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HomeMy WebLinkAboutResolution - 2011-R0551 - Contract - SPAG - HHS Funds, Area Agency On Aging Direct Purchase Of Services - 12_14_2011Resolution No. 2011—RO551 December 14, 2011 Item No. 5.1.1 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute for and on behalf of the City of Lubbock, a Contract with the South Plains Association of Governments (SPAG) for funds passed through the U.S. Department of Health and Human Services to the Texas Department of Aging and Disability Services for an Area Agency on Aging Direct Purchase of Services Program grant and any associated documents. Said Contract is attached hereto and incorporated in this resolution as if fully set forth herein and shall be included in the minutes of the City Council. Passed by the City Council on December 14, 2011 TOMI ARTIN, MAYOR ATTEST: Reb cca Garza, City Secre ry APPROVER AS TO CONTENT: R dy Truesdell, Community Services Director APPROVE AS TO FORM: 11 Chad Weaver, Assistant City Attorney vwxcdocs/RE S.Contract-SPAG November 30, 2011 Ar-C Z1 l- 0C11C'V Resolution No. 2011—Rd551 WO Aging SOUTH PLAINS ASSOCIATION OF GOVERNMENTS AREA AGENCY ON AGING VENDOR AGREEMENT City of Lubbock, hereinafter referred to as Vendor, and the South Plains Association of Governments Area Agency on Aging (AAA) do hereby agree to provide services effective beginning October 1, 2011, in accordance with the Older Americans Act of 1965 (OAA), as amended, regulations of the Department of Aging and Disability Services (DADS), the AAA Direct Purchase of Services program and the stated Scope of Services. The AAA Direct Purchase of Services program is designed to promote the development of a comprehensive and coordinated service delivery system to meet the needs of older individuals (60 years of age or older) and their caregivers. This agreement provides a mechanism for the creation of an individualized network of community resources accessible to a program participant in compliance with the OAA and DADS AAA Access and Assistance guidelines. The purpose of the system of Access and Assistance is to develop cooperative working relationships with service providers to build an integrated service delivery system that ensures broad access to and information about community services, maximizes the use of existing resources, avoids duplication of effort, identifies gaps in services, and facilitates the ability of people who need services to easily find the most appropriate Vendor. 1. SCOPE OF SERVICES A. The Vendor agrees to provide the following service(s) as identified below to program participants authorized by the AAA staff, in accordance with the vendor application, all required assurances, licenses, certifications and rate setting documents, as applicable. Service: CONGREGATE MEALS TRANSPORTATION Service Definition: CONGREGATE MEAL - A hot or other appropriate meal served to an eligible older individual which meets 33'/3 percent of the dietary reference intakes established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences and complies with the most recent Dietary Guidelines for Americans, published by the Secretary of Agriculture, and which is served in a congregate setting. The objective is to reduce food insecurity and promote socialization of older individuals. There are two types of congregate meals: • Standard meal - A regular meal from the standard menu that is served to the majority or all of the participants. • Therapeutic meal or liquid supplement - A special meal or liquid supplement that has been prescribed by a physician and is planned specifically for the participant by a dietitian (e.g., diabetic diet, renal diet, pureed diet, tube feeding). TRANSPORTATION - Taking an older individual from one location to another but does not include any other activity. There are two types of transportation services: • Demand/Response - transportation designed to carry older individuals from specific origin to specific destination upon request. Older individuals request the transportation service in advance of their need, usually twenty-four to forty-eight hours prior to the trip. Form #: AIAAA VA2.0 Ldition Dale: 9119/11 Unit Definition: CONGREGATE MEALS One Meal HOME DELIVERED MEALS: One Meal TRANSPORTATION — Demand/Response: One One-way Trip LEGAL ASSISTANCE: One Hour Service Area (To he Lilled in by provider. Please type or Print neatly): G I -rY aF LU6130c < All Texas Administrative Code standards are located at the Texas Secretary of State website: www.sos.state.tx.us. All Older Americans Act and other required rules and regulations are located at http://www.aoa.p,ov/AoARoot/About/Authorizing Statutes/index.ast)x. Targeting: AAA services are designed to identify eligible program participants, with an emphasis on high -risk program participants and to serve older individuals with greatest economic and social need, low-income minorities and those residing in rural areas, as required by the OAA. B. Services & Reimbursement Methodology: Service Fixed Rate (include rate) Variable Rate (identify range) Cost Reimbursement Congregate 6.94 N/A N/A Transportation 7.70 N/A N/A 2. TERMS OF AGREEMENT A. The Vendor agrees to: 1. provide services in accordance with current or revised DADS policies and standards and the OAA. 2. submit billings with appropriate documentation as required by the AAA by the close of business on the 2nd working day day of each month following the last day of the month in which services were provided. a. If the 2nd working day falls on a weekend or holiday, the information shall be delivered by the close of business on the preceding business day. b. The AAA cannot guarantee payment of a reimbursement request received for more than 45 calendar days of service delivery. c. No reimbursement for services provided will be made if vendor payment invoices are not submitted to the AAA within 45 days of service delivery. 