2004-158-RES AUTHORIZING EXECUTION OF CONTRACT CHANGE NOTICE NO 04 (ATTACHMENT NO 04) TO THE CONTRACT FOR PUBLIC HEALTH SERVICES, TDH DOC. NO 7560022067-2005
RESOLUTION NO. 2004-158
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF PARIS,
PARIS, TEXAS, APPROVING AND AUTHORIZING THE EXECUTION OF
CONTRACT CHANGE NOTICE NO. 04 (ATTACHMENT NO. 04) 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 of the 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, in said Resolution No. 2004-127, authorize the execution of Contract Change Notice No.
01 (Attachment No. 0IA);
WHEREAS, the City Council of the City of Paris did heretofore, on the 9th day of
August, 2004, in said Resolution No. 2004-139, authorize the execution of Contract Change
Notices No.2 (Attachment No. 02) and No.3 (Attachment 03);
WHEREAS, said contract is in need of further amendment, and it is deemed appropriate
that the forms of Contract Change Notice No. 04 (Attachment 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 forms for the Contract for Public Health Services, TDH Document
No. 7560022067-2005, Contract Change Notice No. 04 (Attachment No. 04) 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, Contract Change Notice No. 04 (Attachment
No. 04) and 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~'
Jay Guest, Mayor Pro Tem
ATTEST:
APPROVED AS TO FORM:
.
DEPARTMENT OF STATE HEALTH SERVICES
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS
COUNTY OF TRAVIS
DSHS Document No. 7560022067 2005
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
arties thereto now desire to amend such contract attachment(s) as follows:
SUMMARY OF TRANSACTION:
ATT NO. 04 : 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.
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 STA TE 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:
DB peSD - Rev. 6/04
Cover Page 1
EXHIBIT ~
DETAILS OF ATTACHMENTS
Aui DSHS Program 10/ Term Financial Assistance Direct Total Amount
Amd DSHS Purchase Assistance (DSHS Share)
No. Order Number Begin End Source of Amount
Funds*
01A IMMlLOCALS 01/01/04 12/31/04 State 93.268 33,389.00 0.00 33,389.00
o00ooo1782
02 ACFHlPHC 09/01/04 08/31/05 151,558.00 0.00 151,558.00
C038917OO0
03 OPHPILPHS 09/01/04 08/31/05 120,519.00 0.00 120,519.00
C039254OO0
04 BNSIWIC-CARD 10/01/04 09/30/05 0.00 0.00 0.00
C039512000
DSHS Document No.7560022067 2005 Totals $305,466.00 $ 0.00 $305,466.00
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 DET All.S.
it
Cover Page 2
DOCUMENT NO. 7560022067-2005
ATTACHMENT NO. 04
PURCHASE ORDER NO. C039512000
PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: BUREAU OF NUTRITION SERVICES
TERM: October 01,2004 THRU: September 30,2005
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY shall administer RECEIVING AGENCY'S Special Supplemental
Nutrition Program for Women, Infant, and Children (WIC) to provide supplemental food
instruments, nutrition education and counseling to enhance good health care at no cost to 10w-
income pregnant and postpartum women, infants and children identified to be at nutritional risk.
PERFORMING AGENCY shall complete the following: it
A. Perform professional, administrative and clerical services necessary to determine
eligibility, provide food instruments, and provide appropriate nutrition education and
counseling to qualified women, infants and children in a specified geographic area.
PERFORMING AGENCY shall ensure adequate staff coverage and uninterrupted
delivery of services. 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 in this contract Attachment. During the term of this contract
Attachment, USDA will issue regulations, instructions, policies and/or directives, which
may be incorporated into the RECEIVING AGENCY'S WIC Program Policy and
Procedures Manual and program rules.
PERFORMING AGENCY shall provide services in the authorized geographic service
area(s) described in PERFORMING AGENCY'S application and agreed to by
RECEIVING AGENCY'S WIC Program. PERFORMING AGENCY can change the
authorized geographic service area(s) with written approval from RECEIVING
AGENCY'S WIC Program. If RECEIVING AGENCY'S WIC Program disagrees on
change of geographic service area(s), PERFORMING AGENCY may terminate this
contract Attachment with at least thirty (30) days written notice.
B. Assist in the collection of data that will identify benefits of this nutrition intervention
program and furnish financial, health, nutrition education and any other special reports in
a timely manner as required by RECEIVING AGENCY'S WIC Programs written rules
and policies for the compilation of such data.
C. Determine eligibility of applicants through assessment of their income, residence and
nutritional status, and provide nutrition education and counseling to eligible applicants.
