HomeMy WebLinkAboutWashington State Department of Health Amendment # 17MASON COUNTY PUBLIC HEALTH
2022-2024 CONSOLIDATED CONTRACT
Page 1 of 1
CONTRACT NUMBER: CLH31019 AMENDMENT NUMBER: 17
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:
WIC Nutrition Program - Effective March 1, 2024
Amends Statements of Work for the following programs:
Office of Drinking Water Group B Programs - Effective January 1, 2022
Deletes Statements of Work for the following programs:
2.Exhibit B-17 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B -16 Allocations
as follows:
Increase of $66,719 for a revised maximum consideration of $6,881,311.
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 (Feb 29, 2024 08:12 PST)
David Windom
Feb 29, 2024
-enda en-i&.on (Feb 29, 2024 09:19 PST)
Feb 29, 2024
EXHIBIT B-17
Mason County Public Health ALLOCATIONS Contract Number:CLH31019
Contract Term: 2022-2024 Date:February 1, 2024
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
FFY25 USDA WIC Client Svs Contracts NGA Not Received Amd 17 10.557 333.10.55 10/01/24 12/31/24 10/01/24 09/30/25 $18,075 $18,075 $60,250
FFY24 USDA WIC Client Svs Contracts 7WA700WA7 Amd 17 10.557 333.10.55 03/01/24 09/30/24 10/01/23 09/30/24 $42,175 $42,175
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
LHJ Funding Period Funding Period
Chart of AccountsStatement of Work
DOH Use Only
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EXHIBIT B-17
Mason County Public Health ALLOCATIONS Contract Number:CLH31019
Contract Term: 2022-2024 Date:February 1, 2024
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
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
FFY24 HRSA MCHBG LHJ Contracts B04MC52960 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
SFY1 GFS - Group B Amd 17 N/A 334.04.90 01/01/24 06/30/24 07/01/23 06/30/25 $6,469 $6,469 $19,407
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
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
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EXHIBIT B-17
Mason County Public Health ALLOCATIONS Contract Number:CLH31019
Contract Term: 2022-2024 Date:February 1, 2024
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
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
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 $6,881,311 $6,881,311
Total consideration:$6,814,592 GRAND TOTAL $6,881,311
$66,719
GRAND TOTAL $6,881,311 Total Fed $2,706,052
Total State $4,175,259
*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 2 Contract Number CLH31019-Amendment 17
Exhibit A
Statement of Work
Contract Term: 2022-2024
DOH Program Name or Title: Office of Drinking Water Group B Programs -
Effective January 1, 2022
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
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 financial support to LHJs implementing local Group B water systems programs.
Revision Purpose: The purpose of this revision is to extend the period of performance from 06/30/23 to 06/30/24 and provide additional financia l support from 01/01/24 through
06/30/24 to LHJs implementing local Group B water systems programs.
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
GFS Group B (FO-SW) 24230103 N/A 334.04.90 01/01/22 06/30/22 6,469 0 6,469
GFS Group B (FO-SW) 24230104 N/A 334.04.90 01/01/23 06/30/23 6,469 0 6,469
SFY1 GFS - Group B 24110843 N/A 334.04.90 01/01/24 06/30/24 0 6,469 6,469
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 12,938 6,469 19,407
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
1 Implement a PARTIAL Group B water
system program. Reference DOH JPR
#CLH24095-1
An executed joint plan of responsibility (JPR) with
DOH identifying responsibilities of a PARTIAL
Group B program.
January 1, 2023 2022 thru June 30, 2023
2024
Lump sum payment
(See Special Billing
Requirements)
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 Billing Requirements:
For January 1, 2022 thru June 30, 2022, LHJ shall submit one invoice no later than June 30, 2022 and payment cannot exceed a maximum cumulative fee of $6,469.
Page 5 of 13
Exhibit A, Statement of Work Page 2 of 2 Contract Number CLH31019-Amendment 17
For January 1, 2023 thru June 30, 2023, LHJ shall submit one invoice no later than June 30, 2023 and payment cannot exceed a maximum cumulative fee of $6,469.
For January 1, 2024 thru June 30, 2024, LHJ shall submit one invoice no later than June 30, 2024 and payment cannot exceed a maximum cumulative fee of $6,469.
Page 6 of 13
Exhibit A, Statement of Work Page 1 of 7 Contract Number CLH31019-Amendment 17
Exhibit A
Statement of Work
Contract Term: 2022-2024
DOH Program Name or Title: WIC Nutrition Program - Effective March 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: March 1, 2024 through December 31, 2024
Statement of Work Purpose: The purpose is to provide Women, Infants, and Children (WIC) Nutrition Program services by following WIC federal regulations, WIC state office
policies and procedures, WIC directives, and other rules. Refer to the Program Specific Requirements section of t his document.
