Program Specific Requirements. The outcome of this performance-based grant is safe, affordable, and stable housing for the clients of the HOPWA Program. LHJ shall provide the following inputs: • Staff who provide services described in this Statement of Work (SOW)
Program Specific Requirements. 1 . A year of high school algebra and geometry with a letter grade of “C” or better.
Program Specific Requirements. General Representations. The Grantee represents and warrants to, and agrees with XXXX, as of the date hereof as follows:
Program Specific Requirements. None- As the instructor, I am recommending that this student receive college credit per this agreement. ( ) Student’s Name (Please Print) Home Telephone Number [ ] Xxxxx-Xxxxxx Community High School Address [ ] Xxxx Xxxxx High School [ [ ] ] Crystal Lake Central High School Crystal Lake South High School [ ] Harvard Community High School City State Zip [ [ ] ] Xxxxxxx Community High School Johnsburg High School Graduation Year Birthdate / / [ ] Marengo Community High School [ ] XxXxxxx East High School DIRECTIONS: Make 2 Copies. Check Box for Appropriate Individual. Distribute to Appropriate Individual. [ ] Student Copy [ ] High School Copy Mail original to: Credentials Evaluation Office (A258H) XxXxxxx County College 0000 XX Xxxxxxx 00 Xxxxxxx Xxxx, XX 00000 [ ] XxXxxxx West High School [ ] Prairie Ridge High School
Program Specific Requirements. This section is for program specific information not included elsewhere. In SOWs where more than one project is listed, each requirement must be identified by MI Code. Exhibit A Statement of Work Contract Term: 2022-2024 DOH Program Name or Title: OI-Promotion of Immunizations to Improve Vaccination Rates - Effective July 1, 2022 Local Health Jurisdiction Name: Snohomish Health District Contract Number: CLH31027 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: July 1, 2022 through June 30, 2023 Statement of Work Purpose: The purpose of this statement of work is to contract with local health to conduct activities to improve immunization coverage rates. Revision Purpose: N/A DOH Chart of Accounts Master Index Title Master Index Code Assistance Listing Number BARS Revenue Code LHJ Funding Period Start Date End Date Current Allocation Allocation Change Increase (+) Total Allocation TOTALS 0 45,150 45,150 Task # Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount
Program Specific Requirements. Tasks in this statement of work may not be subcontracted without prior written approval from the Office of Immunization. Exhibit A Statement of Work Contract Term: 2022-2024 DOH Program Name or Title: Zoonotic Disease Program - WNV Mosquito Surveillance - Effective June 1, 2022 Local Health Jurisdiction Name: Snohomish Health District Contract Number: CLH31027 SOW Type: Original Revision # (for this SOW) 0 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: June 1, 2022 through September 30, 2022 Statement of Work Purpose: The purpose of this statement of work is for Snohomish Health District to conduct weekly mosquito surveillance for West Nile virus (WNV) in Snohomish County during mosquito season, June through September. The detection of the virus in mosquito populations serves as an early warning of disease risk in the localized area. It alerts the local health department to strengthen educational outreach and mosquito control to minimize the health impact of mosquito-borne disease on communities. In addition, data generated by surveillance advances our understanding of the emergence and spread of vector mosquitoes and pathogens in western Washington. Revision Purpose: N/A DOH Chart of Accounts Master Index Title Master Index Code Assistance Listing Number BARS Revenue Code LHJ Funding Period Start Date End Date Current Allocation Allocation Change Increase (+) Total Allocation FFY21 Vector-borne T2&3 Epi ELC FPH 1882121B 93.323 333.93.32 06/01/22 07/31/22 0 1,500 1,500 TOTALS 0 3,000 3,000 Task # Activity Deliverables/Outcomes Due Date/Time Frame Payment Information and/or Amount 1 Conduct weekly mosquito trapping at two (2) site locations in Snohomish County. Purchase of dry ice, as needed Set and collect traps Record field data on DOH-provided reporting forms, including zero catch information. Submit two weekly collections of mosquitoes along with complete corresponding data on reporting forms for trapping events to DOH. Should no mosquitoes be collected during a trapping event, the data reporting form documenting the effort is to be emailed to the DOH Program contact. Weekly by Thursday during mosquito season, June through September Reimbursement up to $3,000 (including staff time, transportation, and costs related to mosquito surveillance activities) DOH Program and Fiscal Contact Information for all...
Program Specific Requirements. All work will be performed in accordance with the revised and approved project plans to be submitted to DOH. Restrictions on Funds (what funds can be used for which activities, not direct payments, etc) CDC Funding Regulations and Policies xxxxx://xxx.xxx.xxx/grants/documents/General-Terms-and-Conditions-Non-Research-Awards.pdf Monitoring Visits (frequency, type) The DOH program contact may conduct monitoring visits during the life of this project. The type, duration, and timing of visit will be determined and scheduled in cooperation with the subawardee. The DOH Fiscal Monitoring Unit may conduct fiscal monitoring site visits during the life of this project Special Billing Requirements:
Program Specific Requirements. All work will be performed in accordance with the revised and approved project plans to be submitted to DOH. Restrictions on Funds (what funds can be used for which activities, not direct payments, etc) CDC Funding Regulations and Policies xxxxx://xxx.xxx.xxx/grants/documents/General-Terms-and-Conditions-Non-Research-Awards.pdf Monitoring Visits (frequency, type) The DOH program contact may conduct monitoring visits during the life of this project. The type, duration, and timing of visit will be determined and scheduled in cooperation with the subawardee. The DOH Fiscal Monitoring Unit may conduct fiscal monitoring site visits during the life of this project Special Billing Requirements Payment: Upon approval of deliverables and receipt of an invoice voucher, DOH will reimburse for actual allowable costs incurred. Billings for services on a monthly fraction of the budget will not be accepted or approved.
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. See 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 $32,750 $43,500 for Task 1, and $3,000 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 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 Survey Report which has been accepted by ODW. Detailed guidance is provided in the Field Guide for Sanitary Surv...
Program Specific Requirements. The Network Service Provider shall incorporate any additional program-specific funds appropriated by the Legislature or contracted for Behavioral Health Services. Any increases shall be documented through an amendment to this contract, resulting in a current fiscal year funding and corresponding service increase. Such increase in services must be supported by additional deliverables as outlined in the amendment. The Network Service Provider shall adhere to the Exhibits and Incorporated Documents for program specific funds as outlined in Appendix A of this contract. All Exhibits and Incorporated Documents can be found on the LSF Health Systems website: xxxxx://xxx.xxxxxxxxxxxxxxxx.xxx/contract-documents/. Appendix B outlines all of the exemptions pertaining to this contract. Appendix C outlines all special attachments, beyond Attachment IV, pertaining to this contract. Appendix D outlines all negotiated performance measure targets pertaining to this contract. DocuSign Envelope ID: 40823FC9-1D7C-4C3C-9BE5-D966B322BFF3 ATTACHMENT III The administration of resources awarded by the Department of Children and Families to the Managing Entity to the Network Service Provider may be subject to audits as described in this attachment.
