Lewis County Health Department

LEWIS COUNTY HEALTH DEPARTMENT 2012 – 2014 CONSOLIDATED CONTRACT

CONTRACT NUMBER: C16891 AMENDMENT NUMBER: 14

PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as “DOH”, and LEWIS COUNTY HEALTH DEPARTMENT hereinafter referred to as “LHJ”, pursuant to the Modifications/Waivers clause, and to make necessary changes within the scope of this contract and any subsequent amendments thereto.

IT IS MUTUALLY AGREED: That the contract is hereby amended as follows:

1. Exhibit A Statements of Work, attached and incorporated by this reference, are amended as follows: Adds Statements of Work for the following programs:

Amends Statements of Work for the following programs:  Office of Drinking Water Group A Program - Effective January 1, 2012 Public Health Emergency Preparedness & Response (PHEPR) - Effective July 1, 2013 Deletes Statements of Work for the following programs:

2. Exhibit B-14 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-13 Allocations as follows: Increase of $13,800 for a revised maximum consideration of $2,670,221. Decrease of for a revised maximum consideration of .

No change in the maximum consideration of . Exhibit B Allocations are attached only for informational purposes.

3. Exhibit C-8 Schedule of Federal Awards, attached and incorporated by this reference, amends and replaces Exhibit C-7 .

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 HEALTH DEPARTMENT STATE OF WASHINGTON DEPARTMENT OF HEALTH

______Date Date

APPROVED AS TO FORM ONLY Assistant Attorney General

of 14 AMENDMENT #14 2012-2014 CONSOLIDATED CONTRACT EXHIBIT A STATEMENTS OF WORK TABLE OF CONTENTS

DOH Program Name or Title: Office of Drinking Water Group A Program - Effective January 1, 2012 3 DOH Program Name or Title: Public Health Emergency Preparedness & Response (PHEPR) - Effective July 1, 2013 9

Exhibit A, Statements of Work Page 2 of 14 Contract Number C16891-14 Revised as of March 17, 2014 AMENDMENT #14 Exhibit A Statement of Work Contract Term: 2012-2014

DOH Program Name or Title: Office of Drinking Water Group A Program - Local Health Jurisdiction Name: Lewis County Health Department Effective January 1, 2012 Contract Number: C16891 SOW Type: Revision Revision # (for this SOW) 5 Funding Source Federal Compliance Type of Payment Federal Vendor (if applicable) Reimbursement State ARRA (Recovery Act) Fixed Price Period of Performance: January 1, 2012 through December 31, 2014 Other FFATA (Transparency Act) 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 increase Contract Consideration, revise Due Date information, revise Special Billing Requirements and Special Instructions, and revise DOH and LHJ Roles table.

Chart of Accounts Program Name or Title CFDA # BARS Master Funding Period Current Change Total Revenue Index (LHJ Use Only) Consideration Consideration Increase (+) Code Code Start Date End Date Drinking Water Group A - SS N/A 346.26.64 2421921C 01/01/12 06/30/13 9,000 0 9,000 Drinking Water Group A - TA N/A 346.26.66 2421921D 01/01/12 06/30/13 22,000 0 22,000 Drinking Water Group A - SS N/A 346.26.64 2421921C 07/01/13 12/31/14 11,500 250 11,750 Drinking Water Group A - TA N/A 346.26.66 2421921D 07/01/13 12/31/14 15,000 2,000 17,000 TOTALS 57,500 2,250 59,750

