HomeMy WebLinkAboutResolution - 4111 - Amendment To Contract - TDOH - WIC Services - 03_25_1993Resolution No. 4111
March 25, 1993
Item #25
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock BE and is hereby authorized and
directed to execute for and on behalf of the City of Lubbock a contract
amendment, entitled Contract Change Notice No. 2, TDH Document No. C3000376,
and all associated documents, with the Texas Department of Health to provide
a group nutritional education, individual counseling and prescribed foods as
part of the WIC program administered by the City of Lubbock Health
Department, a copy of said document is attached hereto and incorporated in
this Resolution as if fully set forth herein and shall be included in the
minutes of the Council.
Passed by the City Council th
ATTEST:
etty M. Jo on, ity Secretary
APPROVED AS TO CONTENT:
a armon, Wistan ity
Manager for Public Safe & Services
APPROVED AS TO FORM:
uonala b. vanaiver, t1rSt ASS
City Attorney
DGV:dw/agenda-D2/WIC.res
March 17, 1993
TEXAS DEPARTMENT OF HEALTH Resoluti-on No...4111
1100 WEST 49TH STREET March 25, 1993
AUSTIN, TEXAS 78756-3199 Item #25
CONTRACT CHANGE NOTICE NO. 2
STATE OF TEXAS TDH Document No. C3000376
COUNTY OF TRAVIS
The Texas Department of Health, hereinafter referred to as RECEIVING AGENCY, d=d
heretofore enter into a contract in writing with
LUBBOCK CITY HEALTH DEPARTMENT
hereinafter referred to as PERFORMING AGENCY. The parties thereto now desire to
amend such contract as follows:
SUMMARY OF TRANSACTION: ;
Revision to public health services contract. ;
Attachment No. 05 - Amendment to add a new attachment for WIC program to ;
provide group nutritional education, individual counseling;
and prescribed foods at no cost to individuals identified
as having nutritional deficiencies. ;
All terms and conditions not hereby amended remain in full force and effect.
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David R_-Langston, Mayor--
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)a;-; March 25, 1993
^mac 1UPAR"1 r- 7 0v �ser.*2
HC-71VIIG AG-ENCY
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i.lnda 7arrow, Chief
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DOCUMENT NO. C3C00376
ATTACTMNT NO. 05
PERFORMING AGENCY: LUBBOCK C:TY 32ALTH DEPART?='NT
RECEIVING N37NCY PROGRAM: BUREAU OF WOMEN, INFANTS, AND CHILDREN'S NUTRITION
TERM: April 1, 1993 THROUGH September 30, 1993
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY will provide supplemental food instruments and nutrition
education, as an adjunct to good health care at no cost to low income pregnant
and postpartum women, infants, and children identified to be at nutritional
risk. In meeting this goal the PERFORMING AGENCY will:
A. Perform professional, administrative, and clerical services necessary to
provide special supplemental food instruments to qualified women, infants,
and children in a specified geographic area. Services will be performed
according to the terms and specifications of RECEIVING AGENCY and/or USDA.
Regulations, instructions, policies, and/or directives will be issued to
PERFORMING AGENCY as they are formulated and appear in the State WIC
Policy and Procedure Manual, which is hereby incorporated by reference and
made a part hereof.
RECEIVING AGENCY will notify the PERFORMING AGENCY, by letter, of the
authorized geographic service area(s). These geographic area(s) may be
subject to charge upon written notice by the RECEIVING AGENCY and approved
by the PERFORMING AGENCY.
B. Assist in the collection and evaluation of data which will identify medi-
cal benefits of this nutrition intervention program and to furnish
financial, dietary, medical, nutrition education, and any other special
reports in a timely manner as required by the RECEIVING AGENCY for the
compilation of the aforesaid data.
C. Determine eligibility of applicants, register participants, collect data,
conduct measurements, provide nutrition education, and maintain records as
required.
D. Make available appropriate health services to participants up to the
income level specified in the RECEIVING AGENCY's Program policies and
inform applicants of the health services that are available. When health
services are provided through referral, the PER=ORM.ING AGENCY must have.a
plan for continued efforts to make health services available to partici-
pants at the clinic or through written agreements with health care
providers.
E. issue prenumbered food instruments to qualified participants who will use
such instruments to obtain specified food items from participating
vendors; maintain complete accountability and security of all food
instruments received from the RECEIVING AGENCY; and be held financially
responsible for all unaccounted for food instruments and/or those issued
to ineligible participants. The PERFORMING AGENCY will also be held
-1-
rLT:ancia7 7,, accc,:ntab e For-,inaut ized infant Formulas issued to
participants.
PERFORMING AGENCY will comply with all applicable laws, regulations,
standards, and guidelines established at Federal, State and Local levels as
these regulations now appear or may be amended during the period of this
attachment. These include but are not limited to:
1. Child Nutrition Act of 1966, as amended (42 USC 1786)
2. Public Laws 99-500 and 99-591
3. ChiId Nutrition act and WIC Bureau Reauthorization Act of 1989, Public
Law 101-147
4. Uniform Federal Assistance Regulations 7 CFR Part 3015 and 3016
5. Applicable Federal Regulations located in 7 CFR Part 246
6. State WIC Policy and Procedures Manual
SECTION II. LEGAL AUTHORITY TO CONTRACT:
Chapters 12 and 121 of the Health and SaFety Code.
SECTION ITI. SPECIAL PROVISIONS:
General Provisions, APPLICABLE, LAWS AND STANDARDS Article, is amended to
include the following:
PERFORMING AGENCY will respond in writing to all review and audit
exceptions and recommendations within thirty calendar days of their
receipt.
General Provisions, ASSUF.ANCES Article, is hereby amended to include the
following:
PERFORMING AGENCY hereby agrees that it will comply with Title VI of
Civil Rights Act of 1964 (42 USC 2000d et.seq.), Title IX of the
Education Amendments of 1972 (20 USC 1681 et.seq.), Section 504 of
the Rehabilitation Act of 1973 (29 USC 794), Age Discrimination Act
of 1975 (42 USC 6101 et.seq.); all provisions required by the implement-
ing regulations of the Department of Agriculture; Department of Justice
Enforcement Guidelines, 28 CFR Parts 50.3 and 42; and FNS directives and
guidelines, to the effect that, no person will, on the grounds of race,
color, national origin, sex, age, or handicap, be excluded from partici-
pation under any program or activity for which the PERFORMING AGENCY
receives Federal financial assistance from FNS, and hereby gives assurance
that it will immediately take measures necessary to effectuate this
attachment.