A TT ACHMENT - Page 1
D. Provide immunizations to eligible participants;
E. Train PERFORMING AGENCY'S Local Agency staff;
F. Conduct outreach to potential applicants and make referrals to other Health and Human
Service providers.
G. Complete surveys as requested.
H. Maintain applicant/participant records as required by RECEIVING AGENCY'S WIC
Program's written rules and policies.
I. Determine participants' access to health care, medical care and other human services, and
make appropriate referrals. PERFORMING AGENCY shall have a system in place to
provide participants with appropriate health services or make appropriate referrals to
health care providers under written agreements that ensure ~onfidentiality of participants'
personal information. ~
J. Issue prenumbered food instruments furnished by RECEIVING AGENCY'S WIC
Program to qualified participants who shall use such instruments to obtain specified food
items from participating vendors; maintain complete accountability and security of all
food instruments received from RECEIVING AGENCY'S WIC Program.
PERFORMING AGENCY shall be held financially responsible for all unaccounted for
food instruments and/or for the redeemed value of those issued to ineligible participants.
In addition, PERFORMING AGENCY shall be held financially liable for issuance of
infant formula instruments that are not authorized or prescribed according to the Texas
WIC Policy and Procedure Manual.
K. Review the immunization records of WIC Program applicants/participants and provide
immunizations as needed in accordance with the WIC Policy and Procedures Manual or
as otherwise approved in writing by RECEIVING AGENCY'S WIC Program.
L. 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 the PERFORMING AGENCY'S
Annual Plan of Operations as approved by RECEIVING AGENCY'S WIC Program and
incorporated by reference.
M. Implement or expand PERFORMING AGENCY'S Breastfeeding Peer Counseling
program to provide training and salary incentives of peer counselors who assist pregnant
and breastfeeding WIC participants in normal breastfeeding situations. This funding item
is contingent upon availability and whether participation is requested by PERFORMING
AGENCY and approved in writing by RECEIVING AGENCY'S WIC Program.
N. Implement Lactation services for WIC participants who have breastfeeding problems that
are beyond the expertise of PERFORMING AGENCY'S local WIC staff and/or peer
A TT ACHMENT - Page 2
counselors using International Board Certified Lactation Consultants or the most
qualified equivalent. Lactation services may also include PERFORMING AGENCY'S
Local WIC Agency staff training and the provision of lactation equipment. RECEIVING
AGENCY'S WIC Program will provide written approval of PERFORMING AGENCY'S
plan to use lactation funding. PERFORMING AGENCY'S plan must include
qualifications of any non-board Certified Lactation consultant, which is included in the
proposal.
O. Ensure adequate staff coverage and uninterrupted delivery of WIC services if any
member of PERFORMING AGENCY'S staff is approved in writing by RECEIVING
AGENCY'S WIC Program 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.
P. RECEIVING AGENCY'S WIC Program will provide three (3) types of breastpumps for
eligible WIC participants by distributing breastpumps to PERFORMING AGENCY or by
authorizing PERFORMING AGENCY to purchase breastpump collection kits. If
PERFORMING AGENCY is authorized to purchase the breastpump collection kits,
RECEIVING AGENCY'S WIC Program will provide written notification of the specific
types of collection kits. If this requirement is implemented, then the actual cost of
collection kits purchased by PERFORMING AGENCY will be reimbursed by
RECEIVING AGENCY'S WIC Program utilizing WIC Food Grant funds. When
PERFORMING AGENCY receives or is authorized to purchase collection kits, Nutrition
Services and Administration funds may not be used for that purpose. The cost for the
purchase of the breastpump collection kits will not affect administrative surplus
calculations. The number and cost of the collection kits purchased shall be identified
separately on the face of the claim for reimbursement (State of Texas Purchase Voucher,
Form B-13).
Q. Implement or expand PERFORMING AGENCY'S use of a Registered Dietitian (RD) to
provide an array of technical services. With prior written approval from RECEIVING'
AGENCY'S WIC Program, obtain the services of a RD who is registered with the
Commission on Dietetic Registration to provide services for PERFORMING AGENCY
such as: assistance with quality assurance, staff 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, including, but not limited to:
1. Uniform Federal Assistance Regulations, 7 CPR Parts 15, 15a, 15b, 246, 248,
3016,3017 and 3018;
2. WIC Program Rules, 25 Texas Administrative Code, ~~ 31.11-31.37; and
A TT ACHMENT - Page 3
3. Child Nutrition Act of 1966. as amended, 42 USC 1786.
The following documents are incorporated by reference and made a part of this contract
Attachment:
1. RECEIVING AGENCY Standards for Public Health Clinic Services. revised
January 31,2004;
2. USDA Food and Nutrition Service (FNS) Guidelines;
3. USDA FNS Instructions issued under the FNS Directives Management System;
and
4. Texas WIC Policy and Procedures Manual. dated 6/2002 or latest revision.
A copy of the current WIC Policy and Procedure Manual has been made available to
PERFORMING AGENCY. The WIC Policy and Procedure Manual, all revisions made to the
WIC Policy and Procedure Manual through the Texas WIC Bulletin webiste, 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 and Program roles as well as state and federal laws and
amendments governing or regulating the WIC Progr~.
