HomeMy WebLinkAboutResolution - 2021-R0480 - Senior Center Operations Contract with SPAG 12.7.21Resolution No. 2021-R0480
Item No. 7.19
December 7, 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, a South Plains Association of Governments Area
Agency on Aging Subrecipient Agreement and related documents from the State of Texas,
acting by and through the Texas Health and Human Services and the South Plains
Association of Governments (SPAG), for funds passed through the U.S. Department of
IIealth and Human Services to the State of Texas. Said Agreement 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
ATTEST:
I eb cca Garza, City S te ry
APPROVED AS TO CONTENT:
AlAodu Lu� ,L�
Brooke Witcher, Assistant City Manager
APPROVED AS TO FORM:
December 7, 2021
"r --- - --'- —
DANIEL M. POPE, MAYOR
RES. Subrecipient Agreement 2021 SPAG Area Agency on Aging
11.19.21
Resolution No. 2021-R0480
AreaAgency
SOUTH PLAINS ASSOCIATION OF GOVERNMENTS
WonAging AREA AGENCY ON AGING
SUBRECIPIENT AGREEMENT
City of Lubbock, hereinafter referred to as Subrecipient, and South Plains Association of Governments
Area Agency on Aging (AAA) do hereby agree to provide services effective beginning October 1, 2021,
in accordance with the Older Americans Act of 1965 (OAA), as amended, regulations of the Health and
Human Services Commission (HHSC), the AAA Direct Purchase of Services program and the stated Scope
of Services.
The AAA Direct Purchase of Services program is designed to promote the development of a comprehensive
and coordinated service delivery system to meet the needs of older individuals (60 years of age or older)
and their caregivers. This agreement provides a mechanism for the creation of an individualized network
of community resources accessible to a program participant in compliance with the OAA and HHSC AAA
Access and Assistance guidelines.
The purpose of the system of Access and Assistance is to develop cooperative working relationships with
service providers to build an integrated service delivery system that ensures broad access to and information
about community services, maximizes the use of existing resources, avoids duplication of effort, identifies
gaps in services, and facilitates the ability of people who need services to easily find the most appropriate
Subrecipient.
1. SCOPE OF SERVICES
A. The Subrecipient agrees to provide the following service(s) as identified below to program
participants authorized by the AAA staff, in accordance with the Subrecipient application, all
required assurances, licenses, certifications and rate setting documents, as applicable.
Service:
CONGREGATE MEALS
HOME DELIVERED MEALS
TRANSPORTATION
Service Definition:
CONGREGATE MEAL - A hot or other appropriate meal served to an eligible older person in a
congregate setting.
HOME DELIVERED MEAL - Hot, cold, frozen, dried, canned, fresh, or supplemental food (with
a satisfactory storage life) delivered to a person who is eligible in their place of residence. The
objective is to reduce food insecurity; help the recipient sustain independent living in a safe and
healthful environment.
TRANSPORTATION DEMAND/RESPONSE - Transportation designed to carry an older person
from a specific origin to a specific destination upon request. An older person requests the
transportation service in advance of their need, usually twenty-four to forty-eight hours prior to the
trip.
Unit Definitions:
CONGREGATE MEALS: One Meal
HOME DELIVERED MEALS: One Meal
TRANSPORTATION — Demand/Response: One One-way Trip
Form #: AIAAAVA2.0
Edition Date: 9/_19/11
All Texas Administrative Code standards are located at the Texas Secretary of State website:
Welcome to the Texas Administrative Code
All Older Americans Act and other required rules and regulations are located at:
.acl. ❑ n delis.
Targeting: AAA services are designed to identify eligible program participants, with an emphasis
on high -risk program participants and to serve older individuals with greatest economic and social
need, low-income minorities and those residing in rural areas, as required by the OAA.
B. Nutrition Requirements:
The nutrition program guidelines align with the most recent Dietary Guidelines for Americans
(DGAs) and dietary reference intakes (DRIs). The established guidelines specifically address
prevalent disease conditions for the aging population.
Providers must serve meals that:
• Comply with the most recent DGA, published by the U.S. Department of Health and Human
Services (DHHS) Secretary and the Secretary of Agriculture;
• Provide a minimum of 33-1/3 percent of the DRI established by the Food and Nutrition Board
of the Institute Medicine of the National Academics of Science, Engineering and Medicine, if
the program provides one meal per day; and
• Meet any special dietary needs of people participating in the program, to the maximum extent
practicable.
C. Services & Reimbursement Methodology:
Service
Fixed Rate
(include rate)
Variable Rate
(identify range)
Cost
Reimbursement
Congregate
N/A
N/A
$7.84
Home Delivered
N/A
N/A
$7.12
Transportation — D/R
N/A
N/A
$10.51
2. TERMS OF AGREEMENT
A. The Subrecipient agrees to:
1. provide services in accordance with current or revised HHSC policies and standards and the
OAA.
2. submit billings with appropriate documentation as required by the AAA by the close of business
on the 2nd working day of each month following the last day of the month in which services
were provided.