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
FFY24 USDA WIC CLIENT SVS CONTRACTS 7610124B 10.557 333.10.55 03/01/24 09/30/24 0 42,175 42,175
FFY25 USDA WIC CLIENT SVS CONTRACTS 76101251 10.557 333.10.55 10/01/24 12/31/24 0 18,075 18,075
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 0 60,250 60,250
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
1 WIC Nutrition Program See “Billing
Requirements” below.
1.1 Maintain authorized participating caseload at 100% based on
quarterly average as determined from monthly caseload
management reports generated at state WIC office.
The Department of Health (Department) State WIC Nutrition
Program has the option of reducing authorized participating
caseload and corresponding funding when:
1.Unanticipated funding situations occur.
2.Reallocations are necessary to redistribute caseload
statewide.
3.Caseload declines.
Outcomes based on monthly participation
data from state WIC caseload management
reports.
Authorized participating
caseload for March 2024
through December 2024
= 300
Page 7 of 13
Exhibit A, Statement of Work Page 2 of 7 Contract Number CLH31019-Amendment 17
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
1.2 Submit the annual Nutrition Services Plan for each year of the
contract.
Nutrition Services Plan Due 9/30/24 Payment withheld if not
received by due date.
1.3 Submit the annual Nutrition Services Expenditure Report for
each year of the contract.
Nutrition Services Expenditure Report 11/30/24 Payment withheld if not
received by due date.
1.4
Tell participants about other health services in the agency. If
needed, develop written agreements with other health care
agencies and refer participants to these services.
Documentation must be available for
review by WIC monitor staff. Biennial WIC Monitor
1.5 Provide nutrition education services to participants and
caregivers in accordance with federal and state requirements.
Documentation must be available for
review by WIC monitor staff. Biennial WIC Monitor
1.6 Issue WIC benefits while assuring adequate WIC card security
and reconciliation.
Documentation must be available for
review by WIC monitor staff. Biennial WIC Monitor
1.7
Collect data, maintain records, and submit reports to effectively
enforce the non-discrimination laws (Refer to Civil Rights
Assurances below).
Documentation must be available for
review by WIC monitor staff. Biennial WIC Monitor
1.8a Submit entire WIC and Breastfeeding Peer Counseling Budget
Workbook for each year of the contract
Budget Workbook Due 2/29/24
1.8b Submit Rev-Exp Report spreadsheet from the WIC Budget
Workbook monthly with A-19
Revenue and Expense Report and A-19 Due monthly through
December 31, 2024
2 Breastfeeding Promotion
2.1
Provide breastfeeding promotion activities in accordance with
federal and state requirements.
Status report of chosen activities in
Nutrition Services Plan.
Documentation must be available for
review by WIC monitor staff.
Due 11/30/24
Biennial WIC Monitor
2.2
Work with community partners to improve practices that affect
breastfeeding. Choose one or more of the following projects:
▪Provide staff, health care providers and community
partners virtual breastfeeding training resources.
▪Work with employers who likely employ low-income
people to create worksite environments that support
breastfeeding.
▪Work with birthing hospitals to improve maternity care
practices that affect WIC participant breastfeeding rates.
▪Provide participants access to lactation consultants.
▪Other projects will need pre-approval from the State WIC
Office.
Status report of chosen activities in
Nutrition Services Plan.
Documentation must be available for
review by WIC monitor staff.
Due 8/30/24
Biennial WIC Monitor
Page 8 of 13
Exhibit A, Statement of Work Page 3 of 7 Contract Number CLH31019-Amendment 17
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
3 Farmers Market Nutrition Program (FMNP) See “Billing
Requirements” below.
3.1
Distribute all Farmers Market Nutrition Program checks to
eligible WIC participants between June and September 30 of
current year.
Send completed readable copy of FMNP
check registers to State WIC office on a
weekly basis following FMNP procedures.
Documentation must be available for
review by WIC monitor staff.
Weekly June-Sept. 2024
All sent by Oct. 1, 2024
Biennial WIC Monitor
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 Transpare ncy 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
Program Manual, Handbook, Policy References:
The LHJ shall be responsible for providing services according to rules, regulations and other information contained in the fo llowing:
• WIC Federal Regulations, USDA, and FNS 7CFR Part 246.
• Washington State WIC Nutrition Program Policy and Procedure Manual
• Office of Management and Budget, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, 2 CFR 200
• Farmers Market Nutrition Program Federal Regulations, USDA, FNS 7CFR Part 248
• Other directives issued during the term of the contract
Staffing Requirements:
The LHJ shall:
• Use Competent Professional Authority staff, as defined by WIC policy, to determine participant eligibility, prescribe an appr opriate food package and offer nutrition
education based on the participants’ needs.
