2000-156-RES RATIFYING THE EXECUTION OF CONTRACT CHANGE
RESOLUTION NO. 2000-156
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF PARIS,
PARIS, TEXAS, RATIFYING THE EXECUTION OF CONTRACT CHANGE
NOTICE NO. 01 (ATTACHMENT NO. 03), REGARDING THE
SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, AND
CHILDREN (WIC), AND AUTHORIZING THE EXECUTION OF
CONTRACT CHANGE NOTICE NO. 02 (ATTACHMENT NO. 04),
REGARDING IMMUNIZATION, TO THE CONTRACT FOR PUBLIC
HEALTH SERVICES, TDH DOCUMENT NO. 7560022067-2001; MAKING
OTHER FINDINGS AND PROVISIONS RELATED TO THE SUBJECT; AND
PROVIDING AN EFFECTIVE DATE.
WHEREAS, the State of Texas is a funding partner with the County of Lamar and the City
of Paris for the Paris-Lamar County Health Department; and,
WHEREAS, the City Council ofthe City of Paris did heretofore, on the 14th day of August,
2000, in Resolution No. 2000-110, authorize the execution of a Contract for Public Health Services,
TDH Document No. 7560022067-2001, which is the conduit through which the state funds are
recei ved; and,
WHEREAS, the City Manager did heretofore, on the 22nd day of August, 2000, execute
Contract Change Notice No. 01 (Attachment No. 03), regarding the Supplemental Nutrition Program
for Women, Infants, and Children (WIC), to said Contract and it is deemed appropriate that the form
of said Contract Change Notice No. 01, attached hereto as Exhibit A, be approved, and that such
execution be in all things ratified; and,
WHEREAS, said contract is in need of an additional amendment, and it is deemed
appropriate that the form of Contract Change Notice No. 02 (Attachment No. 04), regarding
Immunization, attached hereto as Exhibit B, be approved, and that the City Manager be authorized
to execute the same on behalf of the City of Paris, which is the authorized contracting entity for the
performing agency, the Paris-Lamar County Health Department; NOW, THEREFORE,
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF PARIS, PARIS,
TEXAS:
Section 1. That the findings set out in the preamble to this resolulion are hereby in all things
approved.
Section 2. That the forms of the Contract Change Notices Nos. 01 and 02 to the Contract
for Public Health Services, TDH Document No. 7560022067-2001, attached hereto as Exhibits A
and B, respectively, be, and the same are hereby, approved.
Section 3. That the execution by the City Manager on the 22nd day of August, 2000, on
behalf of the City of Paris, which is the authorized contracting entity for the performing agency, the
Paris-Lamar County Health Department, of Contract Change Notice No. 01 (Attachment No. 03),
regarding the Supplemental Nutrition Program for Women, Infants, and Children (WIC), to the
Contract for Public Health Services, be, and the same is hereby, ratified.
Section 4. That the City Manager be, and he is hereby, authorized and directed to execute,
on behalf of the City of Paris, which is the authorized contracting entity for the performing agency,
the Paris-Lamar County Health Department, Contract Change Notice No.2 (Attachment No. 04),
regarding Immunization, to the Contract for Public Health Services, under the terms and conditions
and in the form shown in Exhibit B, attached hereto.
Section 5. That this resolution shall be effective from and after its date of passage.
PASSED AND APPROVED this 13th day of November, 2000.
~:Z~
~,
Michael J. Pfies r, M or
ATTEST:
~L-.__'~{l~
Mattie Cunningham, City Clerk
..'
.f)
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS
TDH Document No.756oo22067 2001
COUNTY OF TRAVIS
CONTRACT CHANGE NOTICE NO. Q!
The Texas Department of Health, hereinafter referred to as RECEIVING AGENCY, did heretofore enter into a contract in writing with
PARIS-LAMAR COUNTY HEALTH DEPARTMENT hereinafter referred to as PERFORMING AGENCY. The parties thereto now
desire to amend such contract altachment(s) as follows:
SUMMARY OF TRANSACTION:
ATT. NO.03: BNS - WIC CARD PARTICIPATION
All terms and conditions not hereb amended remain in full force and effect.
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
Authorized Contracting Entity (type above if different
from PERFORMING AGENCY) for and in behalf of:
PERFORMING AGENCY:
RECEIVING AGENCY:
PARIS-LAMAR C UNTY HEALTH DEPARTMENT
TEXAS DEPARTMENT ~
By: . /-
(Signatu of person authorized to sign contracts)
By:
Date:
08-22-2000
Sidney P. Shelton, Chief
Bureau of Financial Services
(Name and Title)
c;? 115 ( cO
MICHAEL E. MALONE, CITY MANAGER
(Name and Title)
Date:
RECOMMENDED:
eN GMD - Rev. 3/99
Cover Page 1
EXHIBIT A
:
DETAILS OF ATTACHMENTS
All! TDH Term Financial Assistance Direct Total Amount
Amd Program! Source of Assistance (TDH Share)
No. m Begin End Amount
Funds.