Form #: AIAAAVA2.0
Edition Date: 9/ _99/11
a. If the 2"d working day falls on a weekend or holiday, the information shall be delivered by
the close of business on the following business day.
b. The AAA cannot guarantee payment of a reimbursement request received for more than 45
calendar days of service delivery.
c. No reimbursement for services provided will be made if Subrecipient payment invoices are
not submitted to the AAA within 45 days of service delivery.
d. Reimbursement checks must be cashed or deposited within 30 days from date received.
3. encourage program participant contributions (program income) on a voluntary and confidential
basis. Such contributions will be properly safeguarded and accurately accounted for as receipts
and expenditures on Subrecipient's financial reports if contributions are not required to be
forwarded to the AAA. Client contributions (program income) will be reported fully, as
required, to the AAA. Subrecipient agrees to expend all program income to expand or enhance
the program/service under which it is earned.
4. notify the AAA Director immediately if, for any reason, the Subrecipient becomes unable to
provide the service(s).
5. maintain communication and correspondence concerning program participants' status.
6. establish a method to guarantee the confidentiality of all information relating to the program
participant in accordance with applicable federal and state laws, rules, and regulations. This
provision shall not be construed as limiting AAA or any federal or state authorized
representative's right of access to program participant case records or other information relating
to program participants served under this agreement.
7. keep financial and program supporting documents, statistical records, and any other records
pertinent to the services for which a claim for reimbursement was submitted to the AAA. The
records and documents will be kept for a minimum of five years after close of Subrecipient's
fiscal year.
8. make available at reasonable times and for required periods all fiscal and program participant
records, books, and supporting documents pertaining to services provided under this agreement,
for purposes of inspection, monitoring, auditing, or evaluations by AAA staff, the Comptroller
General of the United States and the State of Texas, through any authorized representative(s).
9. if applicable, comply with the HHSC process for Centers for Medicare and Medicaid Services
(CMS) screening for excluded individuals and entities involved with the delivery of the Legal
Assistance and Legal Awareness services.
B. The Subrecipient further agrees:
I . The agreement may be terminated for cause or without cause upon the giving of 30 days
advance written notice.
2. The agreement does not guarantee a total level of reimbursement other than for individual
units/services authorized; contingent upon receipt of funds.
3. Subrecipient is an independent provider, NOT an agent of the AAA. Thus, the Subrecipient
indemnifies, saves and holds harmless the South Plains Association of Governments AAA
against expense or liability of any kind arising out of service delivery performed by the
Subrecipient. Subrecipient must immediately notify the AAA if the Subrecipient becomes
involved in or is threatened with litigation related to program participants receiving services
funded by the AAA.
Form #: AIAAA_VA2.0
Edition Date: 9/19/11
4. Employees of the Subrecipient will not solicit or accept gifts or favors of monetary value by or
on behalf of program participants as a gift, reward or payment.
C. Through the Direct Purchase of Services program, the South Plains Association of Governments
AAA agrees to:
1. review program participant intake and assessment forms completed by the Subrecipient, as
applicable, to determine program participant eligibility. Service authorization is based on
program participant need and the availability of funds.
2. provide timely written notification to Subrecipient of program participant's eligibility and
authorization to receive services.
3. maintain communication and correspondence concerning the program participants' status.
4. provide timely technical assistance to Subrecipient as requested and as available.
5. conduct quality -assurance procedures, which may include on -site visits, to ensure quality
services are being provided and if applicable, CMS exclusion reviews are conducted.
6. provide written policies, procedures, and standard documents concerning program participant
authorization to release information (both a general and medical/health related release), client
rights and responsibilities, contributions, and complaints/grievances and appeals to all program
participants.
7. contingent upon the AAA's receipt of funds authorized for this purpose from HHSC, reimburse
the Subrecipient based on the agreed reimbursement methodology, approved rate(s), service(s)
authorized, and in accordance with subsection (A)(2) of this document, within 45 days of the
AAA's receipt of Subrecipient's invoice.
3. ASSURANCES
The Subrecipient shall comply with:
A. Title VI of the Civil Rights Act of 1964 (42 U.S.C. §2000d et.seq.)
B. Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. §794)
C. Americans with Disabilities Act of 1990 (42 U.S.C. §12101 et seq.)
D. Age Discrimination in Employment Act of 1975 (42 U.S.C. §§6101-6107)
E. Title IX of the Education Amendments of 1972 (20 U.S.C. §§1681-1688)
F. Food Stamp Act of 1977 (7 U.S.C. §200 et seq.)
G. Drug Free Workplace Act of 1988
H. Texas Senate Bill 1 - 1991, as applicable
I. HHSC administrative rules, as set forth in the Texas Administrative Code, to the extent applicable
to this Agreement
J. Certification Regarding Debarment - 45CFR §92.35 Subawards to debarred and suspended
parties; this document is required annually as long as this agreement is in effect
K. Centers for Medicare and Medicaid Services (CMS) State Medicaid Director Letter SMDL #09-
001 regarding Individuals or Entities Excluded from Participation in Federal Health Care
Programs
L. HHSC Information Letter 11-07 — Obligation to Identify Individuals or Entities Excluded from
Participation in Federal Health Care Programs
Forth #: AIAAAVA2.0
Edition Date- 9/ _99/1,
4. ATTACHMENTS
A. Description of Assurance A — H listed in section 3 of this document.
B. List of Focal Points in the AAA planning and service area.
5. SIGNATURES
For the faithful erf ance of the terms of this agreement, the parties affix their signatures and bind
themselves effe tive ctober 1, 2021.