3. encourage program participant contributions (program income) on a voluntary and confidential basis. Such contributions will be properly safeguarded and accurately accounted for as receipts and expenditures on Vendor's financial reports if contributions are not required to be forwarded to the AAA. Client contributions (program income) will be reported fully, as required, to the AAA. Forin #: AIAAA VA2.0 ? Edition Date: 9119/11 Vendor agrees to expend all program income to expand or enhance the program/service under which it is earned. 4. notify the AAA Director immediately if, for any reason, the Vendor becomes unable to provide the service(s). 5. maintain communication and correspondence concerning program participants' status. 6. establish a method to guarantee the confidentiality of all information relating to the program participant in accordance with applicable federal and state laws, rules, and regulations. This provision shall not be construed as limiting AAA or any federal or state authorized representative's right of access to program participant case records or other information relating to program participants served under this agreement. 7. keep financial and program supporting documents, statistical records, and any other records pertinent to the services for which a claim for reimbursement was submitted to the AAA. The records and documents will be kept for a minimum of five years after close of vendor's fiscal year. 8. make available at reasonable times and for required periods all fiscal and program participant records, books, and supporting documents pertaining to services provided under this agreement, for purposes of inspection, monitoring, auditing, or evaluations by AAA staff, the Comptroller General of the United States and the State of Texas, through any authorized representative(s). 9. if applicable, comply with the DADS process for Centers for Medicare and Medicaid Services (CMS) screening for excluded individuals and entities involved with the delivery of the Legal Assistance and Legal Awareness services. B. The Vendor further agrees: 1. The agreement maybe terminated for cause or without cause upon the giving of 30 days advance written notice. 2. The agreement does not guarantee a total level of reimbursement other than for individual units/services authorized; contingent upon receipt of funds. 3. Vendor is an independent provider, NOT an agent of the AAA. Thus, the Vendor indemnifies saves and holds harmless the South Plains Association of Governments AAA against expense or liability of any kind arising out of service delivery performed by the Vendor. Vendor must immediately notify the AAA if the Vendor becomes involved in or is threatened with litigation related to program participants receiving services funded by the AAA. 4. Employees of the Vendor will not solicit or accept gifts or favors of monetary value by or on behalf of program participants as a gift, reward or payment. C. Through the Direct Purchase of Services program, the South Plains Association of Governments AAA agrees to: 1. review program participant intake and assessment forms completed by the Vendor, as applicable, to determine program participant eligibility. Service authorization is based on program participant need and the availability of funds. 2. provide timely written notification to Vendor of program participant's eligibility and authorization to receive services. 3. maintain communication and correspondence concerning the program participants' status. 4. provide timely technical assistance to Vendor as requested and as available. Form #: AIAAA_VA2.0 Edition Date: WIWI I 5. conduct quality -assurance procedures, which may include on -site visits, to ensure quality services are being provided and if applicable, CMS exclusion reviews are conducted. 6. provide written policies, procedures, and standard documents concerning program participant authorization to release information (both a general and medicalfhealth related release), client rights and responsibilities, contributions, and complaints/grievances and appeals to all program participants. 7. contingent upon the AAA's receipt of funds authorized for this purpose from DADS, reimburse the Vendor based on the agreed reimbursement methodology, approved rate(s), service(s) authorized, and in accordance with subsection (A)(2) of this document, within 45 days of the AAA's receipt of Vendor's invoice. Form #: AIAAA_VA2.0 4 Edition Date: 9/19/11 3. ASSURANCES The Vendor shall comply with: A. Title VI of the Civil Rights Act of 1964 (42 U.S.C. §2000d et.seq.) B. Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. §794) C. Americans with Disabilities Act of 1990 (42 U.S.C. § 12101 et seq.) D, Age Discrimination in Employment Act of 1975 (42 U.S.C. §§6101-6107) E. Title IX of the Education Amendments of 1972 (20 U.S.C. §§ 1681-1688) F. Food Stamp Act of 1977 (7 U.S.C. §200 et seq.) G. Drug Free Workplace Act of 1988 H. Texas Senate Bill 1 - 1991, as applicable 1. DADS administrative rules, as set forth in the Texas Administrative Code, to the extent applicable to this Agreement J. Certification Regarding Debarment - 45CFR §92.35 Sub awards to debarred and suspended parties; this document is required annually as long as this agreement is in effect K. Centers for Medicare and Medicaid Services (CMS) State Medicaid Director Letter SMDL #09-001 regarding Individuals or Entities Excluded from Participation in Federal Health Care Programs L. DADS