2004-139-RES AUTHORIZING CONTRACT CHANGE NOTICE NOS. 02 (ATTACHMENT NO. 02) AND 03 (ATTACHMENT NO 03) TO THE CONTRACT FOR PUBLIC HEALTH SERVICES, TDH DOC. NO. 7560022067-2005
RESOLUTION NO. 2004-139
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF PARIS,
PARIS, TEXAS, APPROVING AND AUTHORIZING THE EXECUTION OF
CONTRACT CHANGE NOTICE NOS. 02 (ATTACHMENT NO. 02) AND 03
(ATTACHMENT NO. 03) TO THE CONTRACT FOR PUBLIC HEALTH
SERVICES, TDH DOCUMENT NO. 7560022067-2005; 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 12th day of July,
2004, in Resolution No. 2004-126, authorize the execution of a Contract for Public Health
Services, TDH Document No. 7560022067-2005, which is the conduit through which the state
funds are received; and,
WHEREAS, the City Council of the City of Paris did heretofore, on the 12th day of July,
2004, also in said Resolution No. 2004-127, authorize the execution of Contract Change Notice
No. 01 (Attachment No. OIA);
WHEREAS, said contract is in need of further amendment, and it is deemed appropriate
that the forms of Contract Change Notice No. 02 (Attachment No. 02) attached hereto as Exhibit
A, and Contract Change Notice No. 03 (Attachment No. 03) attached hereto as Exhibit B be
approved, and that the City Manager be authorized to execute the same on behalf ofthe 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 forms for the Contract for Public Health Services, TDH Document
No. 7560022067-2005, Contract Change Notice No. 02 (Attachment No. 02) attached hereto
as Exhibit A, and Contract Change Notice No. 03 (Attachment No. 03) attached hereto as
Exhibit B, be, and the same are 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, Contract Change Notice No.
02 (Attachment No. 02), and Contract Change Notice 03 (Attachment No. 03) under the terms
and conditions and in the form shown in Exhibits A and B, attached hereto.
Section 4. That this resolution shall be effective from and after its date of passage.
PASSED AND APPROVED this 9th day of August, 2004.
ATTEST:
1;/' /~
herian Dixon, Assistant City Clerk
APPROVED AS TO FORM:
.
DEPARTMENT OF STATE HEALTH SERVICES
1100 "VEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS
COUNTY OF TRAVIS
DSHS Document No. 7560022067 2005
Contract Change Notice No. 02
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
arties thereto now desire to amend sllch contract atrachment(s) as follows:
SUMMARY OF TRANSACTION:
ATT NO. 02 : AC FAM. HEALTH-PRIMARY HEALTH CARE
All terms and conditions not hereb amended remain in full force and effect. J
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 DEPARTl\1ENT
DEPARTMENT OF STATE HEALTH SERVICES
By:
(Signature of person authorized to sign)
By:
(Signature of person authorized to sign)
(Name and Title)
Bob Burnette, Director
Procurement and Contracting Services Division
(Name and Title)
Date:
Date:
By:
ERFO IN AGENCY Director, if different
from person authorized to sign contract
KR PCSD - Rev. 6/04
Cover Page 1
EXHIBIT
A
. )
DETAILS OF ATTACHMENTS
Att/ DSHS Program IDI Term Financial Assistance Direct Total Amount
Amd DSHS Purchase Assistance (DSHS Share)
No. Order Number Begin End Source of Amount
Funds*
01A IMM/LOCALS 01/01/04 12131/04 State 93.268 33,389.00 0.00 33,389.00
0000001782
02 ACFH/PHC 09/01/04 08/31/05 151,558.00 0.00 151,558.00
C038917000
DSHS Document No.7560022067 2005 Totals $184,947.00 $ 0.00 $184,947.00
Change 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. 7560022067-2005
A TT ACHMENT NO. 02
PURCHASE ORDER NO. C038917000
PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: ASSOCIATE COMMISSIONER FOR FAMILY
HEALTH
TERM: September 01, 2004 THRU: August 31,2005
SECTION 1. SCOPE OF WORK:
PERFORMING AGENCY shall deliver comprehensive health care services to eligible low-
income individuals as authorized under the Health and Safety Code, Chapter 31, Texas Primary
Health Care Services Act.
~
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, including but not limited to:
. RECEIVING AGENCY'S Primary Health Care (PHC) Program Rules, 25 TAC, Chapter
39;
. RECEIVING AGENCY'S PHC Handbook, and any revisions; and
. Texas PHC Services Act, Health and Safety Code, Chapter 31.
