HomeMy WebLinkAboutResolution - 2021-R0166 - Contract HHS001019500024 with DSHS, COVID-19 Immunization Grant 5.11.2021Resolution No. 2021-R0166
Item No. 8.2.1
May 11, 2021
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, Department of State Health Services Contract No.
HHS001019500024 under the COVID-19 Immunizations Grant Program, by and between the
City of Lubbock and the State of Texas' Department of State Health Services, and all related
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 May 11, 2021
DANIEL M. POPE, AYOR
ATTEST:
Rebe ca Garza, City Secr ary M T
APPROVED AS TO CONTENT:
Bill Ho on, Deputy i anager
APPROVED AS TO FORM:
Rya4Bre, Assis ant City Attorney
RES.DSHS Contract No. HHS001019500024 COVID-19 Grant
4.20.21
DocuSign Envelope ID: A50FDECF-2E82-4FD7-9602-BA6CE007EE8E Resolution No. 2021-R0166
SIGNATURE DOCUMENT FOR
DEPARTMENT OF STATE HEALTH SERVICES
CONTRACT No. HHS001019500024
UNDER THE
COVID-19 IMMUNIZATIONS GRANT PROGRAM
I. PURPOSE
The DEPARTMENT OF STATE HEALTH SERVICES ("SYSTEM AGENCY"), a pass -through
entity, and CITY OF LUBBOCK ("GRANTEE") (each a "Party" and collectively the "Parties")
enter into the following grant contract to provide funding for the COVID-19
Immunizations Grant Program (the "Contract").
II. LEGAL AUTHORITY
This Contract is authorized by and in compliance with the Public Health Services Act
Section 317, 42 U.S. Code Section 247B, and Texas Government Code Chapter 791 and
Texas Health and Safety Code Chapters 12 and 121.
III. DURATION
The Contract is effective on the signature date of the latter of the Parties to sign this
Contract and terminates on June 30, 2024, unless renewed, extended, or terminated
pursuant to the terms and conditions of the Contract. System Agency, at its sole discretion,
may extend this Contract for any period(s) of time, provided the Contract term, including
all extensions or renewals, does not exceed five years. Notwithstanding the limitation in
the preceding sentence, System Agency, at its sole discretion, also may extend the Contract
beyond five years as necessary to ensure continuity of service, for purposes of transition,
or as otherwise determined by System Agency to serve the best interests of the State.
IV. BUDGET
The total amount of this Contract will not exceed $2,761,375.00. Grantee is not required
to provide matching funds.
All expenditures under the Contract will be in accordance with ATTACHMENT B, BUDGET.
V. CONTRACT REPRESENTATIVES
The following will act as the representative authorized to administer activities under this
Contract on behalf of its respective Party.
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System Agency
Department of State Health Services
P.O. Box 149347 - Mail Code 1990
Austin, Texas 78714-9347
Attention: Holly Zoerner
VI. LEGAL NOTICES
Grantee
City of Lubbock
P.O. Box 2000
Lubbock, Texas 79457
Attention: Katherine Wells
Any legal notice required under this Contract shall be deemed delivered when deposited by
the System Agency either in the United States mail, postage paid, certified, return receipt
requested; or with a common carrier, overnight, signature required, to the appropriate address
below:
System Agency
Health and Human Services Commission
Attn: Office of the Chief Counsel
MC 1100
4900 North Lamar Boulevard
Austin, Texas 78751
With copy to
Department of State Health Services
Attention: General Counsel
P.O. Box 149347 - Mail Code 1911
Austin, Texas 78714-9347
Grantee
City of Lubbock
P.O. Box 2000
Lubbock, Texas 79457
Attention: Katherine Wells
VII. NOTICE REQUIREMENTS
Notice given by Grantee will be deemed effective when received by the System Agency.
Either Party may change its address for notices by providing written notice to the other Party.
All notices submitted to System Agency must:
A. include the Contract number;
B. be sent to the person(s) identified in the Contract; and,
C. comply with all terms and conditions of the Contract.
VIII. ADDITIONAL GRANT INFORMATION
System Agency Data Universal Numbering System (DUNS) Number: 807391511
Federal Award Identification Number (FAIN): NH231P922616
DSIIS Contract #111IS00I0I9500024
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Assistance Listing Name and Number: Immunization Cooperative Agreements 93.268
Federal Award Date: 01/15/2021
Federal Award Project Period through 6/30/2024
Name of Federal Awarding Agency: CDC Office of Financial Resources
Awarding Official Contact Information:
Freda Johnson
Email: wve2 a,cdc.gov
SIGNATURE PAGE FOLLOWS
DSHS Conti -act #.1IIIS00101950002.1
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SIGNATURE PAGE FOR SYSTEM AGENCY
CONTRACT No. HHS001019500024
SYSTEM AGENCY GRANTEE
Signature Signature
Printed Name:
Title:
Date of Execution:
Printed Name:
Daniel Pope
Title: Mayor
Date of Execution: May 11, 2021
THE FOLLOWING ATTACHMENTS TO SYSTEM AGENCY CONTRACT NO.
HHS001019500024 ARE INCORPORATED BY REFERENCE:
ATTACHMENT A: STATEMENT OF WORK
ATTACHMENT B: BUDGET
ATTACHMENT C: HHS UNIFORM TERMS AND CONDITIONS - GRANT
ATTACHMENT D: HHS CONTRACT AFFIRMATIONS
ATTACHMENT E: FEDERAL ASSURANCES AND CERTIFICATIONS
ATTACHMENT F: HHS DATA USE AGREEMENT
ATTACHMENT G: FFATA FORM
ATTACHMENTS FOLLOW
DSHS Contract #HHS001019500024
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ATTACHMENT A
STATEMENT OF WORK
I. GRANTEE RESPONSIBILITIES
Grantee will conduct any of the following eligible activities that is aligned with the
approved workplan:
A. Increase COVID-19 vaccination capacity across the jurisdiction, including among
high -risk and underserved populations.
1. Increase the number of vaccine provider sites, including with pharmacies. This
can be done through a competitive application process, through enrollment of
specific providers into such a program, or through other means.
2. Enroll/train vaccine providers, including complementary providers, to build
capacity to vaccinate pediatric and adult populations in accordance with ACIP
recommendations.
3. Enlist/educate adult providers, including specialists that see high -risk patients,
to identify and refer patients to vaccination clinics if they are not themselves
vaccinators.
4. Fund local health departments to expand their operations (e.g., providing
vaccinations during evenings, overnight, and on weekends) and to increase their
throughput.
5. Support public health workforce recruitment and training including working
with health providers from rural communities, communities of color, and/or
communities of high social vulnerability (See CDC's Social Vulnerability Index
(SVI)).
6. Implement vaccine strike teams, mobile vaccine clinics, satellite clinics,
temporary, or off -site clinics to travel and provide vaccination services in non-
traditional settings and/or to supplement the work of local health departments
in underserved communities.
B. Ensure high -quality and safe administration of COVID-19 vaccines.
1. Implement site visits to COVID-19 vaccination clinics to provide monitoring
and quality assurance support (supportive supervision) and to promote quality
improvement.
2. Support vaccine administration sites by responding to issues, questions, and
ensuring training as needed for new products or changes to products.
3. Provide supplies (including personal protective equipment (PPE)), equipment,
and training to providers and partners for:
i. Vaccine storage and handling, including monitoring temperature of
vaccines
ii. Vaccine transport, including any vaccine -specific considerations, for
temporary mass vaccination clinics
iii. Vaccine administration
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4. Ensure vaccine administration sites have appropriate capabilities to address
adverse events, including anaphylaxis.
5. Support provider training and reporting of vaccine adverse events to VAERS.
C. Ensure equitable distribution and administration of COVID-19 vaccines.
1. Monitor vaccination coverage among population subgroups, identifying
populations and geographic areas with low coverage. Implement and evaluate
interventions and direct vaccine and vaccination efforts to increase coverage.
2. Monitor and improve access to vaccinations in communities of high social
vulnerability (CDC's Social Vulnerability Index (SVI)).
3. Continue and expand on the work of Vaccine Equity Committees (or similar
committees) to ensure transparency and engagement with the community.
4. Have a written plan to address high -risk and specific populations (including
older adults) and how to reach each group, including congregate settings (e.g.,
correctional facilities), homeless populations, essential workers, and others.
5. Partner, plan, and implement vaccination activities with critical organizations.
These organizations could include but are not limited to:
i. Colleges and Universities
ii. Occupational health settings for large employers
iii. Churches or religious institutions
iv. Federally Qualified Health Centers (FQHCs), including Community
Health Centers (CHCs)
v. Pharmacies
vi. Long-term care facilities (LTCFs), including independent living facilities,
assisted living centers, and nursing homes
vii. Organizations and businesses that employ critical workforce
viii. First responder organizations
ix. Non-traditional providers and locations that serve high -risk populations
x. Other partners that serve underserved populations
6. Plan and implement vaccination activities with organizations and businesses
that employ frontline essential workers as defined by the Cybersecurity &
Infrastructure Security Agency (CISA).
D. Grantee must obtain approval from System Agency on the workplan within 30 days
of Contract execution.
E. Submit a quarterly program report on the report template to be provided by System
Agency by the last business day of the month following the end of each quarter of
the Contract for System Agency review. Submit reports by electronic mail to
ImmunizationContractsCOVID3@dshs.texas.gov and to
holly.zoerner Wshs.texas.gov. The email "Subject Line" and the name of the
attached file for all reports should be clearly identified with the Grantee's Name
and Contract Number.
F. Grantee may use funds to pay pre -award costs which date back to December 1,
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2020, that are directly related to the activities outlined in the Statement of Work.
All pre -award costs must be approved in writing by System Agency.
G. Grantee may not use funds for research, clinical care, fundraising activities, or
funding an award to another party or provider who is ineligible. Other than normal
and recognized executive -legislative relationships, no funds may be used for:
1. Publicity or propaganda purposes, for the preparation, distribution, or use of
any material designed to support or defeat the enactment of legislation before
any legislative body;
2. The salary or expenses of any grant or contract recipient, or agent acting for
such recipient, related to any activity designed to influence the enactment of
legislation, appropriations, regulation, administrative act or Executive order
proposed or pending before any legislative body.
II. PERFORMANCE MEASURES
The System Agency will monitor the Grantee's performance of the requirements in
Attachment A and compliance with the Contract's terms and conditions.
III. INVOICE AND PAYMENT
A. Grantee will request payments using the State of Texas Purchase Voucher (Form
B-13) at http://www.dshs.state.tx.usi'grants.1fomis.shtm. The Voucher and any
supporting documentation will be mailed or submitted by fax or electronic mail to
the address/number below.
Department of State Health Services
Claims Processing Unit, MC 1940
1100 West 491h Street
P.O. Box 149347
Austin, TX 78714-9347
FAX: (512) 458-7442
EMAIL: invoices a,dshs.state.tx.us
EMAIL: CMSInvoicesRdshs.texas.gov
B. Grantee will be paid on a cost reimbursement basis and in accordance with
ATTACHMENT B, BUDGET to this Contract.
C. Grantee shall maintain all documentation that substantiates invoices and make the
documentation available to System Agency upon request. In the event a cost
reimbursed under the Contract is later determined to be unallowable, then the
Grantee will reimburse System Agency for that cost.
