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06-D DSHS Contract CO No. 4 DRAFT F:A TTORNEY\RESWORK\CURREN1\ Health Contract change Order No.4, A TT .0IA. 2006 February 3, 2006 RESOLUTION NO. A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF PARIS, PARIS, TEXAS, APPROVING AND AUTHORIZING THE EXECUTION OF CONTRACT CHANGE ORDER NOTICE NO. 04 FOR PUBLIC HEALTH SERVICES, DSHS DOCUMENT NO. 7560022067-2006 (ATTACHMENT NO. OtA: RLSS-LOCAL PUBLIC HEALTH SYSTEM; 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 Contract for Public Health Services, Contract Change Notice No. 04 DSHS Document No. 7560022067-2006(Attachment No. OIA), RLSS - Local Public Health System is the conduit through which the state funds are received; and, WHEREAS, it is appropriate that the form of said Contract Change Notice No. 04, attached hereto as Exhibit A, 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 resolution are hereby in all things approved. Section 2. That the form of the Contract for Public Health Services, Contract Change Notice No. 04 DSHS Document No. 7560022067-2006 (Attachment No. OIA) RLSS - Local Public Health System, attached hereto as Exhibit A, be, and the same is hereby, approved. Section 3. 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, the Contract for Public Health Services, Contract Change Notice No. 04, under the terms and conditions and in the form shown in Exhibit A, attached hereto. Section 4. That this resolution shall be effective from and after its date of passage. PASSED AND APPROVED this 13th day of February, 2006. ATTEST: Janice Ellis, City Clerk APPROVED AS TO FORM: John D. Lestock, Assistant City Attorney Curtis Fendley, Mayor DEPARTMENT OF STATE HEALTH SERVICES 1100 WEST 49TH STREET AUSTIN, TEXAS 78756-3199 ST ATE OF TEXAS COUNTY OF TRA VIS DSHS Document No. 7560022067 2006 Contract Change Notice No. 04 The Department of State Health Services, 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 . h d' d h h () tll partIes t ereto now eSlre to amen suc contract aUac ment s as 0 ows: SUMMARY OF TRANSACTION: ATT NO. OIA: RLSS-LOCAL PUBLIC HEALTH SYSTEM All terms and conditions not hereby amended remain in full force and effect. EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN. CITY OF PARIS Authorized Contracting Entity (type above if different from PERFORMING AGENCY) for and in behalf of: PERFORMING AGENCY: RECEIVING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT DEPARTMENT OF STATE HEALTH SERVICES By: By: (Signature of person authorized to sign) (Signature of person authorized to sign) Bob Burnette, Director Client Services Contracting Unit (Name and Title) (Name and Title) Date: Date: RECOM~ENDED' By: I~ Ihrt~~ / (PERFO MING AGENCY Director, if different from person authorized to sign contract JC CSCU - Rev. 6/05 EXHIBIT A- Cover Page 1 DET AILS OF A TT ACHMENTS Attl DSHS Program ID/ Term Financial Assistance Direct Total Amount Amd DSHS Purchase Assistance (DSHS Share) No. Order Number Begin End Source of Amount Funds* 01A RLSS/LPHS 09/01/05 08/31/06 State 93.991 109,998.00 0.00 109,998.00 0000309899 02 IMM/LOCALS 09/01/05 08/31/06 State 93.268 50,023.00 0.00 50,023.00 0000309169 03 CHS/PHC 09/01/05 08/31/06 State 151,558.00 0.00 151,558.00 0000309477 04 NSS/WIC-CARD 10/01/05 09/30/06 10.557 93.268 0.00 0.00 0.00 0000311608 DSHS Document No.7560022067 2006 Totals $311,579.00 $ 0.00 $311,579.00 Change No. 04 *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. 7560022067-2006 ATTACHMENT NO. OlA PURCHASE ORDER NO. 0000309899 PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT RECEIVING AGENCY PROGRAM: REGIONAL AND LOCAL SERVICES SECTION TERM: September 01,2005 THRU: August 31, 2006 It is mutually agreed by and between the contracting parties to amend the conditions of Document No. 7560022067 2006 -Olas written below. All other conditions not hereby. amended are to remain in full force and effect. SECTION 1. SCOPE OF WORK is revised to include the following: PERFORMING AGENCY shall comply with applicable RECEIVING AGENCY programmatic guidelines in accordance with activities outlined in the final accepted FY06 Service Delivery Plan. PERFORMANCE MEASURES PERFORMING AGENCY shall complete the PERFORMANCE MEASURES as stated in the FY 06 LPHS Service Delivery Plan, and as agreed upon by RECEIVING AGENCY, and hereby attached as Exhibit B. SECTION 1. SCOPE OF WORK, fourth paragraph, is revised to add the following bulleted items: · PERFORMING AGENCY'S FY 06 LPHS Service Delivery Plan; · FY 05 Texas Application for Preventive Health and Health Services Block Grant Funds; and · Government Code section 403.1055, "Permanent Fund for Children and Public Health". SECTION II. SPECIAL PROVISIONS, second paragraph, IS revised to add the following: PERFORMING AGENCY shall submit an Annual Budget and Expenditures Report in a format specified by and to RECEIVING AGENCY by December 15, 2006. ATTACHMENT - Page I . ,. DEPARTMENT OF STATE HEALTH SERVICES RECEIVING AGENCY PROGRAM: REGIONAL AND LOCAL SERVICES SECTION PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT CONTRACT TERM: 09/01/05 THRU: 08/31/06 BUDGET PERIOD: 09/01/05 THRU 08/31/06 DSHS DOC. NO. 7560022067 200601A CHG.04 REVISED CONTRACT BUDGET FINANCIAL ASSISTANCE OBJECT CLASS CATEGORIES CURRENT APPROVED CHANGE NEW OR REVISED BUDGET (A) REQUESTED (B) BUDGET (C) Personnel $45,200.00 $42,798.00 $87,998.00 Fringe Benefits . 15,059.50 6,940.50 22,000.00 Travel 0.00 0.00 0.00 Equipment 0.00 0.00 0.00 Supplies 0.00 0.00 0.00 Contractual 0.00 0.00 0.00 Other 0.00 0.00 0.00 Total Direct Charges $60,259.50 $49,738.50 $109,998.00 Indirect Charges 0.00 0.00 0.00 TOTAL $60,259.50 $49,738.50 $109,998.00 PERFORMING AGENCY SHARE: Program Income 0.00 0.00 0.00 Other Match 0.00 0.00 0.00 RECEIVING AGENCY SHARE $60,259.50 $49,738.50 $109,998.00 PERFORMING AGENCY SHARE $0.00 $0.00 $0.00 Detail on Indirect Cost Rate Type: Rate 0.00 Base $0.00 Total $0.00 Budget Justification: Amendment is to extend end term from 02/28/06 to 08/31/06 and budget funds for additional 6 months. 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"" ~ S ..c fr Q., 8- ~""Q~='QJ ..... ,.Q l"'l C'-l "" - ~ l"'l l"'l CERTIFICA TION REGARDING LOBBYING CERTIFICA TION 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 cO,nnection 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, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2) 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-Ill, "Disclosure Form to Report Lobbying," in accordance with it's instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all sub awards at all tiers (including subcontracts, subgrants, and contracts under grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact 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 impos~d 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 tha $10,000 and not more than $100,000 for each such failure. ;1-/-(! Date 7560022067 2006-01 Application or Contract Number PARIS-LAMAR COUNTY HEALTH DEPARTMENT Organization Name and Address 740 6TH ST SW PARIS, TX 75460-8530 .,