07-F Health Contract - CO2DRAFT
F:kAttorney\LisakResolutions\CURRENTkHealth Contract 2003 CO2 Res.wpd
January 8, 2003
RESOLUTION NO.
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF PARIS,
PARIS, TEXAS, APPROVING AND AUTHORIZING THE EXECUTION OF
CONTRACT CHANGE NOTICE NO. 02 (ATTACHMENT NO. 05) TO THE
CONTRACT FOR PUBLIC HEALTH SERVICES, TDH DOCUMENT NO.
7560022067-2003; 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 July,
2002, in Resolution No. 2002-119, authorize the execution of a Contract for Public Health
Services, TDH Document No. 7560022067-2003, 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
August, 2002, in Resolution No. 2002-131, authorize the execution of Contract Change Notice
No. 01 (Attachments Nos. 02, 03, and 04) 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. 02 (Attachment No. 05), 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. 02 to the Contract for Public
Health Services, TDH Document No. 7560022067-2003, 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.
02 (Attachment No. 05), 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 January, 2003.
ATTEST:
Michael J. Pfiester, Mayor
Mattie Cunningham, City Clerk
APPROVED AS TO FORM:
Larry W. Schenk, City Attorney
TEXAS DEPARTMENT OF HEALTH
I100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS TDH Document No. 7560022067 2003
COUNTY OF TRAVIS Contract Change Notice No. 02
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. 05 : BNS - WIC CARD PARTICIPATION
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 TEXAS D.F.,P.A.RTMENT OF HEALTH
By: By: ~ '
(Signature of person authorized to sign) (Signature of person authorized to sign)
Melanie A. Doyle, Director
t'tichael E. F. alonea, C'it? l, lanalger Grants Management Division
(Name and Title) (Name and Title)
Date: Date: I&l {~{0~
RECOMME ED: - /
(PE~/~)I~G A'GEN~'Y Director, if different
,~m person authorized to sign contra~t
VW GMD - Rev. 12/00
Cover Page 1
EXHIBIT.&_
DETAILS OF ATTACHMENTS
Att/ TDH Program ID/ Term Financial Assistance Direct Total Amount
Amd TDH Purchase Order Assistance (TDH Share)
No. Number Begin End Source of Amount
Funds*
OPHP/BIOTERR
01 000C010991 06/01/02 08/31/03 93.283 87,190.00 0.00 87,190.00
ACFH/PHC
02 000C011270 09/01/02 08/31/03 State 180,000.00 0.00 180,000.00
OPH~/LPHS
03 000C011397 09/01/02 08/31/03 State93.991 120,519.00 0.00 120,519.00
IMM/LOCALS
04 000C011588 09101/02 08/31/03 State 50,023.00 0.00 50,023.00
BNS/WIC-CARD
05 0000000362 10/01/02 09/30/03 93.268 10.557 0.00 0.00 0.00
TDH Document No.7560022067 2003 Totals
Change No. 02 $437,732.00 $ 0.00 $437,732.00
*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. 7560022067-2003
ATTACHMENT NO. 05
PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: BUREAU OF NUTRITION SERVICES
TERM: October 01, 2002 THRU: September 30, 2003
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY shall provide supplemental food instruments, nutrition education and
counseling, 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 determine
eligibility, provide food instruments, and provide appropriate nutrition education and
counseling to qualified women, infants and children in a specified geographic ama.
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 Attachment. During the term of this Attachment, USDA
will issue regulations, instructions, policies and/or directives which may be incorporated
into the State WlC Policy and Procedures Manual and program rules.
PERFORMING AGENCY shall provide services in the authorized geographic service
ama(s) described in PERFORMING AGENCY'S application and agreed to by
RECEIVING AGENCY. PERFORMING AGENCY can change the authorized
geographic servic_e area(s) with approval from RECEIVING AGENCY. If RECEIVING
AGENCY disagrees on change of geographic service ama(s), PERFORMING AGENCY
may terminate this contract with at least thirty (30) days written notice.
B. Assist in the collection of data that shall 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 Program's written rules and
policies for the compilation of such data.
C. Determine eligibility of applicants through assessment of their income, residence and
nutritional status; provide nutrition education and counseling; provide immunizations;
train staff; conduct outreach to potential applicants; make referrals to other health and
human service providers; complete surveys as requested; and maintain records as
required by RECEIVING AGENCY Program's written rules and policies.
ATTACHMENT - Page I
D. 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 confidentiality of participants'
personal information.