By accepting this assurance, PERFORMING AGENCY agrees to compile data,.
maintain records and submit reports, as required, to permit effective
enforcement of the nondiscrimination laws and permit authorized USDA
personnel during normal working hours to review such records, books,
and accounts as needed to ascertain compliance with the nondiscrimination.
laws. If there are any violations of this assurance, the Department of
-2-
Agricult— re, Fccd and Service, will have the right to seek
Judicial enforcement of --his assurance. This assurance is binding on
the PERFCRMING AGa!(71, its successors, transferees, and assignees, as
long as they receive assistance or retain possession of any assistance
from the Department of Agriculture. The person or persons whose
signatures appear on the COVER PAGES of this attic^:ment are authorized
to sign. `.hi s assurance on behalf of the PEPF ORMING AGENCY.
General Provisions, STANDARDS FOR FINANCIAL M.A'4AGEMENT Article, Number 1.,
regarding internal budgeting and Number 3., regarding billing, collection,
and fee schedules are not applicable.
General Provisions, OVERTIME COMPENSATION Article, is not applicable.
General Provisions, TERMS & CONDITIONS OF PAYMENT Article, is hereby modified
to include the following paragraphs.
The participant caseload quantity will be assigned by RECEIVING AGENCY by
giving written notice to PERFORMING AGENCY and may be subject to change
from time to time upon written notice to PERFORMING AGENCY from RECEIVING
AGENCY. PERFORMING AGEENCY assumes liability for all food costs resulting
from PERFORMING AGENCY exceeding assigned caseload maximum. The number of
individuals served in excess of assigned caseload are not to be included
in the calculation of earned administrative funds as described below.
RECEIVING AGENCY will reimburse PERFORMING AGENCY for administrative costs
which include participant referral, vendor evaluation and monitoring,
nutrition education, general administrative support, start-up costs,
outreach, applicant screening, and food card issuance.
Administrative costs will be reimbursed based on actual costs, but not to
exceed the "maximum reimbursement" set out below, based upon the sum of
the participants who actually receive food instruments each month plus
infants who do not receive any food instruments whose breastfeeding
mothers were participants, to the extent that the total so derived does
not exceed the PERFORMING AGENCY'S total assigned caseload within any
given month. Surplus funds (the amount by which maximum reimbursements
exceed actual cost) can be accumulated and carried forward within the
attachment term. The time period during which surpluses may be recovered
will be determined by the RECEIVING AGENCY.
PARTICIPANTS SERVED PER MONT?I MAXIMUM REI?BU:RSEMENT
First 500 participants served
$
9.12
per
participant
Next 1000 participants served
$
7.47
per
participant
Next 8500 participants served
$
5.00
per
participant
All additional participants served
$
4.79
per
participant
PERFORMING AGENCY agrees that:
(1) not less than 20% of total administrative costs will be separately
identified and documented as expenditures directly related to nutrition
-3-
education;
(2) RECEIVING AGENCY will reimburse PERFORMING AGENCY for administrative
expenses at a rate not greater than five times the amount of properly
documented expenditures for nutrition education, but not more than is
earned based on actual participation not to exceed PERFORMING AGENCY'S
assigned participant caseload;
(3) RECEIVING AGENCY will increase the maximum reimbursement to PERFORMING
AGENCY by an additional $.50 per each pregnant and breastfeeding woman
participating in the PERFORMING AGENCY'S Program; and
(4) RECEIVING AGENCY will identify annually to PERFORMING AGENCY an amount
of funds that must be spent for breastfeeding promotion. Nutrition
education expenditures must be supported by documentation of participant
attendance or non-attendance. The breastfeeding allocation of funds to
the PERFORMING AGENCY will be based on the RECEIVING AGENCY'S propor-
tional share of the statewide combined total of pregnant and breast-
feeding participants as reported to the RECEIVING AGENCY. For a
PERFORMING AGENCY whose monthly participation falls below 500, RECEIVING
AGENCY has the option to compute the sliding scale allowable at a 500
participant level with the stipulation that the 20% nutrition education
expenditure requirement is met. RECEIVING AGENCY reserves the right to
exclude and/or recover any expenditures that have been claimed and/or
paid that are not authorized by the regulations and/or directives
pertaining to the program.
RECEIVING AGL",TCY also reserves the right to withhold a proportionate
amount of earned administrative funds when evidence exists that
nutrition education and/or breastfeeding promotion is not being provided
by PERFORMING AGENCY, or PERFORMING AGENCY is not complying with the
provisions of USDA and/or RECEIVING AGENCY directives. RECEIVING AGENCY
reserves the right to grant exceptions to the above funding formula.
PERFORMING AGENCY agrees to break out separately on the face of the claim
for reimbursement (State of Texas Purchase Voucher, TDH Form AG-37) the cost
associated with nutrition education, breastfeeding, and other administrative
costs.
General Provisions, ADVANCE PAYMENTS Article, is not applicable to this
attachment.
General Provisions, PRCGFAM INCOME Article, paragraph one, is not applicable
to this attachment.
General Provisions, FINANCIAL REPORTS Article, paragraph three (Annual/Final
Report), first sentence is amended to read:
A final report, Financial Status Report, Federal Form 269 (TDH Form GC-3),
will be submitted no later than December 31st of each year. (Remainder of
paragraph does not change.)
-4-
General Provisions, REPORTS LN-D INSPE'CTICNS Article, paragraph one is hereby
modified to include the following wording:
PERFORMING AGENCY will submit monthly performance data which includes:
Report of Program Operation, AC 30-1;
Report of Card Sequence Used, AC 80-3; and,
Cards Voided, AC 80-4;
Lost/Stolen report, AC 73-10, will be submitted as necessary.
On an annual basis, a Racial EtIhnic Group Participation Form, FNS-191, for
the reporting month of April will be submitted by the seventh working day
of May.
General Provisions, EQUIPMENT AND SUPPLIES Article, is amended by adding the
following:
PERFORMING AGENCY agrees to accept responsibility and financial liability
for all equipment and supplies purchased with RECEIVING AGENCY WIC
Program funds whether purchased locally by the PERFORMING AG0CY, or by
the RECEIVING AGENCY and transferred to the care and custody of the
PERFORMING AGENCY. PERFORMING AGENCY further agrees to conduct an annual
physical inventory of all equipment purchased with RECEIVING AGENCY WIC
Program funds and submit it to the RECEIVING AGENCY WIC Program by
February 28th of each year. RECEIVING AGENCY reserves the right to
recover the cost of equipment or supplies purchased by the RECEIVING
AGENCY and placed in the custody of the PERFORMING AGENCY if such
articles are lost, stolen, or otherwise unlocated.