Information Letter 11-07 — Obligation to Identify Individuals or Entities Excluded from Participation in Federal Health Care Programs 4. ATTACHMENTS A. Description of Assurances A — H listed in section 3 of this document. B. List of Focal Points in the AAA planning and service area. 5. SIGNATURES For the faithful performance of the terms of this agreement, the parties affix their signatures and bind themselves effective October 1, 2011. Authorized Vendor Signature Tom Martin Print Narne Mayor Title December 14, 2011 Date Authorized Signature South Plains Association of Governments (Agency) Attest: Approve s ontent: P.O. Box 3730 — Freedom Station (Address) R �beccaGarza ndy ruesdell Lubbock, Texas 79452 City Secretary Community Services Director (City. State, Zip) Fonn #: AIAAA VA2.0 Edition Date: W19/11 94�� Chad Weaver Assistant City Attorney 5 October 1, 2011 (Date) ASSURANCES ATTACHMENT A. Title V1 of the Civil Riahts Act of 1964 (42 U.S.C. §2000d et.seq. ), which prohibits discrimination because of race, color religion sex or nations origin in all employment practices including hiring, firing, promotion, compensation and other terms, privileges and conditions of employment. B. Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. V94), which states that employers may not refuse to hire or promote handicapped persons solely because of their disability. C. Americans with Disabilities Act of 1990 (42 U.S.C. &12101 et seq.), which prohibits a covered entity from discriminating against a qualified individual on the basis of disability in regard to job application procedures, the hiring, advancement, or discharge of employees, employee compensation, job training, and other terms, conditions, and privileges of employment. D. Age Discrimination in Employment Act of 1975 (42 U.S.C. 16101-6107), prohibits discrimination on the basis of age in programs and activities receiving federal financial assistance. E. Title IX of the Education Amendments of 1972 (20 U.S.C. H1681-1688), which prohibits the use of federal money to support sexually discriminatory practices in education programs such as sexual harassment and employment discrimination, and to provide individual citizens effective protection against those practices. F. Food Stamp Act of 1977 (7 U.S.C. §200 et sect.), whose purpose is to strengthen the agricultural economy; to help to achieve a fuller and more effective use of food abundances; to provide for improved levels of nutrition among low-income households through a cooperative Federal -State program of food assistance to be operated through normal channels of trade; and for other purposes. G. Drug Free Workplace Act of 1988, which requires that all organizations receiving federal grants, regardless of amount granted, maintain a drug -free workplace. H. Texas Senate Bill 1 - 1991, as applicable, which refers to proper reporting of contributions as addressed in OAA §315 and TAC, Title 40, §85.201. Attachment B FOCAL POINTS FOR THE SOUTH PLAINS ASSOCIATION OF GOVERNMENTS REGION FY 2011-2012 CENTER: Abernathy Sr. Citizens Association, Inc. (A-005) DIRECTOR: Louise Thomason H — 298-4055/ C — 789-5165 BOOKKEEPER: Louise Thomason ADDRESS: 717 Avenue C CITY: Abernathy, Texas 79311 PHONE: (806) 298-2842 E-mail: abernathysrcenter@erfwireless.net DAYS & HRS. OPEN: Tues. & Thurs. 8:00-12:00, 1:00-4:00, Wed. 8:00-4:00 SERVICES: SCO. COUNTY: Lubbock CENTER: Anton Sr. Citizens Association, Inc. (A-015) DIRECTOR: Carol Rendon BOOKKEEPER: Carol Rendon ADDRESS: Box 378 (201 Main Street) CITY: Anton, Tes 7"T3 PHONE: (806) 997-2781 E-mail: antonsr@windstream.net DAYS & HRS. OPEN: Mon. — Fri. 8-2 SERVICES: CONG., H.D., SCO. COUNTY: Hockley CENTER: Bailey County Commissioners Court (A-020) DIRECTOR: Shelby Carpenter BOOKKEEPER: Shelby Carpenter ADDRESS: 300 South First Street Room 110 CITY: Muleshoe, Texas 79347 PHONE: (806) 272-3647 E-mail: beaging,1fivearea.c.om DAYS & HRS. OPEN: Mon. -Fri. 8:30-12:00, 1:00-5:00 Fax: (806) 272-4656 SERVICES: H.D., TRANS., B.C. Cell: (806) 518-1675 COUNTY: Bailey CENTER: Bailey County Senior Citizens Assoc., Inc. (A-007) DIRECTOR: Laverne Winn H — (806)272-4491 C — (806) 946-8809 BOOKKEEPER: Brittany Gibbs ADDRESS: 319 S. Main St I PO Box 292 CITY: Muleshoe, Texas 79347 PHONE: (806) 272-4969 E-mail: seniors@iivearea.com DAYS & HRS. OPEN: Mon. — Fri.. 8:00 — 4:00 Fax: (806) 272-4460 SERVICES: CONG., SCO. COUNTY: Bailey UPDATED 10/ 1 1 /2010 CENTER: Brownfield Senior Citizens, Inc. (A-025) DIRECTOR: Betty Charlebois BOOKKEEPER: ADDRESS: P.O. Box 1021 (500 W. Bridges) CITY: Brownfield, Texas 79316 PHONE: (806) 637-6933 E-mail: bndsrcit@vahoo.com DAYS & HRS. OPEN: Mon. - Fri. 8:30-2:30 SERVICES: CONG., H.D., SCO., TRANS. COUNTY: Terry CENTER: Cochran Co. Senior Citizens Assoc., Inc. (A-045) DIRECTOR: Nancy Luper C - (806) 523-3362 BOOKKEEPER: Nancy Luper ADDRESS: 120 W. Wilson CITY: Morton, Texas 79346 PHONE: (806) 266-5121 E-mail: ccsci@valornet.com DAYS & HRS. OPEN: Mon. — Fri. 8-4 Fax #: 266-9027 SERVICES: CONG., SCO., TRANS. COUNTY: Cochran CENTER: Crosby Co. Senior Citizens Assoc., Inc. (A-050) DIRECTOR: Donna Arnold BOOKKEEPER: Donna Arnold ADDRESS: 119 North Berkshire CITY: Crosbyton, Texas 79322 PHONE: (806) 675-2107 (806) 454-0189 (Donna's cell) E-mail: CrosbvCountyS_eniors@windstream.net DAYS & HRS. OPEN: Mon. —Fri. 8-3 SERVICES: CONG., H.D., SCO. COUNTY: Crosby CENTER: Floydada Senior Citizens, Inc. (A-055) DIRECTOR: Sylvia Bueno BOOKKEEPER: Sylvia Bueno ADDRESS: P.O. Box 573 (301 E. Georgia St.) CITY: Floydada, Texas 79235 PHONE: (806) 983-2032 E-mail: senior.citizens@att.net DAYS & HRS. OPEN: Mon. — Fri. 8-2 SERVICES: CONG., H.D., SCO. COUNTY: Floyd UPDATED 1(V 1 1 /2010 2 CENTER: Garza County Trailblazers, Inc. (A-070) DIRECTOR: Ila Workman BOOKKEEPER: Ila Workman ADDRESS: 205 F. IOth CITY: Post, Texas 79356 PHONE: (806) 495-2998 E-mail:2arzatrailblazers@vahoo.com DAYS & HRS. OPEN: Mon. — Fri. 8-2 SERVICES: LONG., H.D., SCO. COUNTY: Garza CENTER: Hale Center Senior Citizens Assoc., Inc. (A-075) DIRECTOR: Vickie Rosales BOOKKEEPER: Vickie Rosales ADDRESS: P.O. Box 205 (416 West 2°d St.) CITY: Hale Center, Texas 79041 PHONE: (806) 839-2428 E-mail: hcsrcenter@sbcglobal.net DAYS & HRS. OPEN: Mon. — Fri. 8-3 SERVICES: CONG., H.D., SCO., TRANS. COUNTY: Hale CENTER: Hockley County Senior Citizens Assoc., Inc. (A-085) DIRECTOR: Susan Sprowls BOOKKEEPER: Olga Gonzales ADDRESS: 1202 Houston CITY: Levelland, Texas 79336 PHONE: (806) 894-2228 E-mail: hcsca@aol.com sksprowls@aol.com DAYS & HRS. OPEN: Mon. --- Fri. 8-4:30 (Smyer: Tues & Fri, 8-3) SERVICES: LONG., H.D., SCO., TRANS. COUNTY: Hockley CENTER: Lorenzo Senior Citizens Assoc., Inc. (A-095) DIRECTOR: Christina Edwards BOOKKEEPER: Christina Edwards ADDRESS: P.O. Box 571 (606 61h St.) CITY: Lorenzo, Texas 79343 PHONE: (806) 634-5957 E-mail: lorenzosca@windstream.net DAYS & HRS. OPEN: Mon. —Fri. 8-3 SERVICES: CONG., H.D., SCO. COUNTY: Crosby UPDATED 10/11/2010 3 CENTER: Lubbock - City of Lubbock (A-100) DIRECTOR: Johnny McLellan, Supervisor: 775-2678 Nancy Neill, 775-2685 ADDRESS: P.O. Box 2000 (1010 9" St.) CITY: Lubbock, Texas 79457 PHONE: (806) 775-2678 E-mail:,imclellan@mail.ci.lubbock.tx.us nneill@mvlubbock.us pibrown@mvlubbock.us DAYS & HRS. OPEN: Mon. —Fri. 8-5 Fax: 775-2686 SERVICES: CONG., TRANS. COUNTY: Lubbock Mae Simmons — 767-2708, Traci Crawford (2004 Oak Avenue 79404), Copper Rawlings — 767-2704, Herminia Martinez (213 40'h Street 79404)140'h & Ave. B }, Maggie Treio — 767- 2705, Ida Aguilar (3200 Amherst 79415), Homestead - 687-7898, Mary Villalobos (5401 56'" Street 79414); Lubbock Senior Center — 767-2710, Paula Brown (2001 19'h Street 79401) FAX 765-0820 CENTER: Lynn County Pioneers (A-110) DIRECTOR: Bianca Baker BOOKKEEPER: Bianca Baker ADDRESS: P.O. Box 223 (1600 S. 3`d St.) CITY: Tahoka, Texas 79373 PHONE: (806) 561-5264 E-mail: Icp@door.net DAYS & HRS. OPEN: Mon. —Fri. 9-3 Fax: 561-5571 SERVICES: CONG., H.D., SCO. (No Cong. in O'Donnell) COUNTY: Lynn CENTER: Motley County Sr. Citizens Association, Inc. (A-112) DIRECTOR: Tommye Keith BOOKKEEPER: Tommye Keith ADDRESS: P. O. Box 184 (621 Stewart Street) CITY: Matador, Texas 79244 PHONE: (806) 347-2496 E-mail: mcsenior@caprock-spur.com DAYS & HRS. OPEN: Monday - Friday 8-3 SERVICES: CONG., H.D., SCO. COUNTY: Motley CENTER: N. Dickens Co. Senior Citizens Assoc., Inc. (A-115) DIRECTOR: Vonda Brendle BOOKKEEPER: Vonda Brendle ADDRESS: P.O. Box 163 (511 Montgomery) CITY: Dickens, Texas 79229 PHONE: (806) 623-5520 E-mail: ndcscc@caprock-spur.com DAYS & HRS. OPEN: Mon. —Fri. 8-2 UPDATED 10/11/2010 4 SERVICES: CONG., H.D., SCO. COUNTY: Dickens CENTER: Senior Citizens Assoc. of S. Dickens County (A-130) DIRECTOR: Beverly Watson BOOKKEEPER: Jean Hoover ADDRESS: 210 Burlington CITY: Spur, Texas 79370 PHONE: (806) 271-4472 E-mail: sscaosdc@caprock-spur.com DAYS & HRS. OPEN: Mon. —Fri. 8-3 SERVICES: CONG., H.D., SCO. COUNTY: Dickens CENTER: Slaton Senior Citizens Assoc., Inc. (A-135) DIRECTOR: Charlotte O'Connell BOOKKEEPER: Charlotte O'Connell ADDRESS: 230 West Lynn CITY: Slaton, Texas 79364 PHONE: (806) 828-3784 E-mail: coconnell@door.net DAYS & HRS. OPEN: Mon. —Fri. 8-4 slatonseniors@door.net SERVICES: CONG., H.D., SCO. COUNTY: Lubbock CENTER: Yoakum County Senior Citizens Assoc., Inc. (A-150) DIRECTOR: Elsie White BOOKKEEPER: Pat Castillo ADDRESS: 412 West 5'h St., #8 CITY: Denver City, Texas 79323 PHONE: (806) 592-8000 E-mail: Patycsc60@windstream.net DAYS & HRS. OPEN: Mon. —Fri. 9-2 Elsieycsc2@crosswind.net Jonigran@gmail.com SERVICES: CONG., H.D., SCO., TRANS. COUNTY: Yoakum Fax: (806) 592-283S LEGEND CONG. - Congregate (on -site) Meals H.D. - Home Delivered Meals SCO. - Senior Center Operations B.C. - Benefits Counseling TRAN. - Transportation Services UPDATED 10/11/2010 5 Schedule of Providers' Board Meetings Abernathy The board meets quarterly, but not on specific dates — Except for the annual meeting on the last Wednesday of Sept. Anton The board meets quarterly, but not on specific dates — Except for meetings in Nov. and Dec. to elect officers Bailey Co. The Commissioners' Court meets 2"d Monday of each month The Board of Directors for home delivered meals meets 2 times a year, but not on specific dates Bailey Co. Sr. The board meets on 2"d Wednesday of each month Brownfield The board meets on 2nd Thursday of each month Cochran Co. The board meets on 1" Tuesday of every other month — With a meeting in December to elect officers Crosby Co. The board meets the 2nd Friday of each month. Annual meeting held the last week in October Floydada The board meets on 2nd Tuesday of each month Garza Co. The board meets on 3d Tuesday of each month Hale Center The board meets on 2"d Monday of Jan., April, July & Oct. Hockley Co. The board meets on 4'h Wednesday of each month Lorenzo The board meets on 2nd Monday of every other month Lynn Co. The board meets quarterly but not on specific dates Motley Co. The board meets quarterly but not on specific dates N. Dickens Co. The board meets 2nd Wednesday of each month S. Dickens Co. The board holds 6 meetings per year (one every 2 months) But not on specific dates, and called meetings as needed Slaton The board meets 2"d Thursday of each month. Called meetings UPDATED 10/11/2010 6 as needed. Yoakum The board meets on 4`h Wednesday of each month UPDATED 10/11/2010 411111 The South Plains Association of Governments Area Agency on Aging Axea Agency