01 COPH/PRIMARY 09/01/00 08/31/0 I State 211,415.00 0.00 211,415.00
02 BRLHO/SURVEY 09/01/00 08/31/0 I State 93.991 121,404.00 0.00 121,404.00
03 BNSIWIC-CARD 10/0 1/00 09/30/01 10.557 93.268 0.00 0.00 0.00
TDH Document No.7560022067 2001 Totals $332,819.00 $0.00 $332,819.00
Chanoe No. 01
.Federal funds are indicated by a number from the Catalog of Federal Domestic Assistance (CFDA), if applicable. REFER TO
BUDGET SECTION OF ANY ZERO AMOUNT ATTACHMENT FOR DETAILS.
Cover Page 2
DOCUMENT NO. 756002206701
ATTACHMENT NO. 03
PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: BUREAU OF NUTRITION SERVICES
TERM: October 01,2000 THRU: September 30,2001
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY shall provide supplemental food instruments, nutrition education, and
immunizations to enhance good health care at no cost to low-income pregnant and postpartum
women, infants, and children identified to be at nutritional risk. In meeting this goal,
PERFORMING AGENCY shall:
A. Perform professional, administrative, and clerical services necessary to provide special
supplemental food instruments and nutrition education to qualified women, infants, and
children in a specified geographic area. Services shall be performed according to the terms
and specifications of RECEIVING AGENCY'S Special Supplemental Nutrition Program
for Women, Infants, and Children (WIC) and/or the United States Department of
Agriculture (USDA) as referenced below. During the term of this Attachment, USDA will
issue regulations, instructions, policies, and/or directives which may be incorporated into
the State WIC Policy and Procedure Manual.
PERFORMING AGENCY will provide services in the authorized geographic service
area(s) described in PERFORMING AGENCY'S application and agreed to by
RECEIVING AGENCY. PERFORMING AGENCY can change the authorized
geographic service area(s) with approval from RECEIVING AGENCY. If RECEIVING
AGENCY disagrees on change of geographic service area(s), PERFORMING AGENCY
may terminate this contract with at least thirty (30) days written notice.
B. Assist in the collection and evaluation of data which will identify medical benefits of this
nutrition-intervention program and furnish financial, dietary, medical, nutrition-education,
and any other special reports in a timely manner as required by RECEIVING AGENCY
Program's written policies for the compilation of such data.
C. Determine eligibility of applicants, register participants, collect data, conduct
measurements, provide nutrition education, and maintain records as required by
RECEIVING AGENCY Program's written policies.
D. Make available appropriate health services to participants whose incomes do not exceed
those specified in RECEIVING AGENCY'S Program policies, and inform applicants of
available health services. PERFORMING AGENCY shall have a system in place to
provide participants with the available health services or provide the services through
referral(s) supported by written agreements with health care providers.
ATTACHMENT - Page 1
"
E. Issue prenumbered food instruments furnished by RECEIVING AGENCY to qualified
participants, who will use such instruments to obtain specified food items from
participating vendors; maintain complete accountability and security of all food instruments
received from RECEIVING AGENCY; and be held financially responsible for all
unaccounted for food instruments and/or those issued to ineligible participants.
PERFORMING AGENCY shall be held financially liable for issuance of infant formula
instruments which are not authorized or prescribed in the State WIC Policy and Procedure
Manual.
F. Review the immunization record of WIC Program applicants/participants-and provide
immunizations as needed, using staff funded under this Attachment in accordance with the
WIC Policy and Procedures Manual provided by RECEIVING AGENCY to
PERFORMING AGENCY or as otherwise approved in writing by RECEIVING AGENCY
Program.
G. Offer services during extended hours of operation outside the traditional times of 8:00 a.m.
to 5:00 p.m., Monday through Friday, according to a plan approved by RECEIVING
AGENCY.
H. Implement or expand PERFORMING AGENCY'S breastfeeding peer counseling program
for training and salaries of peer counselors who assist pregnant and breastfeeding WIC
participants in normal breastfeeding situations, when funding is available, if participation
in this program is requested by PERFORMING AGENCY and approved in writing by
RECEIVING AGENCY.
I. Provide lactation consultation services to WIC clients who have breastfeeding problems
that are beyond the expertise of their local WIC staff and/or peer counselors using
International Board Certified Lactation Consultants or the most qualified equivalent.
RECEIVING AGENCY will provide written approval of PERFORMING AGENCY'S
request for lactation consultation services which must include qualifications if
PERFORMING AGENCY proposes to use a non-certified lactation consultant.
J. Assure adequate staff coverage and uninterrupted delivery of WIC services if any member
of PERFORMING AGENCY'S staff is approved in writing by the RECEIVING AGENCY
to participate in RECEIVING AGENCY'S dietetic internship program. This internship
will consist of no less than 900 hours of supervised learning experiences in a variety of
nutrition-related facilities and will prepare PERFORMING AGENCY'S selected staff
member to better meet the needs of WIC participants.