ut orize Subrecipient Signature
Daniel M. Pope
Print Name
Mayor, City of Lubbock
Title
September 30, 2021
Date
Form #: AIAAA VA2.0
Edition Date: 9/19/11
Authorized Signat
South Plains Association of Governments
(Agency)
P.O. Box 3730 — Freedom Station
(Address)
Lubbock, Texas 79452
(City, State, Zip)
September 30, 2021
(Date)
ASSURANCES ATTACHMENT
A. Title VI of the Civil Rights Act of 1964 (42 U.S.C. 42000d), which prohibits any person
from being excluded from participation in, denied the benefits of, or subjected to
discrimination under any program or activity receiving Federal financial assistance.
B. Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. §794), which states that employers
may not refuse to hire or promote handicapped persons solely because of their disability.
C. Americans with Disabilities Act of 1990 (42 U.S.C. §12101), which prohibits a covered
entity from discriminating against a qualified individual on the basis of disability in regard
to job application procedures, the hiring, advancement, or discharge of employees,
employee compensation, job training, and other terms, conditions, and privileges of
employment.
D. Age Discrimination in Employment Act of 1975 (42 U.S.C. §6101-6107), prohibits
discrimination on the basis of age in programs and activities receiving federal financial
assistance.
E. Food Stamp Act of 1977 (7 U.S.C. �200), whose purpose is to strengthen the agricultural
economy; to help to achieve a fuller and more effective use of food abundances; to provide
for improved levels of nutrition among low-income households through a cooperative
Federal -State program of food assistance to be operated through normal channels of trade;
and for other purposes.
F. Drug Free Workplace Act of 1988, which requires that all organizations receiving federal
grants, regardless of amount granted, maintain a drug -free workplace.
G. Texas Senate Bill 1 - 1991, as applicable, which refers to proper reporting of contributions
as addressed in OAA §315 and TAC, Title 40, §85.201.
FOCAL POINTS FOR
THE SOUTH PLAINS ASSOCIATION OF GOVERNMENTS REGION
AREA AGENCY ON AGING
FY 2021-2022
CENTER:
Bailey County Commissioners Court (A-020)
DIRECTOR:
Judy Coffman
BOOKKEEPER:
Judy Coffman
ADDRESS:
300 South First Street Room 110
CITY:
Muleshoe, Texas 79347 Fax: (806) 272-4656
PHONE:
(806) 272-3647 E-mail: jcoffman(a),co.bailey.tx.us
DAYS & HRS. OPEN:
Mon.-Thur. 8:30-12:00, 1:00-5:00; Fri. 8:00-1:00
SERVICES:
TRANS.
COUNTY:
Bailey
CENTER:
Bailey County Senior Citizens Assoc., Inc. (A-007)
DIRECTOR:
Kaci Lee
ASSISTANT:
ADDRESS:
319 S. Main St / PO Box 292
CITY:
Muleshoe, Texas 79347
PHONE:
(806) 272-4969E-mail: muleshoeseniors a,outlook com
DAYS & HRS. OPEN:
Mon. — Fri. 8:00 — 4:00 Fax: (806) 272-4460
SERVICES:
CONG.
COUNTY:
Bailey
CENTER:
Cochran Co. Senior Citizens Assoc., Inc. (A-045)
DIRECTOR:
Reynalda Alvarado
BOOKKEEPER:
Reynalda Alvarado
ADDRESS:
120 W. Wilson
CITY:
Morton, Texas 79346
PHONE:
(806) 266-5121 E-mail: ccscigriffith6Dgmail_
DAYS & HRS. OPEN:
Mon. — Fri. 8-3:00 Fax #: 266-9027
SERVICES:
CONG., TRANS.
COUNTY:
Cochran
Updated 7/26/19 DD
CENTER:
Crosby Co. Senior Citizens Assoc., Inc. (A-050)
DIRECTOR:
Lenette Fowler
ASSISTANT:
Patsy Weems
ADDRESS:
119 North Berkshire
CITY:
Crosbyton, Texas 79322
PHONE:
(806) 675-2107
E-mail: 119ccsc(2ugmail.com
DAYS & HRS. OPEN:
Mon. --Fri. 8-3
SERVICES:
CONG., H.D.
COUNTY:
Crosby
CENTER:
Garza County Trailblazers, Inc. (A-070)
DIRECTOR:
JoAnn Rathbun
BOOKKEEPER:
LaGayluah McReynolds
ADDRESS:
205 E. 10th
CITY:
Post, Texas 79356
PHONE:
(806) 495-2998 E-mail: 2arzatrailblazersAyahoo.com
DAYS & HRS. OPEN:
Mon. — Fri. 8-1
SERVICES:
CONG., H.D.
