for the project or program.
(f) Take other remedies that may be legally available
Page 15 of 33
Exhibit A, Statement of Work Page 6 of 9 Contract Number CLH31019-Amendment 16
11. Contract Management –
a. Fiscal Guidance
i. Indirect – If charging indirect costs, the CONTRACTOR must have a current federally negotiated rate or 10% De Minimus certification of f ile with DOH. DOH
is not able reimburse indirect costs without an approved indirect cost rate or 10% De Minimus certification on file.
ii. Advance Payments Prohibited – DOH funds are “cost reimbursement” funds. DOH will not make payment in advance or in anticipation of services or supplies
provided. This includes payments of “one-twelfth” of the current fiscal year’s funding.
iii. Duplication of Early Intervention Program (EIP) Services –The CONTRACTOR shall not use contract funds to provide a parallel medication service to EIP.
CONTRACTOR’s providing case management services shall make every effort to enroll clients in EIP.
iv. Payment of Cash or Checks to Clients Not Allowed – Where direct provision of service is not possible or effective, vouchers or similar programs, which may
only be exchanged for a specific service (e.g., transportation), shall be used to meet the need for such services. CONTRACTO R shall administer gift cards
voucher programs to assure that recipients cannot readily convert vouchers into cash.
1) Store gift cards that can be redeemed at one merchant or an affiliated group of merchants for specific goods or services are allowable as incentives for
eligible program participants.
2) General-use prepaid cards are considered “cash equivalent” and are therefore unallowable. Such cards generally bear the logo of a pay ment network, such
as Visa, MasterCard, or American Express, and are accepted by any merchant that accepts those credit or debit cards as payment. Gift cards that are
cobranded with the logo of a payment network and the logo of a merchant or affiliated group of merchants are general-use prepaid cards, not store gift
cards, and therefore are unallowable.
3) The CONTRACTOR must ensure that a policy for managing gift cards with strong internal controls is in place.
v. Funds for Needle Exchange Programs Not Allowed with Federal Funding – CONTRACTOR shall not expend contract federal funds to support needle
exchange programs using funds from HIV Community Services Tasks.
vi. Travel – Out of staff travel requires prior approval from DOH and must follow GSA guidelines and reimbursement rates.
vii. Supervision, under DOH Community Programs contracts, will be understood as the delivery of a set of interrelated functions encompassing administrative,
educational and supportive roles that work collectively to ensure clinical staff (i.e., case managers, navigators, coordinato rs, assistants, coaches) are equipped
with the skills necessary to deliver competent and ethical services to clients that adhere to best practices within applicable fields as well as all relevant Statewide
Standards. Supervisors must meet the criteria set forth within the WA State HIV Case Manag ement Standards and provide the level of interaction and review
detailed in that document.
It is the understanding of DOH that Supervision funded under the direct program portion of this contract include at minimum, the provision of at least two of the
three functions detailed here: administrative, educational or supportive supervision. Supervision that encompasses only administrative functions will not be
considered billable under Direct Program. To that end, it is the expectation of DOH that those personnel identified as Superv isors have no more than one degree
of separation from direct client care. Exceptions to this rule can be presented and considered to and by DOH Contract Management. It will fall to the requesti ng
organization to satisfactorily demonstrate that any Supervisory positions falling within the scope of Direct Program are meet ing the expectation of provision of
educational or supportive supervision with the aim of directly impacting client experiences, quality of services, and adheren ce to best practices and Statewide
Standards.
viii. Small and Attractive items – Each Contractor shall perform a risk assessment (both financial and operational) on the agency’s assets to identify those ass ets that
are particularly at risk or vulnerable to loss. Operational risks include risks associated with data security on mobile or portable computing devices that store or
Page 16 of 33
Exhibit A, Statement of Work Page 7 of 9 Contract Number CLH31019-Amendment 16
have access to state data. Assets so identified that fall below the state’s capitalization policy are considered small and at tractive assets. The Contractor shall
develop written internal policies for managing small and attractive assets. Internal policies should take into consideration the Office of the Chief Information
Officer (OCIO) IT Security Standard 141 Section 5.8 Mobile Computing and Section 8.3 Media Handling and Disposal at https://ocio.wa.gov/policies.