*May Support PHIP Task Payment Information and/or Task/Activity/Description State and Local Deliverables/Outcomes Due Date/Time Frame Number Amount Standards/Measures 1 Trained LHJ staff will conduct sanitary 1. Provide inspection reports to Inspection reports due to LHJ shall be paid $250 for each surveys of small community and non- DOH Regional Office where the DOH Regional Office completed sanitary survey of a community Group A water systems the water system is located. within 30 days of non-community system with identified by DOH Office of Drinking Reports shall include: conducting the sanitary three for fewer connections Water (DOH) Regional Office. a. Cover letter. survey. (inclusive of all associated costs b. Small Water System such as consulting fee, travel, See Special Instructions for task checklist. Inspection reports with lodging, per diem). activity. c. Updated Water Facilities Significant Deficiencies or Inventory (WFI). Significant Findings are LHJ shall be paid $500 for each d. Photos of water system. due to the DOH Regional completed sanitary survey of a e. Any other supporting Office within 20 calendar non-community system with documents. days of conducting the four or more connections and sanitary survey. The each community system Exhibit A, Statements of Work Page 3 of 14 Contract Number C16891-14 Revised as of March 17, 2014 AMENDMENT #14 *May Support PHIP Task Payment Information and/or Task/Activity/Description State and Local Deliverables/Outcomes Due Date/Time Frame Number Amount Standards/Measures 2. Provide DOH Regional Regional Office will (inclusive of all associated costs Office with quarterly reports review, revise as such as consulting fee, travel, documenting deliverables. necessary, approve, and lodging, per diem). Reports shall include: return the report to the a. List of sanitary surveys LHJ within 5 calendar Payment is authorized upon conducted during the days. The LHJ will sign receipt and acceptance of quarter. and send the report to the inspection reports and b. List of uncooperative water system within 30 submittal of quarterly reports systems. days of the inspection. documenting deliverables. c. Water system identified by name, PWS ID#, Inspection reports without county, and date Significant Deficiencies or surveyed. Significnat Findings can be mailed in final form, See Special Instructions for without DOH review, deliverable timeframes. directly to the water system and DOH within 30 calendar days of the survey date.

Quarterly reports due to the DOH Regional Office within 30 days of the end of the quarter.

Quarterly periods are: Jan 1 - March 31 April 1 - June 30 July 1 – Sept 30 Oct 1 – Dec 31 2 Trained LHJ staff will provide limited 1. Provide inspection reports to Inspection reports due to LHJ shall be paid for each direct technical assistance to small DOH Regional Office where the DOH Regional Office completed task at the rate community and non-community Group the water system is located. within 30 days of specified below (inclusive of all A.A water Special systems Purpose identified Investigations by DOH (SPI) Reports shall include: providing technical associated costs): a. Summary of assistance assistance, except that B. Follow-up visit after initial technical provided, overall findings SPIs due to a coliform Task 2A: $500 assistance or sanitary survey to confirm and recommendations. exceedance incident (Task Task 2B: $500 work and recommendations were b. Any supporting 2A) must be completed and Task 2C: $750 addressed. documents and photos. the SPI report submitted to C. Assist water system operator c. Water system identified the DOH Regional Office Payment is authorized upon through one-on-one training or TA in by name, PWS ID#, within 2 working days of receipt and acceptance of completing work and recommendations county, and date the service request. inspection reports and

Exhibit A, Statements of Work Page 4 of 14 Contract Number C16891-14 Revised as of March 17, 2014 AMENDMENT #14 *May Support PHIP Task Payment Information and/or Task/Activity/Description State and Local Deliverables/Outcomes Due Date/Time Frame Number Amount Standards/Measures requested by the DOH to meet assistance provided. submittal of quarterly reports applicable drinking water regulations. 2. Provide DOH Regional Quarterly reports are due to documenting deliverables Office with quarterly reports the DOH Regional Office See Special Instructions for task documenting deliverables. within 30 days of the end activity. Reports shall include: of the quarter. a. List summarizing technical assistance Quarterly periods are: provided during the Jan 1 - March 31 quarter. April 1 - June 30 b. Water system identified July 1 – Sept 30 by name, PWS ID#, Oct 1 – Dec 31 county, and date surveyed. 3 LHJ staff performing the activities Prior to attending the training, Annually LHJ shall be paid mileage, per under tasks 1 and 2 will participate submit an “Authorization for diem, and lodging costs in annually in one or more of the Travel (Non Employee)” DOH accordance with the current following DOH-sponsored sanitary Form 710-013 to the DOH rates listed on the OFM Website surveyor trainings and/or regional Program Contact below for http://www.ofm.wa.gov/resourc DOH-LHJ meetings: approval (to ensure that enough es/travel.asp  Introductory Sanitary Survey funds are available). Training  Intermediate Sanitary Survey Training  Advanced Sanitary Survey Workshop  Regional DOH-LHJ Drinking Water meetings *For Information Only: Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a Standard/Measure. More detail on these and/or other revised Standards/Measures that may apply, can be found at: http://www.doh.wa.gov/PublicHealthandHealthcareProviders/PublicHealthSystemResourcesandServices/PublicHealthImprovementPartnershipPHIP/ResourceCatalog/Standards.aspx

