PHSKC Agreement # 2581 APDE - Amendment 1
AMENDMENT
This Amendment between PHSKC and the Recipient changes the referenced Agreement for the following
purpose(s): To amend the scope and budget to administer a survey outside the City of Seattle. Amount this
action: $24,752.50.
Recipient Name & Address: University of Washington, 4333 Brooklyn Ave NE, Office of Sponsored Programs,
Seattle, WA 98105
Project Title: Seattle’s Sweetened Beverage Tax (SBT)
Effective Date of Amendment: Mar 01 2018
Agreement End Date:

No Change

Change to:

Agreement Amount:

No Change

Change to: $180,857.50

Funding Details:

No Change

Funding Source
City of Seattle

Funding Summary:

Revise the following funding details:

PHSKC Contract #
2244 CDIP

Amount
$180,857.50

No Change

FEDERAL:

Effective Dates
Sep 01 2017 to Jul 31
2018

New or Revised
Revised to add
$24,752.50

Revise to read:

COUNTY:

STATE:

OTHER: $180,857.50

Exhibits:
No Change
Revise as follows:
Replace the following Exhibits as attached hereto:
Exhibit A – Scope of Work
Exhibit B – Budget
Exhibit C - Invoice

King County Terms & Conditions:

No Change

Revise as follows:

All other terms and conditions of the referenced Agreement and any previous Agreement amendment not
revised herein shall remain unchanged and in full force and effect.
RECIPIENT SIGNATURE

Diane Wentz
Diane Wentz (Apr 18, 2018)

PHSKC SIGNATURE

Marguerite Ro
Marguerite Ro (Apr 19, 2018)

PRINTED NAME AND TITLE

Diane Wentz
Diane Wentz; Authorized Signing Official
PRINTED NAME AND TITLE

Marguerite Ro
Chief, APDE

DATE SIGNED

Apr 18, 2018
DATE SIGNED

Apr 19, 2018

 Amendment 1
Exhibit A - Scope of Work
A comprehensive evaluation of the impacts of the Sweetened Beverage Tax
Recipient: University of Washington (UW)
Contract Period: September 1, 2017 to July 31, 2018
DESCRIPTION OF OUTCOMES
Outcome 1. Co-lead SBT evaluation team. UW will co-lead SBT evaluation activities with PHSKC to assure that
the evaluation activities as specified in the ordinance are conducted rigorously and that the evaluation plan
includes all of the elements described in Ordinance 125324, are developed in collaboration with the Community
Advisory Board, and are within budget allocations approved by the City. UW will facilitate (or designate a
facilitator for) all evaluation team meetings and provide consultation to overall evaluation design and
implementation to PHSKC, City, and Community Advisory Board.
Deliverables: Create agendas for all evaluation team meetings and develop reports and project proposal memos
and related budget for SBT evaluation activities, which PHSKC will finalize and submit to the City.
Outcome 2. Evaluate the impact of the tax on economic outcomes. UW will be responsible for designing and
implementing the impact evaluation of the tax on taxed and untaxed beverage prices, jobs, and business
revenues. Dr. Jones-Smith, Associate Professor in Health Services and Epidemiology with UW, will provide
oversight on evaluation design. UW staff will collect, enter, code, and analyze data as needed, provide
consultation to PHSKC, City, evaluation staff, and Community Advisory Board about assessing and revising ideas
for improvement. UW will submit findings to PHSKC to comply with reporting requirements as mutually agreed
upon.
Deliverables: Complete 1) annual approved work plan describing additional activities and timelines to
accomplish this outcome, 2) evaluation plan (including conceptual model, data collection plan, draft data
collection instruments, planned analyses and methodologies, a description of limitations, any changes or
improvements made to the evaluation over time, description of members of the research team, and non-City
funded studies of the SBT tax that Recipient will conduct, 3) institutional review board approvals as needed, 4)
mid-point progress report specifying completion of data collection activities, and 5) final baseline evaluation
report.
Outcome 3. Evaluate the impact of the tax on norms and opinions in Seattle, utilizing a comparison area
outside of Seattle to control for secular trends (additional funding secured in order to administer survey in a
comparison area). UW will collaborate with an evaluation consultant to design and implement the impact
evaluation of heightened attention to the adverse health effects of sugary drinks generated by the adoption and
implementation of the tax, on norms and attitudes around sugary beverages in Seattle, utilizing a comparison
area outside of Seattle to control for secular trends. UW (Dr. Jesse Jones-Smith) will work with an evaluation
consultant and a data collection firm to collect, enter, code, and analyze data as needed, and provide
consultation to PHSKC, City, evaluation staff, and Community Advisory Board about assessing and revising ideas
for program improvement. UW and an evaluation consultant will submit findings to PHSKC to comply with
reporting requirements as mutually agreed upon.
Deliverables: Complete 1) annual approved work plan describing additional activities and timelines to
accomplish this outcome, 2) evaluation plan (including conceptual model, data collection plan, draft data
collection instruments, planned analyses and methodologies, a description of limitations, any changes or
improvements made to the evaluation over time, description of members of the research team, and non-City
APDE 2581, Amendment 1 -UW Office of Sponsored Programs

