Approve consolidated contract #CLH31017 Amendment 6 between Lewis County and WA State DOH LEWIS COUNTY PUBLIC HEALTH&SOCIAL SERVICES DEPARTMENT
2022-2024 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH31017 AMENDMENT NUMBER: 6
PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as
"DOH",and LEWIS COUNTY PUBLIC HEALTH&SOCIAL SERVICES DEPARTMENT,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-ofsfundi ngresources/sitepages/home.aspx?=e 1:9a94688da2d94d3 ea80ac7fbc32e4d7c
❑ Adds Statements of Work for the following programs:
Foundational Public Health Services(FPHS)-Effective July 1,2022
❑ Amends Statements of Work for the following programs:
❑ Deletes Statements of Work for the following programs:
2. Exhibit B-6 Allocations,attached and incorporated by this reference,amends and replaces Exhibit B-5 Allocations as
follows:
® Increase of$1,401,000 for a revised maximum consideration of$5,218,637.
❑ 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.
LEWIS COUNTY PUBLIC HEALTH&SOCIAL SERVICES STATE OF WASHINGTON
DEPARTMENT DEPARTMENT OF HEALTH
Signature: Signature:
x�.N..du-•-y. '9.°!tdirikt
Date: Date:
Sep 7,2022 Sep 12,2022
APPROVED AS TO FORM ONLY
Assistant Attorney General
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EXHIBIT B-6
Lewis County Public Health&Social Services Department ALLOCATIONS Contract Number: CLH31017
Contract Term:2022-2024 Date: July 1,2022
Indirect Rate January I,2022 through December 31,2022:22.48%
DOH Use Only
BARS Statement of Work Chart of Accounts Funding Chart of
Federal Award Assist Revenue LHJ Funding Period Funding Period Period Accounts
Chart of Accounts Program Title Identification# Amend# List#* Code** Start Date End Date Start Date End Date Amount SubTotal Total
FFY22 USDA BFPC Prog Mgmt NGA Not Received Amd 5 10.557 333.10.55 01/01/22 09/30/22 10/01/21 09/30/22 $1,793 $45,471 $45,471
FFY22 USDA BFPC Prog Mgmt NGA Not Received Amd 2 10.557 333.10.55 01/01/22 09/30/22 10/01/21 09/30/22 $4,487
FFY22 USDA BFPC Prog Mgmt NGA Not Received Amd 1 10.557 333.10.55 01/01/22 09/30/22 10/01/21 09/30/22 S39,191
FFY23 USDA WIC Client Svs Contracts NGA Not Received Amd 1 10.557 333.10.55 10/01/22 09/30/23 10/01/22 09/30/23 $107,650 $107,650 $466,433
FFY22 USDA WIC Client Svs Contracts 202222W100347 Amd 5 10.557 333.10.55 01/01/22 09/30/22 10/01/21 09/30/22 $33,383 $358,783
FFY22 USDA WIC Client Svs Contracts 202222W100347 Amd I 10.557 333.10.55 01/01/22 09/30/22 10/01/21 09/30/22 $325,400
FFY22 USDA FMNP Prog Mgmt NGA Not Received Amd 4 10.572 333.10.57 05/01/22 09/30/22 10/01/21 09/30/22 $817 $817 $817
FFY22 IAR SNAP Ed Prog Mgnt-Region 5 207WAWA5Q3903 Amd 4 10.561 333.10.56 01/01/22 09/30/22 10/01/21 09/30/22 $33,907 $72,413 $72,413
FFY22 IAR SNAP Ed Prog Mgnt-Region 5 207WAWA5Q3903 Amd 1 10.561 333.10.56 01/01/22 09/30/22 10/01/21 09/30/22 $38,506
FFY21 PHEP BP3 LHJ Funding NU901P922043 Amd 2 93.069 333.93.06 01/01/22 06/30/22 07/01/21 06/30/22 $24,495 $24,495 $24,495
COVID19 Vaccines NH231P922619 Amd 4 93.268 333.93.26 01/01/22 06/30/24 07/01/20 06/30/24 $244,399 $244,399 $244,399