Program Specific Requirements/Narrative Staffing Requirements Trained staff includes staff who have participated annually in one of the DOH-sponsored introductory, intermediate, or advanced Sanitary Surveyor trainings described under Task 3 above. Special References (RCWs, WACs, etc) Chapter 246-290 WAC is the set of rules that regulate Group A water systems. By this statement of work, DOH contracts with the LHJ to conduct sanitary surveys for small community and non-community water systems with groundwater sources. DOH retains responsibility for conducting sanitary surveys for small community and non-community water systems with surface water sources, with the option that the LHJ may request a joint survey.

Exhibit A, Statements of Work Page 5 of 14 Contract Number C16891-14 Revised as of March 17, 2014 AMENDMENT #14

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 $20,500 $20,750 for Task 1 and $37,000 $39,000 for Task 2 and Task 3 combined during the contracting period, to be pa id at the rates specified in the Payment Method/Amount section above.

When invoicing for Task 3, submit receipts and the signed pre-authorization form for non-employee travel to the DOH Program Contact below and a signed A19-1A Invoice Vouc her to the DOH Consolidated Contracts Office, billing to BARS Revenue Code 346.26.66 under Technical Assistance (TA).

Special Instructions Task 1 Upon receipt of system contact information, the LHJ will send the water system a letter notifying them of their the DOH requirement on behalf of DOH to schedule a sanitary survey. Once the survey is scheduled After the system has submitted an application and fee, tThe LHJ will evaluate conduct the survey evaluating the water system for physical and operational deficiencies and prepare a written inspection report. The inspection 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 DOH assistance.

For calendar year 2012, no more than 24 surveys to be completed. For calendar year 2013, no more than 12 surveys to be completed between 01/01/13 – 06/30/13. For calendar year 2013, no more than 14 surveys to be completed between 07/01/13 – 12/31/13.

No more than 8 surveys of non-community systems with three or fewer connections to be completed between January 1, 2014 and December 31, 2014.

No more than 12 surveys of non-community systems with four or more connections and all community systems to be completed between January 1, 2014 and December 31, 2014.

Task 2 The DOH Regional Office shall authorize in advance any technical assistance provided by the LHJ to a water system. LHJ and DOH shall mutually agree on the technical a ssistance to be provided. Technical assistance is defined below and will be paid at the rate specified in the Payment Method/Amount section above.

Task 2A: Special Purpose Investigations (SPI) are inspections to determine the cause of positive coliform samples or emergency problems or as a follow-up investigation to help small water systems address deficiencies found during a routine sanitary survey. This can also include sanitary surveys of newly discovered Group A water systems. Activities could include:  Assisting water system in preparing a coliform monitoring plan.  Educating them on the importance of monitoring and reporting.  Conducting one-on-one training on chlorinator operations and maintenance including, but not limited to, chlorine dosage solution preparation, chemical feed pump adjustments, and chlorine residual tests.  Conducting one-on-one training on flushing and disinfecting techniques of lines after repairs or new construction.  Assisting them to evaluate for potential high health cross connection hazards requiring premises isolation and determine the need for a cross connection control specialist to help them implement a cross connection control program.  Other activities as necessary to help in achieving compliance with applicable drinking water regulations and sound operations and management.

Task 2B: Follow-up visit after initial technical assistance was provided or sanitary survey was conducted to confirm work and recommendations requested by DOH were addressed or completed.

Exhibit A, Statements of Work Page 6 of 14 Contract Number C16891-14 Revised as of March 17, 2014 AMENDMENT #14 Task 2C: Assist small water systems in completing work and recommendations, as requested by the DOH Regional Office, to meet applicable drinking water regulations. Activities could include:

 Assisting water system in completing a Source Susceptibility Assessment and pursuing a susceptibility waiver, as applicable.  Assisting water system in developing a water quality monitoring, reporting and treatment technique program and conducting one-on-one training to help water system achieve compliance with applicable water quality parameters.  Assisting water system in completing a Small Water System Management Program (SWSMP) guide or Existing System Approval (ESA) for submittal to the DOH regional office.  Other activities and one-on-one training or consultation as necessary to help in achieving compliance with applicable drinking water regulations and sound operations and management.

