PHSKC Agreement # 2581 APDE - Amendment 2 AMENDMENT This Amendment between PHSKC and the Recipient changes the referenced Agreement for the following purpose(s): Amendment modifies Outcome 2 & 3, extends the end date, and adds additional funding to complete the existing scope of work. 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: Aug 01 2018 Agreement End Date: No Change Change to: Dec 31 2018 Agreement Amount: No Change Change to: $272,885.47 Funding Details: No Change Funding Source City of Seattle Funding Summary: Revise the following funding details: PHSKC Contract # 2244 APDE Amount $272,885.47 No Change FEDERAL: Effective Dates Aug 01 New or Revised Revised to add $92,027.97 Revise to read: COUNTY: STATE: OTHER: Exhibits: No Change Revise as follows: Replace the following exhibits effective 9/1/18 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 PRINTED NAME AND TITLE DATE SIGNED PHSKC SIGNATURE PRINTED NAME AND TITLE DATE SIGNED Amendment 2 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 December 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. In addition, 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. As part of this work, UW will also conduct descriptive statistics for food security questions from existing healthy food access program studies. UW will submit findings to PHSKC to comply with reporting requirements as mutually agreed upon. Deliverables: Complete 1) evaluation plans including data collection plan, 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, and 2) institutional review board approvals as needed & initiate 2018 data collection activities. 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) evaluation plans including data collection plan, 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 APDE 2581, Amendment 2 -UW Office of Sponsored Programs 1 Recipient will conduct, and 2) institutional review board approvals as needed & initiate 2018 data collection activities. BUDGET Recipients will be reimbursed for work as follows (See Exhibit B for detailed budget): Recipient Budget Year 1 (baseline) Year 1 (baseline): Added additional funding for Ironwood Survey of comparison area outside of Seattle University of Washington Year 2 (1st evaluation year): First half of 1st evaluation year Dollar Awarded ($) $156,105.00 $24,752.50 $92,027.97 (evaluation plan & initiation of data collection activities) Total Awarded Budget Year 1 (baseline) & Year 2 (1 st evaluation year) APDE 2581, Amendment 2 -UW Office of Sponsored Programs Not to exceed: $272,885.47 2 Amendment 2 Exhibit B - Budget A comprehensive evaluation of the impacts of the Sweetened Beverage Tax University of Washington Contract Period September 1, 2017 to December 31, 2018 Year 1 (Baseline) First half: 1st evaluation year Amount ($) Baseline Amount ($) 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 $ $ Total ($): $ 614.27 $ 8,826.23 $ 9,440.50 1) Complete annual approved work plans 2) Complete evaluation plans 3) Complete institutional review board approvals as needed & initiate 2018 data collection activities 4) Complete mid-point progress reports specifying completion of data collection activities 5) Complete final baseline and year 1 evaluation report $ $ $ $ $ Total ($): $ 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 & initiate 2018 data collection activities 4) Complete mid-point progress reports specifying completion of data collection activities $ $ $ $ $ Total ($): $ 4,449.94 7,379.11 1,293.17 55,218.00 33,611.42 101,951.64 $ $ $ N/A 8,975.57 50,861.59 N/A N/A 59,837.16 First half: 1st evaluation year Amount ($) Baseline