The Contractor shall implement specific measures to control small and attractive assets in order to minimize identified risks . Periodically, the Contractor should
perform a follow-up risk assessment to determine if the additional controls implemented are effective in managing the identified risks.
Contractor must include, at a minimum, the following assets with unit costs of $300 or more:
1) Laptops and Notebook Computers
2) Tablets and Smart Phones
Agencies must also include the following assets with unit costs of $1,000 or more:
1. Optical Devices, Binoculars, Telescopes, Infrared Viewers, and Rangefinders
2. Cameras and Photographic Projection Equipment
3. Desktop Computers (PCs)
4. Television Sets, DVD Players, Blu-ray Players, and Video Cameras (home type)
ix. Food and Refreshments – Food and refreshments are not allowable direct costs, unless provided in conjunction with allowable meetings, whose primary
purpose is the dissemination of technical information. Pre-approval is required when food and refreshments are purchased for these meetings. A sign in sheet
with the clients’ ID number from the DOH approved data system as well as an agenda is required to receive reimbursement for t hese charges.
1) The CONTRACTOR shall follow Healthy Nutrition Guidelines for Meetings and Events | Washington State Department of Health when purchasing
food and refreshments for approved meetings.
2) Food for staff meetings/training is unallowable.
PLEASE NOTE: If meals/refreshments are purchased for allowable meetings, food can only be purchased for clients at the per diem rate. Any expenses over
per diem will be denied. U.S. General Services Administration Per Diem Look Up
x. Reimbursement of disallowed costs – The CONTRACTOR agrees to reimburse DOH for expenditures billed to the DOH for costs that are later determined
through audit or monitoring to be disallowed under the requirements of 2 CFR Part 200 –Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Audits.
b. Contract Modifications
i. Notice of Change in Services – The CONTRACTOR shall notify DOH program staff, within 45 days, if any situations arise that may impede implementation of
the services contained in the statement of work. DOH and the CONTRACTOR will agree to strategies for resolving any shortfalls . DOH retains the right to
withhold funds in the event of substantial noncompliance.
ii. Contract Amendments – Effective Date – The CONTRACTOR shall not begin providing services authorized by a contract amendment until the
CONTRACTOR has received a signed and fully executed copy of the contract amendment from DOH.
1) Local Health Jurisdiction (LHJ) Contractors – Request for contract amendments must be received no less than 60 days prior to the Draft Due Date
identified by the CON CON SOW Schedule on the CON CON Dashboard.
2) Non- LHJ Contractors – Request for contract amendments must be received no later than 60 days prior to the end of the Federal Fiscal Year (FFY) and
90 days prior to end of the State Fiscal Year (SFY).
• Amendments must be signed prior to the end of the FFY or SFY end date.
EX. FFY end date is 12/31, contract amendment request due to contract manager by 11/1
Page 17 of 33
Exhibit A, Statement of Work Page 8 of 9 Contract Number CLH31019-Amendment 16
12. Content Review and Website Disclaimer Notice
In accordance with all federal guidance, contractors receiving funds through DOH will submit all proposed written materials r equiring review for HIV-related scientific or
medical accuracy including written materials, audio visual materials, and pictorials, including social marketing and advertising materials, educational materials, social media
communications (e.g., Facebook, twitter) and other electronic communications, such as internet/webpages to the OID Content Review Committee. CONTRACTOR shall
submit all materials to be reviewed for scientific or medical accuracy to:
Michael Barnes, Washington State Department of Health
PO Box 47841
Olympia, WA 98504-7841
Phone: 360-810-1880
Email: Michael.Barnes@doh.wa.gov
For social marketing campaigns and media strategies, please adhere to the program guidance on the review of HIV-related educational and informational materials for CDC
assistance programs https://www.cdc.gov/hiv/pdf/funding/announcements/ps12 -1201/cdc-hiv-ps12-1201-content-review-guidance.pdf
13. Youth and Peer Outreach Workers
All programs, including CONTRACTORS, using youth (either paid or volunteer) in program activities will use caution and judgme nt in the venues / situations where youth
workers are placed. Agencies will give careful consideration to the age appropriateness of the activity or venue. Agencies will also ensure that organizational staff and youth
comply with all relevant laws and regulations regarding entrance into adult establishments and environments. Agencies will al so maintain and implement appropriate safety
protocols that include clear explanation of the appropriate laws and curfews and clearly delineate safe and appropriate parti cipation of youth in program outreach activities.