K. RECEIVING AGENCY may provide breastpumps for eligible WIC participants either by
purchasing and distributing breastpumps to PERFORMING AGENCY or by authorizing
PERFORMING AGENCY to purchase or lease the breastpumps. If PERFORMING
AGENCY is authorized to purchase the breastpumps, RECEIVING AGENCY will provide
written notification of the specific types of breastpumps and collection kits, the inventory
levels permitted, and cost guidelines. If this requirement is implemented, then the actual
cost of breastpumps purchased by PERFORMING AGENCY will be reimbursed by
RECEIVING AGENCY utilizing WIC Food Grant funds. When PERFORMING
AGENCY receives or is authorized to purchase breastpumps, Nutrition Services and
A TT ACHMENT - Page 2
Administration funds may not be used for that purpose. The cost for the purchase of the
breastpumps will not affect administrative surplus calculations. The number and cost of
the breastpumps purchased must be identified separately on the face of the claim for
reimbursement (State of Texas Purchase Voucher, Form B-13).
L. With prior written approval from RECEIVING AGENCY, obtain the services of a
Registered Dietician (RD) who is registered with the Commission on Dietetic Registration
to provide an array of technical services for PERFORMING AGENCY. These services
may include: assistance with quality assurance, training, assistance with the annual
nutrition education and breastfeeding plan, individual counseling for high-risk participants ,
and facilitated discussion classes.
PERFORMING AGENCY shall comply with all applicable federal and state laws, rules,
regulations, standards, and guidelines in effect on the beginning date of this Attachment unless
amended. The following documents are incorporated by reference and made a part of this contract
Attachment. These include:
1. Child Nutrition Act of 1966,42 USC 1786;
2. Uniform Federal Assistance Regulations, 7 CFR Parts 3015 and 3016;
3. Applicable federal regulations located in 7 CFR Part 246; and
4. RECEIVING AGENCY Client Services Standards for Public Health and Community
Clinics, revised June 1997.
A copy of the current WIC Policy and Procedure Manual has been or will be furnished to
PERFORMING AGENCY. The WIC Policy and Procedure Manual, all revisions made to the
WIC Policy and Procedure Manual through the quarterly Texas WIC Bulletin, and written notices
are incorporated into this Agreement by reference. PERFORMING AGENCY has a duty to
become familiar with the contents and procedures contained within the WIC Policy and Procedure
Manual. PERFORMING AGENCY shall comply with all of the requirements of the WIC Policy
and Procedure Manual as well as state and federal laws and amendments governing or regulating
the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
PERFORMING AGENCY is responsible for ensuring that employees or agents acting on behalf
of the PERFORMING AGENCY comply with all of the requirements of the WIC Policy and
Procedure Manual and all state and federal laws and amendments governing and regulating the
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Within 30 days of receipt of an amended standard(s) or guideline(s), PERFORMING AGENCY
shall inform RECEMNG AGENCY program in writing if it will not continue performance under
this Attachment in compliance with the amended standard(s) or guideline(s). RECEIVING
AGENCY may terminate the Attachment immediately or within a reasonable period of time as
determined by RECEIVING AGENCY.
PERFORMANCE MEASURES
The following performance measures will be used to assess, in part, PERFORMING AGENCY'S
effectiveness in providing the services described in this contract Attachment, without waiving the
enforceability of any of the other terms of the contract.
A TT ACHMENT - Page 3
98% of families who participate in the WIC program by receiving food instruments shall also
receive nutrition education classes or individual counseling services to coincide with food voucher
issuance;
Of all pregnant women who enter the WIC program, at least 32 % shall be certified as eligible
during the period of the first trimester of their pregnancy;
88 % of clients who are enrolled in the program, excluding dual participants, transfer locked
and/or migrant clients, shall participate as food instrument recipients each month (breast-feeding
infants are also included in the client count); .
54% of infants whose mothers were participants in the program during pregnancy shall be breast-
fed at or before the time of their certification of eligibility; and
98 % of clients who indicate during the enrollment process that they have no source of health care
shall be referred to at least one source of health care at certification of eligibility.
A monthly activity report which demonstrates PERFORMING AGENCY'S efforts towards
meeting assigned annual targets shall be completed and submitted to RECEIVING AGENCY
within seven (7) working days after the end of each month.
SECTION II. SPECIAL PROVISIONS:
General Provisions, Assurances Article, is hereby amended to include the following:
PERFORMING AGENCY hereby agrees that it shall comply with Title VI of the Civil Rights Act
of 1964, 42 USC ~~2000d et seq., Title IX of the Education Amendments of 1972, 20 USC
~~1681 et seq., Section 504 of the Rehabilitation Act of 1973,29 USC ~794, Age Discrimination
Act of 1975, 42 USC ~~6101 et seq.; all provisions required by implementing the regulations of
the Department of Agriculture, 7 CFR Part 246; Department of Justice Guidelines for
Enforcement of Title VI, Civil Rights Act of 1964; 28 CFR ~50.3 and 28 CFR Part 42; and Food
& Nutrition Service (FNS) directives and guidelines, to the effect that no person will, on the
grounds of race, color, national origin, sex, age, or disability, be excluded from participation
under any program or activity for which PERFORMING AGENCY receives federal financial
assistance from FNS; and hereby gives assurance that it shall immediately take measures necessary
to implement this Attachment.