SECTION IV. BUDGET:
All categories of costs billed to the RECEIVING AGENCY and allocation of such
costs must be in accordance with the "Plan to Allocate Direct Costs," (PADC),
submitted by PERFORMING AGENCY and approved by RECEIVING AGENCY. A listing of
the categories contained in the negotiated PADC are shown in Exhibit A of this
attachment.
-5-
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief
that:
(1) No federal appropriated funds have been paid or will be paid, by
or on behalf of the undersigned, to any person for influencing or
attempting to influence an officer or an employee of any agency,
a member of congress, 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-111, "Disclosure Form to Report
Lobbying," 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
certification is a prerequisite for making or entering into this
tran action im osed by Section 1352, Title 31, U.S. Code. Any person who
fails to ile a required certification shall be subject to a civil
e 1 o ess t 000 and not more than $100,000 for each such
f 'i 1 rye.
P�
March 25, 1993
ignature Date
David R. Langston
Name of Authorized Individual
P.O. Box 2000 Lubbock, TX 79457
Name and Address of Organization
C3000376
Application or Contract Number
u«�.�u�ul-1c yr �uoo r rrvu r1�, r r v r r rco .
Complete mts tour to discum lobbying acuvitles pursuant to 31 U.S.C. I=
(See reverse for public burcen Crsclosurs.)
1. Type of Federal Action:
Z 3umLs of Federal Action:
3. Report Type:
aa•a-oors - -
a. contract
b. grant
c. coaoerame agreement
d. loan
a. ban guarantee
f. loan insurance
L bXYCffsrraoplicadon
b. radial award
C. poet-awaFd
4. Nana and Address of Reporting Entity:
Pdme 7iK � ikrtorKr
Congressional DiuM if known:
L Federal Department/Agenry:
L Federal Action Number, Uknown:
L Initial filing
11 b. material cnangs
For Material Change Only.
year quarter
dais o at report
i It Reporting Entity In No. 4 Is Subawards% Enter Name
and address of Prim:
Congressional District, Yknown:
T. Federal Program Nante/Description:
CFOA Number. 9 applicable:
L Award•Amount; d known:
3
1Qati. Nance and Address of Lobbying Enti b. Individuals Performing Services (lndu&V address d
(if i'rd/vidua4 cairn name. Arsr narne. M n ns tr lss mlrNt . IOs) Mq:
[A F cGrAWxM9W sr.+rai sAuc.A l mon=
11. Amount of Payment (chm* aN that apply): 13. Type of Payment (check au Mat apply).-
3 ❑ Accrual Q planned I a. retainer
12. Form of Payment (check ad that apply):
Q a. Cash
Q b. In -kind; Spechy. nature
value
b. one-time tee
C. commission
d. contingent fee
a. deferred
f. other. specify:
14. Brief Description of Services Performed orto be Performed and Date(s) of Service, including offlcer(a), employee(s).
or Member(s) contacted for Payment indicated in item 11:
(morn Conmason SAasoa Sim f 11.4. i rlaosssa�
13. Continuation Sheets) SI~111•A attached: Q yes Q No
1 & "WO INWO+ rat+ em srolpn vas lone as aurcnm ay we 31 U.S.C.
.camIULThaa.aosu.orr000" acavo«aanumm
Signature:
of ft" WPM waa'1 rasrcrr was 040" Or na oar snow arwl rss
samsacam was maoa or anome UmcL The daao mm is mourw guru car
Print Name:
a 31 1J.S.C.12M Them elason vral a raoorlaa a na Congraw &aura
Title:
armsev ono wo oe aw"me nor ouaK magic L Any canon vAn an a
s• 09 reaurw auiaoa O armq o* suopa a a a" Owwry afro" wa serl
Tslepnone No.: Data:
210.000 W" naf more ~ $100.000 lo► Oem sue+ melee.
.WNPQM "r LOCO
SMA"Od Pam . 1 r 1
INST RUC T ICNS FOR CiMPL—S-MCN CF Si-�t11, DISCLOSURE OF LOBBYING ACTiViT)ES
This d=03uro farm snarl be carraleted by the raearvng entity, whether sucawaraee or orime Federal m=ieM at the ortiatton c
I icit of a covered Fecerai acoon, or a material cnange to a prevcaus tiling, pursuant to Brie 31 U.S.C. 3 on 135Z The tiling c
a form is recurred for eac n payment or agreement to maxs payment to any laocycng entry for intfuenang or attempting to infiuenc
an offlcar or emotoyse of any agenc/. a Memoer at Congress. an officer or emrotoyee of Congress. or an employee of a Memoe
of Congress in connection with a Covered Federal action. Use the SF-1 1 1-A Continuation Sheet for aQdtlonal infon, on d m
space an me farm is inadequate. Camoiete ail items mat aeoly for both the initial tiling and material Grange report Refer to it-,
impterrmnting guidance pualistred by the Cff!ca of Management and Budget for additional information.
1. identify the type of covered Federal aeon for wn= lobbying activity is and/or has been secured to inttuence the out
come of a covered Federal acZan.
2 Identity the status at covered Federal aeon.
3. Idenrgy the aap=nate classifica don of this report it tries is a faifawuo report caused by a material change to
me infarmarlon previously reverted. enter the yew and quarter in which the change occunVd. Eater the dais
at the last previously submitted report by this reporting entity tortnis covered Federal aeon.
4. Enter trio furl name, address. Gty, state and Zip code of the reporting entity. Include Congressional 0lstre.
known. Check the appropriate Gasification of the reporting entity that designates if it i& or experts to be.
a prime or subaward recipient !dertttty the tier of the subawardee, e.g., me first subawardee of the prune is
the I st tier. Suoawarcs include but are not limited to subcontracM subgrants and contract awards under
grams.
S. It the organization filing the report in item 4 cttedcs 'Subawardee', then enter the full name. address. city, state
and zip code of the prime Federal recipient. Include Congressional Clstrict, if known.
S. Enter the name at the Federal agency making the award or loan commitment. Include at least one
arganizanonai level below agency name, it known. For example. 0epartment at Transportation. United States
Coast Guard.
7. Etter the Federal program name or description for the covered Federal action (item 1). if known, enter the tuft
Catalog at Federal Domestic Assistance (CFCA) number for grams, cooperaizve agreements. loam and
loan commitments.