D. Grantee will submit quarterly Financial Status Reports (FSRs) to System Agency
by the last business day of the month following the end of each quarter of the
Contract for System Agency review and financial assessment. The quarters are as
follows:
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1. July 1 through September 30
2. October 1 through December 31
3. January 1 through March 31
4. April 1 through June 30
E. Grantee will submit a request for reimbursement (HHS Form B-13) as a final close-
out invoice not later than forty-five (45) calendar days following the end of the term
of the Contract. Reimbursement requests received in the System Agency office
more than forty-five (45) calendar days following the termination of the Contract
may not be paid.
F. Grantee will submit a final FSR as a final close-out FSR not later than forty-five
(45) calendar days following the end of the term of the Contract.
DSHS Contract #1111S001019500024
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ATTACHMENT B
BUDGET
Organization Name: City of Lubbock
Program ID: IMM/COVID-19
Contract Number: HHS001019500024
Budget
Categories
Total
Budget Amount
Personnel
$32,400.00
Fringe
$13,819.00
Travel
$2,800.00
Equipment
$132,196.00
Supplies
$70,306.00
Contractual
$2,509,854.00
Other
$0.00
Total Direct
$2,761,375.00
Indirect
$0.00
Total
$2,761,375.00
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DSHS Contract #IIIIS001019500024
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Attachment C
HHSC Uniform Terms and Conditions Version 2.16.1
Published and Effective: March 26, 2019
Responsible Office: Chief Counsel
TEXAS
Health and Human Services
Health and Human Services Commission
HHSC Uniform Terms and Conditions -Grant
Version 2.16.1
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TABLE OF CONTENTS
ARTICLE I. DEFINITIONS AND INTERPRETIVE PROVISIONS .................................... 4
1.1
Definitions......................................................................................................................
4
1.2
Interpretive Provisions....................................................................................................
6
ARTICLE II. PAYMENT METHODS AND RESTRICTIONS ..............................................
6
2.1
Payment Methods...........................................................................................................
6
2.2
Final Billing Submission................................................................................................
7
2.3
Financial Status Reports(FSRs).....................................................................................
7
2.4
Use of Funds...................................................................................................................
7
2.5
Use for Match Prohibited...............................................................................................
7
2.6
Program Income.............................................................................................................
7
2.7
Nonsupplanting...............................................................................................................8
2.8
Allowable Costs..............................................................................................................
8
2.9
Indirect Cost Rates.........................................................................................................
8
ARTICLE
III. STATE AND FEDERAL FUNDING................................................................
8
3.1
Funding...........................................................................................................................8
3.2
No Debt Against the State..............................................................................................
8
3.3
Debt and Delinquencies..................................................................................................
8
3.4
Recapture of Funds.........................................................................................................
8
ARTICLE
IV. ALLOWABLE COSTS AND AUDIT REQUIREMENTS ............................. 9
4.1
Allowable Costs............................................................................................................. 9
4.2
Audits and Financial Statements..................................................................................
10
4.3
Submission of Audits and Financial Statements..........................................................
11
ARTICLE
V. AFFIRMATIONS, ASSURANCES AND CERTIFICATIONS .....................
11
5.1
General Affirmations....................................................................................................
11
5.2
Federal Assurances.......................................................................................................
11
5.3
Federal Certifications...................................................................................................
11
ARTICLE
VI. INTELLECTUAL PROPERTY......................................................................
11
6.1
Ownership of Work Product........................................................................................
11
6.2
Grantees Pre-existing Works.......................................................................................
12
6.3
Agreements with Employees and Subcontractors.......................................................
12
6.4
Delivery Upon Termination or Expiration..................................................................
12
6.5
Survival........................................................................................................................12
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ARTICLE VII. RECORDS, AUDIT, AND DISCLOSURE ...................................................
13
7.1
Books and Records.......................................................................................................
13
7.2
Access to Records, Books, and Documents.................................................................
13
7.3
Response/Compliance with Audit or Inspection Findings ...........................................
13
7.4
SAO Audit....................................................................................................................
14
7.5
Confidentiality..............................................................................................................14
ARTICLE VIII. CONTRACT MANAGEMENT AND EARLY TERMINATION ............
14
8.1
Contract Remedies........................................................................................................
14
8.2
Termination for Convenience.......................................................................................
14
8.3
Termination for Cause..................................................................................................
14
ARTICLE IX. MISCELLANEOUS PROVISIONS................................................................
15
9.1
Amendment..................................................................................................................
15
9.2
Insurance......................................................................................................................
15
9.3
Legal Obligations.........................................................................................................
15
9.4
Permitting and Licensure..............................................................................................
16
9.5
Indemnity......................................................................................................................
16
9.6
Assignments.................................................................................................................
16
9.7
Independent Contractor................................................................................................
17
9.8
Technical Guidance Letters..........................................................................................
17
9.9
Dispute Resolution.......................................................................................................
17
9.10
Governing Law and Venue...........................................................................................
17
9.11
Severability...................................................................................................................17
9.12
Survivability.................................................................................................................
18
9.13
Force Majeure...............................................................................................................
18
9.14
No Waiver of Provisions..............................................................................................
18
9.15
Publicity........................................................................................................................18
9.16
Prohibition on Non -compete Restrictions....................................................................
19
9.17
No Waiver of Sovereign Immunity..............................................................................
19
9.18
Entire Contract and Modification.................................................................................
19
9.19
Counterparts.................................................................................................................
19
9.20
Proper Authority...........................................................................................................
19
9.21
E-Verify Program..........................................................................................................
19
9.22
Civil Rights...................................................................................................................
19
9.23
System Agency Data.....................................................................................................
21
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ARTICLE I. DEFINITIONS AND INTERPRETIVE PROVISIONS
1.1 DEFINITIONS
As used in this Contract, unless the context clearly indicates otherwise, the following terms
and conditions have the meanings assigned below:
"Amendment" means a written agreement, signed by the Parties, which documents changes
to the Contract other than those permitted by Work Orders or Technical Guidance Letters.
"Attachment" means documents, terms, conditions, or information added to this Contract
following the Signature Document or included by reference, and made a part of this
Contract.
"Contract" means the Signature Document, these Uniform Terms and Conditions, along with
any Attachments, and any Amendments, or Technical Guidance Letters that may be issued
by the System Agency, to be incorporated by reference for all purposes.
"Deliverable" means the work product(s), including all reports and project documentation,
required to be submitted by Grantee to the System Agency.
"Effective Date" means the date agreed to by the Parties as the date on which the Contract
takes effect.
"Federal Fiscal Year" means the period beginning October 1 and ending September 30 each
year, which is the annual accounting period for the United States government.
"GAAP" means Generally Accepted Accounting Principles.
"GASB" means the Governmental Accounting Standards Board.
"Grantee" means the Party receiving funds under this Contract. May also be referred to as
"Contractor" in certain attachments.
"Health and Human Set -vices Commission" or "HHSC" means the administrative agency
established under Chapter 531, Texas Government Code, or its designee.
"HUB" means Historically Underutilized Business, as defined by Chapter 2161 of the
Texas Government Code.
"Intellectual Property Rights" means the worldwide proprietary rights or interests, including
patent, copyright, trade secret, and trademark rights, as such right may be evidenced by or
embodied in:
i. any idea, design, concept, personality right, method, process, technique, apparatus,
invention, discovery, or improvement;
ii. any work of authorship, including any compilation, computer code, website or web
page design, literary work, pictorial work, or graphic work;
iii. any trademark, service mark, trade dress, trade name, branding, or other indicia of
source or origin;
iv. domain name registrations; and
v. any other proprietary or similar rights. The Intellectual Property Rights of a Party
include all worldwide proprietary rights or interests that the Party may have acquired
by assignment, by exclusive license, or by license with the right to grant sublicenses.
HHSC Grantee. Uniform "1-erms and Conditions
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9.16 PROHIBITION ON NON -COMPETE RESTRICTIONS
Grantee shall not require any employees or Subcontractors to agree to any conditions,
such as non -compete clauses or other contractual arrangements that would limit or restrict
such persons or entities from employment or contracting with the State of Texas.
9.17 NO WAIVER OF SOVEREIGN IMMUNITY
Nothing in the Contract will be construed as a waiver of the System Agency's or the
State's sovereign immunity. This Contract shall not constitute or be construed as a waiver of
any of the privileges, rights, defenses, remedies, or immunities available to the System
Agency or the State of Texas. The failure to enforce, or any delay in the enforcement, of any
privileges, rights, defenses, remedies, or immunities available to the System Agency or the
State of Texas under the Contract or under applicable law shall not constitute a waiver of
such privileges, rights, defenses, remedies, or immunities or be considered as a basis for
estoppel. System Agency does not waive any privileges, rights, defenses, or immunities
available to System Agency by entering into the Contract or by its conduct prior to or
subsequent to entering into the Contract.
9.18 ENTIRE CONTRACT AND MODIFICATION
The Contract constitutes the entire agreement of the Parties and is intended as a complete
and exclusive statement of the promises, representations, negotiations, discussions, and other
agreements that may have been made in connection with the subject matter hereof. Any
additional or conflicting terms in any future document incorporated into the Contract
will be harmonized with this Contract to the extent possible.
9.19 COUNTERPARTS
This Contract may be executed in any number of counterparts, each of which will be an
original, and all such counterparts will together constitute but one and the same Contract.
9.20 PROPER AUTHORITY
Each Party represents and warrants that the person executing this Contract on its behalf
has full power and authority to enter into this Contract.
9.21 E-VERIFY PROGRAM
Grantee certifies that it utilizes and will continue to utilize the U.S. Department of
Homeland Security's E-Verify system to determine the eligibility of:
i. all persons employed to perform duties within Texas during the term of the Contract;
and
ii. all persons, (including subcontractors) assigned by the Grantee to perform work
pursuant to the Contract within the United States of America.
9.22 CIVIL RIGHTS
A. Grantee agrees to comply with state and federal anti -discrimination laws, including:
i. Title VI of the Civil Rights Act of 1964 (42 U.S.C. §2000d et seq.);
ii. Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. §794);
iii. Americans with Disabilities Act of 1990 (42 U.S.C. § 12101 et seq.);
iv. Age Discrimination Act of 1975 (42 U.S.C. §§6101-6107);
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v. Title IX of the Education Amendments of 1972 (20 U.S.C. §§1681-1688);
vi. Food and Nutrition Act of 2008 (7 U.S.C. §2011 et seq.); and
vii. The System Agency's administrative rules, as set forth in the Texas Administrative
Code, to the extent applicable to this Contract.
B. Grantee agrees to comply with all amendments to the above -referenced laws, and all
requirements imposed by the regulations issued pursuant to these laws. These laws
provide in part that no persons in the United States may, on the grounds of race, color,
national origin, sex, age, disability, political beliefs, or religion, be excluded from
participation in or denied any aid, care, service or other benefits provided by Federal or
State funding, or otherwise be subjected to discrimination.