COUNTY:
Garza
CENTER: Hale Center Senior Citizens Assoc., Inc. (A-075)
DIRECTOR: Karen Boyce
ASSISTANT: Dee Rice
ADDRESS: P.O. Box 205 (416 West 21d St.)
CITY: Hale Center, Texas 79041
PHONE: (806) 839-2428 E-mail: hcsrcenter(iDsbc2lobal.net
DAYS & HRS. OPEN: Mon. — Fri. 8-3
SERVICES: CONG., H.D., TRANS.
COUNTY: Hale
CENTER:
Hockley County Senior Citizens Assoc., Inc. (A-085)
DIRECTOR:
Shelly Baigen
ASSISTANT:
Rica Sanchez
ADDRESS:
1202 Houston
CITY:
Levelland, Texas 79336
PHONE:
(806) 894-2228 E-mail: hcscaAaol.com
DAYS & HRS. OPEN:
Mon. — Fri. 8-4:00
SERVICES:
CONG., H.D., TRANS.
COUNTY:
Hockley
Updated 7/26/19 DD
CENTER:
Lorenzo Senior Citizens Assoc., Inc. (A-095)
DIRECTOR:
Denice Sellers
ADDRESS:
P.O. Box 571 (606 6" St.)
CITY:
Lorenzo, Texas 79343
PHONE:
(806) 634-5957 E-mail: lorenzoscaAwindstream.net
DAYS & HRS. OPEN:
Mon. --Fri. 8-2
SERVICES:
CONG., H.D.
COUNTY:
Crosby
CENTER: Lubbock - City of Lubbock (A-100)
DIRECTOR: Matthew Baird, Supervisor: (806) 775-2678
Gabrielle Anglin, (806) 775-2685
ADDRESS: P.O. Box 2000 (1010 9" St.)
CITY: Lubbock, Texas 79457
PHONE: (806) 775-2678
E-mail: MbairdQmail.ci.lubbock.tx.us
Ganglin(u,mylubbock.us
JBeaulieu a�,mail.ci.lubbock.tx.us
DAYS & HRS. OPEN: Mon. - Fri. 8-5 Fax: 806-775-2686
SERVICES: CONG., TRANS.
COUNTY: Lubbock
Mae Simmons — (806) 767-2708, Alvin Hargers (2004 Oak Avenue 79404),
Cooper Rawlings -- (806) 767-2704, Herminia Martinez (213 40t" Street 79404), (401h & Ave. B),
Maggie Treio — (806) 767-2705, Cecilia Gonzalez (3200 Amherst 79415),
Homestead --- (806) 687-7898, Jordan Beaulieu (5401 561 Street 79414);
Lubbock Senior Center — (806) 767-2710, Jordan Beaulieu (2001 19t" Street, 79401) FAX 806-
765-0820
Gloria Gutierrez Transportation Director
CENTER: Lynn County Pioneers (A-110)
DIRECTOR: Sandra Norwood
BOOKKEEPER: Sandra Norwood
ADDRESS: P.O. Box 223 (1600 S. 3`d St.)
CITY: Tahoka, Texas 79373
PHONE: (806) 561-5264 E-mail: lynncopioneers(a7gmail.com
DAYS & HRS. OPEN: Mon. —Fri. 9-3 Fax: 561-5571
SERVICES: CONG., H.D.
COUNTY: Lynn
Updated 7/26/19 DD
CENTER: Senior Citizens Assoc. of S. Dickens County (A-130)
DIRECTOR:
Linda Alexander
BOOKKEEPER:
Jean Hoover
ADDRESS:
210 Burlington
CITY:
Spur, Texas 79370
PHONE:
(806) 271-4472 E-mail: sscaosdc ,caprock-spur.com
DAYS & HRS. OPEN:
Mon. ---Fri. 8-3
SERVICES:
CONG., H.D.
COUNTY:
Dickens
CENTER:
Slaton Senior Citizens Assoc., Inc. (A-135)
DIRECTOR:
Nita Williams
BOOKKEEPER:
Nita Williams
ADDRESS:
230 West Lynn
CITY:
Slaton, Texas 79364
PHONE:
(806) 828-3784 E-mail: slatonseniors ar,door.net
DAYS & HRS. OPEN:
Mon. - -Fri. 8-4
SERVICES:
CONG., H.D.
COUNTY:
Lubbock
CENTER:
Yoakum County Senior Citizens Assoc., Inc. (A-150)
DIRECTOR:
Becky Riley
ASSISTANT:
Amber Cline
BOOKKEEPER:
Shelia Hinson
ADDRESS:
709 W. Broadway (Mail Only to Box 519)
CITY:
Denver City, Texas 79323
PHONE:
(806) 592-8000 E-mail: - ycsc60(awindstream.net
Fax:
(806) 592-2835
DAYS & HRS. OPEN:
Mon. —Fri. 9-3
SERVICES:
CONG., H.D.
COUNTY:
Yoakum
LEGEND
CONG.
— Congregate Meals (on -site)
H.D. -
Home Delivered Meals
TRA.N.