E. Issue prenumbered food instruments furnished by RECEIVING AGENCY 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; and be held financially responsible
for all unaccounted for food instruments and/or for the redeemed value of those issued to
ineligible participants. PERFORMING AGENCY shall be held financially liable for
issuance of infant formula instruments that are not authorized or prescribed according to
the State WIC Policy and Procedure Manual.
F. 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 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 the Annual Plan of Operations as
approved by RECEIVING AGENCY and incorporated by reference.
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. Implement lactation services for 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. Lactation
services may also include staff training and lactation equipment. RECEIVING
AGENCY will provide written approval of PERFORMING AGENCY'S plan to use
lactation funding. The plan shall include qualifications of any non-board certified
lactation consultant PERFORMING AGENCY proposes to use.
J. Ensure adequate staff coverage and uninterrupted delivery of WlC 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 shall consist of no less than 900 hours of supervised learning experiences in a
variety of nutrition-related facilities and shall prepare PERFORMING AGENCY'S
selected staff member to better meet the needs of WIC participants.
K. RECEIVING AGENCY will provide three (3) types of breastpumps for eligible WIC
participants by distributing breastpumps to PERFORMING AGENCY or by authorizing
ATTACHMENT - Page 2
PERFORMING AGENCY to pumhase breastpump collection kits. If PERFORMING
AGENCY is authorized to purchase the bmastpump collection kits, RECEIVING
AGENCY 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 utilizing WlC
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).
L. 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, 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. The following documents are incorporated by reference and made a part of this
contract Attachment.
1. Child Nutrition Act of 1966, as amended, 42 USC 1786;
2. Uniform Federal Assistance Regulations, 7 CFR Pans 15, 15a, 15b, 246, 248,
3016, 3017 and 3018;
3. RECEIVING AGENCY'S Quality Care: Client Services Standards for Public
Health and Community Clinics;
4. WIC Program Rules, 25 Texas Administrative Code, §§ 31.11-31.37;
5. Food and~Nutrition Service (FNS) Guidelines; and
6. FNS Instructions issued under the FNS Directives Management System.
A copy of the current WlC Policy and Procedure Manual has been made available to
PERFORMING AGENCY. The WlC Policy and Procedure Manual, all revisions made to the
WlC Policy and Procedure Manual through the Texas WlC 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 and Program rules as well as state and federal laws and amendments
governing or regulating the WlC Program.
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
ATTACIiMENT - Page 3
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 program in writing if it will not continue performance under this
Attachment in compliance with the amended policy or rule. 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.
· 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);
· 60% 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;
· 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; and, -
· A monthly activity report which demonstrates PERFORMENG 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;
ATTACHMENT - Page 4
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 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 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 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. The participant caseload is subject to
change 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
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 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
ATTACHMENT - Page 5
given month. Surplus funds (the amount by which maximum reimbursements exceed
actual costs) can be accumulated and carded forward within the Attachment term.
Surplus encumbered by September 30 shall be billed and vouchers received by
RECEIVING AGENCY no later than December 31, 2003.
PARTICIPANTS SERVED PER MONTH MAXIMUM REIMBURSEMENT:
During the term of the Attachment, PERFORMING AGENCY shall earn administrative
funds at the rate of $9.45 for each participant served as defined above.
PERFORMING AGENCY shall provide immunizations under the WIC Special Initiative
through September 30, 2003, 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
$4.52 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:
(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 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 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.
(3) RECEIVING 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 is permitted, except for indirect cost 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 shall be spent for breastfeeding promotion. The allocation
ATTACHMENT - Page 6
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 fight 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) RECEIVING AGENCY reserves the fight 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 shall continue to bill RECEIVING
AGENCY for the services provided. If additional funds become available at a
later date for the provision of these services, RECEIVING AGENCY may pay
PERFORMING AGENCY a share of these funds.
(9) RECEIVING 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 defined 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 ~hall 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 (2) month cash advance
in accordance with WIC Program Policy and Procedures.
ATTACHMENT - Page 7
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 RECEIVING
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 31, 2003.
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. PERFORMING AGENCY shall comply with instructions from
RECEIVING AGENCY to transmit immunization activity at intervals specified by
RECEIVING AGENCY.
SECTION III. BUDGET:
All categories of costs billed to RECEIVING AGENCY, and allocation of such costs, shall 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.
ATTACHMENT - Page 8
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 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, 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 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 impose, 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 thgW$100,000 for each such failure.
- - Date
Anthony Bethel~ Administrator
Print Name of Authorized Individual
7560022067 2003-05
Application or Contract Number
pARIS-LAMAR COUNTY HE2~LTH DEPARTMENT
Organization Name and Address
740 SOUTHWEST 6TH
PARIS, TX 75460-0000