PERFORMING AGENCY is responsible for ensuring that employees or agents acting on behalf
of PERFORMING AGENCY comply with all of the requirements of the WIC Policy and
Procedure Manual. Program rules and all state and federal laws and amendments governing and
regulating the WIC Program.
Within thirty (30) days of receipt of an amended policy or rule. PERFORMING AGENCY shall
inform RECEIVING AGENCY'S WIC Program in writing if it will not continue performance
under this contract Attachment in compliance with the amended policy or rule. RECEIVING
AGENCY'S WIC Progi'am may terminate this contract Attachment immediately or within a
reasonable period of time as determined by RECEIVING AGENCY'S WIC Program.
PERFORMING AGENCY shall perform all activities in accordance with PERFORMING
AGENCY'S FY OS workplan. timeframes, and budget. and any revisions as approved by
RECEIVING AGENCY'S WIC Program. These documents are hereby incorporated by
reference and made a part of this contract Attachment.
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 ensure:
ATIACHMENT - Page 4
1) 98% of families who participate in RECEIVING AGENCY'S WIC Program by receiving
food instruments shall also receive nutrition education classes or individual counseling
services to coincide with food voucher issuance;
2) Of all pregnant women who enter RECEIVING AGENCY'S WIC Program, at least 32%
shall be certified as eligible during the period of the first trimester of their pregnancy;
3) 88% of clients who are enrolled in RECEIVING AGENCY'S WIC 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);
4) 60% of infants whose mo~hers were partIcIpants in RECEIVING AGENCY'S WIC
Program during pregnancy shall be breast-fed at or before the time of their certification of
eligibility; and
5) 98% of participants who indicate during the enrollme!lt process of RECEIVING
AGENCY'S WIC Program that they have no source of health care shall be referred to at
least one (1) source of health care at certification of eligibility.
PERFORMING AGENCY shall submit a monthly activity report which demonstrates
PERFORMING AGENCY'S efforts towards meeting assigned annual targets as described in
items 1-5 of the performance measures. The report shall be in an approved format as provided by
RECEIVING AGENCY'S WIC Program, and shall be completed and submitted to RECEIVING
AGENCY'S WIC Program 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 ~8 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 contract 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
A TT ACHMENT - Page 5
such records, books, and accounts as needed to ascertain compliance with the
nondiscrimination laws. The Department of Agriculture, Food and Nutrition Services,
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 contract Attachment are
authorized to sign this Assurance on behalf of PERFORMING AGENCY.
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 contract 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'S WIC Program by
giving written notice to PERFORMING AGENCY. The participant caseload is subject
to change upon written notice to PERFORMING AGENCY from RECEIVING
AGENCY WIC Program with PERFORMING AGENCY'S concurrence.
PERFORMING AGENCY assumes liability for all food costs resulting from
PERFORMING AGENCY exceeding its 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.
RECEIVING AGENCY'S WIC Program will reimburse PERFORMING AGENCY for
administrative costs incurred when determining eligibility, providing appropriate
nutrition education and counseling, issuing food instruments, making participant
referrals, vendor evaluation, outreach, start-up costs and general administrative support.
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 contract Attachment
term. Surplus encumbered by September 30 shall be billed and vouchers received by
RECEIVING AGENCY'S WIC Program no later than December 31,2005.
PARTICIPANTS SERVED PER MONTH MAXIMUM REIMBURSEMENT:
During the term of the contract Attachment, PERFORMING AGENCY shall earn
administrative funds at the rate of $11.41 for each participant served as defined above.
A TT ACHMENT - Page 6
PERFORMING AGENCY shall provide immunizations under RECEIVING AGENCY'S
WIC Special Initiative through September 30, 2005, unless otherwise notified in writing
by RECEIVING AGENCY'S WIC Program. Immunizations administered and funded
under RECEIVING AGENCY'S WIC Special Initiative to WIC applicants/participants
and their siblings will earn administrative funds at the rate of $5.50 per immunization as
reported to RECEIVING AGENCY'S WIC Program via the Texas WIC Information
Network (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'S WIC
Program if it intends to terminate this contract Attachment.