PERFORMING AGENCY shall compile data, maintain records and submit reports, as required,
to permit effective enforcement of the nondiscrimination laws and permit authorized USDA and
State of Texas personnel, during normal working hours, to review such records, books, and
accounts as needed to ascertain compliance with the nondiscrimination laws. The Department of
Agriculture, Food and Nutrition Service, has the right to seek judicial enforcement if
PERFORMING AGENCY violates any nondiscrimination laws. This Assurance is binding on
PERFORMING AGENCY, its successors, transferees, and assignees, as long as they receive
assistance or retain possession of any assistance from the Department of Agriculture. The person
or persons whose signatures appear on the COVER PAGES of this Attachment are authorized to
sign this Assurance on behalf of PERFORMING AGENCY.i
A TT ACHMENT - Page 4
General Provisions, Standards for Financial and Programmatic Management Article, Item A,
regarding internal budgeting and Item C, regarding billing, collection, and fee schedules are not
applicable to this Attachment.
General Provisions, Terms and Conditions of Payment Article, is hereby modified to include
the following paragraphs:
The participant caseload will be assigned by RECEIVING AGENCY Program by giving written
notice to PERFORMING AGENCY and may be subject to change from time to time upon written
notice to PERFORMING AGENCY from RECEIVING AGENCY Program with PERFORMING
AGENCY'S concurrence. PERFORMING AGENCY assumes liability for all food costs resulting
from PERFORMING AGENCY exceeding assigned caseload. The number of individuals served
in excess of assigned caseload are not to be included in the calculation of earned administrative
funds as described below.
RECEMNG AGENCY will reimburse PERFORMING AGENCY for administrative costs which
include participant referral, vendor evaluation, nutrition education, general administrative support,
start-up costs, outreach, applicant screening, and food instrument issuance.
Administrative costs will be reimbursed based on actual costs, but not to exceed the "maximum
reimbursement" set out below, based upon the sum of the participants who actually receive food
instruments each month plus infants who do not receive any food instruments whose breastfeeding
mothers were participants, to the extent that the total so derived does not exceed PERFORMING
AGENCY'S total assigned caseload within any given month. Surplus funds (the amount by which
maximum reimbursements exceed actual costs) can be accumulated and carried forward within the
Attachment term. Surplus encumbered by September 30 must be billed and vouchers received by
RECEIVING AGENCY no later than December 15.
PARTICIPANTS SERVED PER MONTH MAXIMUM REIMBURSEMENT:
During the term of the Attachment, PERFORMING AGENCY will earn administrative funds at
the rate of $.8..M for each participant served as defined above.
PERFORMING AGENCY shall provide immunizations under the WIC Special Initiative through
September 30, 2001, unless otherwise notified in writing by RECEIVING AGENCY.
Immunizations administered and funded under the WIC Special Initiative to WIC
participants/applicants and their siblings will earn administrative funds at the rate of $5.86 per
immunization as reported to RECEIVING AGENCY via the Texas WIN automated system. The
per-shot rate is based on actual cost. When the study of cost-per-shot shows a different actual
cost, then the rate of compensation paid per-shot will change. The PERFORMING AGENCY will
be notified of the change and will have thirty (30) days to provide written notice to the
RECEIVING AGENCY if it intends to terminate this contract.
PERFORMING AGENCY agrees that:
A TT ACHMENT - Page 5
(1) PERFORMING AGENCY shall identify and document separately not less than 19% of
total administrative costs as expenditures directly related to nutrition education. Nutrition
education expenditures shall be supported by documentation of participant attendance or
non-attendance.
(2) RECEIVING AGENCY will reimburse PERFORMING AGENCY for administrative
expenses at a rate not greater than 5.26 times the amount of properly documented
expenditures for nutrition education, but not more than is earned based on actual
participation not to exceed PERFORMING AGENCY'S assigned participant caseload, plus
any incentive funds allocated to PERFORMING AGENCY by the RECEIVING
AGENCY.
(3) RECEMNG AGENCY will limit (cap) PERFORMING AGENCY'S indirect costs to the
lesser of the rate approved by RECEIVING AGENCY'S Fiscal Division or twenty (20)
percent applied to PERFORMING AGENCY'S total direct salaries plus benefits
reimbursed by RECEIVING AGENCY. However, approval shall be obtained from
RECEIVING AGENCY'S Fiscal Division before the recovery of any indirect costs will
be permitted with the exception of indirect costs recoveries using amounts contained in the
Uniform Grants Management Standards (UGMS) for which approval can be granted by the
WIC Program office.