- Transportation Service
Updated 7/26/19 DD
Certification Regarding Debarment
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARY EXCLUSION FOR COVERED CONTRACTS AND GRANTS
Federal Executive Order 12549 requires the Texas Health and Human Services (HHS) to
screen each covered potential subrecipient/grantee to determine whether each has a right to
obtain a contract/grant in accordance with federal regulations on debarment, suspension,
ineligibility, and voluntary exclusion. Each covered subrecipient/grantee must also screen
each of its covered sub-subrecipients/providers.
In this certification "subrecipient/grantee" refers to both subrecipient/grantee and sub-
subrecipient/sub-grantee: "contract/grant" refers to both contract/grant and subcontract/sub-
grant-
By signing and submitting this certification the potential subrecipient/grantee accepts
the following terms:
1. The certification herein below is a material representation of fact upon which reliance
was placed when this contract/grant was entered into. If it is later determined that the
potential subrecipient/grantee knowingly rendered an erroneous certification, in
addition to other remedies available to the federal government, the Department of
Health and Human Services, United States Department of Agriculture or other federal
department or agency, or the Texas Health and Human Services may pursue available
remedies, including suspension and/or debarment.
2. The potential subrecipient/grantee shall provide immediate written notice to the
person to whom this certification is submitted if at any time the potential
subrecipient/grantee learns that the certification was erroneous when submitted or has
become erroneous by reason of changed circumstances.
3. The words "covered contract", "debarred", "suspended", "ineligible", "participant',
"person", "principal", "proposal" and "voluntarily excluded", as used in this
certification have meanings based upon materials in the Definitions and Coverage
sections of federal rules implementing Executive Order 12549. Usage is as defined in
the attachment.
4. The potential subrecipient/grantee agrees by submitting this certification that, should
the proposed covered contract/grant be entered into, it shall not knowingly enter into
any subcontract with a person who is debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this covered transaction, unless authorized
by the Department of Health and Human Services, United States Department of
CERTIFICATION REGARDING DEBARMENT
Page 2
Agriculture or other federal department or agency, and/or the Texas Health and
Human Services, as applicable.
Do you have or do you anticipate having sub-subrecipients/sub-grantees under
this proposed contract? YES NO
5. The potential subrecipient/grantee further agrees by submitting this certification that
it will include this certification titled "Certification Regarding Debarment,
Suspension, Ineligibility, and Voluntary Exclusion for Covered Contracts and Grants"
without modification, in all covered subcontracts and in solicitations for all covered
subcontracts.
6. A subrecipient/grantee may rely upon a certification of a potential sub-
subrecipient/sub-grantee that is not debarred, suspended, ineligible, or voluntarily
excluded from the covered contract/grant, unless the subrecipient/grantee knows that
the certification is erroneous. A subrecipient/grantee must, at a minimum, obtain
certifications from its covered sub-subrecipients/sub-grantees upon each
subcontract's/sub-grant's initiation and upon each renewal.
7. Nothing contained in all the foregoing shall be construed to require establishment of a
system of records in order to render in good faith the certification required by this
certification document. The knowledge and information of a subrecipient/grantee is
not required to exceed that which is normally possessed by a prudent person in the
ordinary course of business dealings.
8. Except for contracts/grants authorized under paragraph 4 of these terms, if a
subrecipient/grantee in a covered contract/grant knowingly enters into a covered
subcontract/subgrant with a person who is suspended, debarred, ineligible, or
voluntarily excluded from participation in the transaction, in addition to other
remedies available to the federal government, Department of Health and Human
Services, United States Department of Agriculture, or other federal department or
agency, as applicable, or the Texas Health and Human Services may pursue available
remedies, including suspension and/or debarment.
CERTIFICATION REGARDING DEBARMENT
Page 3
Indicate which statement applies to the covered potential subrecipient/grantee:
The potential subrecipient/grantee certifies by submission of this certification that
neither it nor its principals are presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from participation in this
contract/grant by any federal department or agency or by the State of Texas.
The potential subrecipient/grantee is unable to certify one or more of the terms in this
certification. In this instance, the potential subrecipient/grantee must attach an
explanation for each of the above terms to which he/she is unable to make
certification. Attach the explanation(s) to this certification.
NAME OF POTENTIAL SUBRECIPIENT/GRANTEE:
SUBRECIPIENT'S VENDOR ID NO./FEDERAL EMPLOYER'S ID NO.:
�"X
Signature of Authorized Representative
Daniel M. Pope
Printed/Typed Name of Authorized Representative
Mayor, City of Lubbock 09/30/2021
Title of Authorized Representative Date
This certification is for FFY 2022 period beginning October 1, 2021 and ending
September 30, 2022.
CERTIFICATION REGARDING DEBARMENT
Page 4
DEFINITIONS
Covered Contract/Grant and Subcontracts/Sub-grants.
(1) Any non -procurement transaction which involves federal funds (regardless of
amount and including such arrangements as sub -grants) and is between the
Texas Health and Human Services or its agents/grantees and another entity.
(2) Any procurement contract for goods or services between a participant and a
person, regardless of type, expected to equal or exceed the federal
procurement small purchase threshold fixed at 10 U.S.C. 2304(g) and 41
U.S.C. 253(g) (currently $100,000) under a grant or sub -grant.