DOH Program Contact: Denise Miles DOH Office of Drinking Water PO Box 47823 Olympia, Washington 98504-7823 [email protected] (360) 236-3028

DOH and LHJ Roles

TASK ODW LHJ Prioritize water systems to be surveyed and technical assistance to be provided during the contract period. X Notify selected systems of the sanitary survey requirement. X X Schedule survey and if needed, , request pre-survey data from ODW and print pre-survey data packet from Sentry. X Review pre-survey data prior to inspection. X Perform inspection and send draft cover letter and inspection report via email to DOH for concurrence within 30 days of X the survey date prior to sending a copy to the Purveyor. Inspection reports should include deliverables as specified above for each task. Perform inspection, write up findings and mail final report to DOH and water system  LHJ survey reports with Significant Deficiencies or Findings identified in the inspection will be sent via email to the X Regional Engineer and [email protected] for review within 20 calendar days of the survey date.  The DOH will review LHJ survey reports, revise as necessary and assign due date and return them to the LHJ to be X signed and sent to the water system within 30 days of the inspection.  LHJ survey reports with Significant Deficiencies and/or Findings will be reviewed and returned via email to the LHJ X within 5 calendar days of receipt by the DOH.  LHJ survey reports without Significant Deficiencies and/or Findings can be mailed in final form, without DOH X review, directly to the water system and DOH within 30 calendar days of the survey date.  The DOH will review surveys without Significant Deficiencies and/or Findings at the request of the LHJ. These X X reports must be sent to the [email protected] and the Regional Engineer mailbox with clear

Exhibit A, Statements of Work Page 7 of 14 Contract Number C16891-14 Revised as of March 17, 2014 AMENDMENT #14 every effort to get back to the LHJ in a timely manner, however turn-around times may vary depending on higher priority reviews. Prior to sending inspection report to purveyor, DOH will review inspection report to determine the public health X significance of any findings and (if needed) provide additional instructions and due dates to the purveyor. Draft report will be returned to LHJ via email within 5 days. All Final inspection reports to include deliverables as specified above to the purveyor and DOH within 30 calendar days X of the survey date. Send inspection reports to include deliverables as specified above to the purveyor and DOH. X When survey findings indicate a need for immediate corrective action per the Significant Deficiencies Directive X X Memorandum K.02, DOH or, if requested, the LHJ will follow-up with the system to ensure the Significant deficiencies and/or Findings have been corrected through Technical Assistance. If necessary, DOH will develop a compliance strategy. Formal enforcement could include: A Bilateral Compliance Agreement (BCA), Departmental Order (DO), or State Health Order (SHO). If the Purveyor is uncooperative and refuses the survey, LHJ will notify DOH by including the non responsive system X information in the 1st quarterly report. DOH will send a violation letter reminding the system of their survey requirement. X If the Purveyor is still uncooperative and refuses the survey, LHJ will notify DOH by including the non responsive system X information in the 2nd quarterly report. DOH will issue a Notice of Violation (NOV) with an offer for a Bilateral Compliance Agreement (BCA) to the non- X responsive system. DOH will invoice water system upon completion of inspection (unless LHJ collects local fees) X Submit quarterly report and A-19 1A invoice to DOH for payment. X Perform joint quality control surveys with DOH upon request. X X Annually review and confirm work completed; schedule new assignments; re-negotiate contract and discuss concerns or X X provide feedback on the program and process.

Exhibit A, Statements of Work Page 8 of 14 Contract Number C16891-14 Revised as of March 17, 2014 AMENDMENT #14 Exhibit A Statement of Work Contract Term: 2012-2014

DOH Program Name or Title: Public Health Emergency Preparedness & Response Local Health Jurisdiction Name: Lewis County Health Department (PHEPR) - Effective July 1, 2013 Contract Number: C16891 SOW Type: Revision Revision # (for this SOW) 2 Funding Source Federal Compliance Type of Payment Federal Subrecipient (if applicable) Reimbursement State ARRA (Recovery Act) Fixed Price Period of Performance: July 1, 2013 through June 30, 2014 Other FFATA (Transparency Act) Statement of Work Purpose: The purpose of this statement of work is to establish the funding and tasks for the Public Health Emergency Preparedness and Response program for the 2013 - 2014 grant period.