14. Whistleblower
a. Whistleblower statue, 41 U.S.C. & 4712, applies to all employees working for CONTRACTOR, subcontractors, and subgrantees on federal grants and contracts. The
statue (41 U.S.C. & 4712) states that an “employee of a CONTRACTOR, subcontractor, grantee, or subgrantee, may not be dischar ged, demoted, or otherwise
discriminated against as a reprisal for “whistleblowing.” In addition, whistleblower protections cannot be waived by an agreem ent, policy, form, or condition of
employment.
b. The National Defense Authorization Act (NDAA) for Fiscal Year 2013 (Pub. L. 112-239, enacted January 2, 2013) mandates a pilot program entitled “Pilot Program for
Enhancement of Contractor Employee Whistleblower Protections.” This program requires all gran tees, their subgrantees, and subcontractors to:
i. Inform their employees working on any federal award they are subject to the whistleblower rights and remedies of the pilot pr ogram
ii. Inform their employees in writing of employee whistleblower protections under 41 U.S.C. & 4712 in the predominant native lang uage of the workforce; and,
iii. CONTRACTOR and grantees will include such requirements in any agreement made with a subcontractor or subgrantee.
15. Allowable Costs
All expenditures incurred and reimbursements made for performance under this statement of work shall be based on actual allow able costs. Costs can include direct labor,
direct material, and other direct costs specific to the performance of activities or ac hievement of deliverables under this statement of work.
For information in determining allowable costs, please reference OMB Circulars:
2 CFR200 (State, Local and Indian Tribal governments) at: https://www.federalregister.gov/documents/2013/12/26/2013 -30465/uniform-administrative-requirements-cost-
principles-and-audit-requirements-for-federal-awards
**Disclosure of information is governed by the Washington Administrative Code (WAC) 246-101-120, 520 and 635, and the Revised Code of Washington (RCW) 70.24.080,
70.24.084, and 70.24.105 regarding the exchange of medical information among health care providers related to HIV/AIDS or STI diagnosis and treatment. Please note that
Page 18 of 33
Exhibit A, Statement of Work Page 9 of 9 Contract Number CLH31019-Amendment 16
CONTRACTORs fit under the definition of “health care providers” and “individuals with knowledge of a person with a reportable disease or condition” in the WAC and
RCW.
DOH statutory authority to have access to the confidential information or limited Dataset(s) identified in this agreement to the Information Recipient: RCW 43.70.050
Information Recipient’s statutory authority to receive the confidential information or limited Dataset(s) identified in this Agreement: RCW 70.02.220 (7)
Page 19 of 33
Exhibit A, Statement of Work Page 1 of 3 Contract Number CLH31019-Amendment 16
Exhibit A
Statement of Work
Contract Term: 2022-2024
DOH Program Name or Title: Office of Immunization COVID-19 Vaccine -
Effective January 1, 2022
Local Health Jurisdiction Name: Mason County Public Health
Contract Number: CLH31019
SOW Type: Revision Revision # (for this SOW) 5 Funding Source
Federal Subrecipient
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price Period of Performance: January 1, 2022 through June 30, 2024
Statement of Work Purpose: The purpose of this statement of work (SOW) is to provide funding to conduct COVID-19 vaccine activities.
Revision Purpose: The purpose of this revision is to add Program Specific Requirements in reference to unallowable costs and update Master Index Codes.
DOH Chart of Accounts Master Index Title
Master
Index
Code
Assistance
Listing
Number
BARS
Revenue
Code
LHJ Fund
Start Date
ing Period
End Date
Current
Allocation
Allocation
Change
None
Total
Allocation
COVID19 Vaccines R4 74310259 93.268 333.93.26 01/01/22 06/30/24 354,803 0 354,803
COVID 19 CDC Vaccines 74310236 93.268 333.93.26 01/01/22 06/30/24 354,803 0 354,803
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 709,606 0 709,606
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
The purpose of this statement of work is to identify activities and provide funding to support COVID vaccine response outreac h, education, and operations. The activities may
include other vaccines recommended for the audience population, as long as COVID vaccine is the primary focus and references to other vaccines are secondary.
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.
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 for actual
costs incurred, not to
exceed total funding
consideration amount.