• Use a Registered Dietitian (RD) or other qualified nutritionist to provide nutrition services to high risk participants, to include development of a high-risk care plan. The
RD is also responsible for quality assurance of WIC nutrition services. See WIC Policy for qualifications for a Registered D ietitian and other qualified nutritionist.
• Assign a qualified person to be the Breastfeeding Coordinator to organize and direct local agency efforts to meet federal and state policies regarding breastfeeding
promotion and support. The Breastfeeding Coordinator must be an International Board Certif ied Lactation Consultant or attend an intensive lactation management course,
or other state approved training.
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Exhibit A, Statement of Work Page 4 of 7 Contract Number CLH31019-Amendment 17
Restrictions on Funds (i.e., disallowed expenses or activities, indirect costs, etc.):
The LHJ shall follow the instructions found in the Policy and Procedure Manual under WIC Allowable Costs and 2 CFR Part 200 U niform Administrative Requirements, Cost
Principles, and Audit Requirements for Federal Awards.
Special References (i.e., RCWs, WACs, etc.):
What is the WIC program?
1. The WIC program in the state of Washington is administered by the Department of Health.
2. The WIC program is a federally funded program established in 1972 by an amendment to the Child Nutrition Act of 1966. The pur pose of the program is to provide nutrition
and health assessment; nutrition education; nutritious food; breastfeeding counseling; and referral services to pregnant, breastfeeding, and postpartum women, infants, and
young children in specific risk categories.
3. Federal regulations governing the WIC program (7 CFR Part 246) require implementation of standards and procedures to guide th e state's administration of the WIC program.
These regulations define the rights, responsibilities, and legal procedures of WIC employees, participants, persons acting on behalf of a participant, and retailers. They are
designed to promote:
a. High quality nutrition services;
b. Consistent application of policies and procedures for eligibility determination;
c. Consistent application of policies and procedures for food benefit issuance and delivery; and
d. WIC program compliance.
4. The WIC program implements policies and procedures stated in program manuals, handbooks, contracts, forms, and other program documents approved by the USDA Food
and Nutrition Service.
5. The WIC program may impose sanctions against WIC participants for not following WIC program rules stated on the WIC rights an d responsibilities.
6. The WIC program may impose monetary penalties against persons who misuse WIC benefits or WIC food but who are not WIC participants.
Monitoring Visits (i.e., frequency, type, etc.):
Program and fiscal monitoring are done on a biennial (every two years) basis and are conducted onsite.
The LHJ must maintain on file and have available for review, audit and evaluation:
• All criteria used for certification, including information on income, nutrition risk eligibility and referrals
• Program requirements
• Nutrition education
• All financial records
Assurances/Certifications:
1. Computer Equipment Loaned by the Department of Health WIC Nutrition Program
In order to perform WIC program activities, the Department requires computer equipment, such as computers, signature pads, document scanners, card readers and printers to
be in local WIC clinics or to be transported to mobile clinics. This equipment (“Loa ned Equipment”) is owned by the Department and loaned to the local agency (Contractor).
The Loaned Equipment is supported by the Department. This equipment shall be used for WIC business only or according to WIC Policy and Procedures.
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Exhibit A, Statement of Work Page 5 of 7 Contract Number CLH31019-Amendment 17
An inventory of Loaned Equipment is kept by the Department. Each time Loaned Equipment is changed, the parties shall complet e the Equipment Transfer Form and the
Department updates the inventory. A copy of the Transfer Form will be provided to the contractor. Copies of the updated inventory list may be requested at any time.
The LHJ agrees to:
a. Defend, protect and hold harmless the Department or any of its employees from any claims, suits or actions arising from the u se of this Loaned Equipment.
b. Assume responsibility for any loss or damage from abnormal wear or use, or from inappropriate storage or transportation. The Department may enforce this by:
1) Requiring reimbursement from the LHJ of the value of the Loaned Equipment at the time of the loss or damage.
2) Requiring the LHJ to replace the Loaned Equipment with equipment of the same type, manufacturer, and capabilities (as pre -approved by the Department), or
3) Assertion of a lien against the Contractor's property.
c. Notify the Department immediately of any damage to Loaned Equipment.
d. Notify the Department prior to moving or replacing any Loaned Equipment.
The Department recommends Contractors carry insurance against possible loss or theft.