8. Enter the most appropriate Federal identifying number available forth the Federal aeon identified in item t (e.g..
Request for Proposal (RFP) nurtroer. invitation for Bid (IFS) number. gram announcement number. ire
cos trac:: grant or loan award nurrttw. the aaoit;tfon/proposal amino! number assigned by the Federal
agency). Include prefixes, e.g.. 'RFP-0E-90-001.'
9. Fat a covered Federal action whirs there has beers an award or loan commitment by the Federal agency, enter
the Federal amount of the award/loan commitment for the prime entity Identified in item,4 or S.
10. (a) Enter the tug none, address. city, sssu and = code at the lobbying entity engaged by the reporting entity
identified in item 4 M influence Use covered Federal acdom
(b) Enter the tug namse of the individual(s) perforating services. and include full address if different from 10
(a). Enter Last Name. First Name. and Middle Initial (MQ.
11. Emorme amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying
amity (item 10). Indcate whether me payment has been made (acn- ) or will be made (planned). Chock all boxes Nat
apply. It this is a material change repom enterthe c urrtulauve amount of payment made or planned to be made.
12 Checscthe approonate oox(es). Check all boxes that a0pty. if payment is made through an in -kind contribution. speedy the
nature and value of trio in -kind payment
13. Ctrecst the appropriate bcx(es). Ctieck all boxes that apply. If other, speedy nature.
14. Provide a scscdlc and detailed description of the services that the lobbyist has performed, arwill be expected to perform.
and the dates) of any services rendered Include all preparatory and mlated ac:Nity, not just time spent in aCltJal contact
with Fecaral otflc ail. Identrtythe Fecaral offlcsal(s) oremployee(s) com=ad pane offlcar(s), employee(s). orMember(s)
of Congress that were caft=ed
15. Chocx whether or not a SF-11 1.A Continuation Sheets) is aitaCred.
16. The certifying affleal shall sign and date the fornL pent his/her name, title. and teleonone number.
PUDW raoorong ouroen nor M oseec9W of Wfftnnaoon ,s *$&no @ o awfagr 30 MWRSM oar nsatnso. ,ockso q pine for .arawe+g rtlotx7orti sews!'" easing
repo saareaa ow"" aria mar.nW" v+e tea naaaet. aria eanow" ant rrPv~q ne mueaon of inforn+eaan. SwW care NWS fogwu,q me ourten *&phase
or MW pew *soars of cvs mwc= of wdanraoan. rx=4" uW"aoM w rea"g Ts ou oft . :0 e+e C"Ce of uWagemaa ant &4490L Pcsoenaont xecul=w
P�alaa (03"4o-.an..vausngaon. O.C. 20302.
Texas Department o
David R. Smith, M.D. 1100 West 49th Street
Commissioner Austin, Texas 78756-3199
(512)458-7111
f
Health
Robp- k. MacLean, M.D.
Commissioner
�I11
�e s
May 26, 1993
DOUG GOODMAN
PUBLIC HEATH ADMIN.
LUBBOCK CITY HEALTH DEPARTMENT
P. 0. BOX 2548
LUBBOCK, TX 79408-2548
TDH Document No. C3000376
Change No. 02
Dear Mr. Goodman:
I have enclosed an approved copy of your public health services contract. Please
file it with the office of record for your agency.
If we may be of further assistance, please call us at 512/458-7470.
Sincerely,
e)
Glenn W. Rust, Acting Director
Grants Management Division
GWR:am
Enclosure
STATE OF TEXAS
COUNTY OF TRAVIS
TEXAS DEPARTMEN_' OF HEALTH Resolution No. ,4111
1100 WEST'49TH *STREET March 25, 1993
AUSTIN, TEXAS 78756-3199 Item #25
CONTRACT CHANGE NOTICE NO. 2
TDH Document No. C3000376
The Texas Department of Health, hereinafter referred to as RECEIVING AGENCY, did
heretofore enter into a contract in writing with
LUBBOCK CITY HEALTH DEPARTMENT
hereinafter referred to as PERFORMING AGENCY. The parties thereto now desire to
amend such contract as follows:
SUMMARY OF TRANSACTION:
Revision to public health services contract.
Attachment No. 05 - Amendment to add a new attachment for WIC program to
provide group nutritional education, individual counseling;
and prescribed foods at no cost to individuals identified
as having nutritional deficiencies.
,
All terms and conditions not hereby amended remain in full force and effect.
' to , t :,; N T „a, ..,., ,
s%nCr:?C Y ;;w?:.C.... �R:GiYA's� 0:, :FR �r: s5 ::���V.
C77, CF 12H0C%
Alit arized Con::ac:in, ant.:7 type acave
?-R"01H. +G ACR107,
David R. Langston, Mayor
—_-----------------------------------------
Nawe anc *;
7' `22f---------- —
nanre of person autdorited
to sign
nda Farrow, C:et
3nreau of "inancia: cervices --
(Name aad "i.ie)
Ra7e: March 25, 1993 .ate: A/D /7' 1 0 2
Rp:cli
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Caazge No. 02
;
'--------------------------------'-----------
'F9Ce:3 funds are 1^d:...ed CY 3 3iVDe: .CG3 .�e C3:d:Og GI 7e1?Ld: G' S.1C ASS:S:a'C? "? A;, ------
H&F.3 :0 9CD 3T SSCT.uri 0. ANY 3"s30 AMOUNT A..1. 11 . .0� D-:Ai.-
COVER - ?age 2
DOCUMENT NO. C3C00376
ATTACH VENT NO. 05
PERFORMING AGZICY: !UBBOCK CITY HEALTH DEPARTM_KNI
RECEIVING AGENCY PROGRAM: 3UREAU OF WOMEN, INFANTS, AND CHILDREN'S NUTRITION
TERM: April 1, 1993
SECTION I. SCOPE OF WORK:
THROUGH September 30, 1993
PERFORMING AGENCY will provide supplemental food instruments and nutrition
education, as an adjunct to good health care at no cost to law income pregnant
and postpartum women, infants, and children identified to be at nutritional
risk. In meeting this goal the PERFORMING AGENCY will:
A. Perform professional, administrative, and clerical services necessary to
provide special supplemental food instruments to qualified women, infants,
and children in a specified geographic area. Services will be performed
according to the terms and specifications of RECEIVING AGENCY and/or USDA.
Regulations, instructions, policies, and/or directives will be issued to
PERFORMING AGENCY as they are formulated and appear in the State WIC
Policy and Procedure Manual, which is hereby incorporated by reference and
made a part hereof.