C. Grantee agrees to comply with Title VI of the Civil Rights Act of 1964, and its
implementing regulations at 45 C.F.R. Part 80 or 7 C.F.R. Part 15, prohibiting a
contractor from adopting and implementing policies and procedures that exclude or
have the effect of excluding or limiting the participation of clients in its programs,
benefits, or activities on the basis of national origin. State and federal civil rights
laws require contractors to provide alternative methods for ensuring access to services
for applicants and recipients who cannot express themselves fluently in English.
Grantee agrees to take reasonable steps to provide services and information, both orally
and in writing, in appropriate languages other than English, in order to ensure that
persons with limited English proficiency are effectively informed and can have
meaningful access to programs, benefits, and activities.
D. Grantee agrees to post applicable civil rights posters in areas open to the public
informing clients of their civil rights and including contact information for the HHS Civil
Rights Office. The posters are available on the HHS website at:
http://hhscx.hhsc.texas.gov/system-support- services/civil-rights/publications
E. Grantee agrees to comply with Executive Order 13279, and its implementing
regulations at 45 C.F.R. Part 87 or 7 C.F.R. Part 16. These provide in part that any
organization that participates in programs funded by direct financial assistance from the
United States Department of Agriculture or the United States Department of Health
and Human Services shall not discriminate against a program beneficiary or prospective
program beneficiary on the basis of religion or religious belief.
F. Upon request, Grantee shall provide HHSC's Civil Rights Office with copies of the
Grantee's civil rights policies and procedures.
G. Grantee must notify HHSC's Civil Rights Office of any civil rights complaints received
relating to its performance under this Contract. This notice must be delivered no more
than ten (10) calendar days after receipt of a complaint. Notice provided pursuant to
this section must be directed to:
HHSC Civil Rights Office
701 W. 5 1 " Street, Mail Code W206
Austin, Texas 78751
Phone Toll Free: (888) 388-6332
Phone: (512) 438-4313
TTY Toll Free: (877) 432-7232
Fax: (512) 438-5885.
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9.23 SYSTEM AGENCY DATA
As between the Parties, all data and information acquired, accessed, or made available to
Contractor by or through System Agency or System Agency contractors, including all
electronic data generated, processed, transmitted, or stored by Contractor in the course of
providing data processing services in connection with Contractor's performance hereunder,
(the "System Agency Data"), is owned solely by System Agency. Contractor has no right
or license to use, analyze, aggregate, transmit, create derivatives of, copy, disclose, or process
the System Agency Data except as required for Contractor to fulfill its obligations under the
Contract or as authorized in advance in writing by System Agency. For the avoidance of
doubt, Contractor is expressly prohibited from using, and from permitting any third party to
use, System Agency Data for marketing, research, or other non -governmental or commercial
purposes, without the prior written consent of System Agency.
HHSC Grantee Uniform Terms and Conditions
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HEALTH AND HUMAN SERVICES
CONTRACT NO. HHS001019500024
Attachment D CONTRACT AFFIRMATIONS
For purposes of these Contract Affirmations, HHS includes both the Health and Human Services
Commission (HHSC) and the Department of State Health Services (DSHS). System Agency
refers to HHSC, DSHS, or both, that will be a party to this Contract. These Contract
Affirmations apply to all Contractors regardless of their business form (e.g., individual,
partnership, corporation).
By entering into this Contract, Contractor affirms, without exception, understands, and agrees
to comply with the following items through the life of the Contract:
1. Contractor represents and warrants that these Contract Affirmations apply to Contractor
and all of Contractor's principals, officers, directors, shareholders, partners, owners, agents,
employees, subcontractors, independent contractors, and any other representatives who
may provide services under, who have a financial interest in, or otherwise are interested in
this Contract and any related Solicitation.
2. Complete and Accurate Information
Contractor represents and warrants that all statements and information provided to HHS
are current, complete, and accurate. This includes all statements and information in this
Contract and any related Solicitation Response.
3. Public Information Act
Contractor understands that HHS will comply with the Texas Public Information Act
(Chapter 552 of the Texas Government Code) as interpreted by judicial rulings and
opinions of the Attorney General of the State of Texas. Information, documentation, and
other material prepared and submitted in connection with this Contract or any related
Solicitation may be subject to public disclosure pursuant to the Texas Public Information
Act. In accordance with Section 2252.907 of the Texas Government Code, Contractor is
required to make any information created or exchanged with the State pursuant to the
Contract, and not otherwise excepted from disclosure under the Texas Public Information
Act, available in a format that is accessible by the public at no additional charge to the
State.
4. Contracting Information Requirements
Contractor represents and warrants that it will comply with the requirements of Section
552.372(a) of the Texas Government Code. Except as provided by Section 552.374(c) of
the Texas Government Code, the requirements of Subchapter J (Additional Provisions
Related to Contracting Information), Chapter 552 of the Government Code, may apply to
the Contract and the Contractor agrees that the Contract can be terminated if the Contractor
knowingly or intentionally fails to comply with a requirement of that subchapter.
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5. Assignment
A. Contractor shall not assign its rights under the contract or delegate the performance of
its duties under the contract without prior written approval from System Agency. Any
attempted assignment in violation of this provision is void and without effect.
B. Contractor understands and agrees the System Agency may in one or more transactions
assign, pledge, or transfer the Contract. Upon receipt of System Agency's notice of
assignment, pledge, or transfer, Contractor shall cooperate with System Agency in
giving effect to such assignment, pledge, or transfer, at no cost to System Agency or to
the recipient entity.
6. Terms and Conditions
Contractor accepts the Solicitation terms and conditions unless specifically noted by
exceptions advanced in the form and manner directed in the Solicitation, if any, under
which this Contract was awarded. Contractor agrees that all exceptions to the Solicitation,
as well as terms and conditions advanced by Contractor that differ in any manner from
HHS' terms and conditions, if any, are rejected unless expressly accepted by System
Agency in writing.
7. HHS Right to Use
Contractor agrees that HHS has the right to use, produce, and distribute copies of and to
disclose to HHS employees, agents, and contractors and other governmental entities all or
part of this Contract or any related Solicitation Response as HHS deems necessary to
complete the procurement process or comply with state or federal laws.
8. Release from Liability
Contractor generally releases from liability and waives all claims against any party
providing information about the Contractor at the request of System Agency.
9. Dealings with Public Servants
Contractor has not given, has not offered to give, and does not intend to give at any time
hereafter any economic opportunity, future employment, gift, loan, gratuity, special
discount, trip, favor, or service to a public servant in connection with this Contract or any
related Solicitation, or related Solicitation Response.
10. Financial Participation Prohibited
Under Section 2155.004, Texas Government Code (relating to financial participation in
preparing solicitations), Contractor certifies that the individual or business entity named in
this Contract and any related Solicitation Response is not ineligible to receive this Contract
and acknowledges that this Contract may be terminated and payment withheld if this
certification is inaccurate.
11. Prior Disaster Relief Contract Violation
Under Sections 2155.006 and 2261.053 of the Texas Government Code (relating to
convictions and penalties regarding Hurricane Rita, Hurricane Katrina, and other
disasters), the Contractor certifies that the individual or business entity named in this
Contract and any related Solicitation Response is not ineligible to receive this Contract and
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acknowledges that this Contract may be terminated and payment withheld if this
certification is inaccurate.
12. Child Support Obligation
Under Section 231.006(d) of the Texas Family Code regarding child support, Contractor
certifies that the individual or business entity named in this Contract and any related
Solicitation Response is not ineligible to receive the specified payment and acknowledges
that the Contract may be terminated and payment may be withheld if this certification is
inaccurate.
13. Suspension and Debarment
Contractor certifies that it and its principals are not suspended or debarred from doing
business with the state or federal government as listed on the State of Texas Debarred
Vendor List maintained by the Texas Comptroller of Public Accounts and the System for
Award Management (SAM) maintained by the General Services Administration. This
certification is made pursuant to the regulations implementing Executive Order 12549 and
Executive Order 12689, Debarment and Suspension, 2 C.F.R. Part 376, and any relevant
regulations promulgated by the Department or Agency funding this project. This provision
shall be included in its entirety in Contractor's subcontracts, if any, if payment in whole or
in part is from federal funds.
14. Excluded Parties
Contractor certifies that it is not listed in the prohibited vendors list authorized by
Executive Order 13224, "Blocking Property and Prohibiting Transactions with Persons
Who Commit, Threaten to Commit, or Support Terrorism, " published by the United States
Department of the Treasury, Office of Foreign Assets Control.'
15. Foreign Terrorist Organizations
Contractor represents and warrants that it is not engaged in business with Iran, Sudan, or a
foreign terrorist organization, as prohibited by Section 2252.152 of the Texas Government
Code.
16. Executive Head of a State Agency
In accordance with Section 669.003 of the Texas Government Code, relating to contracting
with the executive head of a state agency, Contractor certifies that it is not (1) the executive
head of an HHS agency, (2) a person who at any time during the four years before the date
of this Contract was the executive head of an HHS agency, or (3) a person who employs a
current or former executive head of an HHS agency.
17. Human Trafficking Prohibition
Under Section 2155.0061 of the Texas Government Code, Contractor certifies that the
individual or business entity named in this Contract is not ineligible to receive this contract
and acknowledges that this Contract may be terminated and payment withheld if this
certification is inaccurate.
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18. Franchise Tax Status
Contractor represents and warrants that it is not currently delinquent in the payment of any
franchise taxes owed the State of Texas under Chapter 171 of the Texas Tax Code.
19. Debts and Delinquencies
Contractor agrees that any payments due under this Contract shall be applied towards any
debt or delinquency that is owed to the State of Texas.
20. Lobbying Prohibition
Contractor represents and warrants that payments to Contractor and Contractor's receipt of
appropriated or other funds under this Contract or any related Solicitation are not prohibited
by Sections 556.005, 556.0055, or 556.008 of the Texas Government Code (relating to use
of appropriated money or state funds to employ or pay lobbyists, lobbying expenses, or
influence legislation).
21. Buy Texas
Contractor agrees to comply with Section 2155.4441 of the Texas Government Code,
requiring the purchase of products and materials produced in the State of Texas in
performing service contracts.
22. Disaster Recovery Plan
Contractor agrees that upon request of System Agency, Contractor shall provide copies of
its most recent business continuity and disaster recovery plans.
23. Computer Equipment Recycling Program
If this Contract is for the purchase or lease of computer equipment, then Contractor certifies
that it is in compliance with Subchapter Y, Chapter 361 of the Texas Health and Safety
Code related to the Computer Equipment Recycling Program and the Texas Commission
on Environmental Quality rules in 30 TAC Chapter 328.
24. Television Equipment Recycling Program
If this Contract is for the purchase or lease of covered television equipment, then Contractor
certifies that it is compliance with Subchapter Z, Chapter 361 of the Texas Health and
Safety Code related to the Television Equipment Recycling Program.
25. Cybersecurity Training
A. Contractor represents and warrants that it will comply with the requirements of Section
2054.5192 of the Texas Government Code relating to cybersecurity training and
required verification of completion of the training program.
B. Contractor represents and warrants that if Contractor or Subcontractors, officers, or
employees of Contractor have access to any state computer system or database, the
Contractor, Subcontractors, officers, and employees of Contractor shall complete
cybersecurity training pursuant to and in accordance with Government Code, Section
2054.5192.
