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00013 Division of Public Health Agreement Addendum FY 16-17 Page 1 Lee County Health Department Epidemiology/PH Preparedness & Response Local Health Department Legal Name DPH Section/Branch Name Wayne Mixon, 919-546-1831 613 Ebola Preparedness and Response Wayne.mixon@dhhs.nc.gov Activity Number and Description DPH Program Contact (name, telephone number with area code, and email) 07/01/2016 — 05/31/2017 Service Period DPH Program Signature Date (only required for a negotiable agreement addendum) 08/01/2016 — 06/30/2017 Payment Period ❑ Original Agreement Addendum ® Agreement Addendum Revision # 2 Please do not put the Budgetary Estimate revision # here.) I. Background: No change. 11. Purpose: This Agreement Addendum Revision #2 provides additional funding enabling the Local Health Department to document progress in Zika preparedness by carrying out the task as described below. III. Scope of Work and Deliverables: As of January 1, 2017, this Agreement Addendum Revision # 2 adds Paragraph 5 as follows: 5. Complete the Zika Preparedness Checklist provided by PHP&R. Completing the capabilities and tasks as documented in this Checklist assures a robust and thorough Zika response program. IV. Performance Measures/Reportina Requirements: As of January 1, 2017, this Agreement Addendum Revision #2 adds Paragraph 6 as follows: 6. Provide a completed Zika Planning Checklist to the Sub -Recipient Grants Monitor by June 1, 2017 V. Performance Monitorins and Ouality Assurance: No change. VI. Funding Guidelines or Restrictions: No change. Health Director Signature (use blue ink) Date Local Health Department to complete: LHD program contact name: (If follow up information is needed by DPH) Phone number with area code: Email address: Signature on this page signifies you have read and accepted all oases of this document. December 2016