RECEIVING AGENCY will notify the PERFORMING AGENCY, by letter, of the
authorized geographic service area(s). These geographic area(s) may be
subject to change upon written notice by the RECEIVING AGENCY and approved
by the PERFORMING AGENCY.
B. Assist in the collection and evaluation of data which will identify medi-
cal benefits of this nutrition intervention program and to furnish
financial, dietary, medical, nutrition education, and any other special
reports in a timely manner as required by the RECEIVING AGENCY for the
compilation of the aforesaid data.
C. Determine eligibility of applicants, register participants, collect data,
conduct measurements, provide nutrition education, and maintain records as
required.
D. Make available appropriate health services to participants up to the
income level specified in the RECEIVING AGENCY's Program policies and
inform applicants of the health services that are available. When health
services are provided through referral, the PERFORMING AGENCY must have a
plan for continued efforts to make health services available to partici-
pants at the clinic or through written agreements with health care
providers.
E. issue prenumbered food instruments to qualified participants who will use
such instruments to obtain specified food items from participating
vendors; maintain complete accountability and security of all food
instruments received from the RECEIVING AGENCY; and be held financially
responsible for all unaccounted for food instruments and/or those issued
to ineligible participants. The PERFORMING AGENCY will also be held
-1-
iinanciaily accountable for unauthorized infant for -mu as issued to
participants.
PERFORMING AGENCY will comply with all applicable laws, regulations,
standards, and guidelines established at Federal, State and Local levels as
these regulations now appear or may be amended during the period of this
attachment. These include but are not limited to:
1. Child Nutrition Act of 1966, as amended (42 USC 1786)
2. Public Laws 99-500 and 99-591
3. Child Nutrition Act and WIC Bureau Reauthorization Act of 1989, Public
Law 101-147
4. Uniform Federal Assistance Regulations 7 CFR Part 3015 and 3016
5. Applicable Federal Regulations located in 7 CYR Pars 246
6. State WIC Policy and Procedures Manual
SECTION II. LEGAL AUTHORITY TO CONTRACT:
Chapters 12 and 121 of the Health and Safety Code.
SECTION III. SPECIAL PROVISIONS:
General Provisions, APPLICABLE LAWS AND STANDARDS Article, is amended to
include the following:
PERFORMING AGENCY will respond in writing to all review and audit
exceptions and recommendations within thirty calendar days of their
receipt.
General Provisions, ASSURANCES Article, is hereby amended to include the
following:
PERFORMING AGENCY hereby agrees that it will comply with Title VI of
Civil Rights Act of 1964 (42 USC 2000d et.seq.), Title IX of the
Education Amendments of 1972 (20 USC 1681 et.seq.), Section: 504 of
the Rehabilitation Act of 1973 (29 USC 794), Age Discrimination Act
of 1975 (42 USC 6101 et.seq.); all provisions required by the implement-
ing regulations of the Department of Agriculture; Department of Justice
Enforcement Guidelines, 28 CFR Parts 50.3 and 42; and FNS directives and
guidelines, to the effect that, no person will, on the grounds of race,
color, national origin, sex, age, or handicap, be excluded from partici-
pation under any program or activity for which the PERFORMING AGENCY
receives Federal financial assistance from FNS, and hereby gives assurance
that it will immediately take measures necessary to effectuate this
attachment.
By accepting this assurance, PERFORMING AGENCY agrees to compile data,
maintain records and submit reports, as required, to permit effective
enforcement of the nondiscrimination laws and permit authorized USDA
personnel during normal working hours to review such records, books,
and accounts as needed to ascertain compliance with the nondiscriminatior.
laws. If there are any violations of this assurance, the Department of
Ira
Agriculture, ?cod andNu-riticn Service, will have the right to seek
judicial enforcement of This assurance. Phis assurance is binding on
the PERFCRMING AGENCY, its successors, transferees, and assignees, as
long as they receive assistance or retain possession of any assistance
from the Department of Agriculture. The person or persons whose
signatures appear on the COVER PAGES of this attachment are authorized
to sign this assurance on behalf of the PERFORMING AGENCY.
General Provisions, STANDARDS FOR FINANCIAL MANAGEMENT Article, Number 1.,
regarding internal budgeting and Number 3., regarding billing, collection,
and fee schedules are not applicable.
General Provisions, OVERTIME COMPENSATION Article, is not applicable.
General Provisions, TERMS & CONDITIONS OF PAYMENT Article, is hereby modified
to include the following paragraphs.
The participant caseload quantity will be assigned by RECEIVING AGENCY by
giving written notice to PERFORMING AGENCY and may be subject to change
from time to time upon written notice to PERFORMING AGENCY from RECEIVING
AGENCY. PERFORMING AGENCY assumes liability for all food costs resulting
from PERFORMING AGENCY exceeding assigned caseload maximum. The number of
individuals served in excess of assigned caseload are not to be included
in the calculation of earned administrative funds as described below.
RECEIVING AGENCY will reimburse PERFORMING AGENCY for administrative costs
which include participant referral, vendor evaluation and monitoring,
nutrition education, general administrative support, start-up costs,
outreach, applicant screening, and food card issuance.
Administrative costs will be reimbursed based on actual costs, but not to
exceed the "maximum reimbursement" set out below, based upon the sum of
the participants who actually receive food instruments each month plus
infants who do not receive any food instruments whose breastfeeding
mothers were participants, to the extent that the total so derived does
not exceed the PERFORMING AGENCY'S total assigned caseload within any
given month. Surplus funds (the amount by which maximum reimbursements
exceed actual cost) can be accumulated and carried forward within the
attachment term. The time period during which surpluses may be recovered
will be determined by the RECEIVING AGENCY.