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26. Restricted Employment for Certain State Personnel
Contractor acknowledges that, pursuant to Section 572.069 of the Texas Government
Code, a former state officer or employee of a state agency who during the period of state
service or employment participated on behalf of a state agency in a procurement or contract
negotiation involving Contractor may not accept employment from Contractor before the
second anniversary of the date the Contract is signed or the procurement is terminated or
withdrawn.
27. No Conflicts of Interest
A. Contractor represents and warrants that it has no actual or potential conflicts of interest
in providing the requested goods or services to System Agency under this Contract or
any related Solicitation and that Contractor's provision of the requested goods and/or
services under this Contract and any related Solicitation will not constitute an actual or
potential conflict of interest or reasonably create an appearance of impropriety.
B. Contractor agrees that, if after execution of the Contract, Contractor discovers or is
made aware of a Conflict of Interest, Contractor will immediately and fully disclose
such interest in writing to System Agency. In addition, Contractor will promptly and
fully disclose any relationship that might be perceived or represented as a conflict after
its discovery by Contractor or by System Agency as a potential conflict. System
Agency reserves the right to make a final determination regarding the existence of
Conflicts of Interest, and Contractor agrees to abide by System Agency's decision.
28. Fraud, Waste, and Abuse
Contractor understands that HHS does not tolerate any type of fraud, waste, or abuse.
Violations of law, agency policies, or standards of ethical conduct will be investigated, and
appropriate actions will be taken. Pursuant to Texas Government Code, Section 321.022,
if the administrative head of a department or entity that is subject to audit by the state
auditor has reasonable cause to believe that money received from the state by the
department or entity or by a client or contractor of the department or entity may have been
lost, misappropriated, or misused, or that other fraudulent or unlawful conduct has occurred
in relation to the operation of the department or entity, the administrative head shall report
the reason and basis for the belief to the Texas State Auditor's Office (SAO). All employees
or contractors who have reasonable cause to believe that fraud, waste, or abuse has occurred
(including misconduct by any HHS employee, Grantee officer, agent, employee, or
subcontractor that would constitute fraud, waste, or abuse) are required to immediately
report the questioned activity to the Health and Human Services Commission's Office of
Inspector General. Contractor agrees to comply with all applicable laws, rules, regulations,
and System Agency policies regarding fraud, waste, and abuse including, but not limited
to, HHS Circular C-027.
A report to the SAO must be made through one of the following avenues:
• SAO Toll Free Hotline: 1-800-TX-AUDIT
• SAO website: http://sao.fraud.state.tx.us/
All reports made to the OIG must be made through one of the following avenues:
• OIG Toll Free Hotline 1-800-436-6184
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• OIG Website: ReportTexasFraud.com
• Internal Affairs Email: InternalAffairsReferral@hhsc.state.tx.us
• OIG Hotline Email: OIGFraudHotline@hhsc.state.tx.us.
• OIG Mailing Address: Office of Inspector General
Attn: Fraud Hotline
MC 1300
P.O. Box 85200
Austin, Texas 78708-5200
29. Antitrust
The undersigned affirms under penalty of perjury of the laws of the State of Texas that:
A. in connection with this Contract and any related Solicitation Response, neither I nor
any representative of the Contractor has violated any provision of the Texas Free
Enterprise and Antitrust Act, Tex. Bus. & Comm. Code Chapter 15;
B. in connection with this Contract and any related Solicitation Response, neither I nor
any representative of the Contractor has violated any federal antitrust law; and
C. neither I nor any representative of the Contractor has directly or indirectly
communicated any of the contents of this Contract and any related Solicitation
Response to a competitor of the Contractor or any other company, corporation, firm,
partnership or individual engaged in the same line of business as the Contractor.
30. Legal and Regulatory Actions
Contractor represents and warrants that it is not aware of and has received no notice of any
court or governmental agency proceeding, investigation, or other action pending or
threatened against Contractor or any of the individuals or entities included in numbered
paragraph 1 of these Contract Affirmations within the five (5) calendar years immediately
preceding execution of this Contract or the submission of any related Solicitation Response
that would or could impair Contractor's performance under this Contract, relate to the
contracted or similar goods or services, or otherwise be relevant to System Agency's
consideration of entering into this Contract. If Contractor is unable to make the preceding
representation and warranty, then Contractor instead represents and warrants that it has
provided to System Agency a complete, detailed disclosure of any such court or
governmental agency proceeding, investigation, or other action that would or could impair
Contractor's performance under this Contract, relate to the contracted or similar goods or
services, or otherwise be relevant to System Agency's consideration of entering into this
Contract. In addition, Contractor acknowledges this is a continuing disclosure requirement.
Contractor represents and warrants that Contractor shall notify System Agency in writing
within five (5) business days of any changes to the representations or warranties in this
clause and understands that failure to so timely update System Agency shall constitute
breach of contract and may result in immediate contract termination.
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31. No Felony Criminal Convictions
Contractor represents that neither Contractor nor any of its employees, agents, or
representatives, including any subcontractors and employees, agents, or representative of
such subcontractors, have been convicted of a felony criminal offense or that if such a
conviction has occurred Contractor has fully advised System Agency in writing of the facts
and circumstances surrounding the convictions.
32. Unfair Business Practices
Contractor represents and warrants that it has not been the subject of allegations of
Deceptive Trade Practices violations under Chapter 17 of the Texas Business and
Commerce Code, or allegations of any unfair business practice in any administrative
hearing or court suit and that Contractor has not been found to be liable for such practices
in such proceedings. Contractor certifies that it has no officers who have served as officers
of other entities who have been the subject of allegations of Deceptive Trade Practices
violations or allegations of any unfair business practices in an administrative hearing or
court suit and that such officers have not been found to be liable for such practices in such
proceedings.
33. Entities that Boycott Israel
Contractor represents and warrants that (1) it does not, and shall not for the duration of the
Contract, boycott Israel or (2) the verification required by Section 2271.002 of the Texas
Government Code does not apply to the Contract. If circumstances relevant to this
provision change during the course of the contract, Contractor shall promptly notify System
Agency.
34. E-Verify
Contractor certifies that for contracts for services, Contractor shall utilize the U.S.
Department of Homeland Security's E-Verify system during the term of this Contract to
determine the eligibility of:
1. all persons employed by Contractor to perform duties within Texas; and
2. all persons, including subcontractors, assigned by Contractor to perform work
pursuant to this Contract within the United States of America.
35. Former Agency Employees — Certain Contracts
If this Contract is an employment contract, a professional services contract under Chapter
2254 of the Texas Government Code, or a consulting services contract under Chapter 2254
of the Texas Government Code, in accordance with Section 2252.901 of the Texas
Government Code, Contractor represents and warrants that neither Contractor nor any of
Contractor's employees including, but not limited to, those authorized to provide services
under the contract, were former employees of an HHS Agency during the twelve (12)
month period immediately prior to the date of the execution of the contract.
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36. Disclosure of Prior State Employment — Consulting Services
If this Contract is for consulting services,
A. In accordance with Section 2254.033 of the Texas Government Code, a Contractor
providing consulting services who has been employed by, or employs an individual
who has been employed by, System Agency or another State of Texas agency at any
time during the two years preceding the submission of Contractor's offer to provide
services must disclose the following information in its offer to provide services.
Contractor hereby certifies that this information was provided and remains true, correct,
and complete:
1. Name of individual(s) (Contractor or employee(s));
2. Status;
3. The nature of the previous employment with HHSC or the other State of Texas
agency;
4. The date the employment was terminated and the reason for the termination; and
5. The annual rate of compensation for the employment at the time of its termination.
B. If no information was provided in response to Section A above, Contractor certifies
that neither Contractor nor any individual employed by Contractor was employed by
System Agency or any other State of Texas agency at any time during the two years
preceding the submission of Contractor's offer to provide services.
37. Abortion Funding Limitation
Contractor understands, acknowledges, and agrees that, pursuant to Article IX, Section
6.25 of the General Appropriations Act (the Act), to the extent allowed by federal and state
law, money appropriated by the Texas Legislature may not be distributed to any individual
or entity that, during the period for which funds are appropriated under the Act:
1. performs an abortion procedure that is not reimbursable under the state's Medicaid
program;
2. is commonly owned, managed, or controlled by an entity that performs an abortion
procedure that is not reimbursable under the state's Medicaid program; or
3. is a franchise or affiliate of an entity that performs an abortion procedure that is not
reimbursable under the state's Medicaid program. The provision does not apply to a
hospital licensed under Chapter 241, Health and Safety Code, or an office exempt under
Section 245.004(2), Health and Safety Code. Contractor represents and warrants that it
is not ineligible, nor will it be ineligible during the term of this Contract, to receive
appropriated funding pursuant to Article IX, Section 6.25.
38. Funding Eligibility
Contractor understands, acknowledges, and agrees that, pursuant to Chapter 2272 of the
Texas Government Code, except as exempted under that Chapter, HHSC cannot contract
with an abortion provider or an affiliate of an abortion provider. Contractor certifies that it
is not ineligible to contract with HHSC under the terms of Chapter 2272 of the Texas
Government Code.
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39. Prohibition on Certain Telecommunications and Video Surveillance Services or
Equipment (2 CFR 200.216)
Contractor certifies that the individual or business entity named in this Response or
contract is not ineligible to receive the specified contract or funding pursuant to 2 CFR
200.216.
40. False Representation
Contractor understands, acknowledges, and agrees that any false representation or any
failure to comply with a representation, warranty, or certification made by Contractor is
subject to all civil and criminal consequences provided at law or in equity including, but
not limited to, immediate termination of this Contract.
41. False Statements
Contractor represents and warrants that all statements and information prepared and
submitted by Contractor in this Contract and any related Solicitation Response are current,
complete, true, and accurate. Contractor acknowledges any false statement or material
misrepresentation made by Contractor during the performance of this Contract or any
related Solicitation is a material breach of contract and may void this Contract. Further,
Contractor understands, acknowledges, and agrees that any false representation or any
failure to comply with a representation, warranty, or certification made by Contractor is
subject to all civil and criminal consequences provided at law or in equity including, but
not limited to, immediate termination of this Contract.
42. Permits and License
Contractor represents and warrants that it will comply with all applicable laws and maintain
all permits and licenses required by applicable city, county, state, and federal rules,
regulations, statutes, codes, and other laws that pertain to this Contract.
43. Drug -Free Workplace
Contractor represents and warrants that it shall comply with the applicable provisions of
the Drug -Free Work Place Act of 1988 (41 U.S.C. §701 et seq.) and maintain a drug -free
work environment.
44. Equal Employment Opportunity
Contractor represents and warrants its compliance with all applicable duly enacted state
and federal laws governing equal employment opportunities.
45. Federal Occupational Safety and Health Law
Contractor represents and warrants that all articles and services shall meet or exceed the
safety standards established and promulgated under the Federal Occupational Safety and
Health Act of 1970, as amended (29 U.S.C. Chapter 15).
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46. Signature Authority
Contractor represents and warrants that the individual signing this Contract Affirmations
document is authorized to sign on behalf of Contractor and to bind the Contractor.