(4) RECEIVING AGENCY will identify annually to PERFORMING AGENCY an amount
of funds that must be spent for breastfeeding promotion. The allocation of breastfeeding
funds to PERFORMING AGENCY will be based on PERFORMING AGENCY'S
proportional share of the statewide combined total of pregnant and breastfeeding
participants as reported to RECEIVING AGENCY.
(5) RECEIVING AGENCY also reserves the right to withhold a proportionate amount of
earned administrative funds when evidence exists that nutrition education and/or
breastfeeding promotion is not being provided by PERFORMING AGENCY, or
PERFORMING AGENCY is not complying with the provisions of USDA and/or
RECEIVING AGENCY directives.
(6) RECEMNG AGENCY reserves the right to utilize a competitive offering for the award
of any future contracts at the end of the term of this Attachment.
(7) RECEIVING AGENCY may amend or terminate this Attachment if available funds
become reduced, depleted, or unavailable during the term of the Attachment to the extent
that the WIC Program is unable to provide administrative funding at the rate(s) shown
above. RECEIVING AGENCY will provide written notification to PERFORMING
AGENCY of such fact.
(8) RECEIVING AGENCY may pay for additional services as specified in this Attachment
if provided by PERFORMING AGENCY during the term of this Attachment (but not
otherwise paid during the term of this Attachment) if it is in the best interest of the State
and RECEIVING AGENCY Program to do so. If PERFORMING AGENCY exceeds the
amount of earned administrative funds as stated above, PERFORMING AGENCY will
continue to bill RECEIVING AGENCY for the services provided. If additional funds
ATTACHMENT - Page 6
become available at a later date for the provision of these services, RECEIVING
AGENCY may pay PERFORMING AGENCY a share of these funds.
(9) RECEMNG AGENCY may provide incentives to WIC local agencies for clients who are
provided WIC services outside the normal traditional hours to the extent that federal
funding is available.
(10) RECEIVING AGENCY may adjust the base reimbursement rate defmed above during the
term of this Attachment if it is in the best interest of the State and RECEIVING AGENCY
and if additional administrative WIC Grant funds are available.
PERFORMING AGENCY shall indicate separately on the face of the claim for reimbursement
(State of Texas Purchase Voucher, TDH Form B-13) the costs associated with nutrition education,
breast-feeding, and other administrative costs.
General Provisions, Advance Payments Article, is not applicable to this Attachment. However,
PERFORMING AGENCY will be allowed the option of receiving a two-month cash advance in
accordance with WIC Program Policy and Procedures.
General Provisions, Program Income, paragraph one, is not applicable to this Attachment.
General Provisions, Overtime Compensation Article, is not applicable to this Attachment.
General Provisions, Equipment and Supplies Article, is replaced with the following:
PERFORMING AGENCY shall accept responsibility and financial liability for all equipment and
supplies purchased with RECEIVING AGENCY funds, whether purchased locally by
PERFORMING AGENCY or by RECEIVING AGENCY and transferred to the care and custody
of PERFORMING AGENCY. PERFORMING AGENCY shall conduct an annual physical
inventory of all equipment purchased by RECEIVING AGENCY and submit it at a time to be
specified by RECEMNG AGENCY. RECEIVING AGENCY reserves the right to recover the
cost of equipment or supplies purchased by RECEIVING AGENCY and placed in the custody of
PERFORMING AGENCY if such articles are lost, stolen, or otherwise unaccounted for.
General Provisions, Reports Article, second paragraph, second sentence, is replaced with the
following:
A final report, Financial Status Report, Federal Form 269 (TDH Form GC-3), shall be submitted
no later than December 15, 2001.
General Provisions, Reports Article, third paragraph, is hereby modified to include the following:
PERFORMING AGENCY shall submit Immunization Dose Forms on a weekly basis.
PERFORMING AGENCY shall comply with instructions from RECEIVING AGENCY to
transmit immunization activity at intervals specified by RECEIVING AGENCY.
SECTION III. BUDGET:
ATTACHMENT - Page 7
All categories of costs billed to RECEIVING AGENCY, and allocation of such costs, must be in
accordance with the "Plan to Allocate Direct Costs" (PADC) submitted by PERFORMING
AGENCY and approved by RECEIVING AGENCY. This document is incorporated herein by
reference and made a part of this Attachment.
A TT ACHMENT - Page 8
CER'... ICATION REGARDING LOBBYI,,";
CERTIFICATION FOR CONTRACTS. GRANTS.
LOANS AND COOPERATIVE AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief that:
(1)
No federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or an
employee of any agency, a member of Congress in connection with the awarding of any
federal contract, the making of any federal grant, the making of any federal loan, the
entering into of any cooperative agreement, and the extension, continuatlbn, renewal,
amendment, or modification of any federal contract, grant, loan, or cooperative
agreement.