PARTICIPANTS SERVED PER MONTH
First 500 participants served
Next 1000 participants served
Next 8500 participants served
All additional participants served
PERFORMING AGENCY agrees that:
MAXIMUM REIMBURSEMENT
$ 9.12 per participant
$ 7.47 per participant
$ 5.00 per participant
$ 4.79 per participant
(1) not less than 20% of total administrative costs will be separately
identified and documented as expenditures directly related to nutrition
-3-
education;
(2) RECEIVING AGENCY will reimburse PERFORMING AGENCY for administrative
expenses at a rate not greater than five times the amount of properly
documented expenditures for nutrition education, but not more than is
earned based on actual participation not to exceed PERFORMING AGENCY'S
assigned participant caseload;
(3) RECEIVING AGENCY will increase the maximum reimbursement to PERFORMING
AGENCY by an additional $.50 per each pregnant and breastfeeding woman
participating in the PERFORMING AGENCY'S Program; and
(4) RECEIVING AGENCY will identify annually to PERFORMING AGENCY an amount
of funds that must be spent for breastfeeding promotion. Nutrition
education expenditures must be supported by documentation of participant
attendance or non-attendance. The breastfeeding allocation of funds to
the PERFORMING AGENCY will be based on the RECEIVING AGENCY'S propor-
tional share of the statewide combined total of pregnant and breast-
feeding participants as reported to the RECEIVING AGENCY. For a
PERFORMING AGENCY whose monthly participation falls below 500, RECEIVING
AGENCY has the option to compute the sliding scale allowable at a 500
participant level with the stipulation that the 20% nutrition education
expenditure requirement is met. RECEIVING AGENCY reserves the right to
exclude and/or recover any expenditures that have been claimed and/or
paid that are not authorized by the regulations and/or directives
pertaining to the program.
RECEIVING AGENCY also reserves the right to withhold a proportionate
amount of earned administrative funds when evidence exists that
nutrition education and/or breastfeeding promotion is not being provided
by PERFORMING AGENCY, or PERFORMING AGENCY is not complying with the
provisions of USDA and/or RECEIVING AGENCY directives. RECEIVING AGENCY
reserves the right to grant exceptions to the above funding formula.
PERFORMING AGENCY agrees to break out separately on the face of the claim
for reimbursement (State of Texas Purchase Voucher, TDk Form AG-37) the cost
associated with nutrition education, breastfeeding, and other administrative
costs.
General Provisions, ADVANCE PAYMENTS Article, is not applicable to this
attachment.
General Provisions, PROGRAM INCOME Article, paragraph cne, is not applicable
to this attachment.
General Provisions, FINANCIAL REPORTS Article, paragraph t:�xee (Annual/Final
Report), first sentence is amended to read:
A final report, Financial Status Report, Federal Form 269 (TDH Form GC-3),
will be submitted no later than December 31st of each year. (Remainder of
paragraph does not change.)
-4-
General Provisions, REPORTS AND INSPECTIONS Article, paragraph one is hereby
modified to include the following wording:
PERFORMING AGENCY will submit monthly performance data which includes:
Report of Program Operation, AC 80-1;
Report of Card Sequence Used, AC 80-3; and,
Cards Voided, AC 80-4;
Lost/Stolen report, AC 78-10, will be submitted as necessary.
On an annual basis, a Racial Ethnic Group Participation Form, FNS-191, for
the reporting month of April will be submitted by the seventh working day
of May.
General Provisions, EQUIPMENT AND SUPPLIES Article, is amended by adding the
following:
PERFORMING AGENCY agrees to accept responsibility and financial liability
for all equipment and supplies purchased with RECEIVING AGENCY WIC
Program funds whether purchased locally by the PERFORMING AGENCY, or by
the RECEIVING AGENCY and transferred to the care and custody of the
PERFORMING AGENCY. PERFORMING AGENCY further agrees to conduct an annual
physical inventory of all equipment purchased with RECEIVING AGENCY WIC
Program funds and submit it to the RECEIVING AGENCY WIC Program by
February 28th of each year. RECEIVING AGENCY reserves the right to
recover the cost of equipment or supplies purchased by the RECEIVING
AGENCY and placed in the custody of the PERFORMING AGENCY if such
articles are lost, stolen, or otherwise unlocated.
SECTION IV. BUDGET:
All categories of costs billed to the RECEIVING AGENCY and allocation of such
costs must be in accordance with the "Plan to Allocate Direct Costs," (PADC),
submitted by PERFORMING AGENCY and approved by RECEIVING AGENCY. A listing of
the categories contained in the negotiated PADC are shown in Exhibit A of this
attachment.
d.13
w s(z--
Project #75
Lubbock County Health Department
Lubbock, Texas
Exhibit A
FY93 Plan To Allocate Direct Costs
Approved Categories
Personnel Costs
Personnel Benefits
Travel Costs
Equipment Purchase
Outreach
Communications and Utilities
Printing and Reproduction
Supplies
Postage and Shipping
Other Expenses:
A. Nutrition Education Material and Supplies
TEXAS DEPARTMENT bF HEALTH
1100 WEST 49TH STREET
AUSTIN. TEXAS 78756-3199
CONTRACT CHANGE NOTICE NO- 3
STATE OF TEXAS TDH Document No. C_3000.376
COUNTY OF TRAVIS
The Texas Department of Health, hereinafter referred to as RECEIVING AGENCY, did
heretofore enter into a contract in writing with
L..UBBQCK__C_I_TY_. HEA_I,TH..._DEP,ARTMENT.._...
hereinafter referred to as PERFORMING AGENCY. The parties thereto now desire to
amend such contract as follows:
-----------------------------------------------------------------------
SUMMARY OF TRANSACTION:
Revision to public health services contract.
Attachment No. 01A - Community and Rural Health; personal and environmental
health, immunization, and laboratory services, to revise
budget to decrease direct assistance and increase
financial assistance in lieu of state position, Nurse II,
LC000-018, effective 10/01/92.
All terms and conditions not hereby amended remain in full force and effect
RECEIVING AGENCY
TexaDepartment of Healti�
By:
�• ��
(Signature of person authorized
to sign)
Glenn W. Rust, Acting Director
Grants..__Mana.gement Division.....____._._.__.__
(Name and Title)
Date:
Cover - Page 1
RECEIVED
1 9 1993
i.t1860CX CITY HEALTH DEPT
DETAILS OF ATTACHMENTS
Att/1
Financial
Assistance _
1 1 1
As. , TDH ,
n
Term ,
Source of
Direct ;
Total Assistance
No. ; Program
Begin
End _;
Fundsr
;
Amount 1
Assistance ; Amount (TDH Share
_1
01A CRH/I&L-LHS ;
9/ 1/921
8/31/93:
STATE
116,843.001
185,166.001
302,009.00
1
I 1 1
02A ; MCH/FHS-LHS ;
9/ 1/921
8/31/931
STATE
364,981.001
31,404.001
396,385.00
03 ; HIV/EDUC-LHS ;
9/ 1/921
8/31/931
STATE
;
36,000.00:
.001
36,000.00;
1 04 1 HIV/GHC-LHS 1
9/ 1/921,
8/31/931
STATE
1
33,665.001
.001
33,665.00
1
, , I
1 05 1 NIC/CARD-LHS 1
4/ 1/931
1
9/30/931
10.557
1
1
1
.001
1
.001
1
.00;
1 1
1 1 i
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'----------------------------------------------------------------------------------------------------------------------'
1
1 TDH Document No. C3000376
TOTALS
1
$ 551,489.00:
$ 216,570.00:
'
$ 768,059.00
1 Change No. 03
1
1
1
I
1
of Federal Domestic
i
1
Assistance (CFDA),
if applicable.