Authorized representative on behalf of Contractor must complete and sign the following:
Legal Name of Contractor
Assumed Business Name of Contractor, if applicable (d/b/a or `doing business as')
Texas County(s) for Assumed Business Name (d/b/a or `doing business as')
Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed
Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has
been filed
Signature of Authorized Representative
Daniel Pope
Printed Name of Authorized Representative
First, Middle Name or Initial, and Last Name
Physical Street Address
Mailiniz Address if different
Phone Number
Email Address
Federal Employer Identification Number
Texas Franchise Tax Number
Date Signed
Mayor
Title of Authorized Representative
State.Zip
City, State Zip Code
Fax Number
DUNS Number
Texas Payee ID No. —11 digits
Texas Secretary of State Filing
Number
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OMB Number: 4040-0007
Expiration Date: 02/28/2022
ASSURANCES - NON -CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND
IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances.
If such is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
1. Has the legal authority to apply for Federal assistance
and the institutional, managerial and financial capability
(including funds sufficient to pay the non -Federal share
of project cost) to ensure proper planning, management
and completion of the project described in this
application.
2. Will give the awarding agency, the Comptroller General
of the United States and, if appropriate, the State,
through any authorized representative, access to and
the right to examine all records, books, papers, or
documents related to the award; and will establish a
proper accounting system in accordance with generally
accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding
agency.
5. Will comply with the Intergovernmental Personnel Act of
1970 (42 U.S.C. §§4728-4763) relating to prescribed
standards for merit systems for programs funded under
one of the 19 statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to
nondiscrimination. These include but are not limited to:
(a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color
or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C.§§16$1-
1683, and 1685-1686), which prohibits discrimination on
the basis of sex; (c) Section 504 of the Rehabilitation
Act of 1973, as amended (29 U.S.C. §794), which
prohibits discrimination on the basis of handicaps; (d)
the Age Discrimination Act of 1975, as amended (42 U.
S.C. §§6101-6107), which prohibits discrimination on
the basis of age; (e) the Drug Abuse Office and
Treatment Act of 1972 (P.L. 92-255), as amended,
relating to nondiscrimination on the basis of drug
abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) §§523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290
ee- 3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the Civil
Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
made; and, 0) the requirements of any other
nondiscrimination statute(s) which may apply to the
application.
Will comply, or has already complied, with the
requirements of Titles II and III of the Uniform
Relocation Assistance and Real Property Acquisition
Policies Act of 1970 (P.L. 91-646) which provide for
fair and equitable treatment of persons displaced or
whose property is acquired as a result of Federal or
federally -assisted programs. These requirements
apply to all interests in real property acquired for
project purposes regardless of Federal participation in
purchases.
8. Will comply, as applicable, with provisions of the
Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328)
which limit the political activities of employees whose
principal employment activities are funded in whole
or in part with Federal funds.
Previous Edition Usable Standard Form 424B (Rev. 7-97)
Authorized for Local Reproduction Prescribed by OMB Circular A-102
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9. Will comply, as applicable, with the provisions of the Davis -
Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract
Work Hours and Safety Standards Act (40 U.S.C. §§327-
333), regarding labor standards for federally -assisted
construction subagreements.
10. Will comply, if applicable, with flood insurance purchase
requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973 (P.L. 93-234) which requires
recipients in a special flood hazard area to participate in the
program and to purchase flood insurance if the total cost of
insurable construction and acquisition is $10,000 or more.
11. Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91-190) and
Executive Order (EO) 11514; (b) notification of violating
facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in
floodplains in accordance with EO 11988; (e) assurance of
project consistency with the approved State management
program developed under the Coastal Zone Management
Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of
Federal actions to State (Clean Air) Implementation Plans
under Section 176(c) of the Clean Air Act of 1955, as
amended (42 U.S.C. §§7401 et seq.); (g) protection of
underground sources of drinking water under the Safe
Drinking Water Act of 1974, as amended (P.L. 93-523);
and, (h) protection of endangered species under the
Endangered Species Act of 1973, as amended (P.L. 93-
205).
12. Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. §§1271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance
with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U.S.C. §470), EO 11593
(identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of
1974 (16 U.S.C. §§469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of
human subjects involved in research, development, and
related activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of
1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et
seq.) pertaining to the care, handling, and treatment of
warm blooded animals held for research, teaching, or
other activities supported by this award of assistance.
16. Will comply with the Lead -Based Paint Poisoning
Prevention Act (42 U.S.C. §§4801 et seq.) which
prohibits the use of lead -based paint in construction or
rehabilitation of residence structures.
17. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMB Circular No. A-133,
"Audits of States, Local Governments, and Non -Profit
Organizations."
18. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.
19. Will comply with the requirements of Section 106(g) of
the Trafficking Victims Protection Act (TVPA) of 2000, as
amended (22 U.S.C. 7104) which prohibits grant award
recipients or a sub -recipient from (1) Engaging in severe
forms of trafficking in persons during the period of time
that the award is in effect (2) Procuring a commercial
sex act during the period of time that the award is in
effect or (3) Using forced labor in the performance of the
award or subawards under the award.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
TITLE
Mayor
APPLICANT ORGANIZATION
DATE SUBMITTED
City of Lubbock
Standard Form 424E (Rev. 7A7) Back
DocuSign Envelope ID: A50FDECF-2E824FD7-9602-BA6CE007EE8E
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 employee of an agency, a Member of
Congress, an officer or employee of Congress, or an employee of 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-LLL, "Disclosure of Lobbying Activities," in accordance with its 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
imposed 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.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief, that:
If any 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 commitment providing for the United States to insure or
guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying
Activities," in accordance with its instructions. Submission of this statement is a prerequisite for making or
entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the
required statement shall be subject to a civil penalty of not less than $10,000 and not more than $100,000
for each such failure.
` APPLICANT'S ORGANIZATION
` PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE
Prefix: I ` First Name: Middle Name:
` Last Name: Suffix:
Title: Fmayo P
` SIGNATURE: ` DATE:
DocuSign Envelope ID: A50FDECF-2E82-4FD7-9602-BA6CE007EE8E
ATTACHMENT F
HHS DATA USE AGREEMENT
This Data Use Agreement ("DUA"), effective as of the date the Base Contract into which
it is incorporated is signed ("Effective Date"), is entered into by and between a Texas Health and
Human Services Enterprise agency ("HHS"), and the Contractor identified in the Base Contract, a
political subdivision of the State of Texas ("CONTRACTOR").
ARTICLE 1.
PURPOSE; APPLICABILITY; ORDER OF PRECEDENCE
The purpose of this DUA is to facilitate creation, receipt, maintenance, use, disclosure or
access to Confidential Information with CONTRACTOR, and describe CONTRACTOR's rights
and obligations with respect to the Confidential Information. 45 CFR 164.504(e)(1)-(3). This DUA
also describes HHS's remedies in the event of CONTRACTOR's noncompliance with its
obligations under this DUA. This DUA applies to both Business Associates and contractors who
are not Business Associates who create, receive, maintain, use, disclose or have access to
Confidential Information on behalf of HHS, its programs or clients as described in the Base
Contract.
As of the Effective Date of this DUA, if any provision of the Base Contract, including any
General Provisions or Uniform Terms and Conditions, conflicts with this DUA, this DUA controls.
ARTICLE 2.
DEFINITIONS
For the purposes of this DUA, capitalized, underlined terms have the meanings set forth in
the following: Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 (42
U.S.C. § 1320d, et seq.) and regulations thereunder in 45 CFR Parts 160 and 164, including all
amendments, regulations and guidance issued thereafter; The Social Security Act, including Section
1137 (42 U.S.C. §§ 1320b-7), Title XVI of the Act; The Privacy Act of 1974, as amended by the
Computer Matching and Privacy Protection Act of 1988, 5 U.S.C. § 552a and regulations and
guidance thereunder; Internal Revenue Code, Title 26 of the United States Code and regulations and
publications adopted under that code, including IRS Publication 1075; OMB Memorandum 07-18;
Texas Business and Commerce Code Ch. 521; Texas Government Code, Ch. 552, and Texas
Government Code §2054.1125. In addition, the following terms in this DUA are defined as follows:
"Authorized Purpose" means the specific purpose or purposes described in the Statement
of Work of the Base Contract for CONTRACTOR to fulfill its obligations under the Base Contract,
or any other purpose expressly authorized by HHS in writing in advance.
"Authorized User" means a Person:
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(1) Who is authorized to create, receive, maintain, have access to, process, view,
handle, examine, interpret, or analyze Confidential Information pursuant to this DUA;
(2) For whom CONTRACTOR warrants and represents has a demonstrable need to
create, receive, maintain, use, disclose or have access to the Confidential Information; and
(3) Who has agreed in writing to be bound by the disclosure and use limitations
pertaining to the Confidential Information as required by this DUA.
"Confidential Information" means any communication or record (whether oral, written,
electronically stored or transmitted, or in any other form) provided to or made available to
CONTRACTOR, or that CONTRACTOR may, for an Authorized Purpose, create, receive, maintain,
use, disclose or have access to, that consists of or includes any or all of the following:
(1) Client Information;
(2) Protected Health Information in any form including without limitation, Electronic
Protected Health Information or Unsecured Protected Health Information (herein "PHI");
(3) Sensitive Personal Information defined by Texas Business and Commerce Code
Ch. 521;
(4) Federal Tax Information;
(5) Individually Identifiable Health Information as related to HIPAA, Texas HIPAA
and Personal Identifying Information under the Texas Identity Theft Enforcement and Protection
Act;
(6) Social Security Administration Data, including, without limitation, Medicaid
information;
(7) All privileged work product;
(8) All information designated as confidential under the constitution and laws of the
State of Texas and of the United States, including the Texas Health & Safety Code and the Texas
Public Information Act, Texas Government Code, Chapter 552.
"Legally Authorized Representative" of the Individual, as defined by Texas law, including
as provided in 45 CFR 435.923 (Medicaid); 45 CFR 164.502(g)(1) (HIPAA); Tex. Occ. Code §
151.002(6); Tex. H. & S. Code § 166.164; and Estates Code Ch. 752.
ARTICLE 3.
CONTRACTOR'S DUTIES REGARDING CONFIDENTIAL INFORMATION
3.01 Obligations of CONTRACTOR
CONTRACTOR agrees that:
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(A) CONTRACTOR will exercise reasonable care and no less than the same
degree of care CONTRACTOR uses to protect its own confidential, proprietary and trade
secret information to prevent any portion of the Confidential Information from being used in
a manner that is not expressly an Authorized Purpose under this DUA or as Required by Law.
45 CFR 164.502(b)(1); 45 CFR 164.514(d)
(B) Except as Required by La�Lv, CONTRACTOR will not disclose or allow access
to any portion of the Confidential Information to any Person or other entity, other than
Authorized User's Workforce or Subcontractors (as defined in 45 C.F.R. 160.103) of
CONTRACTOR who have completed training in confidentiality, privacy, security and the
importance of promptly reporting any Event or Breach to CONTRACTOR's management, to
carry out CONTRACTOR's obligations in connection with the Authorized Purpose.
HHS, at its election, may assist CONTRACTOR in training and education on specific or
unique HHS processes, systems and/or requirements. CONTRACTOR will produce
evidence of completed training to HHS upon request. 45 C.F.R. 164.308(a)(5)(i); Texas
Health & Safety Code §181.101
All of CONTRACTOR's Authorized Users, Workforce and Subcontractors with access to a state
computer system or database will complete a cybersecurity training program certified under Texas
Government Code Section 2054.519 by the Texas Department of Information Resources or offered
under Texas Government Code Sec. 2054.519(f).
