HomeMy WebLinkAboutWashington State Department of Health Amendment # 21MASON COUNTY PUBLIC HEALTH
2022-2024 CONSOLIDATED CONTRACT
Page 1 of 1
CONTRACT NUMBER: CLH31019 AMENDMENT NUMBER: 21
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:
Injury & Violence Prevention-Overdose Data to Action in States - Effective November 1, 2024
Amends Statements of Work for the following programs:
Office of Drinking Water Group A Program - Effective January 1, 2022
Office of Immunization COVID-19 Vaccine - Effective January 1, 2022
Deletes Statements of Work for the following programs:
2.Exhibit B-21 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B -20 Allocations
as follows:
Increase of for a revised maximum consideration of .
Decrease of $682,448 for a revised maximum consideration of $8,371,457.
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
Page 1 of 18
David Windom (Oct 31, 2024 11:49 PDT)
David Windom
Oct 31, 2024
- nda n-i&.on (Oct 31, 2024 1ц:0ц PDT)
Oct 31, 2024
EXHIBIT B-21
Mason County Public Health ALLOCATIONS Contract Number:CLH31019
Contract Term: 2022-2024 Date:October 1, 2024
Indirect Rate January 1, 2022 through December 31, 2022: 17.26%
Indirect Rate January 1, 2023 through December 31, 2023: 18.44%
Indirect Rate January 1, 2024 through December 31, 2024: 18.95%
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 7WA700WA7 Amd 20 10.557 333.10.55 10/01/24 12/31/24 10/01/24 09/30/25 $1,800 $24,875 $78,716
FFY25 USDA WIC Client Svs Contracts 7WA700WA7 Amd 18 10.557 333.10.55 10/01/24 12/31/24 10/01/24 09/30/25 $5,000
FFY25 USDA WIC Client Svs Contracts 7WA700WA7 Amd 17 10.557 333.10.55 10/01/24 12/31/24 10/01/24 09/30/25 $18,075
FFY24 USDA WIC Client Svs Contracts 7WA700WA7 Amd 18 10.557 333.10.55 03/01/24 09/30/24 10/01/23 09/30/24 $11,666 $53,841
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
FFY24 PHEP BP1-CDC-LHJ Partners NU90TU000055 Amd 20 93.069 333.93.06 07/01/24 12/31/24 07/01/24 06/30/25 $29,605 $29,605 $29,605
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
FFY24 CDC PCH OD2A Prevention NU17CE10218 Amd 21 93.136 333.93.13 11/01/24 12/31/24 09/01/24 08/31/25 $17,533 $17,533 $17,533
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
FFY25 CDC VFC Ops NGA Not Received Amd 20 93.268 333.93.26 07/01/24 12/31/24 07/01/24 06/30/25 $5,600 $5,600 $11,760
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
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 CDC Vaccines NH23IP922619 Amd 21 93.268 333.93.26 01/01/22 06/30/24 07/01/20 06/30/24 ($354,803)$0 $0
COVID19 CDC Vaccines NH23IP922619 Amd 4 93.268 333.93.26 01/01/22 06/30/24 07/01/20 06/30/24 $354,803
COVID19 Vaccines R4 NH23IP922619 Amd 21 93.268 333.93.26 01/01/22 06/30/24 07/01/20 06/30/24 ($354,803)$0 $0
COVID19 Vaccines R4 NH23IP922619 Amd 1 93.268 333.93.26 01/01/22 06/30/24 07/01/20 06/30/25 $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
LHJ Funding Period Funding Period
Chart of AccountsStatement of Work
DOH Use Only
Page 1 of 4
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EXHIBIT B-21
Mason County Public Health ALLOCATIONS Contract Number:CLH31019
Contract Term: 2022-2024 Date:October 1, 2024
Indirect Rate January 1, 2022 through December 31, 2022: 17.26%
Indirect Rate January 1, 2023 through December 31, 2023: 18.44%
Indirect Rate January 1, 2024 through December 31, 2024: 18.95%
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
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, 19 93.354 333.93.35 07/01/23 12/31/24 07/01/23 06/30/25 $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
FFY25 HRSA MCHBG LHJ Contracts NGA Not Received Amd 20 93.994 333.93.99 10/01/24 12/31/24 10/01/24 09/30/25 $16,923 $16,923 $139,476
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
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
Page 2 of 4
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EXHIBIT B-21