S Direct Purchase of Service G Fiscal Year 2012 Vendor ApplicationlRenewal Update $ swrl r� lt�ir�o. Please type or clearly print application information. Char of Lubbock Vendor Name/Legal Entity DBA (if applicable) Physical Address: 2001 19th Street Lubbock Senior Center), Parks Administration, 1611 10th Street, Lubbock, TX 79401 Mailing Address: Tax Identification Number (SSN or Federal ID): Fax Number (including area code): 17560005906 806-775-2686 Type of Provider: �Governmental Agency Private Non -Profit Private For Profit City Government County Government Other: Authorizing Official: Title: Tom Martin Mayor Email Address: Telephone: tnuirtin rr m%lubbock.us 806-775-2003 Billing Contact Person and billing address: Title: Nancy Neill, City of Lubbock, PO Box 2000, Lubbock, TX 794 Indoor Recreation Coordinator Email Address: Telephone: nneil l a niy lubhock. us 806-775-2685 Number of Years Organization has been in business: Is Organization Bonded? (Ad of bondng knWomm) 32 Years 0 Yes No Has anyone involved in the direct provision of client services If Yes, Explain: been convicted of a felony (In -home Services only)? Yes 0 No Does Organization have liability insurance? -et #A_ abt cerfiffcate of all - - _ 0Yes ET No Conflicts of Interest: Attach information of applicable names and relationship of any employee(s) or officers of your organization that may have a conflict of interest with the South Plains Association of Governments Area Agency on Aging staff person or Advisory Council member. DPS Application Page 1 1; 2. 3. 4, Service and Bidding Information: A. Proposed Service: B. Service Area: City of Lubbock C. Proposed DADS AM AAA cost per unit: $ 6.94 A. Proposed Service: Home Delivered Meals B. Service Area: NIA C. Proposed DADS AM AAA cost per unit: $ NIA A. Proposed Service: Transportation B. Service Area: City of Lubbock C. Proposed DADS A&I AAA cost per unit: $ 7.70 A. Proposed Service: S. Service Area: C. Proposed DADS A&I AAA cost per unit: $ Signature: Whole cost per unit: $ 6.96 Whole cost per unit: $ NIA Whole cost per unit: $ 7.91 Whole cost per unit: $ I, Nancy Neill certify that the information provided in this application is true and Printed Name correct to the best of my knowledge. ram, (� �L Saturday, October 01, 2011 Authoriz4M tgrtature T— owe DPS Application Page 2 city of )bock TEXAS CERTIFICATE OF SELF-INSURANCE The undersigned officer of the City of Lubbock, Texas, a Texas home rule municipality, hereby certifies that the City of Lubbock has a $500,000.00 self - insured retention for Automobile and General Liability in accordance with the laws of the State of Texas. The City of Lubbock has a policy that covers Property/Bodily Injury over $500,000.00 per occurrence with One Beacon America Insurance Company under policy #791-000-230-0001 which expires on 10/01/12. The current net asset balance of the self-insurance fund is S3,397,295. The existing cash asset balance is $8,650,340 as of the date stated below. By: Leisa Hutcheson Risk Management Coordinator Date: September 30, 2011 DATE TO FROM SUBJECT N k400 city of lubbock TEXAS PARKS AND RECREATION October 1, 2011 South Plains Association of Government City of Lubbock — Senior Center Programs FY 2011-2012 Operating Hours and Holidays for SPAG Grant Number of Name of Sites Serving Days Lubbock Senior Center 250 Rawlings Community Center 250 Simmons Senior Center 250 Trejo Supercenter 250 Homestead Senior Program 250 Holidays Observed Dates Thanksgiving Day November 24, 2011 Day After Thanksgiving November 25, 2011 Christmas Eve December 23, 2011 Christmas Day December 26, 2011 New Year's Day January 2, 2012 Martin Luther King, Jr. Day January 16, 2012 Good Friday April 6, 2012 Memorial Day May 28, 2012 4th of July July 4, 2012 Labor Day September 3, 2012 Days and Hours of Operation M-F 8:00 am - 5:00 pm M-F 8:30 am - 4:00 pm M-F 8:30 am - 4:00 pm M-F 8:30 am - 4:00 pm M-F 9:00 am - 1:00 pm Certification Regarding Debarment CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION FOR COVERED CONTRACTS AND GRANTS Federal Executive Order 12549 requires the Texas Department of Aging and Disability Services (TDADS)) to screen each covered potential vendor/grantee to determine whether each has a right to obtain a contract/grant in accordance with federal regulations on debarment, suspension, ineligibility, and voluntary exclusion. Each covered vendor/grantee must also screen each of its covered sub vendors/providers. In this certification "vendor/grantee" refers to both vendor/grantee and sub vendor/sub- grantee: "contract/grant" refers to both contract/grant and subcontract/sub-grant. By signing and submitting this certification the potential vendor/grantee accepts the following terms: The certification herein below is a material representation of fact upon which reliance was placed when this contract/grant was entered into. It is later determined that the potential vendor/grantee knowingly rendered an erroneous certification, in addition to other remedies available to the federal government, the Department of Health and Human Services. United States Department of Agriculture or other federal department or agency, or the Texas Department of Aging and Disability Services may pursue available remedies, including suspension and/or debarment. 2. The potential vendor/grantee shall provide immediate written notice to the person to whom this certification is submitted if at any time the potential vendor/grantee learns that the certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 3. The words "covered contract," " debarred," "suspended," "ineligible," "participant," "person," "principal," "proposal," and "voluntarily excluded," as used in this certification have meanings based upon materials in the Definitions and Coverage sections of federal rules implementing Executive Order 12549, Usage is as defined in the attachment. 