COVID19 Vaccines R4 NH231P922619 Auld I 93.268 333.93.26 01/01/22 06/30/24 07/01/20 06/30/24 $362,090 $362,090 $362,090
FFY22 PPHF Ops NH231P922619 Amd 3 93.268 333.93.26 01/01/22 06/30/22 07/01/21 06/30/22 $500 $500 $500
FFY22 VFC IQIP N11231P922619 Amd 3 93.268 333.93.26 01/01/22 06/30/22 07/01/21 06/30/22 $33,335 $33,335 $33,335
FFY23 VFC Ops NGA Not Received Amd 5 93.268 333.93.26 07/01/22 06/30/23 07/01/22 06/30/23 $5,715 $5,715 $14,834
FFY22 VFC Ops NH231P922619 Amd 3 93.268 333.93.26 01/01/22 06/30/22 07/01/21 06/30/22 $3,404 $9,119
FFY22 VFC Ops NH231P922619 Amd 2 93.268 333.93.26 01/01/22 06/30/22 07/01/21 06/30/22 $5,715
FFYI9COVIDCARES NU5OCK000515 Amd2 93.323 333.93.32 01/01/22 04/22/22 04/23/20 07/31/24 $12,420 $12,420 $12,420
FFY19 ELC COVID Ed LHJ Allocation NU5OCK000515 Amd 5 93.323 333.93.32 01/01/22 10/18/22 05/19/20 10/18/22 $588 $588 $588
FFY19 ELC COVID Ed LHJ Allocation NU5OCK000515 Amd 4 93.323 333.93.32 01/01/22 10/18/22 05/19/20 10/18/22 ($138,413) $0
FFY19 ELC COVID Ed LHJ Allocation NU5OCK000515 Amd 2 93.323 333.93.32 01/01/22 10/18/22 05/19/20 10/18/22 $138,413
FFY20 ELC EDE LHJ Allocation NU5OCK000515 Amd 5 93.323 333.93.32 01/01/22 12/31/22 01/15/21 07/31/24 $3,906 $985,099 $985,099
FFY20 ELC EDE LHJ Allocation NU5OCK000515 Amd 4 93.323 333.93.32 01/01/22 12/31/22 01/15/21 07/31/24 ($199,903)
FFY20 ELC EDE LHJ Allocation NU5OCK000515 Amd 2 93.323 333.93.32 01/01/22 12/31/22 01/15/21 07/31/24 $1,181,096
FFY22 MCHBG LHJ Contracts B0445251 Amd 4 93.994 333.93.99 01/01/22 09/30/22 10/01/21 09/30/22 $1,703 $64,866 $64,866
FFY22 MCHBG LHJ Contracts B0445251 Amd 1 93.994 333.93.99 01/01/22 09/30/22 10/01/21 09/30/22 $63,163
Page 1 of 2
EXHIBIT B-6
Lewis County Public Health&Social Services Department ALLOCATIONS Contract Number: CLH31017
Contract Term:2022-2024 Date: July 1,2022
Indirect Rate January 1,2022 through December 31,2022:22.48%
DOH Use Only
BARS Statement of Work Chart of Accounts Funding Chart of
Federal Award Assist Revenue LHJ Funding Period Funding Period Period Accounts
Chart of Accounts Program Title Identification# Amend# List#* Code** Start Date End Date Start Date End Date Amount SubTotal Total
GFS-Group B(FO-SW) Amd 1 N/A 334.04.90 01/01/22 06/30/22 07/01/21 06/30/22 $25,877 $25,877 $25,877
FPHS-LHJ-Proviso(YR2) Amd 6 N/A 336.04.25 07/01/22 06/30/23 07/01/21 06/30/23 $1,401,000 $1,401,000 $2,855,000
FPHS-LHJ-Proviso(YR2) Amd 1 N/A 336.04.25 07/01/22 06/30/23 07/01/21 06/30/23 $727,000 $727,000
FPHS-LHJ-Proviso(YR1) Amd 1 N/A 336.04.25 01/01/22 06/30/22 07/01/21 06/30/23 $727,000 $727,000
YR24 SRF-Local Asst(15%)(FO-SW)SS Amd I N/A 346.26.64 01/01/22 12/31/22 07/01/21 06/30/23 $8,000 $8,000 $8,000
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 $2,000 $2,000 $2,000
TOTAL $5,218,637 S5,218,637
Total consideration: $3,817,637 GRAND TOTAL $5,218,637
$1,401,000
GRAND TOTAL $5,218,637 Total Fed S2,327,760
Total State $2,890,877
*Catalog of Federal Domestic Assistance
**Federal revenue codes begin with"333". State revenue codes begin with"334".
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