Mason County Public Health ALLOCATIONS Contract Number:CLH31019
Contract Term: 2022-2024 Date:October 1, 2024
Indirect Rate January 1, 2022 through December 31, 2022: 17.26%
Indirect Rate January 1, 2023 through December 31, 2023: 18.44%
Indirect Rate January 1, 2024 through December 31, 2024: 18.95%
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
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 Local OPI Prev & Supp Proviso Amd 21 N/A 334.04.93 11/01/24 12/31/24 07/01/24 06/30/25 $9,625 $9,625 $9,625
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
SFY25 FPHS-LHJ Funds-GFS Amd 20 N/A 336.04.25 07/01/24 12/31/24 07/01/24 06/30/25 $1,049,000 $2,098,000 $4,196,000
SFY25 FPHS-LHJ Funds-GFS Amd 19 N/A 336.04.25 07/01/24 12/31/24 07/01/24 06/30/25 $1,049,000
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
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 27 SRF - Local Asst (15%) SS Amd 21 N/A 346.26.64 01/01/24 12/31/24 07/01/23 06/30/25 $15,800 $15,800 $39,800
YR 26 SRF - Local Asst (15%) SS Amd 21 N/A 346.26.64 01/01/24 12/31/24 07/01/23 06/30/25 ($15,800)$0
YR26 SRF - Local Asst (15%) SS Amd 18 N/A 346.26.64 01/01/24 12/31/24 07/01/23 06/30/25 $2,000
YR26 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
YR25 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
YR25 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 18 N/A 346.26.65 01/01/22 12/31/24 07/01/21 12/31/24 $2,000 $39,800 $39,800
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
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
Page 3 of 4
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EXHIBIT B-21
Mason County Public Health ALLOCATIONS Contract Number:CLH31019
Contract Term: 2022-2024 Date:October 1, 2024
Indirect Rate January 1, 2022 through December 31, 2022: 17.26%
Indirect Rate January 1, 2023 through December 31, 2023: 18.44%
Indirect Rate January 1, 2024 through December 31, 2024: 18.95%
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 27 SRF - Local Asst (15%) TA Amd 21 N/A 346.26.66 01/01/24 12/31/24 07/01/23 06/30/25 $1,000 $1,000 $2,000
YR 26 SRF - Local Asst (15%) TA Amd 21 N/A 346.26.66 01/01/24 12/31/24 07/01/23 06/30/25 ($1,000)$0
YR26 SRF - Local Asst (15%) TA Amd 18 N/A 346.26.66 01/01/24 12/31/24 07/01/23 06/30/25 $1,000
YR25 SRF - Local Asst (15%) TA Amd 18 N/A 346.26.66 01/01/23 12/31/23 01/01/23 12/31/23 ($1,000)$0
YR25 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
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 $8,371,457 $8,371,457
Total consideration:$9,053,905 GRAND TOTAL $8,371,457
($682,448)
GRAND TOTAL $8,371,457 Total Fed $2,084,573
Total State $6,286,884
*Catalog of Federal Domestic Assistance
**Federal revenue codes begin with "333". State revenue codes begin with "334".
Page 4 of 4
Page 5 of 18
Exhibit A, Statement of Work Page 1 of 6 Contract Number CLH31019-Amendment 21
Exhibit A
Statement of Work
Contract Term: 2022-2024
DOH Program Name or Title: Injury & Violence Prevention-Overdose Data to
Action in States - Effective November 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: November 1, 2024 through December 31, 2024
Statement of Work Purpose: The purpose of this statement of work (SOW) is to allocate funds to Mason County Public Health Department to implement overdose prevention
strategies under the CDC Overdose Data to Action in States (OD2A-S) Cooperative Agreement.
NOTE: The 2022-2024 consolidated contract term ends on December 31, 2024. The new 2025-2027 consolidated contract term begins on January 1, 2025. Funding
amounts in this SOW reflect projected spending for the two months (November/December) remaining in the 2022-2024 contract term. Task activities with due dates
after December 31, 2024 and funds for the January 1, 2025 through August 31, 2025 budget period along with any unspent fundin g from this SOW, will be included in a
new SOW in the 2025-2027 contract term.