Page 20 of 33
Exhibit A, Statement of Work Page 2 of 3 Contract Number CLH31019-Amendment 16
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
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
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.
Written report describing
activity/activities and progress made to-
date and strategies used (template to be
provided)
June 30, Annually Reimbursement for actual
costs incurred, not to
exceed total funding
consideration amount.
3.C Catalog activities and conduct an evaluation of the strategies
used
Written report, showing the strategies used
and the final progress of the reach
(template to be provided)
June 30, annually Reimbursement for actual
costs incurred, not to
exceed total funding
consideration amount.
3.D As needed to meet community needs, expand operations to
increase vaccine throughput (i.e., providing vaccinations during
evenings, overnight, and on weekends) or adjust vaccine
delivery approaches to optimize access. Activities may include
vaccine strike teams, mobile vaccine clinics, satellite clinics,
temporary, or off-site clinics to travel and provide vaccination
services in non-traditional settings, or to supplement the work
of local health departments in underserved communities, and
may include administration costs for other vaccines co-
administered at the events. These activities may be done by the
local health department or in collaboration with community
partners. (see Restrictions on Funds below)
Reports summarizing quantity, type, and
frequency of activities
December 31 and
June 30, annually
Reimbursement for actual
costs incurred, not to
exceed total funding
consideration amount.
DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site. Questions related to this SOW, or any other
finance-related inquiry, may be sent to finance@doh.wa.gov.
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 Unique Entit y Identifier (UEI) generated by SAM.gov.
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.
Page 21 of 33
Exhibit A, Statement of Work Page 3 of 3 Contract Number CLH31019-Amendment 16
Program Specific Requirements
Restrictions on Funds (i.e., disallowed expenses or activities, indirect costs, etc.):
Coverage of co-administration costs for other vaccines administered at vaccination events does NOT apply to the FEMA Mass Vaccination funding. Coverage of co-
administration costs only applies to the vaccine funding (COVID19 Vaccine R4, MI 74310230) allocated for Task 3 of the consolidated contract. FEMA Mass Vaccination
funding is only available to cover the costs for COVID vaccine administration and cannot be used for co -administration costs of other vaccines.
Unallowable Costs:
There are limitations from the funding source on allowable costs for this contract. If the contractor is unsure if a cost is allowable, they should contact the contract manager for
approval of the cost prior to making the purchase or charge.
• Advertising costs (e.g., conventions, displays, exhibits, meetings, memorabilia, gifts, souvenirs)
• Alcoholic beverages
• Building, purchases, construction, capital improvements
• Clinical care (non-immunization services)
• Entertainment costs
• Fundraising Cost
• Goods and services for personal use
• Honoraria
• Independent Research
• Land acquisition
• Legislative/lobbying activities
• Interest on loans for the acquisition and/or modernization of an existing building
• Payment of a bad debt, collection of improper payments
• Promotional and/or incentive materials (e.g. plaques, clothing, and commemorative items such as pens, mugs/cups, folders/folios, lanyards, magnets, conference bags)
• Purchase of food/meals (unless part of required travel per diem costs)
• Vehicle Purchase
Page 22 of 33
Exhibit A, Statement of Work Page 1 of 2 Contract Number CLH31019-Amendment 16
Exhibit A
Statement of Work
Contract Term: 2022-2024
DOH Program Name or Title: Office of Immunization-Perinatal Hepatitis B -
Effective July 1, 2023
Local Health Jurisdiction Name: Mason County Public Health
Contract Number: CLH31019
SOW Type: Revision Revision # (for this SOW) 2 Funding Source
Federal Subrecipient
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price Period of Performance: July 1, 2023 through June 30, 2024
Statement of Work Purpose: The purpose of this statement of work (SOW) is to define required Perinatal Hepatitis B activities, deliverables, and funding
Revision Purpose: The purpose of this revision is to add Program Specific Requirements in reference to unallowable costs.
DOH Chart of Accounts Master Index Title
Master
Index
Code
Assistance
Listing
Number
BARS
Revenue
Code
LHJ Fund
Start Date
ing Period
End Date
Current
Allocation
Allocation
Change
None
Total
Allocation
FFY24 CDC PPHF Ops 74310246 93.268 333.93.26 07/01/23 06/30/24 550 0 550
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 550 0 550
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
1 1. In coordination with hospitals, health care providers, and
health plans (if applicable), conduct activities to prevent
perinatal hepatitis B infection in accordance with the
Perinatal Hepatitis B Prevention Program Guidelines,
including the following:
• Identification of hepatitis B surface antigen (HBsAG)-
positive pregnant women and pregnant women with
unknown HBsAg status.