The following documents are incorporated by reference and made a part of this contract
Attachment. These include:
. RECEIVING AGENCY Family & Community Health Services Grants FY2005
Competitive Request For Proposal (RFP);
. PERFORMING AGENCY'S FY200S Component II, Attachment E application and any
revisions; and
. RECEIVING AGENCY'S Texas Department of Health (TDH) Standards for Public
Health Clinic Services, revised January 31, 2004.
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.
A TT ACHMENT - Page 1
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.
PERFORMING AGENCY shall report on:
. Screening, referral and PHC eligibility services (PHC-200)
. Client intake - new and recertitied clients (PHC-200)
. Number ofPHC eligible clients receiving medical services (pHC-200)
. Clients served by month (PHC-200)
. Cost and type of services provided (PHC-200)
. Client demographic data (PHC-300) (annual)
ELIGIBILITY:
All individuals considered for PHC eligibility must be screened ani'determined eligible using a
TDH or PHC program approved screening tool as updated in the spring of each year when
federal poverty levels and eligibility determination forms are revised.
CO-PA Y:
PERFORl'vlING AGENCY may assess co-pay from clients provided services by RECEIVING
AGENCY under this Attaclunent. A co-pay assessment may not exceed 25% of the amount
RECEIVING AGENCY pays PERFORMING AGENCY for the provision of a given service. A
client shall not be denied services due to inability to pay. Local Health Departments shall
comply with RECEIVING AGENCY fee collection policies detailed in 25 TAC ~ 1.91.
PERFOR:L\1ING AGENCY shall make reasonable efforts to investigate and apply for all other
sources of third party funding available to or identified by the patient before submitting claims
for allowable costs to RECEIVING AGENCY Program.
PERFORMING AGENCY shall provide services to clients who live or who receive services in
the following county (ies)/area: Lamar.
SECTION II. SPECIAL PROVISIONS:
General Provisions, Reports Article, is revised to include the following:
PERFORMING AGENCY shall submit monthly reports within 30 days following the
end of the month. RECEIVING AGENCY Program requires comprehensive reports that
allow the Program to assess the volume and quality of services being provided.
A TT ACHMENT - Page 2
FINANCIAL ASSISTANCE
CURRENT
OI3JECT CLASS CATEGORIES NEW OR REVISED APPROVED CHANGES
BUDGET BUDGET REQUESTED
a. PE R50NN E L............. .... ............... 80,160.00 0.00 80,160.00
b. FRINGE I\ENEFITS.......................... 19,840.00 0.00 19,840.00
c. TRAVEL................................. 1,477.00 0.00 1,477.00
d. EQUIPM LNT................................ 0.00 0.00 0.00
e. S U PPLI ES........ ..... .................... 10.940.00 0.00 10,940.00
f. CONTRACruAL.............................. 30,500.00 0.00 30,500.00
a OTHER..... ............................... 8,641.00 0.00 8,641.00
O'
~
h. TOTAL 01 RECT CHARGES..................... 151,558.00 0.00 151,558.00
i. INDlREC'I. CHARGES......................... 0.00 0.00 0.00
TOTAL............ .............. ...... .... 151,558.00 j 0.00 151,558.00
k. RECEIVIi,G AGENCY SHARE................... 151,558.00 0.00 151,558.00
I. PERFOR1\IING AGENCY SHARE (Includes m. PI) 0.00 0.00 0.00
m. PROGRA\I INCOME:
0.00 0.00 0.00
01.2. Progr:l111 Income (projected)......... 0.00 0.00 0.00
01.3. Other i\latch......................... 0.00 0.00 0.00
CONTRACT TERM
l3egin Date.................................... 9/1/2004
End D:i1~...................................... 8/3112005
DEl AIL 0:'-1 INDIRECT COST:
TYPE OF R\ TE PROVISIONAL................
PREDETERMINED.............
Fll',AL......................
FI :\ED......................
RATE......... ............................ 0.00000 0.00000 0.00000
BA5E........ ............................. 0.00 0.00 0.00
TOTAL Il"DIRECT CHARGES.................... 0.00 0.00 0.00
Financial status reports are due the 30th of December, 30th of March, 30th of June, and the 30th of November.
'" . .
,
..'. \
CERTIFICATION REGARDING LOBBYING
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 influendng 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," :tin accordance with it's
instructions.
(3)
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.
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 imposl?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 than 10,000 and not more th r each such failure.
7-15-04
Date
ANTHONY BETHEL
Print Name of Authorized Individual
7560022067 2005-02
Application or Contract Number
PARIS-LAMAR COUNTY HEALTH DEPARTMENT
Organization Name and Address
740 6TH ST SW
PARIS, TX 75460-8530
.
