HomeMy WebLinkAboutResolution - 4342 - Contract Change #2 To #C4000133 - TDOH - HIV & Tuberculosis Programs - 12_09_1993Resolution #4342
December 9, 1993
Item #19
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 Contract Change
No. 2 to the Public Health Services Contract, TDH Document No. C4000133, with
the Texas Department of Health, which Change No. 2 includes attachments for
HIV Intervention and Tuberculosis Outreach programs, which Contract Change No.
2 is attached herewith, which shall be spread upon the minutes of the Council
and as spread upon the minutes of this Council shall constitute and be a part
of this Resolution as if fully copied herein in detail.
Passed by the City Council this 9th day of
ATTEST:
'I't, W-Y--L'
etty(M. Johri-s—brU City Secretary
APPROVED AS TO CONTENT:
Doug man,41pment
ing Director
Community Dev
APPROVED AS TO FORM:
a '1- >-
E)Wald G. Vandiver, Firs
Assistant City Attorney
DGV:dp\Agenda #3\TDH.Res
December 1, 1993
December 1993.
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 73756-3199
CONTRACT CHANGE NOTICE NO. 2
STATE: OF TEXAS TDH Document Nc. C4000'S
COUNTY OF TRAVIS —
The Texas Department cf Health, hereinafter referred to as RECEI'ITNG AGENCY, did
heretofore enter into a contract in writing with
LUBBOCK CITY HEALTH DEPARTMENT
hereinafter referred to as PE?FORMING AGENCY. The parties thereto new desire tc
amend such contract as follows:
--------------------------------------------------------------------------------
SUMMARY OF TRANSACTION:
Revision to public health services contract. '
Amendment to add new attachments;
Att. 04, Establish and/or maintain HIV/AIDS health education/risk for the ;
targeted populations;
Att. 05, Tuberculosis outreach for high risk individuals;
Att. 06, WIC to provide group nutrition education, individual counseling &
prescribe food to individuals identified as having nutritional deficiencies.;
All terms and conditions not hereby amended remain in full for-e and effect. ;
EX;CJTED IN DUPLICATE ORIGINALS ON THE DATES SHO''ON,
CiTY OF L 0330CK.
Authorized Contracting Entity hype above
if different from PERFORMING AGENCY)
'or an � behalf cf:
P
(Signature of person author
to sign contracts)
David R. Langston, Mayor -
(Name and Title)
Date: 1 2/ 1 5/ 9 3
RECOMMENDED:
nA_-1_e cc�'\
B• .
(PER RMING AGENCY Direbpr,
if different from pe
authorized to sign contract)
APPROVED AS TO •-
Z"Y_tyl'
TEXAS DEPARTMENT OF HEALTH
RECEIVING AGENCY
i ig a of person authorized
sign contracts)
Linda Farrow, Chief
Bureau or Financial Services
(Name and Title)
Date: _1 1 5 /9 �1
APPROVED AS TO FORM:
BY: —
Office of General Counsel
�.THILS 0 ATTACHMEENTS
AL• • ____--- — -----
am. "er.n Source of Direct Total Assistance
4a_; Pr;ira;n g°ui" Errd ponds* ?4'.xunt WistailCe i Amount 1T0H Snare)
J'
rr { r E n nr nni?�Ct'lr''?�S.,''gig %+; i '34� ` Jr.-- „64,90 °.vv, �[,51o.OD, S�t,S�T.Ut11
]
�� rtn°•' ^et�1
STY"E_ lc , , ,.1 .3.TfAv,
€ 1 t
f E I 1
013 AB- S 941 11K-1 a,31r` 4; STATE 30;-6,000.00: '6,000.00
D! I n, STATE
E e� P 1 I E I
1 �' E �C- r5 9f 1. 3> 94; �T,T� �a,4i1.aE, 00, 43,471.0G!
E t
05 E31U-R-LqS l/ 1,93, 2121194, STATE t�,�73.�01, .00-! 20,013.00,
i t f
F S. 00f E 1t
:f:3; 9;"—'�uf?» ?0.557 ._ATE v, 00, W
t I 1
I I P ! € 1 !
! 1 t 1 t I
3 E ! I t [ 1 I
I ! I 1 1 1
r !1 1 E r I 3
E 1 3 } I !
1 I € t
t 3 I E 3
I F r I i i
3 3 1 i i 1 I
i 1 1 I
1 t I 1 € S I I
F 1 { I 1
E t I { I E I 3
1 1 I 1 r F I 1
t t ! E I 3 [
1 1 1 1 t I t 1
1 1 I 1 ! 1 [ F
I I I 1 i 1 1
1 I I 1 3 1 1 I
1 1 1 1 ] 1 I I
I 1 1 1 1 E t E
i I F F I k 1 E
1 ! ] 3 f E 1 t
[ [ 1 1 t E 1 1
1 1 ! [ 1 1 1 t
I I [ 1 I 1 I I
1 I t ! I ! 3 t
E E 1 I t 1 [ I
3 1 I 1 1 1 E 1
1 E I I 1 I F !
I 1 t F 1 1 } [
I I 1 ( E I I I
E [ I I f I 1 1
1 1 1 1 E 1 t 1
I F i 1 1 1 F 1
1 I 1 E [ E 1 ]
i 1 i F F I I 1
t [ I 1 E ] I 1
I I E E 1 1 I I
E I k [ 1 1 1 E
I I 1 E 1 t E !