• Reporting of HBsAg-positive women and their infants.
• Case management for infants born to HBsAg-positive
women to ensure administration of hepatitis B immune
globulin (HBIG) and hepatitis B vaccine within 12
hours of birth, the completion of the 3-dose hepatitis B
vaccine series, and post vaccination serologic testing.
Enter information for each case identified
into the Perinatal Hepatitis B Tracker
By the last day of each
month
Reimbursement for actual
costs incurred, not to
exceed total funding
consideration amount.
Page 23 of 33
Exhibit A, Statement of Work Page 2 of 2 Contract Number CLH31019-Amendment 16
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
2.Provide technical assistance to birthing hospitals to
encourage administration of the hepatitis B birth dose to all
newborns within 12 hours of birth, in accordance with
Advisory Committee on Immunization Practices (ACIP)
recommendations.
3.Report all perinatal hepatitis B investigations, including
HBsAg-positive infants, in the Perinatal Hepatitis B
Module of the Washington State Immunization
Information System.
DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site. Questions related to this SOW, or any other
finance-related inquiry, may be sent to finance@doh.wa.gov.
Federal Funding Accountability and Transparency Act (FFATA) (Applies to federal grant awards.)
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 Unique Entit y Identifier (UEI) generated by SAM.gov.
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
Unallowable Costs:
There are limitations from the funding source on allowable costs for this contract. If the contractor is unsure if a cost is allowable, they should contact the contract manager for
approval of the cost prior to making the purchase or charge.
•Advertising costs (e.g., conventions, displays, exhibits, meetings, memorabilia, gifts, souvenirs)
•Alcoholic beverages
•Building, purchases, construction, capital improvements
•Clinical care (non-immunization services)
•Entertainment costs
•Fundraising Cost
•Goods and services for personal use
•Honoraria
•Independent Research
•Land acquisition
•Legislative/lobbying activities
•Interest on loans for the acquisition and/or modernization of an existing building
•Payment of a bad debt, collection of improper payments
•Promotional and/or incentive materials (e.g., plaques, clothing, and commemorative items such as pens, mugs/cups, folders/folios, lanyards, magnets, conference bags)
•Purchase of food/meals (unless part of required travel per diem costs)
•Vehicle Purchase
Page 24 of 33
Exhibit A, Statement of Work Page 1 of 3 Contract Number CLH31019-Amendment 16
Exhibit A
Statement of Work
Contract Term: 2022-2024
DOH Program Name or Title: Office of Immunization-Promotion of Immunizations to
Improve Vaccination Rates - Effective July 1, 2023
Local Health Jurisdiction Name: Mason County Public Health
Contract Number: CLH31019
SOW Type: Revision Revision # (for this SOW) 2 Funding Source
Federal Subrecipient
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price Period of Performance: July 1, 2023 through June 30, 2024
Statement of Work Purpose: The purpose of this statement of work is to contract with local health to conduct activities to improve immunization coverage rates
Revision Purpose: The purpose of this revision is to add Program Specific Requirements in reference to unallowable costs.
DOH Chart of Accounts Master Index Title
Master
Index
Code
Assistance
Listing
Number
BARS
Revenue
Code
LHJ Fund
Start Date
ing Period
End Date
Current
Allocation
Allocation
Change
None
Total
Allocation
FFY24 CDC VFC Ops 74310241 93.268 333.93.26 07/01/23 06/30/24 6,160 0 6,160
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 6,160 0 6,160
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
1 Develop a proposal to improve immunization coverage rates for
a target population by increasing promotion activities and
collaborating with community partners (can use pre and post
qualitative or quantitative collection methods
Examples of qualitative & quantitative methods/measures:
▪ Surveys, Questionnaires, Interviews
▪ Immunization coverage rates expressed in percentages
▪ Observations (i.e., feedback from surveys/interviews,
social media posts comments)
▪ Analytic tools (i.e., google analytics measuring
website traffic, page views etc.)