DEPARTMENT OF STATE HEALTH SERVICES
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS
COUNTY OF TRAVIS
DSHS Document No. 75600220672005
Contract Change Notice No. 03
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
arties thereto now desire to amend such contract attachment(s) as follows:
SUMMARY OF TRANSACTION:
ATT NO. 03 : OPHP - LOCAL PUBLIC HEALTH SYSTEM
All terms and conditions not hereb 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:
(Signature of person authorized to sign)
By:
(Signature of person authorized to sign)
(Name and Title)
Bob Burnette, Director
Procurement and Contracting Services Division
(Name and Title)
Date:
Date:
RMING AGENCY Director, if different
rson authorized to sign contract
CE PCSD - Rev. 6/04
cXH~B1T B
Cover Page 1
-n E.T A I L S 0 FAT T A C H MEN T S
Attl DSHS Program 101 Term Financial Assistance Direct Total Amount
Amd DSHS Purchase Assistance (DSHS Share)
No. Order Number Begin End Source of Amount
Funds*
01A IMM/LOCALS 01/01/04 12/31/04 State 93.268 33,389.00 0.00 33,389.00
o00ooo1782
02 ACFHIPHC 09/01/04 08/31/05 151,558.00 0.00 151,558.00
C038917000
03 OPHP/LPHS 09/01/04 08/31/05 120,519.00 0.00 120,519.00
C039254000
DSHS Document No.7560022067 2005 Totals $305,466.00 $ 0.00 $305,466.00
Chan5e No. 03 .
*Federal funds are indicated by a number from the (;:atalog of Federal Domestic Assistance (CFDA), if applicable. REFER TO
BUDGET SECTION OF ANY ZERO AMOUNT ATTACHMENT FOR DETAILS.
J.
Cover Page 2
DOCUMENT NO. 7560022067-2005
ATTACHMENT NO. 03
PURCHASE ORDER NO. C039254000
PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: OFFICE OF PUBLIC HEALTH PRACTICE
TERM: September 01, 2004 THRU: August 31, 2005
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY shall improve or strengthen local public health infrastructure within
the State of Texas by: -
. Developing objective(s) to address a public health issue;
. Utilizing resources provided through this contract attachment to conduct activities
and services that provide or support the delivery of essential public health services;
. Assessing, monitoring, and evaluating the essential public health activities and
services provided through this contract attachment; and
. Developing strategies to improve the delivery of essential public health service(s) to
identified service area.
These tasks shall be performed in accordance with PERFORMING AGENCY'S FY 05 Local
Public Health System (LPHS) Service Delivery Plan, dated May 27,2004 and the FY 05 Texas
Application for Preventive Health and Health Services Block Grant Funds, dated June 15, 2004.
The assessment and/or evaluation activities must include a standard that is identified in
PERFORMING AGENCY'S FY 05 LPHS Service Delivery Plan. Acceptable standards include
the National Public Health Performance Standards approved by the Centers for Disease Control
and Prevention, Performance Standards developed by the Texas Association of Local Health
Officials, Healthy People 2010, and any federal, state or local law or regulation governing the
delivery of essential public health services. Other evaluation methods utilizing standards not .
listed in this contract Attachment must be pre-approved by RECEIVING AGENCY.
PERFORMING AGENCY shall comply with all applicable federal and state laws, rules,
regulations, standards including, but not limited to, the following:
. Chapter 23-11 of the Healthy People 2010;
. Section 121.002, Texas Health & Safety Code, definition of ten essential public health
services; and
. Government Code, Section 403.1055, "Permanent Fund for Children and Public Health".
. Texas Administrative Code, Title 25, Chapter 83, Subchapter A "Permanent Fund for
Children and Public Health".
A IT ACHMENT - Page 1
PERFORMING AGENCY shall comply with all applicable regulations, standards, and
guidelines in effect on the beginning date of this contract Attachment.
The following documents are incorporated by reference and made a part of this contract
Attachment:
. PERFORMING AGENCY'S FY 05 LPHS Service Delivery Plan; and
. FY 05 Texas Application for Preventive Health and Health Services Block Grant Funds.
PERFORMING AGENCY may not use funds from the Permanent Fund for Children and Public
Health for lobbying expenses under the Government Code, Section 403.1067.
RECEIVING AGENCY shall inform PERFORMING AGENCY in writing of any changes to
applicable federal and state laws, rules, regulations, standards and guidelines. PERFORMING
AGENCY shall comply with the amended law, rule regulation, standard or guideline except that
PERFORMING AGENCY shall inform RECEIVING AGENCY Program in writing if it shall
not continue performance under this Attachment within thirty (30) days of receipt of an 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
PERFORMING AGENCY shall complete the PERFORMANCE MEASURES as stated in the
FY 05 LPHS Service Delivery Plan, and as agreed upon by RECEIVING AGENCY, and hereby
attached as Exhibit A.