1

 funded studies of the SBT tax that Recipient will conduct, 3) institutional review board approvals as needed, 4)
mid-point progress report specifying completion of data collection activities, and 5) final baseline evaluation
report.
BUDGET
Recipients will be reimbursed for work as follows (See Exhibit B for detailed budget):
Recipient

University of Washington

Budget

Dollar Awarded ($)

Baseline

$156,105.00

Added additional funding to administer survey
in a comparison area outside of Seattle

$24,752.50

Total Awarded Budget

Not to exceed: $180,857.50

APDE 2581, Amendment 1 -UW Office of Sponsored Programs

2

 Amendment 1
Exhibit B - Budget
A comprehensive evaluation of the impacts of the Sweetened Beverage Tax
University of Washington
Contract Period September 1, 2017 to July 31, 2018
Outcome 1: Co-lead SBT Evaluation Team
1) Create Agendas for evaluation team meetings
2) Develop reports, project proposal memos and related budget for SBT evaluation activities

Outcome 2: Evaluate the impact of the tax on economic outcomes
1) Complete annual approved work plans
2) Complete evaluation plans
3) Complete institutional review board approvals as needed
4) Complete mid-point progress reports specifying completion of data collection activities
5) Complete final baseline and Year 1 evaluation report

$
$
Total ($): $

Amount ($)
614.27
8,826.23
9,440.50

$
$
$
$
$
Total ($): $

Amount ($)
4,449.94
7,379.11
1,293.17
55,218.00
33,611.42
101,951.64

Outcome 3: Evaluate the impact of the tax on norms and opinions in Seattle, utilizing a comparison area outside of Seattle to control for
secular trends
1) Complete annual approved work plans
2) Complete evaluation plans
3) Complete institutional review board approvals as needed
4) Complete mid-point progress reports specifying completion of data collection activities
5) Complete final baseline and Year 1 evaluation reports

$
$
$
$
$
Total ($): $
GRAND TOTAL ($): $

Amount ($)
539.72
8,819.70
179.91
58,846.58
1,079.45
69,465.36
180,857.50

 ALL FIELDS MUST BE COMPLETED FOR PROMPT PAYMENT PROCESSING

King County Accounts Payable Information

INVOICE

Purchase Order #

Contract Number: 2581 APDE
Exhibit: C
Contract Period of Performance:

Supplier Name
Supplier #
Supplier Pay Site
Remit to Address

9/1/17-7/31/18

University of Washington
Grant and Contract Accounting
Box 354966
Seattle, WA 98195-4966
(206) 616-9995
gcahelp@uw.edu

Invoice Date
Invoice #
Amount to be Paid
Note to AP
Payment Type (Circle One)
Print on Remittance
PH Program name & phone

Submit signed hardcopy invoice to:
Tamara Babasinian
Seattle Sweetened Beverage Tax Evaluation
Public Health - Seattle & King County
401 5th Ave., Suite 1300
Seattle, WA 98104

Start
Date

CHECK or ACH

End
Date

Invoice for services rendered under this contract
for the period of:
MM/DD/YY

Project

Organization

Acct

Task

Award

DPH Acct

CPA

CFDA

Amount

Attach sheet for multiple POETAs

Direct Costs

Budget

Previously Billed

Current

Cumulative

Balance

Outcome 1

$

9,440.50

$

-

$

-

$

-

$

Outcome 2

$

101,951.64

$

-

$

-

$

-

$ 101,951.64

Outcome 3
Grand Total

$

69,465.36

$

-

$

-

$

-

$

$

180,857.50

$

-

$

$
Amount Due

-

$ 180,857.50

9,440.50
69,465.36

I, the undersigned, do hereby certify under the laws of the State of Washington penalty of perjury, that this is a true and correct claim for reimbursement services rendered. I understand that any false
claims, statements, documents, or concealment of material fact may be prosecuted under applicable Federal and State laws. This certification includes any attachments which serve as supporting
documentation to this reimbursement request.

Signed
Print Name

Date

PH Program Manager Approval

For Public Health Use Only
Received
Date
Initial

Entered

CM/PM Review

FM Review

Official Copy Rcvd

Date