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 CDC PCH OD2A PREVENTION 77520240 93.136 333.93.13 11/01/24 12/31/24 0 17,533 17,533
SFY25 LOCAL OPI PREV & SUPP PROVISO 77550855 N/A 334.04.93 11/01/24 12/31/24 0 9,625 9,625
0 0 0
0 0 0
0 0 0
TOTALS 0 27,158 27,158
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
1. OD2A-S 8.1.1
The LHJ will conduct weekly syringe services program
(SSP)/harm reduction outreach throughout Mason
County through their mobile SSP unit.
The LHJ will re-establish encampment/street-based
harm reduction outreach to increase engagement with
people experiencing homelessness, including people
with disabilities or different access and functional
Progress report update on the process to
re-establish encampment/street-based
outreach and implementing home
service expansion.
Collection of semi-annual and
annual performance measures.
DOH will provide a template to
collect specific data for each
activity. The first submission of
data will be due on 11/22/24.
Future submission dates will be
updated in the January
amendment.
Monthly invoices for actual
cost reimbursement will be
submitted to DOH.
Total of all invoices will not
exceed $25,233 through
December 31, 2024.
One-Time Enhancement
funds must be spent by the
Page 6 of 18
Exhibit A, Statement of Work Page 2 of 6 Contract Number CLH31019-Amendment 21
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
needs. The LHJ will choose at least two dates per
month for inter-agency co-location of street outreach.
The LHJ will implement home service expansion,
including to Tribal reservations, of their SSP to
increase equitable delivery and improved access to
care/services, increase access to harm reduction
education and services including increased naloxone
distribution.
Quarterly progress reports with
updates on the implementation of
all tasks are due to DOH.
Progress report timeline
Period Due
Date
11/01/24-
01/31/25
02/01/25
02/01/25-
03/31/25
04/01/25
04/01/25-
06/30/25
07/01/25
07/01/25-
08/31/25
10/31/25
Note: The final progress report of
this contract budget period is due
on the same date that the final
A19 invoice for this budget
period must be submitted.
end of the Federal Fiscal
Year ending on August 31,
2025.
2. OD2A-S 8.2.1
The LHJ will Expand overdose prevention education
and naloxone distribution (OPEND) to participants of
their SSP and broader community to increase
awareness of the drug overdose epidemic, harm
reduction efforts, evidence-based approaches, and
provide linkages to care. This will include hosting
trainings around the county, including to Tribal youth
and youth in the juvenile detention system, and
distributing psychostimulant overdose/overamping
education and response materials during outreach.
The LHJ will increase naloxone distribution during
outreach efforts, maintain naloxone availability at the
Public Health office on a walk-in basis, supply
partnering agency with naloxone to distribute at weekly
Transit Center Overdose Prevention outreach table.
This will include a partnership with the Skokomish
Nation to distribute naloxone to youth who are at risk
of experiencing or witnessing an overdose.
Progress report updates on the number
of trainings conducted, a description of
the content of the trainings, and the
audience for the trainings. This should
include an update on the process to
partner with the Skokomish Nation.
3. OD2A-S 8.2.2
The LHJ will improve access to low-threshold
medications for opioid use disorder (MOUD) and
treatment for substance use disorder.
The LHJ will include MOUD induction to Syndemic
Clinical services for SSP participants and provide
information, referrals, or warm hand-offs and follow-
up care to SSP/harm reduction participants at outreach
sites or by phone.
Progress report update on:
• The process to include MOUD
induction in syndemic clinical
services
• Collaboration with local MOUD
providers and the attendance of
community collaboration meetings
• Development and dissemination of
the survey for SSP participants
Page 7 of 18
Exhibit A, Statement of Work Page 3 of 6 Contract Number CLH31019-Amendment 21
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
The LHJ will provide program participants and
community partners with accurate and up to date
MOUD information by collaborating with local
MOUD providers to stay updated on the MOUD access
landscape. The LHJ will attend community
collaboration meetings and maintain relationships with
network of MOUD providers.
The LHJ will conduct a survey of SSP participants to
collect information about their experience or
perception of low-threshold MOUD access in Mason
County and share results with MOUD providers to
encourage reducing barriers.