Revision Purpose: The purpose of this revison is to add HPP funding to allow the LHJ to provide preparedness training and educational opportunities to staff and partners and to add PHEP funding to reconfigure two 10-foot enclosed cargo trailers to store emergency response equipment and supplies. Chart of Accounts Program Name or Title CFDA # BARS Master Funding Period Current Change Total Revenue Index (LHJ Use Only) Consideration Consideration Increase (+) Code Code Start Date End Date FFY13 PHEPR LHJ FUNDING 93.069 333.93.06 18101430 07/01/13 06/30/14 82,417 0 82,417 FFY13 PHEPR HC SYSTEMS - PREP 93.889 333.93.88 61301101 07/01/13 06/30/14 0 5,000 5,000 FFY13 PHEPR PLANNING & EXERCISES 93.069 333.93.06 18101340 07/01/13 06/30/14 0 6,550 6,550 TOTALS 82,417 11,550 93,967

Payment Task *May Support PHAB Task/Activity/Description Deliverables/Outcomes Due Date/Time Frame Information and/or Number Standards/Measures Amount

FFY13 PHEPR HC SYSTEMS – PREP (HPP)

HPP 1 Provide preparedness training and Submit year-end progress report 06/30/14 Reimbursement for educational opportunities to staff and summarizing activities. costs, not to exceed partners. total funding consideration amount.

FFY13 PHEPR LHJ FUNDING (PHEP)