4. The potential vendor/grantee agrees by submitting this certification that, should the proposed covered contract/grant be entered into, it shall knowingly into any subcontract with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the Department of Health and Human Services, United States Department of CERTIFICATION REGARDING DEBARMENT Page 2 Agriculture or other federal department or agency, and/or the Texas Department of Aging and. Disability Services, as applicable. Do you have or do you anticipate having sub vendors/sub-grantees under this proposed contract? Yes X No 5. The potential vendor/grantee further agrees by submitting this certification that it will include this certification titled "Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion for Covered Contracts and Grants" without modification, in all covered subcontracts and in solicitations for all covered subcontracts. 6. A vendor/grantee may rely upon a certification of a potential sub vendor/sub-grantee that is not debarred, suspended, ineligible, or voluntarily excluded from the covered contract/grant, unless the vendor/grantee knows that the certification is erroneous. A vendor/grantee must, at a minimum obtain certifications from its covered sub vendors/sub-grantees upon each subcontract's/sub-grant's initiation and upon each renewal. 7. Nothing contained in all the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification by this certification document. The knowledge and information of a vendor/grantee is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 8. Except for contracts/grants authorized under paragraph 4 of these terms, if a vendor/grantee in a covered contract/grant knowingly enters into a covered subcontract/subgrant with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in the transaction, in addition to other remedies available to the federal government, Department of Health and Human Services, United States Department of Agriculture, or other federal department or agency, as applicable, and/or the Texas Department of Aging and Disability Services may pursue available remedies, including suspension and/or debarment. CERTIFICATION REGARDING DEBARMENT Page 3 Indicate which statement applies to the covered potential vendor/grantee: x The potential vendor/grantee certifies by submission of this certification that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this contract/grant by any federal department or agency or by the State of Texas. The potential vendor/grantee is unable to certify one or more of the terms in this certification. In this instance, the potential vendor/grantee must attach an explanation for each of the above terms to which it is unable to make certification. Attach the explanation(s) to this certification. NAME OF POTENTIAL VENDOR/GRANTEE City of Lubbock VENDOR ID NO. /FEDERAL EMPLOYERS ID NO. 17560005906 r Signature of Authorized Representative Chad Weaver Printed/Typed Name of Authorized Representative Assistant City Attorney Title of Authorized Representative Date This certification is for FY 2012, period beginning October 1, 2011 and ending September 30, 2012. CERTIFICATION REGARDING DEBARMENT Page 4 DEFINITIONS Covered Contract/Grant and Subcontracts/Sub-grants. (1) Any non -procurement transaction which involves federal funds (regardless of amount and including such arrangements as sub -grants) and is between the Texas Department of Aging and Disability Services or its agents/grantees and another entity. (2) Any procurement contract for goods or services between a participant and a person, regardless of type, expected to equal or exceed the federal procurement small purchase threshold fixed at 10 U.S.C. 2304(g) and 41 U.S.C. 253(g) (currently $25,000) under a grant or sub -grant. (3) Any procurement contract for goods or services between a participant and a person under a covered grant, sub -grant, contract or subcontract, regardless of amount, under which that person will have a critical influence on or substantive control over that covered transaction including: a. Principal investigators. b. Providers of audit services required by the Texas Department of Aging and Disability Services or federal funding source. C. Researchers. DEBARMENT An action taken by a debarring official in accordance with 45 CFR Part 76 (or comparable federal regulations) to exclude a person from participating in covered contracts/grants. A person so excluded is "debarred." GRANT An award of financial assistance, including cooperative agreements, in the form of money, or property in lieu of money, by the federal government to an eligible grantee. INELIGIBLE Excluded from participation in federal non -procurement programs pursuant to a determination of ineligibility under statutory, executive order, or regulatory authority, other an Executive Order 12549 and its agency implementing regulations: for example, excluded pursuant to the Davis -Bacon Act and its implementing regulations, the equal employment opportunity acts and executive orders, or the environmental protection acts and executive orders. A person is ineligible where the determination of ineligibility affects such person's eligibility to participate in more than one covered transaction. CERTIFICATION REGARDING DEBARMENT Page 5 PARTICIPANT Any person who submits a proposal for, enters into, or reasonably may be expected to enter into a covered contract. This term also includes any person who acts on behalf of or is authorized to commit a participant in a covered