(C) CONTRACTOR will establish, implement and maintain appropriate
sanctions against any member of its Workforce or Subcontractor who fails to comply with this
DUA, the Base Contract or applicable law. CONTRACTOR will maintain evidence of
sanctions and produce it to HHS upon request.45 C.F.R. 164.308(a)(1)(ii)(C); 164.530(e);
164.410(b); 164.530(b)(1)
(D) CONTRACTOR will not, except as otherwise permitted by this DUA,
disclose or provide access to any Confidential Information on the basis that such act is
Required by Law without notifying either HHS-or CONTRACTOR's own legal counsel to
determine whether CONTRACTOR should object to the disclosure or access and seek
appropriate relief. CONTRACTOR will maintain an accounting of all such requests for
disclosure and responses and provide such accounting to HHS within 48 hours of HHS'
request. 45 CFR 164.504(e)(2)(ii)(A)
(E) CONTRACTOR will not attempt to re -identify or further identify
Confidential Information or De -identified Information, or attempt to contact any Individuals
whose records are contained in the Confidential Information, except for an Authorized
Purpose, without express written authorization from HHS or as expressly permitted by the
Base Contract. 45 CFR 164.502(d)(2)(i) and (fi) CONTRACTOR will not engage in
prohibited marketing or sale of Confidential Information. 45 CFR 164.501, 164.508(a)(3)
and (4); Texas Health & Safety Code Ch. 181.002
(F) CONTRACTOR will not permit, or enter into any agreement with a
Subcontractor to, create, receive, maintain, use, disclose, have access to or transmit
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Confidential Information to carry out CONTRACTOR's obligations in connection with the
Authorized Purpose on behalf of CONTRACTOR, unless Subcontractor agrees to comply
with all applicable laws, rules and regulations. 45 CFR 164.502(e)(1)(ii); 164.504(e)(1)(i)
and (2).
(G) CONTRACTOR is directly responsible for compliance with, and enforcement
of, all conditions for creation, maintenance, use, disclosure, transmission and Destruction of
Confidential Information and the acts or omissions of Subcontractors as may be reasonably
necessary to prevent unauthorized use. 45 CFR 164.504(e)(5); 42 CFR 431.300, et seq.
(H) If CONTRACTOR maintains PHI in a Designated Record Set which is
Confidential Information and subject to this Agreement, CONTRACTOR will make PHI
available to HHS in a Designated Record Set upon request. CONTRACTOR will provide PHI
to an Individual, or Legally Authorized Representative of the Individual who is requesting
PHI in compliance with the requirements of the HIPAA Privacy Regulations.
CONTRACTOR will release PHI in accordance with the HIPAA Privacy Regulations upon
receipt of a valid written authorization. CONTRACTOR will make other Confidential
Information in CONTRACTOR's possession available pursuant to the requirements of
HIPAA or other applicable law upon a determination of a Breach of Unsecured PHI as defined
in HIPAA. CONTRACTOR will maintain an accounting of all such disclosures and provide
it to HHS within 48 hours of HHS' request. 45 CFR 164.524and 164.504(e)(2)(ii)(E).
(I) If PHI is subject to this Agreement, CONTRACTOR will make PHI as
required by HIPAA available to HHS for review subsequent to CONTRACTOR's
incorporation of any amendments requested pursuant to HIPAA. 45 CFR
164.504(e)(2)(ii)(E) and (F).
(J) If PHI is subject to this Agreement, CONTRACTOR will document and make
available to HHS the PHI required to provide access, an accounting of disclosures or
amendment in compliance with the requirements of the HIPAA Privacy Regulations. 45 CFR
164.504(e)(2)(ii)(G) and 164.528.
(K) If CONTRACTOR receives a request for access, amendment or accounting
of PHI from an individual with a right of access to information subject to this DUA, it will
respond to such request in compliance with the HIPAA Privacy Regulations.
CONTRACTOR will maintain an accounting of all responses to requests for access to or
amendment of PHI and provide it to HHS within 48 hours of HHS' request. 45 CFR
164.504(e)(2).
(L) CONTRACTOR will provide, and will cause its Subcontractors and agents
to provide, to HHS periodic written certifications of compliance with controls and
provisions relating to information privacy, security and breach notification, including
without limitation information related to data transfers and the handling and disposal of
Confidential Information. 45 CFR 164.308; 164.530(c); I TA 202.
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(M) Except as otherwise limited by this DUA, the Base Contract, or law
applicable to the Confidential Information, CONTRACTOR may use PHI for the proper
management and administration of CONTRACTOR or to carry out CONTRACTOR's
legal responsibilities. Except as otherwise limited by this DUA, the Base Contract, or law
applicable to the Confidential Information, CONTRACTOR may disclose PHI for the
proper management and administration of CONTRACTOR, I or to carry out
CONTRACTOR's legal responsibilities, if. 45 CFR 164.504(e)(4)(A).
(1) Disclosure is Required by Law, provided that CONTRACTOR complies with
Section 3.01(D); or
(2) CONTRACTOR obtains reasonable assurances from the person or entity to
which the information is disclosed that the person or entity will:
(a)Maintain the confidentiality of the Confidential Information in accordance
with this DUA;
(b) Use or further disclose the information only as Required by Law or for
the Authorized Purpose for which it was disclosed to the Person; and
(c)Notify CONTRACTOR in accordance with Section 4.01 of any Event or
Breach of Confidential Information of which the Person discovers or should have
discovered with the exercise of reasonable diligence. 45 CFR
164.504 (e) (4) (ii) (B).
(N) Except as otherwise limited by this DUA, CONTRACTOR will, if required
by law and requested by HHS, use commercially reasonable efforts to use PHI to provide data
aggregation services to HHS, as that term is defined in the HIPAA, 45 C.F.R. § 164.501 and
permitted by HIPAA. 45 CFR 164.504(e)(2)(i)(B)
(0) CONTRACTOR will, on the termination or expiration of this DUA or the
Base Contract, at its expense, send to HHS or Destroy, at HHS's election and to the -extent
reasonably feasible and permissible by law, all Confidential Information received from HHS
or created or maintained by CONTRACTOR or any of CONTRACTOR's agents or
Subcontractors on HHS's behalf if that data contains Confidential Information.
CONTRACTOR will certify in writing to HHS that all the Confidential Information that has
been created, received, maintained, used by or disclosed to CONTRACTOR, has been
Destroyed or sent to HHS, and that CONTRACTOR and its agents and Subcontractors have
retained no copies thereof. Notwithstanding the foregoing, HHS acknowledges and agrees
that CONTRACTOR is not obligated to send to HHSC and/or Destroy any Confidential
Information if federal law, state law, the Texas State Library and Archives Commission
records retention schedule, and/or a litigation hold notice prohibit such delivery or
Destruction. If such delivery or Destruction is not reasonably feasible, or is impermissible by
law, CONTRACTOR will immediately notify HHS of the reasons such delivery or
Destruction is not feasible, and agree to extend indefinitely the protections of this DUA to the
Confidential Information and limit its further uses and disclosures to the purposes that make
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the return delivery or Destruction of the Confidential Information not feasible for as long as
CONTRACTOR maintains such Confidential Information. 45 CFR 164.504(e)(2)(ii)Q)
(P) CONTRACTOR will create, maintain, use, disclose, transmit or Destroy
Confidential Information in a secure fashion that protects against any reasonably anticipated
threats or hazards to the security or integrity of such information or unauthorized uses. 45
CFR 164.306, 164.530(c)
(Q) If CONTRACTOR accesses, transmits, stores, and/or maintains Confidential
Information, CONTRACTOR will complete and return to HHS at
infosecurity@hhsc.state.tx.us the HHS information security and privacy initial inquiry (SPI)
at Attachment 1 . The SPI identifies basic privacy and security controls with which
CONTRACTOR must comply to protect HHS Confidential Information. CONTRACTOR
will comply with periodic security controls compliance assessment and monitoring by HHS
as required by state and federal law, based on the type of Confidential Information
CONTRACTOR creates, receives, maintains, uses, discloses or has access to and the
Authorized Purpose and level of risk. CONTRACTOR's security controls will be based on
the National Institute of Standards and Technology (MIST) Special Publication 800-53.
CONTRACTOR will update its security controls assessment whenever there are significant
changes in security controls for HHS Confidential Information and will provide the updated
document to HHS. HHS also reserves the right to request updates as needed to satisfy state
and federal monitoring requirements. 45 CFR 164.306.
(R) CONTRACTOR will establish, implement and maintain reasonable
procedural, administrative, physical and technical safeguards to preserve and maintain the
confidentiality, integrity, and availability of the Confidential Information, and with respect to
PHI, as described in the HIPAA Privacy and Security Regulations, or other applicable laws
or regulations relating to Confidential Information, to prevent any unauthorized use or
disclosure of Confidential Information as long as CONTRACTOR has such Confidential
Information in its actual or constructive possession. 45 CFR 164.308 (administrative
safeguards); 164.310 (physical safeguards); 164.312 (technical safeguards);
164.530(c)(privacy safeguards).
(S) CONTRACTOR will designate and identify, a Person or Persons, as Privacy
Official 45 CFR 164.530(a)(1) and Information Security Official, each of whom is authorized
to act on behalf of CONTRACTOR and is responsible for the development and
implementation of the privacy and security requirements in this DUA. CONTRACTOR will
provide name and current address, phone number and e-mail address for such designated
officials to HHS upon execution of this DUA and prior to any change. If such persons fail to
develop and implement the requirements of the DUA, CONTRACTOR will replace them
upon HHS request. 45 CFR 164.308(a)(2).
(T) CONTRACTOR represents and warrants that its Authorized Users each have
a demonstrated need to know and have access to Confidential Information solely to the
minimum extent necessary to accomplish the Authorized Purpose pursuant to this DUA and
the Base Contract, and further, that each has agreed in writing to be bound by the disclosure
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and use limitations pertaining to the Confidential Information contained in this DUA. 45
CFR 164.502, 164.514(d).
(U) CONTRACTOR and its Subcontractors will maintain an updated, complete,
accurate and numbered list of Authorized Users, their signatures, titles and the date they
agreed to be bound by the terms of this DUA, at all times and supply it to HHS, as directed,
upon request.
(V) CONTRACTOR will implement, update as necessary, and document
reasonable and appropriate policies and procedures for privacy, security and Breach of
Confidential Information and an incident response plan for an Event or Breach, to comply
with the privacy, security and breach notice requirements of this DUA prior to conducting
work under the Statement of Work. 45 CFR 164.308, 164.316; 164.514(d); 164.530(i)(1).
(W) CONTRACTOR will produce copies of its information security and privacy
policies and procedures and records relating to the use or disclosure of Confidential
Information received from, created by, or received, used or disclosed by CONTRACTOR for
an Authorized Purpose for HHS's review and approval within 30 days of execution of this
DUA and upon request by HHS the following business day or other agreed upon time frame.
45 CFR 164.308, 164.514(d).
(X) CONTRACTOR will make available to HHS any information HHS requires
to fulfill HHS's obligations to provide access to, or copies of, PHI in accordance with HIPAA
and other applicable laws and regulations relating to Confidential Information.