Admin 1 Complete reporting templates to comply with Submit completed templates. As required Reimbursement for federal grant requirements (e.g., performance costs, not to exceed measures, gap analysis, etc.) total funding Admin 2 Develop work plan for the 2014-2015 grant Submit completed work plan. 03/14/14 consideration amount. cycle. Exhibit A, Statements of Work Page 9 of 14 Contract Number C16891-14 Revised as of March 17, 2014 AMENDMENT #14 Payment Task *May Support PHAB Task/Activity/Description Deliverables/Outcomes Due Date/Time Frame Information and/or Number Standards/Measures Amount Admin 3 Complete mid-year and end-of-year reporting Submit completed reporting 12/20/13 and 06/30/14 templates. templates. 1.1 Engage local subject matter experts for input Submit mid-year and year-end 12/20/13 and 06/30/14 into all-hazards jurisdictional risk assessment. progress reports summarizing activities. 1.2 Research historic jurisdictional occurrences of Submit mid-year and year-end 12/20/13 and 06/30/14 health risks. progress reports summarizing activities. 1.3 Develop appendix that itemizes and Submit mid-year and year-end 12/20/13 and 06/30/14 categorizes potential risks by likelihood and progress reports summarizing severity. activities. 1.4 Meet with jurisdictional partners. Submit mid-year and year-end 12/20/13 and 06/30/14 progress reports summarizing activities. 1.5 Research best practices. Submit mid-year and year-end 12/20/13 and 06/30/14 progress reports summarizing activities. 1.6 Draft menu of available services and how Submit mid-year and year-end 12/20/13 and 06/30/14 jurisdictional partners can access them. progress reports summarizing activities. 1.7 Share menu with jurisdictional partners. Submit mid-year and year-end 12/20/13 and 06/30/14 progress reports summarizing activities. 1.8 Identify potential sites for both open and Submit mid-year and year-end 12/20/13 and 06/30/14 closed points of dispensing (PODs). progress reports summarizing activities. 1.9 Solicit owners/operators of potential sites to Submit mid-year and year-end 12/20/13 and 06/30/14 consider becoming an open or closed point of progress reports summarizing dispensing (POD); or possibly both if they activities. have sufficient facilities available. 1.10 Research for best practices and materials Submit mid-year and year-end 12/20/13 and 06/30/14 needed by point of dispensing (POD) progress reports summarizing operators. activities. 1.11 Develop point of dispensing (POD) Operator Submit mid-year and year-end 12/20/13 and 06/30/14 Toolkit. progress reports summarizing activities. 1.12 Work with point of dispensing (POD) Submit mid-year and year-end 12/20/13 and 06/30/14 operators to develop site-specific plans for progress reports summarizing their POD(s). activities. 1.13 Develop Distribution Annex including Submit mid-year and year-end 12/20/13 and 06/30/14 security functions for medication storage and progress reports summarizing distribution to open and closed points of activities. Exhibit A, Statements of Work Page 10 of 14 Contract Number C16891-14 Revised as of March 17, 2014 AMENDMENT #14 Payment Task *May Support PHAB Task/Activity/Description Deliverables/Outcomes Due Date/Time Frame Information and/or Number Standards/Measures Amount distribution (PODS). 1.14 Conduct table-top or higher exercise using Submit mid-year and year-end 12/20/13 and 06/30/14 Local Health Jurisdictions (LHJs) Mass progress reports summarizing Dispensing Plan, point of distribution (POD) activities. toolkit contents, and Distribution Annex. 1.15 Revise Local Health Jurisdiction (LHJ) Mass Submit mid-year and year-end 12/20/13 and 06/30/14 Dispensing Plan and points of distribution progress reports summarizing (POD) toolkit materials based on the after- activities. action-report and improvement plan. Distribute new toolkits to POD operators. 1.16 Distribute updated Mass Dispensing Plan and Submit mid-year and year-end 12/20/13 and 06/30/14 point of distribution (POD) toolkit materials progress reports summarizing as needed. activities. 1.17 Identify sources of medical professionals Submit mid-year and year-end 12/20/13 and 06/30/14 potentially available for Medical Reserve progress reports summarizing Corp (MRC) participation. activities. 1.18 Develop recruiting Playbook to include media Submit mid-year and year-end 12/20/13 and 06/30/14 and person-to-person outreach. progress reports summarizing activities. 1.19 Execute recruiting Playbook. Submit mid-year and year-end 12/20/13 and 06/30/14 progress reports summarizing activities. 1.20 Build training curriculum using the Center for Submit mid-year and year-end 12/20/13 and 06/30/14 Disease’s (CDC) suggested resources. progress reports summarizing activities. 1.21 Selected individuals to undergo training. Submit mid-year and year-end 12/20/13 and 06/30/14 progress reports summarizing activities. 1.22 Consult with local emergency agency leaders Submit mid-year and year-end 12/20/13 and 06/30/14 to determine roles Medical Reserve Corps progress reports summarizing (MRC) could fill in their emergency activities. operations. 1.23 Research best practices on how to use Medical Submit mid-year and year-end 12/20/13 and 06/30/14 Reserve Corps (MRC) members in these roles. progress reports summarizing activities. 1.24 Develop Playbook for deploying Medical Submit mid-year and year-end 12/20/13 and 06/30/14 Reserve Corps (MRC) members at the request progress reports summarizing of local emergency agencies. activities. 1.25 Research best practices; create public Submit mid-year and year-end 12/20/13 and 06/30/14 preparedness information. progress reports summarizing activities.