If any funds other than federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a member of Congress, an officer or employee of Congress, or an
employee of a member of Congress in connection with this federal contract, grant,
loan, or cooperative agreement, the undersigned shall complete and submit Standard
Form-lIl, "Disclosure Form to Report Lobbying," in accordance with it's
instructions.
The undersigned shall require that the language of this certification be included in the
award documents for all subawards at all tiers (including subcontracts, subgrants,
and contracts under grants, loans and cooperative agreements) and that all
subrecipients shall certify and disclose accordingly.
(2)
(3)
This certification is a material representation offact upon which reliance was placed when
this transaction was made or entered into. Submission of this certification is a prerequisite
for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code.
Any person who fails to file the required certification shall be subject to a civil penalty of not
less than $10,000 and not more than $100,000 for each such failure.
08-22-2000
Date
ANTHONY BETHEL, ADMINISTRATOR
Print Name of Authorized Individual
7560022067 2001-03
ApplIcatIOn or l:ontract Number
PARIS-LAMAR COUNTY HEALTH DEPARTMENT
urgamzatlon Name and Address
740 SOUTHWEST 6TH.
PARIS, TX 75460-0000
~
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS
TDH Document No.756oo22067 2001
CONTRACT CHANGE NOTICE NO. Q2
COUNTY OF TRAVIS
The Texas Department of Health, hereinafter referred to as RECEIVING AGENCY, did heretofore enter into a contract in writing with
PARIS-LAMAR COUNTY HEALTH DEPARTMENT hereinafter referred to as PERFORMING AGENCY. The parties thereto now
desire to amend such contract attachment(s) as follows:
SUMMARY OF TRANSACTION:
ATT. NO. 04: IMMUNIZATION DIVISION
All terms and conditions not hereb amended remain in full force and effect.
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
Authorized Contracting Entity (type above if different
from PERFORMING AGENCY) for and in behalf of:
PERFORMING AGENCY:
RECEIVING AGENCY:
PARIS-LAMAR COUNTY HEALTH DEPARTMENT
TEXAS DEPARTMENT OF HEALTH
By:
- -
(Signature of person authorized to sign contracts)
By:
MICHAEL E. MALONE, CITY MANAGER
(Name and Title)
Sidney P. Shelton, Chief
Bureau of Financial Services
(Name and Tille)
Date:
Date:
(o(llt (YtJlJrJ
RECOMMENDED:
eN GMD - Rev. 3/99
Cover Page 1
EXHl81T B J
DETAILS OF ATTACHMENTS
Alii TDH Term Financial Assistance Direct Total Amount
Amd Program/ Assistance (TDH Share)
No. m Begin End Source of Amount
Funds.
01 COPH/PRIMARY 09/01/00 08/31/0 I State 211,415.00 0.00 211,415.00
02 BRLHO/SURVEY 09/01/00 08/31/0 I State 93.991 121,404.00 0.00 121,404.00
03 BNSIWIC-CARD 10/01/00 09130101 10.557 93.268 0.00 0.00 0.00
04 IMMILOCALS 10101/00 08/31/0 I State 50,023.00 0.00 50,023.00
TDH Document No.7560022067 2001 Totals $382,842.00 $0.00 $382,842.00
Chan~e No. 02
.Federal funds are indicated by a number from the Catalog of Federal Domestic Assistance (CFDA), if applicable. REFER TO
BUDGET SECTION OF ANY ZERO AMOUNT ATTACHMENT FOR DETAILS.
Cover Page 2
DOCUMENT NO. 7560022067-01
ATTACHMENT NO. 04
PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: IMMUNIZATION DIVISION
TERM: October 01,2000 THRU: August 31,2001
SECTION I. SCOPE OF WORK:
The goal of RECEIVING AGENCY Program is to prevent, control, and eliminate vaccine-
preventable diseases by providing and administering biologicals, promoting immunizations,
conducting vaccine-preventable disease surveillance, assessing vaccine coverage levels, and
applying principles of epidemiology and outbreak control measures within budgetary constraints.
PERFORMING AGENCY shall implement an immunization program for children, adolescents,
and adults, with special emphasis on accelerating interventions to improve the immunization
coverage of children two years of age or younger (less than 36 months of age). PERFORMING
AGENCY will incorporate traditional and non-traditional, systematic approaches designed to
eliminate barriers, expand immunization delivery, and establish uniform policies.
PERFORMING AGENCY shall provide services as outlined in PERFORMING AGENCY'S
Fiscal Year (FY) 2001 Contract Renewal Application and work plan and revisions, if any, as
agreed to and approved by RECEIVING AGENCY Program. These documents are adopted by
reference and made a part of this contract Attachment. Any revisions to these documents shall be
approved by RECEIVING AGENCY Program and transmitted in writing to PERFORMING
AGENCY.
PERFORMING AGENCY shall monitor the incidence of vaccine-preventable disease to rapidly
detect and address disease outbreaks.