contract/grant as an agent or representative of another participant. PERSON Any individual, corporation, partnership, association, unit of government, or legal entity, however organized, except: foreign governments or foreign governmental entities, public international organizations, foreign government owned (in whole or part) or controlled entities, and entities consisting wholly or partially of foreign governments or foreign governmental entities. PRINCIPAL Officer, director, owner, partner, key employee, or other person within a participant with primary management or supervisory responsibilities; or a person who has a critical influence on or substantive control over a covered contract/grant whether or not the person is employed by the participant. Persons who have a critical influence on or substantive control over a covered transaction are: (1) Principal investigators. (2) Providers of audit services required by the Texas Department of Aging and Disability Services or federal funding source. (3) Researchers. PROPOSAL A solicited or unsolicited bid, application, request, invitation to consider or similar communication by or on behalf of a person seeking to receive a covered contract/grant. SUSPENSION An action taken by a suspending official in accordance with 45 CFR part 76 (or comparable federal regulations) that immediately excludes a person from participating in covered contracts/grants for a temporary period, pending completion of an investigation and such legal, debarment, or Program Fraud Civil Remedies Act proceedings as may ensue. A person so excluded is "suspended." VOLUNTARY EXCLUSION OR VOLUNTARILY EXCLUDED A status of nonparticipation or limited participation in covered transactions assumed by a person pursuant to the terms of a settlement. 10/27/11 5:16 PM Provider Name: C,ty of Lubbock AAA Name: Area Agency on Aging of South Plains Congregate Meals BUDGET WORKSHEET CALCULATION OF THE PER MEAL. UNIT RATE 1. Total Budgeted Expenses for Contract Year 1. $ 281,695.80 2. Total Number of Anticipated Meals to be Provided by Funding Source Other Funds DADS A& AAA 16.200 Eligible Meals 16.830 Other Sources 5 0 Other Funds - Non -Eligible Program Income 7,470 Meats 0 Other Sources 6 0 2. 40.500 3. Whole Unit Rate (Line 1 divided by Line 2) 3. $ 6.96 Reimbursement Calculation DADS A&I AAA 4. Projected NSIP per Meal Value 0.66 S. Rate Less NSIP per Meal Value $ 6.30 6. Mandatory Local Match of 10% $ 0.63 If Applicable, Match Reduction From the In -kind Match Certification form $ (0,61) Required Cash Match $ 0.02 7. Proposed Meal Rate (Line 3 minus line 6) $ 6,94 — If any portion of the required match is in -kind, you must complete an In -Kind Match Certification form. By signing below, the provider acknowledges that all related records are subject to audit in accordance with contract requirements and all applicable federal and state laws. City of Lubbock Tom Martin, Mayor Legal Name of Contracted Provider Printed/Typed Name of Signer ' December 14, 2011 Signature Date Area Agency on Aging of South Plains Name of Area Agency on Aging Tim C. Pierce T Nakne of Si ner Signature October 1, 2011 Date Attest: R ecca Garza City Secretary Community Services Aa as to rm: pp7 Chad Weaver Assistant City Attorney 10/27/11 5:16 PM Provider Name: City of Lubbock AAA Name: Area Agency on Aging of South Plains Congregate :deals BUDGET WORKS"EET CERTIFICATION AS SIGNER OF THIS BUDGET WORKSHEET, I HEREBY CERTIFY THAT: • I have read the note below and the instructions applicable to this budget worksheet. • I have reviewed this budget worksheet after its preparation. • To the best of my knowledge and belief, this budget worksheet is true, correct and complete, and was prepared in accordance with the instructions applicable to this budget worksheet. This budget worksheet was prepared from the books and records of the contracted provider. • I acknowledge that all books and records related to this rate setting process are subject to audit in accordance with contract requirements and all applicable federal and state laws. Note: The person legally responsible for the conduct of the contracted provider must sign this Budget Worksheet Certification. If a sole proprietor, the owner must sign the Budget Worksheet Certification. If a partnership, a partner must sign the Budget Worksheet Certification. If a corporation, the person authorized by the Board of Directors Resolution must sign the Budget Worksheet Certification. Misrepresentation of information contained in the budget worksheet may result in adverse action, up to and including contract termination. Furthermore, falsification of information in the budget worksheet may result in a referral for prosecution. City of Lubbock Name of Contracted Provider December 14, 2011 Do to Signer Authority: ❑ Sole Proprietor (check one) ❑ Partner Corporate Officer Tom Martin, Mayor PrintedfTyped Name of Signer Signature Association Officer ❑ Board Member Governmental Official Attest: Approve to c e A o d a5 f0 Re cca Catza dy Truesdell Chad Weaver City cretary Community Services Di ctor Assistant City Attomey 10/27/11 5:16 PM AAA Name: Area Agency on Aging of South Plains Congregate Meals !N -KINI) V_1f( IICERIIFI(:%IION Provider: C i I N apt Lubbock In -kind Contribution(s): $20,097 For any item identified below, you must maintain support documentation. ITEM DATE OF RECEIPT VALUE RSVP Volunteers i� Lubbock Senior Center $20,097 7 Volunteers'. l I hrslday X 252 days X $7.25/hr Minumum Wage TOTAL $20,097 Note: All contributions must meet the requirements of IRS Publication 561 Imp: uh/ir,,-pdfp56I.pdt Examples of Documentation Include: Rent: 1. Letter of Agreement with Owner 2. Adequate Valuation of