*Federal funds are indicated by a number
from the Catalog
REFER TO BUDGET SECTION OF ANY
ZERO AMOUNT ATTACHMENT
FOR
DETAILS.
COVER - Page 2
TEXAS DEPARTMENT OF HEALTH
Receiving Agency/Program: CRH -..IMM/LAB-LHS
-- .................... ..... ................. _. —
Performing Agency LUBBOCK CITY. HEALTH DEPARTMENT
TDH Document No C3000376 Change # 3 Term Se-No....
tember_ 1, 1992 _ August_ 3]_,__.1993
Attachment/Amendment_No 01A.... IAC No (.. _
REVISED CONTRACT BUDGET
/-------------------------------- ----------------------------------------------
----------------------------------DIRECT ASSISTANCE
' Current Approved 'Change Requested ' New or Revised
------------- Budget (a) (b) Budget (c)
-------------------------------------------------------------------------'
Personnel (No. Pos. 2) '
$69,612.00
Travel
.00
Laboratory Support
ISTD 1
$14,000.00
Drugs
.00
ITB Drugs
.00
Vaccines
I
$127,283.00
Other, _.._............. ......__ I ....._..._._..-._...........
I -
. 00
TDH Direct bssistance
$2I0;8�5.-00
ITDH Financial Assist. �._,.._.._..__...___....___...
$91,114.00
TDH Share ,------$30,009_00
\----------------------------
($25,729.) 00
.00
.00
.00
.00
_. 00
........_.__....---.._(.$.2 -9 �72 4.00 )
1...---....... _............ $2.5..,..729.000
$43,883.00
.00 ;
$14,000.00 ;
.00
.00 '
$127,283:00
-.._......_..._....... .00
$.15; Ibb 00
$,116,843.00
.___...__..._._-.$307,I70
/--------------------------------------------------------------------------------------`
+----------------
----- -----------FINANCIAL-ASSISTANCE
'
-------------------------------------------
Current Approved 'Change
Requested '
New or Revised '
,ObjectClassCategories ;
Budget (a)
(b) ;
Budget (c)
Ia.Personnel
I------------------------------------------------------------------------------------
$53,698.00
$25,729.00
$79,427.00 '
'
Ib. Fringe Benefits ;
$13,416.00 ;
.00 ;
$13,416.00-
-------------------------------------------------------------------------------------
Ic Travel ;
.00-;---------------------------------------
y
00
--------------------------------------------Equipment ;
Id.
le Supplies ;
---00-;
.00 ;
-----00-;-
_00
----00-
_00
--------------------------------------------------------------------------------------
If. Contractual ;
$24,000.00 ;
.00
$24,000.00
'
-------------------- --------------------
IIg. Other ;
----------------------------------------------
.00-,-
00 ,
-------------------------------------------
Ih Total Direct Charges ;
I--------------------
--------------------------------
$91,114.00 ;
$25,729.00 ;
--.00-'
$116,843.00
Indirect Charges ;
.00
------------------------------------------------------------
yj. Total- ;
$91,114.00 ;
--.00-;-
$25,729.00 ;
--------------.00j
$116,843.00 j
-----------
RECEIVING AGENCY share-;--------$91,114.00
-----------
;--------$25,729.00
;
---------------------
11. PERFORMING AGENCY share'
--------
.00 '
---------
.00 '
------$116,843.00-�
_00
Includesm PI-
-
----------------- ------------------------------------------------------------------
Im_ Program Income ;
I---------------------
.00 ;
.00 ;
'
.00 '
----------------------------------------------------------------
IDetai.l on Indirect Charges:
!
Type of Rate (Mark one Box) Provisional
Predetermined
Final
Fixed
Rate ..._...._0_.00 Base .....__._._.....-...._.._._.
__
___..... - 00 Total Indirect Charges ........ _--
................................. ......_. -_00
-------------------------------------------------------------------------------------
EXPLANATION OF CHANGE:
Delete state position, Nurse II, LC000-018 @ $2,339 month and budget local
;position @ $2,339 month, effective 10/01/9L
rorm No. yt�-ya
Rev. 03/91
TF;C;I:; [IFF'ARi i7Ei� i i'iF fIf :";I TI
I L 0 0 WF' T 49TI; 3TRFF.T
Att I- Ti!. IFS Ai6 19
COttTRACT CHA0GE tlOTTCF. HO 4
STA TE F T F XA;i I BFi Q( ri::I Iale, n t, i1c)
(-,OUtt F'Y OF T[?AVI
The Texas 0epart.rm,rit. )f Health, hereinaft::,r refer; tad to &3 RECFIVIi4G AGEilCY, dial
hp.n'tof)rc= >'n.t.,I it ) nl o a :on i. ra.ct. Ul wr t t i iiq with
LtJBBOCIK CITY HEALTH DEPARTHEk_ T ..
here-triaft.er to a:i� PERFOPHING, Ai;EiRCY. lire part. es thereto now desire to
amend such cont.ract as follows:
--------------------------------------------------------------------------------------
SUMMARY OF TRAiJ:iACTTOil:
1
Revisi-on to pub .:i.c, hea l.th services corltrac.t.
Attachmarit. i4o. 06 - Amendment to adri a new attac;hlnent, for Immuniz. t.:.on
Division to fund a special immunization initiative to
increase immunity levels for preschool children for ;
measles, mumps, rubella, Haemophi.lus influenzae type b,
diphtheria, tetanus, pertussis and polio.
1 c
All terms and conditions not hereby amended remain in full force and effect. ;
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
CITY OF LUBBOCK
Authorized Contracting Entity (type above ;
if different from PERFORMING AGENCY) ;
for and in behalf of: ;
1 1
1 Texas Department of Health
W866tKRkKKWtk$RlkT T$lQAX _ _ _ __o_ City eal_th Pept.