(3) Any procurement contract for goods or services between a participant and a
person under a covered grant, sub -grant, contract or subcontract, regardless of
amount, under which that person will have a critical influence on or
substantive control over that covered transaction including:
a. Principal investigators.
b. Providers of audit services required by the Texas Health and Human
Services or federal funding source.
C. Researchers.
DEBARMENT
An action taken by a debarring official in accordance with 45 CFR Part 76 (or
comparable federal regulations) to exclude a person from participating in covered
contracts/grants. A person so excluded is "debarred."
GRANT
An award of financial assistance, including cooperative agreements, in the form of
money, or property in lieu of money, by the federal government to an eligible grantee.
INELIGIBLE
Excluded from participation in federal non -procurement programs pursuant to a
determination of ineligibility under statutory, executive order, or regulatory authority,
other an Executive Order 12549 and its agency implementing regulations: for
example, excluded pursuant to the Davis -Bacon Act and its implementing regulations,
the equal employment opportunity acts and executive orders, or the environmental
protection acts and executive orders. A person is ineligible where the determination
of ineligibility affects such person's eligibility to participate in more than one covered
transaction.
CERTIFICATION REGARDING DEBARMENT
Page 5
PARTICIPANT
Any person who submits a proposal for, enters into, or reasonably may be expected to
enter into a covered contract. This term also includes any person who acts on behalf
of or is authorized to commit a participant in a covered contract/grant as an agent or
representative of another participant.
PERSON
Any individual, corporation, partnership, association, unit of government, or legal
entity, however organized, except: foreign governments or foreign governmental
entities, public international organizations, foreign government owned (in whole or
part) or controlled entities, and entities consisting wholly or partially of foreign
governments or foreign governmental entities.
PRINCIPAL
Officer, director, owner, partner, key employee, or other person within a participant
with primary management or supervisory responsibilities: or a person who has a
critical influence on or substantive control over a covered contract/grant whether or
not the person is employed by the participant. Persons who have a critical influence
on or substantive control over a covered transaction are:
(1) Principal investigators.
(2) Providers of audit services required by the Texas Health and Human Services
or federal funding source.
(3) Researchers.
PROPOSAL
A solicited or unsolicited bid, application, request, invitation to consider or similar
communication by or on behalf of a person seeking to receive a covered
contract/grant.
SUSPENSION
An action taken by a suspending official in accordance with 45 CFR part 76 (or
comparable federal regulations) that immediately excludes a person from
participating in covered contracts/grants for a temporary period, pending completion
of an investigation and such legal, debarment, or Program Fraud Civil Remedies Act
proceedings as may ensue. A person so excluded is "suspended."
VOLUNTARY EXCLUSION OR VOLUNTARILY EXCLUDED
A status of nonparticipation or limited participation in covered transactions assumed
by a person pursuant to the terms of a settlement.
10/21/21 1:46 PM
Provider Name: City of Lubbock
AAA Name: Area Agency on Aging of South Plains
Region Number.
Home Delivered Meals
BUDGET WORKSHEET CALCULATION OF THE PER MEAL UNIT RATE
1. Total Budgeted Expenses for Contract Year 1. $ 172,225.41
2. Total Number of Anticipated Meals to be Provided by Funding Source
HHS OAAA 15,400
Title XX
0 Title XIX
0
Other Funds
Other Funds -
Program Income 2,200 Eligible Meals
4,400 Non -Eligible Meals
0 2. 22,000
3. Whole Unit Rate (Line 1 divided by Line 2)
3. $ 7.83
Reimbursement Calculation
HHS
OAAA &
Title XX
Title XIX
4. Projected NSIP per Meal Value
0.73
N/A
5. Rate Less NSIP per Meal Value
$
7.10
N/A
6. Mandatory Local Match of 10% $
0.71
•• If Applicable, Match Reduction
From the In -kind Match
Certification form $
Required Cash Match
$
0.71
N/A
7. Proposed Meal Rate (Line 3 minus Line 6)
$
7.12 $
7.83
8. Rate Cap Applicable to Title XIX, Title XX
and HHS OAAA Common Providers
$
5.31 $
6.12
9. Excess of Cap Rate Reduction
$ (1.81) $
(1.71)
Accepted Unit Rate for Current Year
$
7.12
NA
" If any portion of the required match is in -kind, you must complete an In -Kind Match Certification form.
By signing below, the provider acknowledges that all related records are subject to audit in accordance with contract
requirements and all applicable federal and state laws.
City of Uibbock
LeElnirvider
Signature
Area Agency on Aging of South Plains
Name of Area Agency on Aging
Tim C. Pierce
Prin yped I me o igne
Signature
September 30, 2021
Date
Daniel M. Pope
Printed/Typed Name of Signer
September 30, 2021
Date
0
Health and Human Services
NA
Printedrryped Name of Signer
Signature
Date
10/21/21 1:46 PM
Provider Name: City of Lubbock
AAA Name: Area Agency on Aging of South Plains
Region Number.
Home Delivered Meals
BUDGET WORKSHEET CERTIFICATION
AS SIGNER OF THIS BUDGET WORKSHEET, I HEREBY CERTIFY THAT:
• I have read the note below and the instructions applicable to this budget worksheet.