CONTRACTOR will provide such information in a time and manner reasonably agreed upon
or as designated by the Secretary of the U.S. Department of Health and Human Services, or
other federal or state law. 45 CFR 164.504(e)(2)(i)(I).
(Y) CONTRACTOR will only conduct secure transmissions of Confidential
Information whether in paper, oral or electronic form, in accordance with applicable rules,
regulations and laws. A secure transmission of electronic Confidential Information in motion
includes, but is not limited to, Secure File Transfer Protocol (SFTP) or Encryption at an
appropriate level. If required by rule, regulation or law, HHS Confidential Information at rest
requires Encryption unless there is other adequate administrative, technical, and physical
security. All electronic data transfer and communications of Confidential Information will be
through secure systems. Proof of system, media or device security and/or Encryption must be
produced to HHS no later than 48 hours after HHS's written request in response to a
compliance investigation, audit or the Discovery of an Event or Breach. Otherwise, requested
production of such proof will be made as agreed upon by the parties. De -identification of HHS
Confidential Information is a means of security. With respect to de -identification of PHI,
"secure" means de -identified according to HIPAA Privacy standards and regulatory guidance.
45 CFR 164.312, 164.530(d).
(Z) For each type of Confidential Information CONTRACTOR creates, receives,
maintains, uses, discloses, has access to or transmits in the performance of the Statement of
HHS Data Use Agreement
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Work, CONTRACTOR will comply with the following laws rules and regulations, only to
the extent applicable and required by law:
• Title 1, Part 10, Chapter 202, Subchapter B, Texas Administrative Code;
• The Privacy Act of 1974;
• OMB Memorandum 07-16;
• The Federal Information Security Management Act of 2002 (FISMA);
• The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
as defined in the DUA;
• Internal Revenue Publication 1075 - Tax Information Security Guidelines
for Federal, State and Local Agencies;
• National Institute of Standards and Technology (NIST) Special Publication
800-66 Revision 1 - An Introductory Resource Guide for Implementing the
Health Insurance Portability and Accountability Act (HIPAA) Security
Rule;
• NIST Special Publications 800-53 and 800-53A - Recommended Security
Controls for Federal Information Systems and Organizations, as currently
revised;
• NIST Special Publication 800-47 - Security Guide for Interconnecting
Information Technology Systems;
• NIST Special Publication 800-88, Guidelines for Media Sanitization;
• NIST Special Publication 800-111, Guide. to Storage of Encryption
Technologies for End User Devices containing PHI; and
Any other State or Federal law, regulation, or administrative rule relating to the specific HHS,
program area that CONTRACTOR supports on behalf of HHS.
(AA) Notwithstanding anything to the contrary herein, CONTRACTOR will treat
any Personal Identifying Information it creates, receives, maintains, uses, transmits, destroys
and/or discloses in accordance with Texas Business and Commerce Code, Chapter 521 and
other applicable regulatory standards identified in Section 3.01(Z), and Individually
Identifiable Health Information CONTRACTOR creates, receives, maintains, uses,
transmits, destroys and/or discloses in accordance with HIPAA and other applicable
regulatory standards identified in Section 3.01(Z).
ARTICLE 4.
BREACH NOTICE, REPORTING AND CORRECTION REQUIREMENTS
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4.01 Breach or Event Notification to HHS. 45 CFR 164.400414.
(A) CONTRACTOR will cooperate fully with HHS in investigating, mitigating to
the extent practicable and issuing notifications directed by HHS, for any Event or Breach of
Confidential Information to the extent and in the manner determined by HHS.
(B) CONTRACTOR'S obligation begins at the Discovery of an Event or Breach
and continues as long as related activity continues, until all effects of the Event are mitigated
to HHS's reasonable satisfaction (the "incident response period"). 45 CFR 164.404.
(C) Breach Notice:
(1) Initial Notice.
(a) For federal information, including without limitation, Federal
Tax Information, Social Security Administration Data, and Medicaid Client
Information, within the first, consecutive clock hour of Discovery, and for
all other types of Confidential Information not more than 24 hours after
Discovery, or in a timeframe otherwise approved by HHS in writing, initially
report to HHS's Privacy and Security Officers via email at:
privacy@HHSC.state.tx.us and to the HHS division responsible for this
DUA; and IRS Publication 1075; Privacy Act of 1974, as amended by the
Computer Matching and Privacy Protection Act of 1988, 5 U.S.C. § 552a;
OMB Memorandum 07-16 as cited in HHSC-CMS Contracts for
information exchange.
(b) Report all information reasonably available to
CONTRACTOR about the Event or Breach of the privacy or security of
Confidential Information. 45 CFR 164.410.
(c) Name, and provide contact information to HHS for,
CONTRACTOR's single point of contact who will communicate with HHS
both on and off business hours during the incident response period.
(2) Formal Notice. No later than two business days after the Initial Notice
above, provide formal notification to privacy@HHSC.state.tx.us and to the HHS
division responsible for this DUA, including all reasonably available information
about the Event or Breach, and CONTRACTOR's investigation, including without
limitation and to the extent available: For (a) - (m) below: 45 CFR 164.400-414.
(a) The date the Event or Breach occurred;
(b) The date of CONTRACTOR's and, if applicable,
Subcontractor's Discovery;
(c) A brief description of the Event or Breach; including how it
occurred and who is responsible (or hypotheses, if not yet determined);
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(d) A brief description of CONTRACTOR's investigation and the
status of the investigation;
(e) A description of the types and amount of Confidential
Information involved;
(f) Identification of and member of all Individuals reasonably
believed to be affected, including first and last name of the Individual and if
applicable the, Legally Authorized Representative, last known address,
age, telephone number, and email address if it is a preferred contact method,
to the extent known or can be reasonably determined by CONTRACTOR at
that time;
(g) CONTRACTOR's initial risk assessment of the Event or
Breach demonstrating whether individual or other notices are required by
applicable law or this DUA for HHS approval, including an analysis of
whether there is a low probability of compromise of the Confidential
Information or whether any legal exceptions to notification apply;
(h) CONTRACTOR's recommendation for HHS's approval as to
the steps Individuals and/or CONTRACTOR on behalf of Individuals,
should take to protect the Individuals from potential harm, including without
limitation CONTRACTOR's provision of notifications, credit protection,
claims monitoring, and any specific protections for a Legally Authorized
Representative to take on behalf of an Individual with special capacity or
circumstances;
(i) The steps CONTRACTOR has taken to mitigate the harm or
potential harm caused (including without limitation the provision of
sufficient resources to mitigate);
- 0) The steps CONTRACTOR has taken, or will take, to prevent
or reduce the likelihood of recurrence of a similar Event or Breach;
(k) Identify, describe or estimate the Persons, Workforce,
Subcontractor, or Individuals and any law enforcement that maybe involved
in the Event or Breach;
(1) A reasonable schedule for CONTRACTOR to provide regular
updates during normal business hours to the foregoing in the future for
response to the Event or Breach, but no less than every three (3) business
days or as otherwise directed by HHS, including information about risk
estimations, reporting, notification, if any, mitigation, corrective action, root
cause analysis and when such activities are expected to be completed; and
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(m) Any reasonably available, pertinent information, documents or
reports related to an Event or Breach that HHS requests following
Discovery.
4.02 Investigation, Response and Mitigation. 45 CFR 164.308, 310 and 312;164.530
(A) CONTRACTOR will immediately conduct a full and complete investigation,
respond to the Event or Breach, commit necessary and appropriate staff and resources to
expeditiously respond, and report as required to and by HHS for incident response purposes
and for purposes of HHS's compliance with report and notification requirements, to the
reasonable satisfaction of HHS.
(B) CONTRACTOR will complete or participate in a risk assessment as directed
by HHS following an Event or Breach, and provide the final assessment, corrective actions
and mitigations to HHS for review and approval.
(C) CONTRACTOR will fully cooperate with HHS to respond to inquiries and/or
proceedings by state and federal authorities, Persons and/or Individuals about the Event or
Breach.
(D) CONTRACTOR will fully cooperate with HHS's efforts to seek appropriate
injunctive relief or otherwise prevent or curtail such Event or Breach, or to recover or protect
any Confidential Information, including complying with reasonable corrective action or
measures, as specified by HHS in a Corrective Action Plan if directed by HHS under the Base
Contract.
4.03 Breach Notification to Individuals and Reporting to Authorities. Tex. Bus. &
Comm. Code §521.053; 45 CFR 164.404 (Individuals), 164.406 (Media); 164.408
(Authorities)
(A) HHS may direct CONTRACTOR to provide Breach notification to
Individuals, regulators or third -parties, -as specified by HHS following a Breach.
(B) CONTRACTOR shall give HHS an opportunity to review and provide
feedback to CONTRACTOR and to confirm that CONTRACTOR's notice meets all
regulatory requirements regarding the time, manner and content of any notification to
Individuals, regulators or third -parties, or any notice required by other state or federal
authorities, including without limitation, notifications required by Texas Business and
Commerce Code, Chapter 521.053(b) and HIPAA. HHS shall have ten (10) business days to
provide said feedback to CONTRACTOR. Notice letters will be in CONTRACTOR's name
and on CONTRACTOR's letterhead, unless otherwise directed by HHS, and will contain
contact information, including the name and title of CONTRACTOR's representative, an
email address and a toll -free telephone riumber, if required by applicable law, rule, or
regulation, for the Individual to obtain additional information.
(C) CONTRACTOR will provide HHS with copies of distributed and approved
communications.
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(D) CONTRACTOR will have the burden of demonstrating to the reasonable
satisfaction of HHS that any notification required by HHS was timely made. If there are delays
outside of CONTRACTOR's control, CONTRACTOR will provide written documentation of
the reasons for the delay.
(E) If HHS delegates notice requirements to CONTRACTOR, HHS shall, in the
time and manner reasonably requested by CONTRACTOR, cooperate and assist with
CONTRACTOR's information requests in order to make such notifications and reports.
ARTICLE 5.
STATEMENT OF WORK
"Statement of Work" means the services and deliverables to be performed or provided by
CONTRACTOR, or on behalf of CONTRACTOR by its Subcontractors or agents for HHS that are
described in detail in the Base Contract. The Statement of Work, including any future amendments
thereto, is incorporated by reference in this DUA as if set out word-for-word herein.
ARTICLE 6.
GENERAL PROVISIONS
6.01 Oversight of Confidential Information
CONTRACTOR acknowledges and agrees that HHS is entitled to oversee and monitor
CONTRACTOR's access to and creation, receipt, maintenance, use, disclosure of the Confidential
Information to confirm that CONTRACTOR is in compliance with this DUA.
6.02 HHS Commitment and Obligations
HHS will not request CONTRACTOR to create, maintain, transmit, use or disclose PHI in
any manner that would not be permissible under applicable law if done by HHS.
6.03 HHS Right to Inspection
At any time upon reasonable notice to CONTRACTOR, or if HHS determines that
CONTRACTOR has violated this DUA, HHS, directly or through its agent, will have the right to
inspect the facilities, systems, books and records of CONTRACTOR to monitor compliance with this
DUA. For purposes of this subsection, HHS's agent(s) include, without limitation, the HHS Office of
the Inspector General or the Office of the Attorney General of Texas, outside consultants or legal
counsel or other designee.