Exhibit A, Statements of Work Page 11 of 14 Contract Number C16891-14 Revised as of March 17, 2014 AMENDMENT #14 Payment Task *May Support PHAB Task/Activity/Description Deliverables/Outcomes Due Date/Time Frame Information and/or Number Standards/Measures Amount 1.26 Develop training for Medical Reserve Corps Submit mid-year and year-end 12/20/13 and 06/30/14 (MRC) members to engage the public. progress reports summarizing activities. 1.27 Conduct 2 training events with Medical Submit mid-year and year-end 12/20/13 and 06/30/14 Reserve Corps (MRC) members. progress reports summarizing activities. 1.28 Deploy Medical Reserve Corps (MRC) Submit mid-year and year-end 12/20/13 and 06/30/14 members to community events. progress reports summarizing activities. 3.1 Configure two 10-foot enclosed cargo trailers Submit year-end progress reports 06/30/14 to store emergency response equipment and summarizing activities. supplies and to make it usable as a mobile command center. 10.1 Identify staff to work in emergency operations Submit mid-year and year-end 12/20/13 and 06/30/14 center at agency and local levels. progress reports summarizing activities. 10.2 Ensure designated staff members are trained Submit mid-year and year-end 12/20/13 and 06/30/14 to Center for Disease Control (CDC) progress reports summarizing guidelines for potential assignments. activities. 10.3 Review call-out procedures to ensure local Submit mid-year and year-end 12/20/13 and 06/30/14 health is ready to respond as necessary. progress reports summarizing activities. 10.4 Research the Washington State Emergency Submit mid-year and year-end 12/20/13 and 06/30/14 Registry of Volunteers (WAServ) capabilities progress reports summarizing for accessing and coordinating volunteers. activities. 10.5 Assess administrator’s duties and capabilities Submit mid-year and year-end 12/20/13 and 06/30/14 within the Washington State Emergency progress reports summarizing Registry of Volunteers (WAServ). activities. 10.6 Review/update Medical Reserve Corp (MRC) Submit mid-year and year-end 12/20/13 and 06/30/14 application process using the Washington progress reports summarizing State Emergency Registry of Volunteers activities. (WAServ). 10.7 Itemize current Medical Reserve Corp (MRC) Submit mid-year and year-end 12/20/13 and 06/30/14 unit membership by specialty. progress reports summarizing activities. 10.8 Ascertain from local healthcare providers Submit mid-year and year-end 12/20/13 and 06/30/14 which medical specialties would be most progress reports summarizing needed in the event of a disaster. activities. 10.9 Include targeting these specialties in the Submit mid-year and year-end 12/20/13 and 06/30/14 Medical Reserve Corp (MRC) Recruiting progress reports summarizing Playbook. (See Capability 1, Function 2, activities. Priority 2) Exhibit A, Statements of Work Page 12 of 14 Contract Number C16891-14 Revised as of March 17, 2014 AMENDMENT #14 Payment Task *May Support PHAB Task/Activity/Description Deliverables/Outcomes Due Date/Time Frame Information and/or Number Standards/Measures Amount 10.10 Recruit Medical Reserve Corp (MRC) Submit mid-year and year-end 12/20/13 and 06/30/14 members to fill these specialties needs. progress reports summarizing activities. 10.11 Assess means of creating a call center at Submit mid-year and year-end 12/20/13 and 06/30/14 Lewis County Public Health and Social progress reports summarizing Services (LCPHSS). activities. 10.12 Develop training on call center operations. Submit mid-year and year-end 12/20/13 and 06/30/14 progress reports summarizing activities. 10.13 Identify staff and volunteer candidates for Submit mid-year and year-end 12/20/13 and 06/30/14 staffing the call center. progress reports summarizing activities. 10.14 Create Playbook for standing up the Lewis Submit mid-year and year-end 12/20/13 and 06/30/14 County Public Health and Social Services progress reports summarizing (LCPHSS) call center. activities. 10.15 Train identified staff and volunteers to open Submit mid-year and year-end 12/20/13 and 06/30/14 and operate call center. progress reports summarizing activities. 10.16 Assess local populations’ informational Submit mid-year and year-end 12/20/13 and 06/30/14 challenges progress reports summarizing activities. 10.17 Develop background information on topics Submit mid-year and year-end 12/20/13 and 06/30/14 covering risks identified in Local Health progress reports summarizing Jurisdiction (LHJ) risk assessment. activities. 10.18 Create topical information ready for just-in- Submit mid-year and year-end 12/20/13 and 06/30/14 time printing in predominant local languages progress reports summarizing and distribution via website, social media and activities. mass media.

*For Information Only: Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a Standard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at: http://www.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf

Program Specific Requirements/Narrative

Special Requirements: 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.

Exhibit A, Statements of Work Page 13 of 14 Contract Number C16891-14 Revised as of March 17, 2014 AMENDMENT #14

To comply with this act and be eligible to perform the activities in this statement of work, the LHJ must have a Data Universal Numbering System (DUNS®) number.

Information about the LHJ and this statement of work will be made available on http://USASpending.gov by DOH as required by P.L. 109-282.

DOH Program Contact Brad Halstead, Finance Analyst Department of Health PO Box 47890, Olympia, WA 98504-7890 [email protected] PHEPR Deliverable Submission: [email protected] 360-236-4054

Exhibit A, Statements of Work Page 14 of 14 Contract Number C16891-14 Revised as of March 17, 2014