Amount ($) 539.72 8,819.70 179.91 58,846.58 1,079.45 69,465.36 664.43 8,827.49 9,491.92 First half: 1st evaluation year Amount ($) Baseline Amount ($) Outcome 2: Evaluate the impact of the tax on economic outcomes 5) Complete final baseline and year 1 evaluation report Year 2 (Evaluation) $ $ $ Totals ($): $ 180,857.50 $ GRAND TOTAL YEAR 1 (baseline) & YEAR 2 (1st evaluation year) ($): $ N/A 15,889.22 6,809.67 N/A N/A 22,698.89 92,027.97 272,885.47 ALL FIELDS MUST BE COMPLETED FOR PROMPT PAYMENT PROCESSING King County Accounts Payable Information INVOICE Purchase Order # Contract Number: APDE 2581 Exhibit: C Contract Period of Performance: Supplier Name Supplier # Supplier Pay Site Remit to Address 9/1/17-12/31/18 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 $ 18,932.42 $ 9,440.50 $ - $ 9,440.50 $ 9,491.92 Outcome 2 $ 161,788.80 $ 101,951.64 $ - $ 101,951.64 $ 59,837.16 Outcome 3 Grand Total $ 92,164.25 $ 69,465.36 $ - $ 69,465.36 $ 22,698.89 $ 272,885.47 $ 180,857.50 $ $ Amount Due 180,857.50 $ 92,027.97 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 Date Print Name PH Program Manager Approval For Public Health Use Only Received Entered CM/PM Review FM Review Official Copy Rcvd Date Initial Signature: Diane Wentz Diane Wentz (Aug 1, 2018) Email: dwentz@uw.edu Signature: Marguerite Ro Marguerite Ro (Aug 1, 2018) Email: marguerite.ro@kingcounty.gov Date PHSKC Agreement #2581 Amendment 2 for Signature Adobe Sign Document History 08/01/2018 Created: 07/17/2018 By: Allen Cantara (Allen.Cantara@kingcounty.gov) Status: Signed Transaction ID: CBJCHBCAABAAjMKEaGlTPmKL1zy69IY34nx27fpbNiro "PHSKC Agreement #2581 Amendment 2 for Signature" Histo ry Document created by Allen Cantara (Allen.Cantara@kingcounty.gov) 07/17/2018 - 8:33:02 AM PDT- IP address: 52.22.22.121 Document emailed to crbloom@uw.edu for signature 07/17/2018 - 8:33:56 AM PDT Allen Cantara (Allen.Cantara@kingcounty.gov) replaced signer crbloom@uw.edu with marypod@uw.edu 07/19/2018 - 3:00:44 PM PDT- IP address: 146.129.94.197 Document emailed to marypod@uw.edu for signature 07/19/2018 - 3:00:44 PM PDT Document shared with jjoness@uw.edu 07/19/2018 - 3:01:59 PM PDT- IP address: 146.129.94.197 Document shared with rfranc15@uw.edu 07/19/2018 - 3:02:00 PM PDT- IP address: 146.129.94.197 Document viewed by marypod@uw.edu 07/19/2018 - 3:17:27 PM PDT- IP address: 205.175.118.119 Agreement modified by Allen Cantara (Allen.Cantara@kingcounty.gov) 08/01/2018 - 1:44:20 PM PDT Allen Cantara (Allen.Cantara@kingcounty.gov) replaced signer crbloom@uw.edu with Diane Wentz (dwentz@uw.edu) 08/01/2018 - 2:09:39 PM PDT- IP address: 146.129.94.197 Document emailed to Diane Wentz (dwentz@uw.edu) for signature 08/01/2018 - 2:09:40 PM PDT Document viewed by Diane Wentz (dwentz@uw.edu) 08/01/2018 - 2:16:59 PM PDT- IP address: 69.91.226.241 Agreement modified acknowledged by Diane Wentz (dwentz@uw.edu) 08/01/2018 - 2:17:06 PM PDT Document e-signed by Diane Wentz (dwentz@uw.edu) Signature Date: 08/01/2018 - 2:20:32 PM PDT - Time Source: server- IP address: 69.91.226.241 Document emailed to Marguerite Ro (marguerite.ro@kingcounty.gov) for signature 08/01/2018 - 2:20:33 PM PDT Document viewed by Marguerite Ro (marguerite.ro@kingcounty.gov) 08/01/2018 - 3:24:11 PM PDT- IP address: 146.129.91.12 Document e-signed by Marguerite Ro (marguerite.ro@kingcounty.gov) Signature Date: 08/01/2018 - 4:01:46 PM PDT - Time Source: server- IP address: 146.129.91.12 Signed document emailed to Diane Wentz (dwentz@uw.edu), marypod@uw.edu, crbloom@uw.edu, Tamara Babasinian (tamara.babasinian@kingcounty.gov), and 5 more 08/01/2018 - 4:01:46 PM PDT