14-E Health Contract CO3DRAFT
F:kAttorney\LisakResolutions\CURRENTkHealth Contract 2004 CO3 Res.wpd
February 2, 2004
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. 03 (ATTACHMENT NO. 0lA) 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. 0lA), 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. 0lA), 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:
Curtis Fendley, Mayor
Mattie Cunningham, City Clerk
APPROVED AS TO FORM:
Larry W. Schenk, City Attorney
TEXAS DEPARTMENT OF HEALTH
1100 WE§T 49TH §TIIEET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS
COUNTY OF TRAVIS
TDH Document No. 7560022067 2004
Contract Change Notice No. 0~3
The Texas Department of Health, ~ere~na~lter re~erre~] to as ~I~IUIltI~ X~I~NUV, did h~t~q~ s~l~l i~t~ ~ o~nt~aot in ruri[ln~
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. 0lA: AC FAM. HEALTH-PRIMARY HEALTH CARE
All tam anti conciitiong not hcrchy ~m~nrl~ r~nmln tn Iull I~'~ antl ~t't~r,
EXECUTED IN DUPLICATE ORIGINALS ON TI-I~ 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
By:
(Signature of person authorized to sign)
(Name and Title)
Date: ~/
(PE~gMI~G ~G~Y D~rector. if differ~t ' from[person authorized to sign contract
TEXAS DEPARTMENT OF HEALTH
(Signature of person'~]thorized to sign*) '
Bob Burnette, Director
Procurement and Contracting Services Division
(Name and Title)
Date: F3 J-- ~7 ~ c~ ~ .04
SC PCSD- Rev. 2/03
Cover Page 1
DETAILS OF ATTACHMENTS
Atff I TDH Program ID/ Term Financial Assistance Direct Total Amount
Amd , TDH Purchase Order Assistance (TDH Share)
No. Number Begin End Source of Amount
Funds*
ACFHIPHC 09/01/03 08/31/04 State 151,558.00 0.00 151,558.00
0lA 0000001134
BNS/WIC-CARD 10/01/03 09/30/04 93.268 10.557 0.00 0.00 O.OO
02 0000001391
OPHP/LPHS 09/01/03 08/31/04 State 93,991 120,519.00 0.00 120,519.00
03 0000001013
TDH Document No.7560022067 2004 Totals $272,077,00 $ 0.00i $272,077.00
Chanl~e No. 03
*Federal funds are indicated by a number from the Catalog of Federal Domestic Assistance (CFDA). if applicable. REFER TO
BUDOET SECTION OF ANY ZERO AMOUNT ATTACH2vlENT FOR DETAILS.
Cover Page 2
TEXASDEPARTMENT 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 TKRU 08/31/04
TDH DOC. NO. 7560022067 20040 [ A CHG. 03
REVISED CONTRACT BUDGET
FINANCIAL ASSISTANCE
OBJECT CLASS CATEGORIES CURRENT APPROVED CHANGE NEW OR REVISED
BUDGET (A) REQUESTED (B) BUDGET (C)
Personnel ~1,025.00 ~41,6~,00 $$3,250.00
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 $75 379.00 $75 379.00 $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 Served/Units of Service: 1,200
Form No GC.~,
Financial status reports are due the 30th of December, 31st 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 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
thi~ transaction was made or entered into. Submission of this certification is a prerequisite
for making or entering into this transaction impose, d by Section Title 31, U.§. 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 mo e than $ 0,000
?i~ta~re 1 /~., ~~/~, for each such failure. Date
Print Name of Authorized Individual
7560022067 2004-01
Application or Contract Number
PARIS-LAMAR COUNTY HEALTI{ DEPARTMENT
Organization Name and Address
740 SOUTHWEST 6TH
PA~I$, TX 75460-0000