PERFORMING AGENCY shall monitor adverse events following vaccination to rapidly detect
and address unusual or unexpected events.
PERFORMING AGENCY shall administer vaccines or ensure that individuals are linked to health
care providers who provide vaccinations.
PERFORMING AGENCY shall investigate and control vaccine-preventable disease outbreaks in
the population.
PERFORMING AGENCY shall perform population-based assessments to measure vaccine
coverage levels.
PERFORMING AGENCY shall inform and educate the public about vaccines and vaccine-
preventable diseases.
ATTACHMENT - Page 1
PERFORMING AGENCY shall ensure a health care workforce that is knowledgeable about
vaccines, delivery of vaccination services and vaccine-preventable diseases.
PERFORMING AGENCY shall assist in distributing state-supplied vaccines to Texas Health Steps
providers, Medicaid providers, physicians, and. other providers and organizations within
PERFORMING AGENCY'S local area.
PERFORMING AGENCY shall not deny vaccinations to recipients because they do not reside
within PERFORMING AGENCY'S jurisdiction.
PERFORMING AGENCY shall maintain an accurate, up-to-date list of clinics and sites where
public sector (free or low cost) immunization services are offered in PERFORMING AGENCY'S
local area. PERFORMING AGENCY shall update the clinic list monthly and provide the updates
to local area Temporary Aid to Needy Families (T ANF) offices and to RECEIVING AGENCY
Program Director.
No fee may be charged for vaccines provided by RECEIVING AGENCY Program. All vaccines
obtained from RECEIVING AGENCY Program shall be used solely for purposes of this contract
Attachment and shall not be sold to agencies or individuals.
PERFORMING AGENCY shall not collect vaccine administration fees from Medicaid recipients.
Vaccine administration fees collected from non-Medicaid patients shall be kept within guidelines
established by RECEMNG AGENCY. In accordance with 25 TAC ~1.91, no one may be denied
immunization services in public clinics because of inability to pay the administration fee. Fee
schedules shall not be based on vaccine type, formulation, or dose in series. A copy of
PERFORMING AGENCY'S fee schedule shall be submitted to RECEIVING AGENCY Program
by the first working day of the fifth month of this contract Attachment term.
All equipment and vaccine used by PERFORMING AGENCY which are provided by
RECEIVING AGENCY Program, shall be accounted for as public property. RECEIVING
AGENCY Program may investigate equipment or vaccine loss, destruction, spoilage, or other
waste and may then require PERFORMING AGENCY to replace or reimburse RECEIVING
AGENCY Program.
PERFORMING AGENCY shall provide the parent, managing conservator, or guardian of each
patient with a form that is approved by RECEIVING AGENCY Program in compliance with
25 TAC, Chapter 100 to authorize participation in the statewide immunization registry (ImmTrac).
PERFORMING AGENCY shall provide RECEIVING AGENCY Program weekly data transfers
of all vaccines administered in a format that is compatible for inclusion in the statewide
immunization registry (ImmTrac).
PERFORMING AGENCY shall comply with all applicable federal and state laws, rules,
regulations, standards, and guidelines in effect on the beginning date of this contract Attachment
unless amended. The following documents are incorporated by reference and made a part of this
contract Attachment. These include:
A TT ACHMENT - Page 2
. PERFORMING AGENCY'S FY 2001 Contract Renewal Application, and any
revisions;
. . Human Resources Code ~42.043, VTCA;
. Education Code ~~38.001-38.002, VTCA;
. Health and Safety Code ~~81.023 and 161.001-161.009, VTCA;
. 25 TAC ~~97.61-97.77 and 97.101-97.102;
. 25 TAC, Chapter 96;
. 25 TAC, Chapter 100;
. 42 USC ~~247b and 300 aa-25;
. Omnibus Budget Reconciliation Act of 1993, 26 USC ~4980B;
. RECEIVING AGENCY'S Client Services Standards for Public Health and
Community Clinics, revised June 1997;
. RECEIVING AGENCY'S Vaccine-Preventable Disease Surveillance guidelines,
March 15, 1999;
. RECEIVING AGENCY'S Pharmacy guidelines;
. Centers for Disease Control and Prevention's Advisory Committee on
Immunization Practices (ACIP) statement: "Immunization of Health-Care
Workers"; and
. Standards for Pediatric Immunization Practices, February 1996, recommended by
the National Vaccine Advisory Committee, approved by the United States Public
Health Service, and endorsed by the American Academy of Pediatrics.
Within thirty (30) days of receipt of an amended standard(s) or guideline(s), PERFORMING
AGENCY shall inform RECEIVING AGENCY Program, in writing, if it will not continue
performance under this Attachment in compliance with the amended standard(s) or guideline(s).
RECEIVING AGENCY may terminate the Attachment immediately or within a reasonable period
of time as determined by RECEIVING AGENCY.