6.04 Term; Termination of DUA; Survival
This DUA will be effective on the date on which CONTRACTOR executes the DUA, and
will terminate upon termination of the Base Contract and as set forth herein. If the Base Contract is
extended or amended, this DUA shall be extended or amended concurrent with such extension or
amendment.
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(A) HHS may immediately terminate this DUA and Base Contract upon a material
violation of this DUA.
(B) Termination or Expiration of this DUA will not relieve CONTRACTOR of its
obligation to return or Destroy the Confidential Information as set forth in this DUA and to
continue to safeguard the Confidential Information until such time as determined by HHS.
(C) If HHS determines that CONTRACTOR has violated a material term of this
DUA; HHS may in its sole discretion:
(1) Exercise any of its rights including but not limited to reports, access
and inspection under this DUA and/or the Base Contract; or
(2) Require CONTRACTOR to submit to a Corrective Action Plan,
including a plan for monitoring and plan for reporting, as HHS may determine
necessary to maintain compliance with this DUA; or
(3) Provide CONTRACTOR with a reasonable period to cure the
violation as determined by HHS; or
(4) Terminate the DUA and Base Contract immediately, and seek relief in
a court of competent jurisdiction in Texas.
Before exercising any of these options, HHS will provide written notice to
CONTRACTOR describing the violation, the requested corrective action CONTRACTOR
may take to cure the alleged violation, and the action HHS intends to take if the alleged
violated is not timely cured by CONTRACTOR.
(D) If neither termination nor cure is feasible, HHS shall report the violation to the
Secretary of the U.S. Department of Health and Human Services.
(E) The duties of CONTRACTOR or its Subcontractor under this DUA survive
the expiration or termination of this DUA until all the Confidential Information is Destroyed
or returned to HHS, as required by this DUA.
6.05 Governing Law, Venue and Litigation
(A) The validity, construction and performance of this DUA and the legal relations
among the Parties to this DUA will be governed by and construed in accordance with the laws
of the State of Texas.
(B) The Parties agree that the courts of Texas, will be the exclusive venue for any
litigation, special proceeding or other proceeding as between the parties that may be brought,
or arise out of, or in connection with, or by reason of this DUA.
6.06 Injunctive Relief
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(A) CONTRACTOR acknowledges and agrees that HHS may suffer irreparable
injury if CONTRACTOR or its Subcontractor fails to comply with any of the terms of this
DUA with respect to the Confidential Information or a provision of HIPAA or other laws or
regulations applicable to Confidential Information.
(B) CONTRACTOR further agrees that monetary damages may be inadequate to
compensate HHS for CONTRACTOR's or its Subcontractor's failure to comply. Accordingly,
CONTRACTOR agrees that HHS will, in addition to any other remedies available to it at law
or in equity, be entitled to seek injunctive relief without posting a bond and without the
necessity of demonstrating actual damages, to enforce the terms of this DUA.
6.07 Responsibility.
To the extent permitted by the Texas Constitution, laws and rules, and without waiving any
immunities or defenses available to CONTRACTOR as a governmental entity, CONTRACTOR
shall be solely responsible for its own acts and omissions and the acts and omissions of its
employees, directors, officers, Subcontractors and agents. HHS shall be solely responsible for its
own acts and omissions.
6.08 Insurance
(A) As a governmental entity, and in accordance with the limits of the Texas Tort
Claims Act, Chapter 101 of the Texas Civil Practice and Remedies Code, CONTRACTOR
either maintains commercial insurance or self -insures with policy limits in an amount
sufficient to cover CONTRACTOR's liability arising under this DUA. CONTRACTOR will
request that HHS be named as an additional insured. HHSC reserves the right to consider
alternative means for CONTRACTOR to satisfy CONTRACTOR's financial responsibility
under this DUA. Nothing herein shall relieve CONTRACTOR of its financial obligations set
forth in this DUA if CONTRACTOR fails to maintain insurance.
(B) CONTRACTOR will provide HHS with written proof that required insurance
coverage is in effect, at the request of HHS.
6.08 Fees and Costs
Except as otherwise specified in this DUA or the Base Contract, if any legal action or other
proceeding is brought for the enforcement of this DUA, or because of an alleged dispute, contract
violation, Event, Breach, default, misrepresentation, or injunctive action, in connection with any of
the provisions of this DUA, each party will bear their own legal expenses and the other cost incurred
in that action or proceeding.
6.09 Entirety of the Contract
This DUA is incorporated by reference into the Base Contract as an amendment thereto
and, together with the Base Contract, constitutes the entire agreement between the parties. No
change, waiver, or discharge of obligations arising under those documents will be valid unless in
writing and executed by the party against whom such change, waiver, or discharge is sought to be
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enforced. If any provision of the Base Contract, including any General Provisions or Uniform
Terms and Conditions, conflicts with this DUA, this DUA controls.
6.10 Automatic Amendment and Interpretation
If there is (i) a change in any law, regulation or rule, state or federal, applicable to HIPPA and/or
Confidential Information, or (ii) any change in the judicial or administrative interpretation of any
such law, regulation or rule„ upon the effective date of such change, this DUA shall be deemed to
have been automatically amended, interpreted and read so that the obligations imposed on HHS
and/or CONTRACTOR remain in compliance with such changes. Any ambiguity in this DUA will
be resolved in favor of a meaning that permits HHS and CONTRACTOR to comply with HIPAA
or any other law applicable to Confidential Information.
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HzYachment G
Fiscal Federal Funding Accountability and Transparency Act
(FFATA) CERTIFICATION
The certifications enumerated below represent material facts upon which DSHS relies when reporting
information to the federal government required under federal law. If the Department later determines
that the Contractor knowingly rendered an erroneous certification, DSHS may pursue all available
remedies in accordance with Texas and U.S. law. Signor further agrees that it will provide immediate
written notice to DSHS if at any time Signor learns that any of the certifications provided for below were
erroneous when submitted or have since become erroneous by reason of changed circumstances. If the
Signor cannot certify all of the statements contained in this section, Signor must provide written
notice to DSHS detailing which of the below statements it cannot certify and why.
Legal Name of Contractor:
Primary Address of Contractor:
ZIP Code: 9-digits Required www.usps.com
FFATA Contact # 1 Name, Email and Phone Number:
FFATA Contact #2 Name, Email and Phone Number:
DUNS Number: 9-digits Required www.sam.gov
State of Texas Comptroller Vendor Identification Number (VIN) 14 Digits
Printed Name of Authorized Representative
Daniel Pope
Title of Authorized Representative
Mayor
Signature of Authorized Representative
Date
Department of State Health Services corm 4734 — June 2013
DocuSign Envelope ID: A50FDECF-2E82AFD7-9602-BA6CE007EE8E
Fiscal Federal Funding Accountability and Transparency Act
(FFATA) CERTIFICATION
As the duly authorized representative (Signor) of the Contractor, I hereby certify that
the statements made by me in this certification form are true, complete and correct to
the best of my knowledge.
Did your organization have a gross income, from all sources, of less than $300,000 in
your previous tax year? ❑ Yes ❑ No
If your answer is "Yes", skip questions "A", "B", and "C" and finish the certification.
If your answer is "No", answer questions "A" and "B".
A. Certification Regarding % of Annual Gross from Federal Awards.
Did your organization receive 80% or more of its annual gross revenue from federal
awards during the preceding fiscal year? ❑ Yes ❑ No
B. Certification Regarding Amount of Annual Gross from Federal Awards.
Did your organization receive $25 million or more in annual gross revenues from federal
awards in the preceding fiscal year? ❑ Yes ❑ No
If your answer is "Yes" to both question "A" and "B", you must answer question "C".
If your answer is "No" to either question "A" or "B" skip question C" and finish the
certification.
C. Certification Regarding Public Access to Compensation Information.
Does the public have access to information about the compensation of the senior
executives in your business or organization (including parent organization, all branches,
and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d)
of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the
Internal Revenue Code of 1986? ❑ Yes ❑ No
If your answer is "Yes" to this question, where can this information be accessed?
If your answer is "No" to this question, you must provide the names and total
compensation of the top five highly compensated officers below.
Provide compensation information here:
-z-
Department of Slate Health Services Form 4734 — June 2013
Certificate Of Completion
Envelope Id: A50FDECF2E824FD79602BA6CE007EE8E
Subject: New $2,761,375.00; HHS001019500024; City of Lubbock; DSHS/LIDS - IMM/COVID-19
Source Envelope:
Document Pages: 67 Signatures: 0
Certificate Pages: 2 Initials: 0
AutoNav: Enabled
Envelopeld Stamping: Enabled
Time Zone: (UTC-06:00) Central Time (US & Canada)
Record Tracking
Status: Original
4/16/2021 10:08:19 AM
Signer Events
Daniel Pope
dpope@mylubbock.us
Mayor
City of Lubbock
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Andy Marker
Edward. Marker@hhsc.state.tx.us
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Karen Ray
karen.ray@hhs.texas.gov
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Chad Riley
Chad. Riley@hhs.texas.gov
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Jennifer Sims
Jennifer.Sims@dshs.texas.gov
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Person Signer Events
Holder: Texas Health and Human Services
Commission
PCS_DocuSign@hhsc.state.tx.us
Signature
Signature
Dotu1;
aA.cuaao
Status: Sent
Envelope Originator:
Texas Health and Human Services Commission
1100 W. 49th St.
Austin, TX 78756
PCS_DocuSign@hhsc.state.tx.us
IP Address: 167.137.1.16
Location: DocuSign
Timestamp
Sent: 4/16/2021 10:33:43 AM
Viewed: 4/16/2021 10:49:09 AM
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Sent: 4/16/2021 10:33:43 AM
cmucontracts@dshs.texas.gov
Q PI E D
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Caeli Paradise
Sent: 4/16/2021 10:33:43 AM
Caeli.paradise@dshs.texas.gov
COPIED
Contract Manager
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Katherine Wells
Sent: 4/16/2021 10:33:44 AM
kwells@mylubbock.us
COPIED
Director of Public Health
City of Lubbock
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Witness Events
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DocuSign Envelope ID: A50FDECF-2E82AFD7-9602-BA6CE007EE8E
TEXAS
Health and Human
Services
The Honorable Daniel Pope, Mayor
City of Lubbock
P.O. Box 2000
Lubbock, Texas 79457
Texas Department of State Health Services
John Hellerstedt, M.D.
Commissioner
Subject: COVID-19 Vaccination Capacity Contract
Contract Number: HHS001019500024
Contract Amount: $2,761,375.00
Contract Term: Upon Execution through June 30, 2024
Dear Mayor Pope:
Enclosed is the COVID-19 vaccination capacity contract between the
Department of State Health Services and the City of Lubbock.
The purpose of this contract is to increase COVID-19 vaccination capacity for
the jurisdiction.
Please let me know if you have any questions or need additional information.
Sincerely,
Caeli Paradise, CTCM
Contract Manager
512-776-3767
Caeli.paradise@dshs.texas.gov
P.O. Box 149347 - Austin,Texas 78714-9347 - Phore: 888.963.7111 - TTY: 800-735-2889 - www.dshs.texas.gov