• I have reviewed this budget worksheet after its preparation.
• To the best of my knowledge and belief, this budget worksheet is true, correct and
complete, and was prepared in accordance with the instructions applicable to this
budget worksheet.
• This budget worksheet was prepared from the books and records of the contracted
provider.
• I acknowledge that all books and records related to this rate setting process are
subject to audit in accordance with contract requirements and all applicable federal
and state laws.
Note: The person legally responsible for the conduct of the contracted provider must
sign this Budget Worksheet Certification. If a sole proprietor, the owner
must sign the Budget Worksheet Certification. If a partnership, a partner must
sign the Budget Worksheet Certification. If a corporation, the person authorized by the
Board of Directors Resolution must sign the Budget Worksheet Certification.
Misrepresentation of information contained in the budget worksheet may result in
adverse action, up to and including contract termination. Furthermore, falsification of
information in the budget worksheet may result in a referral for
City of Lubbock
Name of Contracted Provider
September 30, 2021
Date
Signer Authority: ❑ Sole Proprietor
(check one) 0 Partner
173 Corporate Officer
Daniel M e
Printed/Typed ame Signer
Signature
r Association Officer
G Board Member
Governmental Official
10/21/21 1:46 PM
Provider Name: City of Lubbock
AAA Name: Area Agency on Aging of South Plains
Congregate Meals
BUDGET WORKSHEET CALCULATION OF THE PER MEAL UNIT RATE
1. Total Budgeted Expenses for Contract Year
2. Total Number of Anticipated Meals to be Provided by Funding Source
Other Funds
HHS OAAA 4,760 Eligible Meals 1,360 Other Sources 5 0
Other Funds -
Non -Eligible
Program Income 680 Meals 0 Other Sources 6 0
3. Whole Unit Rate (Line 1 divided by Line 2)
Reimbursement Calculation
4. Projected NSIP per Meal Value
5. Rate Less NSIP per Meal Value
6. Mandatory Local Match of 10%
" If Applicable, Match Reduction
From the In -kind Match
Certification form
Required Cash Match
HHS OAAA
0.73
$ 7.90
$ 0.79
$ 0.79
7. Proposed Meal Rate (Line 3 minus Line 6) $ 7.84
`• If any portion of the required match is in -kind, you must complete an In -Kind Match Certification form.
By signing below, the provider acknowledges that all related records are subject to audit in accordance with
contract requirements and all applicable federal and state laws.
City of Abock
Legal Name of ont cted Provider
Signs
Area Agency on Aging of South Plains
Name of Area Agency on Aging
Tim C. Pierc
Pri a yped #1 me f Sig r
Signature
September 30, 2021
Date
Daniel M. Pope
Printed/Typed Name of Signer
September 30, 2021
Date
1. $ 58,684.08
2. 6,800
3. $ 8.63
10/21/21 1:46 PM
Provider Name: City of Lubbock
AAA Name: Area Agency on Aging of South Plains
Congregate Meals
BUDGET WORKSHEET CERTIFICATION
AS SIGNER OF THIS BUDGET WORKSHEET, I HEREBY CERTIFY THAT:
• I have read the note below and the instructions applicable to this budget worksheet.
• I have reviewed this budget worksheet after its preparation.
• To the best of my knowledge and belief, this budget worksheet is true, correct and
complete, and was prepared in accordance with the instructions applicable to this
budget worksheet.
• This budget worksheet was prepared from the books and records of the contracted
provider.
• I acknowledge that all books and records related to this rate setting process are
subject to audit in accordance with contract requirements and all applicable federal
and state laws.
Note: The person legally responsible for the conduct of the contracted provider must
sign this Budget Worksheet Certification. If a sole proprietor, the owner
must sign the Budget Worksheet Certification. If a partnership, a partner must
sign the Budget Worksheet Certification. If a corporation, the person authorized by the
Board of Directors Resolution must sign the Budget Worksheet Certification.
Misrepresentation of information contained in the budget worksheet may result in
adverse action, up to and including contract termination. Furthermore, falsification of
information in the budget worksheet may result in a referral for prosecution.
City of Lubbock
Name of Contracted Provider
September 30, 2021
Date
Signer Authority:
(check one)
❑ Sole Proprietor
❑ Partner
❑ Corporate Officer
Daniel M. o e
E
yped ame f Signer
Signature
❑
Association Officer
❑
Board Member
❑
Governmental Official
10/21/21 1:46 PM
Provider Name: City of Lubbock
AAA Name: Area Agency on Aging of South Plains
Transportation
BUDGET WORKSHEET CALCULATION OF THE UNIT RATE
1.Total Budgeted Expenses for Contract Year
2.Total Number of Anticipated Units to be Provided
HHS OAAA -10 % Match
Program
Required 3,850
Income
HHS OAAA - 25 % Match
Local Funds -
Required 0
Eligible Trips
Other Funds -
Non -Eligible
HHS OAAA - Full Unit Rate 0
Trips
3. Cost per unit (Line 1 divided by Line 2) - Full Unit Rate
550 Other Sources 6 0
1,100 Other Sources 7 0
0 Other Sources 8 0
Reimbursement Calculation for Contracts Requiring Unit Rate Match Reduction
1. $ 64,231.94
2. 5,500
3. $ 11.68
4. Mandatory Local Match of 10% $ 1.17
If Applicable, Match Reduction From the In -kind Match Certification form $
Required Match 4. $ 1.17
5.Full Unit Rate Less Required Match (Line 3 minus Line 4: 5. $ 10.51
4. Mandatory Local Match of 25% $ 2.92
If Applicable, Match Reduction From the In -kind Match Certification form $
Required Match 4. $ 2.92
5.Full Unit Rate Less Required Match (Line 3 minus Line 4; 5. $ 8.76
"If any portion of the required match Is in -kind, you must complete an In -Kind Match Certification form.