Written proposal summarizing project plan
and method of assessing/observing change
in target population.
(Template will be provided)
August 1, 2023 Reimbursement for actual
costs incurred, not to
exceed total funding
consideration amount.
Page 25 of 33
Exhibit A, Statement of Work Page 2 of 3 Contract Number CLH31019-Amendment 16
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
2 Upon approval of proposal, implement the plan to increase
immunization coverage rates with the target population
identified.
Written report describing the progress
made on reaching milestones for activities
identified in the plan (template will be
provided)
November 30, 2023
March 31, 2024
Reimbursement for actual
costs incurred, not to
exceed total funding
consideration amount.
3 Develop final report to include comparison of change or
improvement of targeted outcome from start of the
project/intervention [This can be short-term or intermediate
outcomes with overall goal to increase immunization rates]
Examples:
▪ Increased partner knowledge on immunization
guidelines
▪ Change in attitudes about childhood vaccines
▪ Increase in school district immunization coverage
rates
Final written report including measured
and/or observed outcomes [what was
achieved as a result of the
activity/intervention?].
(Template will be provided)
June 15, 2024 Reimbursement for actual
costs incurred, not to
exceed total funding
consideration amount.
DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site. Questions related to this SOW, or any other
finance-related inquiry, may be sent to finance@doh.wa.gov.
Federal Funding Accountability and Transparency Act (FFATA) (Applies to federal grant awards.)
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 s pent.
To comply with this act and be eligible to perform the activities in this statement of work, the LHJ must have a Unique Entit y Identifier (UEI) generated by SAM.gov.
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
Unallowable Costs:
There are limitations from the funding source on allowable costs for this contract. If the contractor is unsure if a cost is allowable, they should contact the contract manager for
approval of the cost prior to making the purchase or charge.
• Advertising costs (e.g., conventions, displays, exhibits, meetings, memorabilia, gifts, souvenirs)
• Alcoholic beverages
• Building, purchases, construction, capital improvements
• Clinical care (non-immunization services)
• Entertainment costs
• Fundraising Cost
• Goods and services for personal use
• Honoraria
• Independent Research
• Land acquisition
Page 26 of 33
Exhibit A, Statement of Work Page 3 of 3 Contract Number CLH31019-Amendment 16
• Legislative/lobbying activities
• Interest on loans for the acquisition and/or modernization of an existing building
• Payment of a bad debt, collection of improper payments
• Promotional and/or incentive materials (e.g., plaques, clothing, and commemorative items such as pens, mugs/cups, folders/folios, lanyards, magnets, conference bags)
• Purchase of food/meals (unless part of required travel per diem costs)
• Vehicle Purchase
Page 27 of 33
Exhibit A, Statement of Work Page 1 of 4 Contract Number CLH31019-Amendment 16
Exhibit A
Statement of Work
Contract Term: 2022-2024
DOH Program Name or Title: Office of People Services-HR-Public Health
Infrastructure Grant - Effective January 1, 2024
Local Health Jurisdiction Name: Mason County Public Health
Contract Number: CLH31019
SOW Type: Original Revision # (for this SOW) Funding Source
Federal Subrecipient
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price Period of Performance: January 1, 2024 through December 31, 2024
Statement of Work Purpose: The purpose of this statement of work is to provide funding to establish, expand, train, and sustain the LHJ public health workforce in accordance
with the CDC Public Health Infrastructure Grant (PHIG).
NOTE: The funding allocation in this SOW is for the period of January 1, 2024 through June 30, 2025. Deliverables with due da tes after December 31, 2024 are shown
for informational purposes only. DOH intends to include any unspent funding in a new SOW in t he next consolidated contract term beginning January 1, 2025 for
continuation of this project through June 30, 2025.
Revision Purpose: N/A
DOH Chart of Accounts Master Index Title
Master
Index
Code
Assistance
Listing
Number
BARS
Revenue
Code
LHJ Fund
Start Date
ing Period
End Date
Current
Allocation
Allocation
Change
Increase (+)
Total
Allocation
FFY22 PH Infrastructure Comp A1-LHJ 92321223 93.967 333.93.96 01/01/24 12/31/24 0 200,000 200,000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 0 200,000 200,000
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
1 Submit names, position titles, email addresses and phone numbers
of key LHJ staff responsible for this statement of work, including
management, program staff, and accounting and/or financial staff.
