Common use of Population(s Clause in Contracts

Population(s. served by this location (select all that apply) General pediatric population General adult population Adults 65 years of age and older Long-term care facility residents (nursing home, assisted living, or independent living facility) Health care workers Critical infrastructure/essential workers (e.g., education, law enforcement, food/agricultural workers, fire services) Military – active duty/reserves Military – veteran People experiencing homelessness Pregnant women Racial and ethnic minority groups Tribal communities People who are incarcerated/detained People living in rural communities People who are underinsured or uninsured People with disabilities People with underlying medical conditions* that are risk factors for severe COVID-19 illness Other people at higher risk for COVID-19 (Specify: ) Does your organization currently report vaccine administration data to the state, local, or territorial immunization information system (IIS)? [List IIS Identifier: ] If YES If NOT, please explain planned method for reporting vaccine administration data to the jurisdiction’s IIS or other designated system as required: If NOT APPLICABLE, please explain: Estimated number of 10-dose multidose vials (MDVs) your location is able to store during peak vaccination periods (e.g., during back-to-school, influenza season) at the following temperatures: Refrigerated (2°C to 8°C): No capacity OR Approximately additional 10-dose MDVs Frozen (-15°C to -25°C): No capacity OR Approximately additional 10-dose MDVs Ultra-frozen (-60°C to -80°C): No capacity OR Approximately additional 10-dose MDVs Storage unit details for this location

Population(s. served by this location (select all that apply) General pediatric population General adult population Adults 65 years of age and older Long-term care facility residents (nursing home, assisted living, or independent living facility) Health care workers Critical infrastructure/essential workers (e.g., education, law enforcement, food/agricultural workers, fire services) Military – active duty/reserves Military – veteran People experiencing homelessness Pregnant women Racial and ethnic minority groups Tribal communities People who are incarcerated/detained People living in rural communities People who are underinsured or uninsured People with disabilities People with underlying medical conditions* that are risk factors for severe COVID-19 illness Other people at higher risk for COVID-19 (Specify: ) Does your organization currently report vaccine administration data to the state, local, or territorial immunization information system (IIS)? [List IIS Identifier: ] If YES If NOT, please explain planned method for reporting vaccine administration data to the jurisdiction’s IIS or other designated system as required: If NOT APPLICABLE, please explain: Estimated number of 10-dose multidose vials (MDVs) your location is able to store during peak vaccination periods (e.g., during back-to-school, school or influenza season) at the following temperatures: Refrigerated (2°C to 8°C): No capacity OR Approximately additional 10-dose MDVs Frozen (-15°C to -25°C): No capacity OR Approximately additional 10-dose MDVs Ultra-frozen (-60°C to -80°C): No capacity OR Approximately additional 10-dose MDVs Storage unit details for this location

Population(s. served by this location (select all that apply) General pediatric population General adult population Adults 65 years of age and older Long-term care facility residents (nursing home, assisted living, or independent living facility) Health care workers Critical infrastructure/essential workers (e.g., education, law enforcement, food/agricultural workers, fire services) Military – active duty/reserves Military – veteran People experiencing homelessness Pregnant women Racial and ethnic minority groups Tribal communities People who are incarcerated/detained People living in rural communities People who are underinsured or uninsured People with disabilities People with underlying medical conditions* that are risk factors for severe COVID-19 illness Other people at higher risk for COVID-19 (Specify: ) Does your organization currently report vaccine administration data to the state, local, or territorial immunization information system (IIS)? [List IIS Identifier: ] If YES If NOT, please explain planned method for reporting vaccine administration data to the jurisdiction’s IIS or other designated system as required: Data will be entered in the NHIIS after required training and creation of clinic location. If NOT APPLICABLE, please explain: Estimated number of 10-dose multidose vials (MDVs) your location is able to store during peak vaccination periods (e.g., during back-to-school, school or influenza season) at the following temperatures: Refrigerated (2°C to 8°C): No capacity OR Approximately additional 10-dose MDVs Frozen (-15°C to -25°C): No capacity OR Approximately additional 10-dose MDVs Ultra-frozen (-60°C to -80°C): No capacity OR Approximately additional 10-dose MDVs Storage unit details for this location

Population(s. served by this location (select all that apply) General pediatric population General adult population Adults 65 years of age and older Long-term care facility residents (nursing home, assisted living, or independent living facility) Health care workers Critical infrastructure/essential workers (e.g., education, law enforcement, food/agricultural workers, fire services) Military – active duty/reserves Military – veteran People experiencing homelessness Pregnant women Racial and ethnic minority groups Tribal communities People who are incarcerated/detained People living in rural communities People who are underinsured or uninsured People with disabilities People with underlying medical conditions* that are risk factors for severe COVID-19 illness Other people at higher risk for COVID-19 (Specify: ) Does your organization currently report vaccine administration data to the state, local, or territorial immunization information system (IIS)? [List IIS Identifier: ] If YES If NOT, please explain planned method for reporting vaccine administration data to the jurisdiction’s IIS or other designated system as required: If NOT APPLICABLE, please explain: NA - NH Does not currently have an IIS Estimated number of 10-dose multidose vials (MDVs) your location is able to store during peak vaccination periods (e.g., during back-to-school, school or influenza season) at the following temperatures: Refrigerated (2°C to 8°C): No capacity OR Approximately additional 10-dose MDVs Frozen (-15°C to -25°C): No capacity OR Approximately additional 10-dose MDVs Ultra-frozen (-60°C to -80°C): No capacity OR Approximately additional 10-dose MDVs Storage unit details for this location