4. OD2A-S 8.2.3
The LHJ will distribute drug checking supplies at
weekly outreach locations through Mason County
including through fixed mobile sites,
street/encampment outreach, home service, and to
other community members as requested. The LHJ will
also provide the Transit Center Overdose prevention
outreach table with test strips.
The LHJ will stay updated on statewide and local drug
trends and produce and disseminate education on safer
use strategies. This will include instructions for how to
use various drug checking supplies and the benefits and
limitations of each.
The LHJ will stay updated on drug use trends by using
information shared by statewide drug checking
programs, attending meetings and webinars centered
around drug-checking, tracking fatal overdose
toxicology data via coroner reports, and
communicating with EMS around witnessed trends.
Progress report update on staying
updated on statewide and local drug
trends and the production and
distribution of education on safer use
strategies.
5. OD2A-S 8.3.1
The LHJ will aim to improve social norms related to
harm reduction strategies and increase awareness of
and access to harm reduction/overdose prevention
Progress report update on engaging
community partners and distributing
education and materials to agencies that
work with PWUD. An update on the
Page 8 of 18
Exhibit A, Statement of Work Page 4 of 6 Contract Number CLH31019-Amendment 21
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
resources. This will include information on wound care
techniques and reducing communicable disease
transmission.
The LHJ will engage people who use drugs (PWUD)
on tailored harm reduction strategies that meet their
actual conditions of use and distribute resources and
materials to all program participants at outreaches.
The LHJ will engage community partners on common
challenges and health issues PWUD face to reduce
stigma, help inform their programs, and increase
awareness of and access to harm reduction resources.
This will include distributing harm reduction education
to agencies that work with PWUD.
The LHJ will create an Oral Health and Drug Use
educational pamphlet that highlights how substance use
is linked to key oral systemic health conditions (ex.
cardiovascular disease, stroke risk, cancer, etc.) and
shares harm reduction strategies to prevent such
concerns. The LHJ will also distribute harm reduction
supplies to participants.
creation of the Oral Health and Drug
Use educational pamphlet.
6. Maintain partnerships
The LHJ will facilitate monthly provider meetings and
attend relevant community housing and behavioral
health meetings to increase cross-sector inter-agency
collaboration, coordination, and communication of
community navigators to increase linkages to care for
people who use drugs.
A progress report update on participation
in community meetings and engagement
with community navigators.
7. Maintain communication with DOH
• The LHJ will meet virtually with the DOH
contract manager on a monthly or quarterly
basis.
• When requested, the LHJ will join meetings
with DOH and CDC OD2A-S project officers
to provide updates on the implementation of
the statement of work activities.
• Monthly or quarterly meetings
• Meetings with CDC as
requested
• Participate in quarterly calls
with all grantees
Page 9 of 18
Exhibit A, Statement of Work Page 5 of 6 Contract Number CLH31019-Amendment 21
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
• The LHJ will participate in quarterly calls
with DOH and other recipients of this funding
to share lessons learned, successes, and
challenges.
8. Evaluation requirements
The LHJ will engage in evaluation activities in the
following ways:
• Collect data on CDC performance measures to
support DOH evaluation plan.
• Provide answers to contextual performance
measures questions.
• Collaborate with the DOH evaluator on a
Targeted Evaluation Project (TEP) that will
provide a greater understanding of navigation
activities.
• Support other evaluation tasks as requested, to
meet overall CDC evaluation requirements.
DOH will provide a template for the
collection of the following data:
• Total number of harm reduction
service encounters (e.g., in-person,
mail, telephone, online)
• Zip code where harm reduction
services were provided (list
“unknown” when location is
unknown)
• Total number of navigators located
in a harm reduction setting or other
setting
• Number of referrals to harm
reduction services for each race
ethnicity
• If possible, total number of hours
spent by each navigator on linkage
to care or referral efforts
• Type of organization where
naloxone was distributed (SSP,
faith-based organizations, schools,
etc.)
• Zip code where naloxone was
distributed (list “unknown” when
unknown)
• Number of naloxone doses
distributed at each type of
organization
• Number of service encounters
involving drug checking
• Zip code for drug checking
encounters (list “unknown” when
unknown)
• Number of referrals to MOUD for
each race/ethnicity
Page 10 of 18
Exhibit A, Statement of Work Page 6 of 6 Contract Number CLH31019-Amendment 21
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information
and/or Amount
• Number of referrals to behavioral
health treatment only (without
MOUD) for each race/ethnicity
• Number of other referrals, if not to
MOUD and behavioral health, with
a description of the type of referral
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 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
Billing Requirements:
DOH awards funding through reimbursement-based billing. Invoices must be submitted monthly on an A19-1A invoice voucher.