PERFORMING AGENCY shall provide activities and services as submitted by PERFORMING
AGENCY and approved by RECEIVING AGENCY in the FY 05 LPHS Service Delivery Plan
in the following county(ies)larea: Lamar.
SECTION II. SPECIAL PROVISIONS:
General Provisions, Reports Article, is revised to include the following paragraphs:
PERFORMING AGENCY shall submit quarterly progress reports which describe progress
toward completing the activities and services contained in PERFORMING AGENCY'S FY 05
LPHS Service Delivery Plan and any written revisions. PERFORMING AGENCY shall submit
the first, second and third quarter's progress reports to RECEIVING AGENCY no later than
thirty (30) days after the end of each quarter, and the final report and improvement plan to
RECEIVING AGENCY sixty (60) days after the end of this contract Attachment term in a
format specified by RECEIVING AGENCY.
ATTACHMENT - Page 2
PERFORMING AGENCY shall submit an Annual Budget and Expenditures Report in a format
specified by and to RECEIVING AGENCY by December 15,2005.
:t
ATTACHMENT - Page 3
FINANCIAL ASSISTANCE
CURRENT
OBJECT CLASS CATEGORIES NEW OR REVISED APPROVED CHANGES
BUDGET BUDGET REQUESTED
a. PERSONNEL................................ 90,400.00 0.00 90,400.00
b. FRINGE BENEFITS.......................... 30,119.00 0.00 30,119.00
c. TRA VEL................................... 0.00 0.00 0.00
d. EQUIPMENT................................ 0.00 0.00 0.00
e. SUPPLIES.......... .... .... ....... ... ..... 0.00 0.00 0.00
f. CONTRACTUAL.............................. 0.00 0.00 0.00
g. OTHER.................................... 0.00 0.00 0.00
-
h. TOTAL DIRECT CHARGES..................... 120,519.00 0.00 120,519.00
i. INDIRECT CHARGES......................... 0.00 0.00 0.00
j. TOTAL.................................... 120,519.00 j 0.00 120,519.00
k. RECEIVING AGENCY SHARE................... 120,519.00 0.00 120,519.00
1. PERFORMING AGENCY SHARE (Includes m. PI) 0.00 0.00 0.00
m. PROGRAM INCOME:
0.00 0.00 0.00
m.2. Program Income (projected)......... 0.00 0.00 0.00
m.3. Other Match......................... 0.00 0.00 0.00
CONTRACT TERM
Begin Date................. ... ............ .... 9/112004
End Date..... ................................. 8/3112005
DETAIL ON INDIRECT COST:
TYPE OF RATE PROVISIONAL................
PREDETERMINED.............
FINAL......................
FIXED......................
RATE...................................... 0.00000 0.00000 0.00000
BASE...................................... 0.00 0.00 0.00
TOTAL INDIRECT CHARGES.................... 0.00 0.00 0.00
Financial status reports are due the 30th of December, 30th of March, 30th of June, and the 30th of November.
. ., , .
Exhibit A
PERFORMANCE MEASURES:
PERFORMING AGENCY: Paris-Lamar County Health Department
Objective #1: PERFORMING AGENCY shall ensure patrons of
restaurants/food establishments are safe from food borne outbreaks.
Performance Measure #1: 100% of restaurants are in compliance with federal,
state and local food handlers regulations in Lamar County.
Objective #2: PERFORMING AGENCY shall ensure local public health system
partners receive information regarding critical public health issues and
appropriate forums are planned and scheduled for developing public health
policies.
~
Performance Measure #2: 100% of public health information provided to local
public system partners is accurate and timely in Lamar County.
Objective #3: PERFORMING AGENCY shall ensure public safety from water
borne disease.
Performance Measure #3: Average 110-120 water tests performed each month.
Exhibit A - Page 1
C fIFICA TION REGARDING LOBi .NG
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-ll1, "Disclosure Form to Report Lobbying," i~ accordance with it's
instructions. .1
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
sub recipients shall certify and disclose accordingly.
(3)
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 than $10,000 and not more than $100,000 for each such failure.
4iJ/j;?~ .
~nat re I
fIJ/Y} h n h/v/ fJ e/~g/
Print Name of Auth6rized Individual
f- 2 -ot/
,
Date
7560022067 2005-03
Application or Contract Number
PARIS-LAMAR COUNTY HEALTH DEPARTMENT
Organization Name and Address
740 6TH ST SW
PARIS, TX 75460-8530