PERFORMANCE MEASURES
The following performance measure(s) will be used, in part, to assess PERFORMING
AGENCY'S effectiveness in providing the services described in this contract Attachment to the
service area, without waiving the enforceability of any of the terms of the contract.
PERFORMING AGENCY shall investigate 100% of all reported vaccine-preventable
diseases in accordance with RECEIVING AGENCY'S Vaccine-Preventable Disease
Surveillance Guidelines.
PERFORMING AGENCY shall report 100% of all vaccine adverse event occurrences in
accordance with the National Vaccine Injury Act of 1986.
PERFORMING AGENCY shall investigate 100% of suspected hepatitis B infections in
pregnant women to assure appropriate treatment and follow-up as directed by Health and
Safety Code ~81.090 and RECEIVING AGENCY'S Vaccine-Preventable Disease
Surveillance Guidelines.
PERFORMING AGENCY shall provide an estimated.4..8Q8 doses of vaccine administered
to clients.
A TT ACHMENT - Page 3
PERFORMING AGENCY shall provide RECEIVING AGENCY Program monthly reports
of doses administered submitted by the fifteenth calendar day of each month for the
previous calendar month, in formats approved by RECEIVING AGENCY Program.
PERFORMING AGENCY shaH implement an immunization reminder or recaH system to
notify parents or guardians of children less than 36 months of age. The notifications may
be automated or manual and may consist of mail or telephone contacts.
PERFORMING AGENCY shaH conduct immunization audits in 100% of assigned child-
care facilities, Head Start, private, and public schools.
PERFORMING AGENCY shall conduct annual assessments in 100% of local health
department sites, sub-contracted entities, and WIC clinics using the Assessment Feedback
Initiative Exchange (AFIX) methodology. PERFORMING AGENCY shaH submit
assessment results to RECEIVING AGENCY Program not more than two weeks after
completion.
PERFORMING AGENCY shaH offer to conduct annual assessments in 100% of Texas
Vaccines for Children (TVFC)-enroHed private provider sites using the Assessment
Feedback Initiative Exchange (AFIX) methodology.
PERFORMING AGENCY shaH conduct monitoring visits in 25 % of TVFC-enroHed
provider sites using the RECEIVING AGENCY'S monitoring tool. PERFORMING
AGENCY shall submit monitoring report to RECEIVING AGENCY Program not more
than two weeks after completion of visit.
PERFORMING AGENCY shall recruit and enroll providers into the TVFC program.
SECTION II. SPECIAL PROVISIONS
General Provisions, Reports Article, is revised to include the following:
PERFORMING AGENCY shaH submit quarterly program reports to RECEIVING
AGENCY Program according to the foHowing timelines and in the formats provided by
RECEIVING AGENCY Program.
NAME OF REPORT APPLICABLE QUARTERS DUE DATES
Immunization Program - September, October, November December 30
Performance Measure December, January, February March 30
Quarterly Report March, April, May June 30
June, July, August September 30
Immunization Program - September, October, November December 30
Recruitment Quarterly December, January, February March 30
Report March, April, May June 30
June, July, August September 30
A TT ACHMENT - Page 4
Travel funds are provided for use only by persons assigned to RECEIVING AGENCY Program.
All out-of-state travel and travel for persons not assigned through this contract Attachment require
prior approval by RECEIVING AGENCY Program Director. Travel expenses shall be reimbursed
in accordance with PERFORMING AGENCY'S written travel policy; if PERFORMING
AGENCY does not have a travel policy in place, travel expenses shall be reimbursed according
to State of Texas travel regulations.
For immunization activities performed under this contract Attachment, General Provisions,
Overtime Compensation Article, is not applicable, and PERFORMING AGENCY shall comply
with the following paragraphs:
PERFORMING AGENCY is authorized to pay employees who are not exempt under the
Fair Labor Standards Act (FLSA), 29 USC, Chapter 8, 9201 et seq., for overtime or
compensatory time at the rate of time and one-half per FLSA.
PERFORMING AGENCY is authorized to pay employees who are exempt under FLSA
on a straight time basis for work performed on a holiday or for regular compensatory time
hours when the taking of regular compensatory time off would be disruptive to normal
business operations.
Authorization for payment under this provision is limited to work directly related to
immunization activities and shall be in accordance with the amount budgeted in this
contract Attachment.
PERFORMING AGENCY shall document proper authorization or approval for any work
performed by exempt or non-exempt employees in excess of 40 hours in a work week.
A TT ACHMENT - Page 5
SECTION III. BUDGET:
PERSONNEL
FRINGE BENEFITS
TRAVEL
EQUIPMENT
SUPPLIES
CONTRACTUAL
OTHER
$29,081.00
8,724.00
2,108.00
0.00
7,000.00
500.00
2,610.00
TOTAL
$50,023.00
Total reimbursements will not exceed $ 50,023.00.
Financial status reports are due the 30th of January, 30th of April, 30th of July, and the 30th of
November.
A TT ACHMENT - Page 6