Due to tight timelines, itemized budgets were not included in this SOW. Itemized budgets will be included in the January amendment. The LHJ must receive written approval from
DOH before making any changes to the SOW activities or itemized budget.
Page 11 of 18
Exhibit A, Statement of Work Page 1 of 4 Contract Number CLH31019-Amendment 21
Exhibit A
Statement of Work
Contract Term: 2022-2024
DOH Program Name or Title: Office of Drinking Water Group A Program -
Effective January 1, 2022
Local Health Jurisdiction Name: Mason County Public Health
Contract Number: CLH31019
SOW Type: Revision Revision # (for this SOW) 7 Funding Source
Federal Contractor
State
Other
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price Period of Performance: January 1, 2022 through December 31, 2024
Statement of Work Purpose: The purpose of this statement of work is to provide funding to the LHJ for conducting sanitary surveys and providing technical assistance to small
community and non-community Group A water systems
Revision Purpose: The purpose of this revision is to update funding provided for Sanitary Survey and Technical Assistance activity assigned 1/1/2024 through 12/31/2024.
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
SANITARY SURVEY FEES SS-STATE 24112522 N/A 346.26.65 01/01/22 12/31/24 39,800 0 39,800
YR 24 SRF - LOCAL ASST (15%) (FO-SW) SS 24239224 N/A 346.26.64 01/01/22 12/31/22 12,400 0 12,400
YR 24 SRF - LOCAL ASST (15%) (FO-SW) TA 24239224 N/A 346.26.66 01/01/22 12/31/22 1,000 0 1,000
YR 25 SRF - LOCAL ASST (15%) SS 24119226 N/A 346.26.64 01/01/23 12/31/23 11,600 0 11,600
YR 25 SRF - LOCAL ASST (15%) TA 24119226 N/A 346.26.66 01/01/23 12/31/23 0 0 0
YR 26 SRF - LOCAL ASST (15%) SS 24119226 N/A 346.26.64 01/01/24 12/31/24 15,800 -15,800 0
YR 26 SRF - LOCAL ASST (15%) TA 24119226 N/A 346.26.66 01/01/24 12/31/24 1,000 -1,000 0
YR 27 SRF - LOCAL ASST (15%) SS 24119227 N/A 346.26.64 01/01/24 12/31/24 0 15,800 15,800
YR 27 SRF - LOCAL ASST (15%) TA 24119227 N/A 346.26.66 01/01/24 12/31/24 0 1,000 1,000
0 0 0
TOTALS 81,600 0 81,600
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount
1 Trained LHJ staff will conduct sanitary
surveys of small community and non-
community Group A water systems
identified by the DOH Office of Drinking
Water (ODW) Regional Office.
See Special Instructions for task activity.
Provide Final* Sanitary Survey Reports
to ODW Regional Office. Complete
Sanitary Survey Reports shall include:
1. Cover letter identifying significant
deficiencies, significant findings,
observations, recommendations,
and referrals for further ODW
follow-up.
Final Sanitary Survey
Reports must be received by
the ODW Regional Office
within 30 calendar days of
conducting the sanitary
survey.
Upon ODW acceptance of the Final Sanitary
Survey Report, the LHJ shall be paid $400 for
each sanitary survey of a non-community
system with three or fewer connections.
Upon ODW acceptance of the Final Sanitary
Survey Report, the LHJ shall be paid $800 for
each sanitary survey of a non-community
Page 12 of 18
Exhibit A, Statement of Work Page 2 of 4 Contract Number CLH31019-Amendment 21
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount
The purpose of this statement of work is to
provide funding to the LHJ for conducting
sanitary surveys and providing technical
assistance to small community and non-
community Group A water systems.
2. Completed Small Water System
checklist.
3. Updated Water Facilities Inventory
(WFI).
4. Photos of water system with text
identifying features
5. Any other supporting documents.
*Final Reports reviewed and accepted
by the ODW Regional Office.
system with four or more connections and each
community system.
