2004-025-RES APPROVING EXECUTION OF CONTRACT CHANGE NOTICE N0O 03 (ATTACHMENT NO. 01A) TO THE CONTRACT FOR PUBLIC HEALTH SERVICES TDH DOC. NO. 7560022067-2004
RESOLUTION NO.
2004-025
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF PARIS,
PARIS, TEXAS, APPROVING AND AUTHORIZING THE EXECUTION OF
CONTRACT CHANGE NOTICE NO. 03 (ATTACHMENT NO. OlA) TO
THE CONTRACT FOR PUBLIC HEALTH SERVICES, TDH DOCUMENT
NO. 7560022067-2004; 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 8th day of
September, 2003, in Resolution No. 2003-148, authorize the execution of a Contract for Public
Health Services, TDH Document No. 7560022067-2004, 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 8th day of
September, 2003, also in said Resolution No. 2003-148, authorize the execution of Contract
Change Notice No. 01 (Attachment No. 02) and Contract Change Notice No. 02 (Attachment No.
03) to said contract; and,
WHEREAS, said contract is in need of further amendment, and it is deemed appropriate
that the form of Contract Change Notice No. 03 (Attachment No. 0IA), 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 Change Notice No. 03 to the Contract for Public
Health Services, TDH Document No. 7560022067-2004, 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. 03 (Attachment
No. 0IA), 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 9th day of February, 2004.
ATTEST:
.~kLu'[uJ ~~
Sherian Dixon, Temporary Acting City Clerk
G'
~-~ /
. 8.. r: /---
.
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS
COUNTY OF TRAVIS
TDH Document No. 7560022067 2004
Contract Change Notice No. 03
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. OIA: AC FAM. HEALTH-PRIMARY HEALTH CARE
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
TEXAS DEPARTMENT OF HEALTH
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)
By:
(PE
Date:
{)(~;;L9 ~ d-f) f)~
SC PCSO - Rev. 2/03
Cover Page 1
EXHIBIT A-
DETAILS OF ATTACHMENTS
Auf TDR Program ID/ Term Financial Assistance Direct Total Amount
Amd TDR Purchase Order Assistance (TDR Share)
No. Number Begin End Source of Amount
Funds.
01A ACFHlPRC 09/01/03 08/31/04 State 151,558.00 0.00 151,558.00
o00ooo 1134
02 BNSIWIC-CARD 10/01/03 09/30/04 93.268 10.557 0.00 0.00 0.00
o00ooo1391
03 OPHPILPRS 09/01/03 08/31/04 State 93.991 120,519.00 0.00 120,519.00
o00ooo 10 13
TDR Document No.7560022067 2004 Totals $272,077.00 $ 0.00 $272,077 .00
Change No. 03
*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
TEXAS DEPARTMENT OF HEALTH
RECEIVING AGENCY PROGRAM: ASSOCIATE COMMISSIONER FOR FAMILY HEALTH
PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT
CONTRACT TERM: 09/01/03 THRU: 08/31/04 BUDGET PERIOD: 09/01/03 THRU 08/31/04
TDH DOC. NO. 7560022067 2oo401A CHG.03
REVISED CONTRACT BUDGET
FINANCIAL ASSISTANCE
OBJECT CLASS CATEGORIES CURRENT APPROVED CHANGE NEW OR REVISED
BUDGET (A) REQUESTED (B) BUDGET(C)
Personnel $41,625.00 $41.625.00 $83,250.00
Fringe Benefits 11.655.00 11,655.00 23.310.00
Travel 630.00 630.00 1,260.00
Equipment 0.00 0.00 0.00
Supplies 3,210.00 3.210.00 6,420.00
Contractual 15.299.00 15,299.00 30,598.00
Other 3,360.00 3,360.00 6.720.00
Total Direct Charges $75.779.00 $75,779.00 $151.558.00
Indirect Charges 0.00 0.00 0.00
TOTAL $75.779.00 $75.779.00 $151,558.00
PERFORMING AGENCY SHARE:
Program Income 0.00 0.00 0.00
Other Match 0.00 0.00 0.00
RECEIVING AGENCY SHARE $75,779.00 $75,779.00 $151,558.00
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: Increase due to extension of term from 2/29/04 to 8/31/04 and increased number to be served.
Revised Number to be ServedlUnits of Service: 1,200
Form No. GC-9
Financial status reports are due the 30th of December, 31st of March, 30th of June. and the 30th of November.
C~~_l'IFICA TION REGARDING LODD\' fNG
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-HI, "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 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.
(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 imposf:?d by Section 1352, Title 31, U.S. Code.
Any person who fails to tile the required certification shall be subject to a civil penalty of not
less than 10,000 and not m9 e than $ 0,000 for each such failure.
Date
Print Name of Authorized Individual
7560022067 2004-01
Application or Contract Number
PARIS-LAMAR COUNTY HEALTH DEPARTMENT
Organization Name and Address
740 SOUTHWEST 6TH
PARIS. TX 75460-0000