Property on a Current Basis (this should be reviewed at least every two years and if senior center, based on property value and center participation) Labor: L Minimum wage 2• Documented prevailing wage in the Area. For prevailing wage information visit the Texas Workforce Commission's website at hnp « titi Ir ar r?.r un . All in -kind labor must be required for the service to be provided. If you would not hire someone to perform the labor if it were not in -kind then you cannot count it. Utilities: I. Copy of Bill 2. Agreement of Amount Paid if Partial City of Lubbock Name of Contracted Provider December 14, 2011 Date Attest: e cca Garza City ecretary Tom Martin, Mayor Printedfryped Name of Signer — a Signature Approv as t 5esDi"rector ndy rue deli Community Servi, AP p ve as to F ern: Chad Weaver Assistant City Attorney Transportation BUDGET WORKSHEET CALCULATION OF THE UNIT RATE 1 Total Budgeted Expenses for Contract Year 2-Total Number of Anticipated Units to be Provided DADS A&I AAA - 10 % Program Match Required 1,628 Income DADS A&I AAA - 25 % Local Funds - Match Required 0 Eligible Trips Other Funds - DADS A&I AAA - Full Unit Non -Eligible Rate 0 Trips 3. Cost per unit (Line 1 divided by Line 2) - Full Unit Rate 275 Other Sources 6 0 2,633 Other Sources 7 0 0 Other Sources 8 0 Reimbursement Calculation for Contracts Requiring Unit Rate Match Reduction 1. $ 35,877.36 2. 4,536 3. $ 7.91 4. Mandatory Local Match of 10% $ 0.79 If Applicable, Match Reduction From the In -kind Match Certification form $ (0.58) Required Match 4. $ 0.21 5. Full Unit Rate Less Required Match (Line 3 minus Line 4; 5. $ 7.70 4. Mandatory Local Match of 25% $ 1.93 •• If Applicable, Match Reduction From the In -kind Match Certification form $ (0.58) Required Match 4. $ 1 A0 5. Full Unit Rate Less Required Match (Line 3 minus Line 4; 5. $ 6.51 -If any portion of the required match is in -kind, you must complete an In -Kind Match Certification form. Contract Reimbursed at Full Cost Per Unit Rate. Match Requirements Will Be Met Through Provision of Additional Units $ 7,91 Contractor Initial AAA Initial City of Lubbock Legal Name of Contracted Provider Signature Tom Martin, Mayor Pnntedlryped Name of Signer December 14, 2011 Date Attcst: Re cca Garza City Secretary ArWi�4,gency on4ging of South Plains Nam of Are Age cy on ging Signs ure Tim C. Pierce PrintedlTyped Name of Signer October 1, 2011 Date Approve to Content - Ran y Truesdell Community Services irector 9 Ap v as o olTn: Chad Weaver Assistant City Attorney 10/27/11 5:16 PM Provider Name: City of Lubbock AAA Name: Area Agency on Aging of South Plains Transportation li[;D(.E-I' NVORKSHEF.T CERTIFICATION AS SIGNER OF THIS BUDGET WORKSHEET, I HEREBY CERTIFY THAT: • I have read the note below and the instructions applicable to this budget worksheet. e I have reviewed this budget worksheet after its preparation. To the best of my knowledge and belief, this budget worksheet is true, correct and complete, and was prepared in accordance with the instructions applicable to this budget worksheet. • This budget worksheet was prepared from the books and records of the contracted provider. • I acknowledge that all books and records related to this rate setting process are subject to audit in accordance with contract requirements and all applicable federal and state laws. Note: The person legally responsible for the conduct of the contracted provider must sign this Budget Worksheet Certification. If a sole proprietor, the owner must sign the Budget Worksheet Certification. If a partnership, a partner must sign the Budget Worksheet Certification. If a corporation, the person authorized by the Board of Directors Resolution must sign the Budget Worksheet Certification. Misrepresentation of information contained in the budget worksheet may result in adverse action, up to and including contract termination. Furthermore, falsification of information in the budget worksheet may result in a referral for prosecution. City of Lubbock Name of Contracted Provider December 14, 2011 Date Tom Martin, Mayor Priatedfryped Name of Signer Signature Signer Authority: Sole Proprietor EJ Association Officer (check one) Partner Board Member Corporate Officer © Governmental Official Attest: Approved to n Reb cca Garza Ran y T esdel City Secretary Community Servic Director f Apv d'as t orm: Chad Weaver Assistant City Attorney 10/27/11 5:16 PM AAA Name: Area Agency on Aging of South Plains Transportation EN-LIN1)NIk I( 11( f:R1111( kIION Provider: { it% of Lubhock In -kind Contribution(s): 5943 for any item identified below, you must maintain support documentation. ITEM DATE OF RECEIPT VALUE Trejo-Volunteer 1/2 hr/day X 252 X $7.25/hr (minimum wage) $943 TOTAL $943 Note: All contributions must meet the requirements of IRS Publication 561 frttp:r, a %%1.pdf Examples of Documentation Include: Rent: 1. Letter of Agreement with Owner 2. Adequate Valuation of Property on a Current Basis (this should be reviewed at least every two years and if senior center, based on property value and center participation) Labor: 1. Minimum wage 2• Documented prevailing wage in the Area. For prevailing wage information visit the Texas Workforce Commission's website at hire; �+N�.irac j22 com . A]1 in -kind labor must be required for the service to be provided. If you would not hire someone to perform the labor if it were not in -kind then you cannot count it. Utilities: I. Copy of Bill 2. Agreement of Amount Paid if Partial City of Lubbock Name of Contracted Provider December 14, 2011 Date Attest: Re ca Garza City Secretary Tom Martin, Mayor Prin�tedfYy—ped Name of Signer Signature - Ap o�ea;31 F I'Irl: Chad Weaver Assistant City Attorney