PERFORMING AGENCY agrees that:
(1) PERFORMING AGENCY shall identify and document separately not less than
19% of total administrative costs as expenditures directly related to nutrition
education and counseling. Nutrition education and counseling expenditures shall
be supported by documentation of participant attend~ce or non-attendance within
the RECEIVING AGENCY'S WIC Program.
(2) RECEIVING AGENCY'S WIC Program 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 and
counseling, 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 RECEIVING
AGENCY'S WIC Program.
(3) RECEIVING AGENCY'S WIC Program will limit (cap) PERFORMING
AGENCY'S indirect costs approved by a federal cognizant agency to twenty (20)
percent applied to PERFORMING AGENCY'S total direct salaries plus benefits
reimbursed by RECEIVING AGENCY'S WIC Program.
(4) RECEIVING AGENCY'S WIC Program will identify annually to
PERFORMING AGENCY an amount of funds that shall 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'S WIC Program.
(5) RECEIVING AGENCY'S WIC Program 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'S WIC Program
directives.
A TT ACHMENT - Page 7
(6) RECEIVING AGENCY'S WIC Program reserves the right to utilize a
competitive offering for the award of any future contracts at the end of the term of
this contract Attachment.
(7) RECEIVING AGENCY'S WIC Program may amend or terminate this contract
Attachment if available funds become reduced, depleted, or unavailable during
the term of the contract Attachment to the extent that the WIC Program is unable
to provide administrative funding at the rate(s) shown above. RECEIVING
AGENCY'S WIC Program will provide written notification to PERFORMING
AGENCY of such fact.
(8) RECEIVING AGEN~CY' S WIC Program may pay for additional services as
specified in this contract Attachment if provided by PERFORMING AGENCY
during the term of this contract Attachment (but not otherwise paid during the
term of this contract Attachment) if it is in the best interest of the State and
RECEIVING AGENCY'S WIC Program to do so. If PERFORMING AGENCY
exceeds the amount of earned administrativ& funds as stated above,
PERFORMING AGENCY shall continue to bill RECEIVING AGENCY'S WIC
Program for the services provided. If additional funds become available at a later
date for the provision of these services, RECEIVING AGENCY'S WIC Program
may pay PERFORMING AGENCY a share of these funds.
(9) RECEIVING AGENCY'S WIC Program may provide incentives to
PERFORMING AGENCY'S Local WIC Agencies for participants who are
provided WIC services outside the normal traditional hours to the extent that
federal funding is available.
(10) RECEIVING AGENCY'S WIC Program may adjust the base reimbursement rate
defined above during the term of this contract Attachment if it is in the best
interest of the State of Texas and RECEIVING AGENCY'S WIC Program 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 contract Attachment.
However, PERFORMING AGENCY will be allowed the option of receiving a two (2) month
cash advance in accordance with WIC Program Policy and Procedures.
General Provisions, Program Income, paragraph one, is not applicable to this contract
Attachment.
General Provisions, Overtime Compensation Article, IS not applicable to this contract
Attachment.
A TT ACHMENT - Page 8
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'S WIC Program funds,
whether purchased locally by PERFORMING AGENCY or by RECEIVING
AGENCY'S WIC Program 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'S WIC Program and submit it at a time
to be specified by RECEIVING AGENCY'S WIC Program. RECEIVING AGENCY'S
WIC Program reserves the right to recover the cost of equipment or supplies purchased
by RECEIVING AGENCY'S WIC Program and placed in the custody of
PERFORMING AGENCY i(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 (Form GC-3), shall be
submitted no later than December 31,2005.
General Provisions, Reports Article, third paragraph, is hereby modified to include the
following:
PERFORMING AGENCY shall submit vaccine report forms as required by
RECEIVING AGENCY'S WIC Program. PERFORMING AGENCY shall comply with
instructions from RECEIVING AGENCY'S WIC Program to transmit immunization
activity at intervals specified by RECEIVING AGENCY'S WIC Program.
SECTION III. BUDGET:
All categories of costs billed to RECEIVING AGENCY'S WIC Program, and allocation of such
costs, shall be in accordance with the "Plan to Allocate Direct Costs" (P ADC) submitted by
PERFORMING AGENCY and approved by RECEIVING AGENCY'S WIC Program. This.
document is incorporated herein by reference and made a part of this contract Attachment.
A TT ACHMENT - Page 9
CEl IFICA TION REGARDING LOBB'. .J!!
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 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,'~ il} 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
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.
s(ft p ~
-r-2J-o'f
Date
7560022067 2005-04
Application or Contract Number
PARIS-LAMAR COUNTY HEALTH DEPARTMENT
Organization Name and Address
740 SOUTHWEST 6TH
PARIS, TX 75460-0000