Payment is inclusive of all associated costs
such as travel, lodging, per diem.
Payment is authorized upon receipt and
acceptance of the Final Sanitary Survey Report
within the 30-day deadline.
Late or incomplete reports may not be accepted
for payment.
2 Trained LHJ staff will conduct Special
Purpose Investigations (SPI) of small
community and non-community Group A
water systems identified by the ODW
Regional Office.
See Special Instructions for task activity.
Provide completed SPI Report and any
supporting documents and photos to
ODW Regional Office.
Completed SPI Reports must
be received by the ODW
Regional Office within 2
working days of the service
request.
Upon acceptance of the completed SPI Report,
the LHJ shall be paid $800 for each SPI.
Payment is inclusive of all associated costs
such as travel, lodging, per diem.
Payment is authorized upon receipt and
acceptance of completed SPI Report within the
2-working day deadline.
Late or incomplete reports may not be accepted
for payment.
3 Trained LHJ staff will provide direct
technical assistance (TA) to small
community and non-community Group A
water systems identified by the ODW
Regional Office.
See Special Instructions for task activity.
Provide completed TA Report and any
supporting documents and photos to
ODW Regional Office.
Completed TA Report must
be received by the ODW
Regional Office within 30
calendar days of providing
technical assistance.
Upon acceptance of the completed TA Report,
the LHJ shall be paid for each technical
assistance activity as follows:
• Up to 3 hours of work: $250
• 3-6 hours of work: $500
• More than 6 hours of work: $750
Payment is inclusive of all associated costs
such as consulting fee, travel, lodging, per
diem.
Payment is authorized upon receipt and
acceptance of completed TA Report within the
30-day deadline.
Late or incomplete reports may not be accepted
for payment.
Page 13 of 18
Exhibit A, Statement of Work Page 3 of 4 Contract Number CLH31019-Amendment 21
Task
# Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount
4 LHJ staff performing the activities under
tasks 1, 2 and 3 attend periodic required
survey training as directed by DOH.
See Special Instructions for task activity.
For training attended in person, prior to
attending the training, submit an
“Authorization for Travel (Non-
Employee)” DOH Form 710-013 to the
ODW Program Contact for approval (to
ensure enough funds are available).
Annually For training attended in person, LHJ shall be
paid mileage, per diem, lodging, and
registration costs as approved on the pre-
authorization form in accordance with the
current rates listed on the OFM Website
http://www.ofm.wa.gov/resources/travel.asp
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 fede ral 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
Data Sharing
The Office of Drinking Water will share water system information and files with the local health jurisdiction to support the work identified in this statement of work. To request
water system data please contact the regional office with the name of the water system, water system ID#, specific information being requested and any timeline requirements. If
allowable, please give administrative staff 3 to 5 business days to provide records.
Program Manual, Handbook, Policy References: Field Guide (DOH Publication 331-486).
Special References:
Chapter 246-290 WAC is the set of rules that regulate Group A water systems. By this statement of work, ODW contracts with the LHJ to conduct sanitary surveys (and SPIs and
provide technical assistance) for small community and non-community water systems with groundwater sources. ODW retains responsibility for conducting sanitary surveys (and
SPIs and provide technical assistance) for small community and non-community water systems with surface water sources, large water systems, and systems with complex
treatment.
LHJ staff assigned to perform activities under tasks 1, 2, and 3 must be trained and approved by ODW prior to performing work. Se e special instructions under Task 4, below.
Special Billing Requirements
The LHJ shall submit quarterly invoices within 30 days following the end of the quarter in which work was completed, noting on the invoice the quarter and year being billed for.
Payment cannot exceed a maximum accumulative fee of $79,600 for Task 1, and $2,000 for Task 2, Task 3 and Task 4 combined during the contracting period, to be paid at the
rates specified in the Payment Method/Amount section above. When invoicing for sanitary surveys, bill half to BARS Revenue Code 346.26.64 and half to BARS Revenue Code
346.26.65.
Page 14 of 18
Exhibit A, Statement of Work Page 4 of 4 Contract Number CLH31019-Amendment 21
When invoicing for Task 1, submit the list of WS Name, ID #, Amount Billed, Survey Date and Letter Date for which you are requesting payment.
