2015-2017 CONSOLIDATED CONTRACT

ACTIVITY TRACKING LOG

LOCAL HEALTH JURISDICTION:Pacific County Health & Human Services Department

Contract # C17121

ContractActivity/Description / Amendment
Number / Date Sent
to LHJ / Exhibit A Statement of Work Program Name or Title / Date
Fully Executed
Amendment
Final / 15 / 10/31/17 / FPHS Communicable Disease & Support Capabilities – Effective July 1, 2017 (Rev.1)
Maternal & Child Health Block Grant – Effective January 1, 2015 (Rev.5)
Suicide Prevention Works! – Effective January 1, 2016 (Rev.3) / 11/06/17
Amendment / 14 / 09/12/17 / Emergency Preparedness & Response – Effective July 1, 2017 (New)
FPHS Communicable Disease & Support Capabilities – Effective July 1, 2017 (New)
Supplemental Nutrition Assistance Program-Education – Effective October 1, 2017 (New)
WIC Nutrition Program – Effective January 1, 2015 (Rev.10) / 09/29/17
Amendment / 13 / 07/10/17 / Office of Immunization & Child Profile – Effective January 1, 2017 (Rev.2)
Recreational Shellfish Activities – Effective July 1, 2017 (New) / 09/27/17
Amendment / 12 / 05/07/17 / Office of Immunization & Child Profile – Effective January 1, 2017 (Rev.1)
WIC Nutrition Program – Effective January 1, 2015 (Rev.9) / 05/15/17
Amendment / 11 / 03/01/017 / WIC Nutrition Program – Effective January 1, 2015 (Rev.8) / 03/28/17
Amendment / 10 / 12/23/16 / Family Planning – Effective January 1, 2016 (Rev.1)
Maternal & Child Health Block Grant – Effective January 1, 2015 (Rev.4)
Office of Immunization & Child Profile – Effective January 1, 2017 (New)
Suicide Prevention Works! – Effective January 1, 2016 (Rev.2)
WIC Nutrition Program – Effective January 1, 2015 (Rev.7) / 02/07/17
Amendment / 9 / 08/31/16 / Emergency Preparedness & Response – Effective July 1, 2016 (New)
Maternal & Child Health Block Grant – Effective January 1, 2015 (Rev.3)
Supplemental Nutrition Assistance Program-Education – Effective October 1, 2016 (New)
WIC Nutrition Program – Effective January 1, 2015 (Rev.6) / 09/23/16
Amendment / 8 / 06/21/16 / Recreational Shellfish Activities – Effective July 1, 2016 (New)
Suicide Prevention Works! – Effective January 1, 2016 (Rev.1) / 06/24/16
Amendment / 7 / 04/22/16 / Supplemental Nutrition Assistance Program-Education – Effective October 1, 2015 (Rev.1)
WIC Nutrition Program – Effective January 1, 2015 (Rev.5) / 05/02/16
Amendment / 6 / 02/26/16 / Suicide Prevention Works! – Effective January 1, 2016 (New)
WIC Nutrition Program – Effective January 1, 2015 (Rev.4) / 03/31/16
Amendment / 5 / 01/07/16 / Family Planning – Effective January 1, 2016 (New)
Office of Immunization & Child Profile – Effective January 1, 2016 (New)
OICP-Prevention & Public Health Funds (PPHF) VTrckS-IIS – Effective December 1, 2015 (New)
WIC Nutrition Program – Effective January 1, 2015 (Rev.3) / 01/28/16
Amendment / 4 / 08/31/15 / Emergency Preparedness & Response – Effective July 1, 2015 (New)
Maternal & Child Health Block Grant – Effective January 1, 2015 (Rev.2)
Recreational Shellfish Activities – Effective July 1, 2015 (New)
Supplemental Nutrition Assistance Program-Education – Effective October 1, 2015 (New)
WIC Nutrition Program – Effective January 1, 2015 (Rev.2) / 09/21/15
Amendment / 3 / 06/22/15 / Maternal & Child Health Block Grant – Effective January 1, 2015 (Rev.1)
Supplemental Nutrition Assistance Program-Education – Effective January 1, 2015 (Rev.2) / 06/30/15
Amendment / 2 / 04/16/15 / Emergency Preparedness & Response – Effective January 1, 2015 (Rev.1)
Supplemental Nutrition Assistance Program-Education – Effective January 1, 2015 (Rev.1)
WIC Nutrition Program – Effective January 1, 2015 (Rev.1) / 04/30/15
Amendment / 1 / 02/27/15 / Family Planning – Effective January 1, 2015 (Rev.1)
Supplemental Nutrition Assistance Program-Education – Effective January 1, 2015 (New) / 03/16/15
2015-2017 Contract
Initial SOW’s / N/A / 11/28/14 / Emergency Preparedness & Response – Effective January 1, 2015
Family Planning – Effective January 1, 2015
Maternal & Child Health Block Grant – Effective January 1, 2015
Office of Immunization & Child Profile – Effective January 1, 2015
Recreational Shellfish Activities – Effective January 1, 2015
WIC Nutrition Program – Effective January 1, 2015 / 12/22/14

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Note: (New) = Original SOW

(Rev.x) = SOW Revision #