Submit information by March 15,
2024, and any changes within 30 days
of the change.
March 15, 2024
Within 30 days of the
change.
Reimbursement for actual
costs not to exceed total
funding allocation amount.
2 Develop a plan to use these funds for one or more of the
allowable costs listed below.
Implementation Plan
June 30, 2024, or sooner.
Page 28 of 33
Exhibit A, Statement of Work Page 2 of 4 Contract Number CLH31019-Amendment 16
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
Submit plan to the DOH Program Contact for review and prior
approval as soon as possible. We want to be sure your planned
activities are allowable, and we will be able to reimburse you for
the expenses.
Funding is intended to establish, expand, train, and sustain public
health staff to support LHJ prevention, preparedness, response,
and recovery initiatives. These include the following short-term
outcomes: increased hiring of diverse public health staff,
increased retention of existing public health staff, and improved
workforce systems and processes. Washington will also move
toward the following intermediate outcome measures as part of
this Workforce initiative: increased size [and capabilities] of the
public health workforce, increased job satisfaction, stronger
public health foundational capabilities, and increased reach of
public health services. Ultimately, these workforce investments
will support accelerated prevention, preparedness, and response to
emerging threats, and improved other public health outcomes.
Funding can be used for permanent full-time and part-time staff,
temporary or term-limited staff, fellows, interns, contractors, and
contracted employees.
Allowable costs include:
• Costs, including wages and benefits, related to recruiting,
hiring, and training of new or existing public health staff.
• Purchase of supplies and equipment to support the
expanded and/or current workforce and any training
related to the use of supplies and equipment.
• Training and education (and related travel) for new and
existing staff on topics such as incident management
training, health equity issues, working with underserved
populations, cultural competency, disease investigations,
informatics or data management, or other needs
identified by the LHJ.
• Costs of contractors and contracted staff.
Notes:
• Preapproval from DOH is required to contract with these
funds.
• Preapproval is required for the purchase of equipment.
(Equipment is a tangible item with an original per-unit
cost of $5,000 or more.)
Requests for approval of contracts
and/or equipment.
As needed
Page 29 of 33
Exhibit A, Statement of Work Page 3 of 4 Contract Number CLH31019-Amendment 16
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
3 Data collection, as applicable, based on activities LHJ has
completed during the reporting period.
Data collection includes:
• Total new hires
• Describe challenges or experiences that have impacted
progress toward achieving set hiring goals.
• Describe promising practices or activities that should be
considered for sustained funding.
• Explain your approach and mitigation plans to address
challenges in meeting these hiring goals.
• Health Equity – Identify metrics to address Diversity,
Equity, and Inclusion (DEI) in hiring.
• Existing Staff budget for this funding.
Note: Reporting periods are -
January 1, 2024–June 30, 2024, July 1, 2024–December 31, 2024,
and January 1, 2025–June 30, 2025.
Data on form provided by DOH. July 10, 2024
January 10, 2025
July 10, 2025
DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site. Questions related to this SOW, or any other
finance-related inquiry, may be sent to finance@doh.wa.gov.
Federal Funding Accountability and Transparency Act (FFATA) (Applies to federal grant awards.)
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 Unique Entit y Identifier (UEI) generated by SAM.gov.
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
Follow all Federal requirements for use of Federal funds:
Code of Federal Regulations (CFR), Title 2, Subtitle A, Chapter II, Part 200
Uniform Administrative Requirements, Cost Principle, and Audit Requirements for Federal Awards
eCFR: 2 CFR Part 200 -- Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards
The following expenses are not allowable with these funds:
• Clothing (except for vests to be worn during exercises or responses).
• Food or beverages.
• Incentives.
• Items to be given to community members (members of the public).
Page 30 of 33
Exhibit A, Statement of Work Page 4 of 4 Contract Number CLH31019-Amendment 16
• Salaries at a rate more than Executive Level II (Federal Pay Scale).
• Vehicles (with preapproval, funds may be used to lease vehicles).
Preapproval from DOH is required to use these funds for:
• Contracting.
• Purchasing equipment. (Equipment is a tangible item with an original per-unit cost of $5,000 or more.)
• Disposition of equipment with a current value of $5,000 or more.
(Equipment is a tangible item with an original per-unit cost of $5,000 or more.)