When invoicing for Task 2-3, submit the list of WS Name, ID #, TA Date and description of TA work performed, and Amount Billed.
When invoicing for Task 4, submit receipts and the signed pre-authorization form for non-employee travel to the ODW Program Contact below and a signed A19-1A Invoice
Voucher to DOH Grants Management, billing to BARS Revenue Code 346.26.66 under Technical Assistance (TA).
Special Instructions
Task 1
Trained LHJ staff will evaluate the water system for physical and operational deficiencies and prepare a Final Sanitary Surve y Report which has been accepted by ODW. Detailed
guidance is provided in the Field Guide for Sanitary Surveys, Special Purpose Investigations and Technical Assistance (Field Guide). The sanitary survey will include an
evaluation of the following eight elements: source; treatment; distribution system; finished water storage; pumps, pump facilities and controls; monitoring, reporting and data
verification; system management and operation; and certified operator compliance. If a system is more complex than anticipated or other significant issues arise, the LHJ may
request ODW assistance.
• No more than 4 surveys of non-community systems with three or fewer connections be completed between January 1, 2022 and December 31, 2022.
• No more than 29 surveys of non-community systems with four or more connections and all community systems to be completed between January 1, 202 2 and
December 31, 2022.
• No more than 0 surveys of non-community systems with three or fewer connections be completed between January 1, 2023 and December 31, 2023.
• No more than 29 surveys of non-community systems with four or more connections and all community systems to be completed between January 1, 2023 and
December 31, 2023.
• No more than 11 surveys of non-community systems with three or fewer connections be completed between January 1, 2024 and December 31, 2024.
• No more than 34 surveys of non-community systems with four or more connections and all community systems to be completed between January 1, 2024 and
December 31, 2024.
The process for assignment of surveys to the LHJ, notification of the water system, and ODW follow -up with unresponsive water systems; and other roles and responsibilities of
the LHJ are described in the Field Guide.
Task 2
Trained LHJ staff will perform Special Purpose Investigations (SPIs) as assigned by ODW. SPIs are inspections to determine th e cause of positive coliform samples or the cause of
other emergency conditions. SPIs may also include sanitary surveys of newly discovered Group A water systems. Additional detail about conducting SPIs is described in the Field
Guide. The ODW Regional Office must authorize in advance any SPI conducted by LHJ staff.
Task 3
Trained LHJ staff will conduct Technical Assistance as assigned by ODW. Technical Assistance includes assisting water system personnel in completing work or verifying work
has been addressed as required, requested, or advised by the ODW to meet applicable drinking water regulations. Examples of technical assistance activities are described in the
Field Guide. The ODW Regional Office must authorize in advance any technical assistance provided by the LHJ to a water system.
Task 4
LHJ staff assigned to perform activities under tasks 1, 2, and 3 must be trained and approved by ODW prior to performing work.
If required trainings, workshops or meetings are not available, not scheduled, or if the LHJ staff person is unable to attend these activities prior to conducting assigned tasks, the
LHJ staff person may, with ODW approval, substitute other training activities to be determined by ODW. Such substitute activi ties may include one-on-one training with ODW
staff, co-surveys with ODW staff, or other activities as arranged and pre-approved by ODW. LHJ staff may not perform the activities under tasks 1, 2, and 3 without completing
the training that has been arranged and approved by ODW.
Page 15 of 18
Exhibit A, Statement of Work Page 1 of 3 Contract Number CLH31019-Amendment 21
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) 6 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 purpsoe of this revision is to remove funds.
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
Decrease (–)
Total
Allocation
COVID19 Vaccines R4 74310259 93.268 333.93.26 01/01/22 06/30/24 354,803 -354,803 0
COVID 19 CDC Vaccines 74310236 93.268 333.93.26 01/01/22 06/30/24 354,803 -354,803 0
0 0 0
0 0 0
0 0 0
0 0 0
TOTALS 709,606 -709,606 0
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 16 of 18
Exhibit A, Statement of Work Page 2 of 3 Contract Number CLH31019-Amendment 21
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 17 of 18
Exhibit A, Statement of Work Page 3 of 3 Contract Number CLH31019-Amendment 21
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/foli os, lanyards, magnets, conference bags)
• Purchase of food/meals (unless part of required travel per diem costs)
• Vehicle Purchase
Page 18 of 18