2. Civil Rights Assurance
a. The LHJ shall perform all services and duties necessary to comply with federal law in accordance with the following Civil Rig hts Assurance.
b. “The Program applicant hereby agrees that it will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et se q.), Title IX of the Education Amendments
of 1972 (20 U.S.C. 1681 et seq.), Section 504 of the Rehabilitation Act of 1973 (29 U.S.C . 794), Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.); all provisions
required by the implementing regulations of the Department of Agriculture; Department of Justice Enforcement Guidelines, 28 C FR 50.3 and 42; and FNS directives and
guidelines, to the effect that, no person shall, on the ground of race, color, national origin, sex, age or handicap, be excluded from pa rticipation in, be denied benefits of, or
otherwise be subject to discrimination under any program or activity for which the Progra m applicant receives Federal financial assistance from FNS; and hereby gives
assurance that it will immediately take measures necessary to effectuate this agreement.
c. “By accepting this assurance, the Program applicant agrees to compile data, maintain records and submit reports as required, to permit effective enforcement of the
nondiscrimination laws and permit authorized USDA personnel during normal working hours to r eview such records, books and accounts as needed to ascertain
compliance with the nondiscrimination laws. If there are any violations of this assurance, the Department of Agriculture, Food and Nutrition Service, shall have the right
to seek judicial enforcement of this assurance. This assurance is binding on the Program applicant, its successors, transferees, and assignees, as l ong as it receives
assistance or retains possession of any assistance from the Department. The person or persons whose signatures appear on the contract are authorized to sign this
assurance on behalf of the Program applicant.”
3. 2CFR 200
The LHJ shall comply with all the fiscal and operations requirements prescribed by the state agency as directed by Federal WI C Regulations (7CFR part 246.6), 2CFR part
200, the debarment and suspension requirements of 2CFR part 200.213, if applicable, the lobbying restrictions of 2CFR part 200.245, and FNS guidelines and instructions and
shall provide on a timely basis to the state agency all required information regarding fiscal and program information.
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Exhibit A, Statement of Work Page 6 of 7 Contract Number CLH31019-Amendment 17
Billing Requirements:
1. Definitions
Contract Period: January 1, 2022 - December 31, 2024
Contract Budget Period: The time period for which the funding is budgeted.
• There are four federal budget periods
January 1, 2022 through September 30, 2022;
October 1, 2022 through September 30, 2023;
October 1, 2023 through September 30, 2024;
October 1, 2024 through December 31, 2024.
2. Billing Information:
a. Billings are submitted on an A-19-1A invoice. These invoices are provided by the Department in the WIC Budget Workbook and include accounting codes for differ ent
budget categories.
b. A-19s are submitted monthly and must be received by the Department within 30 days following the close of each calendar month. Additional A-19s may be submitted at
any time, but must be received within 60 days of the close of the federal budget period.
c. Funds are allocated by budget categories and by federal budget periods (refer to the budget spreadsheet).
d. Funds are encumbered or spent only during the budget period; no carry forward from previous time periods or borrowing from fu ture time periods is allowed.
e. Payments are limited to the amounts allocated for the budget period for each budget category.
f. Billings are based on actual costs for completed activities. Advance payments are not allowed. Back up documentation must be retained by the LHJ and available for
inspection by the Department or other appropriate authorities.
g. Payments will be made only for WIC approved expenditures. Refer to the Washington State WIC Nutrition Program Policy and Proc edure Manual Volume 2, Chapter 4 –
Allowable Costs and 2 CFR Part 200 Uniform Administrative Requirements, Cost Principles, and Aud it Requirements for Federal Awards.
h. If billing for indirect costs, a Cost Allocation Plan or Federal Indirect Cost Agreement must be submitted prior to payment.
Special Instructions:
The LHJ shall:
1. Maintain complete, accurate, and current accounting of all local, state, and federal program funds received and expended.
2. Provide, as necessary, a single audit in accordance with the provisions of 2 CFR Part 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards. This circular requires all recipients and sub-recipients of federal funds to have a single audit performed should they spend $750,000 or more of federal grants
or awards from all sources. Contractors spending less than $750,000 in federal grants or awards may also be subject to audit .
3. Use Breastfeeding Peer Counseling (BFPC) Program funds only to support the peer counseling program. Once the program is esta blished and peer counselors are trained, the
majority of the salary costs must be paid to peer counselors to provide direct services to WIC participants. For a list of allowable costs see Volume 2, Chapter 4 – Allowable
Costs. The priority use of BFPC funds is to hire and train peer counselors to provide breastfeeding peer counseling services to WIC participants.
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Exhibit A, Statement of Work Page 7 of 7 Contract Number CLH31019-Amendment 17
Special Requirements:
SPECIAL REQUIREMENTS
Contract Funding Period Time Period special requirement
funds are available
Amount Special Requirement Description
Other:
Any program requirements that are not followed may be subject to corrective action and may result in monetary fines or repaym ent of funds.
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