B *fflMffi-)MfA# RECEIVING AGENCY fit x P RM G AGEN ;
1 1
By:
1 � 1
!!By-
N_
(Sign u of person authorized ature of person ffr
ized
sign contracts.) Linda Farrow, Chief to sign contracts! ;
Bureau of Financial Serviclfamexxtbak David R. Langstorj
FI?32i=K#x 902Kx �Bx�esa�i��F tooxd��6s�sces _Mayor ;
(Name and Title) (Name and Title)
1
Date: �xB4cxL mRasc I g �99.3_ Date: June 8, 1993
1 -
RECOMMENDED: APPROVED AS FORM:
1
(PERFORMING Y Director, Of ice of Genera Counsel ;
if differe rom person ;
authorized to sign contract) ;
1
1 1
1 1
1
1
-------- -------�_____
Cover - Page 1
DETAILS OF ATTACHMENTS
' Att/'
Financial
Assistance I
An.
TDH
Terre _;
Source of
Q.
_Program__-_,-_;
_B in '
End--:
_Funds* _;
_ Amount
01A
i I
CRH/I&L-LHS ;
1
9/
1/92;
8/31/93;
I
STATE ;
1
116,843.00
t
1 I
02A
1
MCH/FHS-LHS ;
9/
1/92:
1
8/31/93;
1
STATE
I
364,981.00
1 1
1 I
03
i I
I
I
HIV/EDUC-LHS ;
I
9/
1/92:
I
1
8/31/93:
I
I
I
STATE ;
I
I
I
36,000.00
I
1 I
04
I I
I
HIV/GHC-LHS ;
I
9/
1/92:
I
8/31/93;
I
1
STATE
I
I
33,665.00:
I
1 1
05
1 1
1
WIC/CARD-LHS ;
I
4/
1/93:
1
9/30/93:
1
1
10.557 ;
1
1
.00
1
1 i
06
I
IMM/SPEC-LHS
5/
1/93:
1
8/31/93:
1
STATE ;
1
20,562.00
1 I
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1
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1
1
1
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1 �
Direct Total Assistance
Assistance _ ; Amount LT H Share)
185,166.00: 302,009.00:
I I
I 1
31,404.00: 396,385.00
.00: 36,000.00
.00: 33,665.00,'
1 1
1 1
.00: Do:
l 1
1 1
.00: 20,562.00:
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1 I 1 1 1 1 1 1
'""""-"""""'-----""-""""""'-""""-"""--""""'-•-___""--'""---------"'---------"'-------- I
TDH Document No. C3000376 TOTALS ; $ 572,051.00: $ 216,570,00: $ 788,621.00
Change No. 04
1 I 1 I I
*Federal funds are indicated by a number from the Catalog of Federal Domestic Assistance (CFDA), if applicable.
REFER TO BUDGET SECTION OF ANY ZERO AMOUNT ATTACHMENT FOR DETAILS.
COVER - Page 2
J.3000376
ATTACHMENT HO. 06
PERFORMING AGENCY: I._(JBBnCK CITY HEALTH OEPARTMENT
RECEIVING AGENCY PROGRAM,- IMMUNIZATION 01VT ION
TERM: May 1, 1993 THROUGH August 31, 1993
SECTION I. SCOPE OF WORK:
Under this special immunization initiative.., PERFORMING AGENCY is to increase
immunity levels for preschool children ( targeting ages birth througil two
years) for measles, mumps, rubella, Haemophilus inf:luenzae type b, diphtheria,
tetanus, pertussis, and po_li.o vaccines. PERFORMING AGENCY wi.Ll utilize all
necessary measures to promote immunizations and to inform parents/guardians of
the clinics nearest their neighborhood.
PERFORMING AGENCY agrees to comply with the following: Texas Immunization
Laws, Rules, and Regulations; Chapter 42, Human Resources Code; Sections 2.09
and 2.09A, Texas Education Code; and Section 31.7 of the PHS Act as amended.
PERFORMING AGENCY agrees to closely adhere to both the spirit and intent of
the "Standards for Pediatric Immunization Practices," as recommended by the
National Vaccine Advisory Committee, approved by the USPHS and endorsed by the
American Academy of Pediatrics.
PERFORMING AGENCY will be evaluated on both the total number of doses s
administered and the number of DTP 4 administered to children who are two
years old or younger. The number of doses administered during this contract
period will be compared to the number of doses administered to the target age
group during the same period in 1992.
PERFORMING AGENCY will provide an estimated ....._1.,350_... .... .... doses administered over
and above its current average level of doses administered to clients in the
county(ies)/areas defined as:
tYus.a.Qcx
SECTION II. LEGAL AUTHORITY TO CONTRACT:
Chapters 12 and .12.1, Health and Safety Code.
SECTION III. SPECIAL PROVISIONS:
PERFORMING AGENCY understands that federal law guarantees access to
immunization services in public clinics regardless of ability to pay.
PERFORMING AGENCY further understands that the bilingual poster "Fees for
Vaccine Administration," (Form 6-36, available from the Immunization Division)
must be posted where it may be easily seen by patients in each immunization
waiting room.
PERFORMING AGENCY agrees that if fees are collected, they will be kept to a
minimum and that no one may be denied immunization services because of in-
-1-
ability to pay the fee.. Fee schedules will not be based upon a cast per dose_
PERFORMING AGENCY understands that all vaccines used in RECEIVING AGENCY
Immunization Programs are purchased with public funds and must be accounted
for the same as other public property. PERFORMING AGENCY further understands
that vaccine loss, destruction, spoilage, or other waste, may be investigated
by the RECEIVING AGENCY, Immunization Division, which may then require re-
imbursement or replacement of the lost vaccines.
PERFORMING AGENCY agrees to provide RECEIVING AGENCY, Immunization Division,
monthly reports of vaccine utilizationlloss, within ten days after the end of
each month, on forms provided by RECEIVING AGENCY (Forms C5, CSA, C33, C33A)_
SECTION IV. BUDGET:
Personnel
$17,098.00
Fringe Benefits
.00
Travel
.00
Equipment
2,264.00?
Supplies
1,200.00
Contractual
.00
Other
.00
Total Direct Costs $20,562.00
Indirect .00
TOTAL $20,562.00
Financial status reports (FSRs) are due the 30th of June and September
and the 15th of October.
Total reimbursements will not exceed $20,562.00.
Equipment list attached.
-2-
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
PROGRAM WITHIN!
RECEIVING, AGENCY: IMMUNIZATION DIVISION
TOH DOC. NO: C3000376
ATTACHMENT NO: 06
CHANGE NO: 04
EQUIPMENT LIST
No. of Unit
Item Desc_riotion Units Cost Extension
1 486 PC laptop computer with 1 2264 $ 2,264.00
internal modem, 120 mg HD plus
software
-------------
TOTAL $ 2,264.00
-------------
Items may be brand name, if specified, or equivalent.