• Leasing vehicles.
• Out of state travel.
Note: Preapproval is no longer required for paying overtime.
See also DOH A19 Documentation Matrix for additional expenses that may require preapproval.
BILLING
All expenses on invoices must be related to statement of work tasks.
Submit invoices monthly on a signed A19 with backup documentation appropriate for risk level. DOH will provide A19 and risk level.
• If your invoice includes indirect costs, you must have an indirect rate cost agreement approved by DOH.
• If you have no expenses related to this contract for a month, let your DOH Primary Point of Contact know via email.
• Submit final billing within 60 days of the end of the contract period.
Page 31 of 33
Exhibit A, Statement of Work Page 1 of 2 Contract Number CLH31019-Amendment 16
Exhibit A
Statement of Work
Contract Term: 2022-2024
DOH Program Name or Title: Zoonotic Disease Program-WNV Mosquito
Surveillance - Effective June 1, 2022
Local Health Jurisdiction Name: Mason County Public Health
Contract Number: CLH31019
SOW Type: Revision Revision # (for this SOW) 2 Funding Source
Federal Subrecipient
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price Period of Performance: June 1, 2022 through September 30, 2023
Statement of Work Purpose: The purpose of this statement of work is for Mason County Public Health to conduct bi-weekly mosquito surveillance for West Nile
virus (WNV) in Mason County during mosquito season, June through September. The detection of the virus in mosquito populations serves as an early warning of disease risk in
the localized area. It alerts the local health department to strengthen educational outreach and mosquito control to minimize the health impact of mosquito-borne disease on
communities. In addition, data generated by surveillance advances our understanding of the emergence and spread of vector mos quitoes and pathogens in western Washington.
Revision Purpose: Adding funds to FFY23 Vector-borne T2&3 Epi ELC FPH to cover additional expenses.
DOH Chart of Accounts Master Index Title
Master
Index
Code
Assistance
Listing
Number
BARS
Revenue
Code
LHJ Fund
Start Date
ing Period
End Date
Current
Allocation
Allocation
Change
Increase (+)
Total
Allocation
FFY21 Vector-borne T2&3 Epi ELC FPH 1882121B 93.323 333.93.32 06/01/22 07/31/22 2,750 0 2,750
FFY22 Vector-borne T2&3 Epi ELC FPH 1882122B 93.323 333.93.32 08/01/22 07/31/23 4,550 0 4,550
FFY23 Vector-borne T2&3 Epi ELC FPH 1882123B 93.323 333.93.32 08/01/23 09/30/23 1,200 195 1,395
0 0 0
0 0 0
0 0 0
TOTALS 8,500 195 8,695
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
1 Conduct every other week mosquito trapping at two (2) site
locations in Mason County.
Purchase of dry ice and CO2 canisters, as needed
Set and collect traps
Record field data on DOH-provided reporting forms, including
zero catch information
Submit two weekly collections of
mosquitoes along with complete
corresponding data on reporting forms for
trapping events to DOH.
Should no mosquitoes be collected during
a trapping event, the data reporting form
documenting the effort is to be emailed to
the DOH Program contact.
Weekly by Thursday
during mosquito season,
June through September
Payment for task will be
reimbursed for actual
expenses up to the
maximum available
within the funding periods
described in the Funding
Table above.
See below Restrictions
on Funds.
Page 32 of 33
Exhibit A, Statement of Work Page 2 of 2 Contract Number CLH31019-Amendment 16
DOH Program and Fiscal Contact Information for all ConCon SOWs can be found on the DOH Finance SharePoint site. Questions related to this SOW, or any other
finance-related inquiry, may be sent to finance@doh.wa.gov.
Federal Funding Accountability and Transparency Act (FFATA) (Applies to federal grant awards.)
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 Unique Entity Identifier (UEI) generated by SAM.gov.
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
Restrictions on Funds (i.e., disallowed expenses or activities, indirect costs, etc.):
The current project period is June 1, 2023 – September 30, 2023. Billing outside this date range will be provided to DOH at no cost.
CDC Funding Regulations and Policies: https://www.cdc.gov/grants/documents/General-Terms-and-Conditions-Non-Research-Awards.pdf
Billing Requirements: LHJ may bill monthly. Invoices must be received no more than 60 days after the billing period.
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