Contract Reimbursed at Full Cost Per Unit Rate. Match Requirements Will Be Met Through Provision of Additional Units
$ 11.68
Contractor Initial AAA Initial
City of LuwAk
Leg I Name of Co ac d Provi r
Signature
Daniel M. Pope
Printed/Typed Name of Signer
09/30/21
Date
Area Agency on Agin of South Plains
e of Ara on Aging
Signa
Tim C. Pierce
Printed/Typed Name of Signer
09/30/21
Date
10/21/21 1:46 PM
Provider Name: City of Lubbock
AAA Name: Area Agency on Aging of South Plains
Transportation
BUDGET WORKSHEET CERTIFICATION
AS SIGNER OF THIS BUDGET WORKSHEET, I HEREBY CERTIFY THAT:
• I have read the note below and the instructions applicable to this budget worksheet.
• I have reviewed this budget worksheet after its preparation.
• To the best of my knowledge and belief, this budget worksheet is true, correct and
complete, and was prepared in accordance with the instructions applicable to this
budget worksheet.
• This budget worksheet was prepared from the books and records of the contracted
provider.
• I acknowledge that all books and records related to this rate setting process are
subject to audit in accordance with contract requirements and all applicable federal
and state laws.
Note: The person legally responsible for the conduct of the contracted provider must
sign this Budget Worksheet Certification. If a sole proprietor, the owner
must sign the Budget Worksheet Certification. If a partnership, a partner must
sign the Budget Worksheet Certification. If a corporation, the person authorized by the
Board of Directors Resolution must sign the Budget Worksheet Certification.
Misrepresentation of information contained in the budget worksheet may result in
adverse action, up to and including contract termination. Furthermore, falsification of
information in the budget worksheet may result in a referral for prosecution.
City of Lubbock
Name of Contracted Provider
September 30, 2021
Date
Signer Authority: Sole Proprietor
(check one) Partner
Corporate Officer
Daniel M. Ne
Printed/Typed N e J;:er-
Signature
Association Officer
Board Member
Governmental Official
The South Plains Association of Governments Area Agency on Aging Area Agency
SPAG Direct Purchase of Service
Fiscal Year 2022 Subrecipient Application/Renewal Update jZonAging
�Im
Please type or clearly print application information.
City of Lubbock
Subrecipient Name/Legal Entity
DBA (if applicable)
Physical Address:
Mailing Address (complete even if same as above):
Tax Identification Number (SSN or Federal ID):
Fax Number (including area code):
Type of Provider (check one):
Governmental Agency Private Non -Profit Private For Profit
City Government County Government Other:
Authorizing Official:
Title:
Email Address:
Telephone:
Billing Contact Person and billing address:
Title:
Email Address:
Telephone:
Number of Years Organization has been in business:
Is Organization Bonded?
(Attach certificate of bonding insurance)
Years
Yes No
Has anyone involved in the direct provision of client services
If Yes, Explain:
been convicted of a felony (In -home Services
only)? Not Applicable
Not Applicable
■ Yes ■ No
Does Organization have liability insurance?
Attach a copy of all applicable State and Federal
(Attach certificate ofa►►insurances)
Yes No
licenses and /or certifications for your business.
Conflicts of Interest: Attach information of applicable names and relationship of any employee(s) or officers of
your organization that may have a conflict of interest with the South Plains Association of Governments
Area Agency on Aging staff person or Advisory Council member.
DPS Application
Page 1
1;
0
3.
4.
Service and Bidding Information:
Proposed Service:
Congregate Meals
B. Service Area:
C. Proposed HHS OAAA cost per unit:
G 7 ad
A. Proposed Service:
Home Delivered Meals
B. Service Area:
C. Proposed HHS OAAA cost per unit:
$ 7.12
A. Proposed Service:
N/A
B. Service Area:
Transportation Demand / Respon
C. Proposed HHS OAAA cost per unit:
$ 10.51
A. Proposed Service:
N/A
B. Service Area:
N/A
Proposed HHS OAAA cost per unit:
Signature:
Whole cost per unit:
G a a4
Whole cost per unit:
$ 7.83
Whole cost per unit:
Q 44 an
Whole cost per unit:
I, , certify that the information provided in this application is true and
Printed Name
correct to the best of my knowledge.
Authorized Signature
September 30, 2021
Date
DPS Application
Page 2