1 I E E 1 { I E
€..—..----.—..-----..,..----—...........---------------------------------------------.....----..--------------------......---------I
TDH Document No, C4000133 TOTALS $ 547,707.00: $ 292,067.00: $ 839,774.00t,
Change No. 02
t I 1
] F 1 E
*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
DOCUMENT NO. C4000133
ATTACHMENT NO. 04
a-_,R r_,RM1NG AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: HIV DIVISION
L_ September ' , ! 993 THROUGH August 3 ; , 1394
SECTION I. SCOPE Gr WORK:
FZR�GRk-4T 4G AGENCY agrees to conduct health education/risk red- -t4 _,o firr ac z
which ,prevent infe tlon and reduce the transmission of human mmunodeficlency
vrtrus/.acquired immunodeficiency syndrome (HIV/AIDS3. Project activities and
materals will be appropriate to the general public or the target, populations
identified in PERFORMING AGENCY'S objectives. Strategies to accomplish the
projects must demonstrate cost-effectiveness, innovation, coordination, and
c:_,llaboratfor with other community efforts.
A'l inlormatio,n and education materials developed and provided by PERFORMING
AGENCY vii11 be accurate, comprehensive, and consistent with current findings
of the united States Public Health Service.
PER-ORY7NG AGENCY agrees that all activities will be performed in accordance
with RECEIVING AGENCY's (TEXAS DEPARTMENT OF HEALTH) program rules, guide-
lines, and request for proposal (RFP) and PERFORMING AGENCY's objectives,
activities work plans, and detailed budget as approved by RECEIVING AGENCY.
All of the above named documents are adopted by reference as part of this
Attachment. Any revisions to said documents will be approved by RECEIVING
AGENCY and transmitted in writing to PERFORMING AGENCY,
PERFORMING AGENCY agrees to comply with the following:
Chapters 81 and 85 of the Health and Safety Code.
PERFORMING AGENCY will provide an estimated 5,000 clients with
services/units of service in or benefiting the county(ies)/area defined as:
LUBBOCK.
SECTION II. LEGAL AUTHORITY TO CONTRACT:
Chapters 12 and 121, Health and Safety Code.
SECTION III. SPECIAL PROVISIONS:
RECEIVING AGENCY will supply PERFORMING AGENCY with the most current version
of the document entitled "Content of AIDS -Related Written Materials,
Pictorials, Audiovisuals, Questionnaires, Survey Instruments, and Educational
Sessions in Centers for Disease Control Assistance Programs," and its preface
which is written by RECEIVING AGENCY. PERFORMING AGENCY has provided
RECEIVING AGENCY with written acknowledgement of receipt and assurance of
compliance with these guidelines. All of the above referenced documents are
incorporated as part of this Attachment as though written herein verbatim.
--1-
PERFORMING AGENCY, or any subcontractor, shall not transfer a client record
(Wall ing a patient record to another entity cr person without written
consent from the client or patient, or someone authorized to act on his or her
behalf; 0we,°er, the RECEIVING AGENCY (TEXAS DEPARTMENT OF HEALTH) may require
PERFORMING AGENCY, or any subcontractor, to transfer :a client or patient
record to the RECEIVING AGENCY ( TEXAS DEPARTMENT GP REAL T H ` if the transfer
is necessary to protect either the confidentiality cf the record or the health
and welfare of the client or patient.
The RECEIV 2 A.E;NC7 TEKS DEPARTMENT OF HEALTH) shall have access to a
client record (incluaing s patient record) in the possession of PERFORMING
AGENCY, or any subcontractor, under authority of the Health and Safety Code,
Chapters 81 and 35, and the Texas Revised Civil Statutes, ,Article 4495b
Medical Practice Act). in such cases, the RECEIVING AGENCY (TEXAS DEPARTMENT
OF HEALTH) ;:hall keep confidential any information obtained from the client
or patient record, as required by the Health and Safety Code, Chapter 81, and
the Texas RevisedCivil Statutes, Article 4405b.
Due to the sensitive and highly personal nature of HIV/AIDS-related
information, strict adherence to the General Provisions Confidentiality
Article is required. PERFORMING .AGENCY success depends upon whether persons
at risk believe that the program observes this principle.
Program reports are due no later than the 20th of the month following the end
of each quarter.
PERFORMING AGENCY will authorize their staff to attend training, conferences,
and meetings for which funds were budgeted and approved by RECEIVING AGENCY.
SECTION IV. BUDGET:
Personnel
$25,300,00
Fringe Benefits
7,178.00
Travel
1,840.00
Equipment
600.00
Supplies
1,198.00
Contractual
3,640.00
Other
2,050.00
Total Direct Costs $41,806.00
Indirect 1,665.00 **
TOTAL $43,471.00
Financial status reports (FSRs) are due the 30th of December, March,
June, September and the 15th of October.
Total reimbursements will not exceed $43,471.00.
* Equipment List attached
** Indirect cost is based on 0GCMA, Table 1.
-2-
PERFORMING AGENCY: LUBBOCK CITV HEALTH DEPARTM ENT
PROGRAM 'WITHIN
RECEIVING AGENCY: HIV DIVISION
TLH DOC. NO: C4CO0133
ATTACHMENT NO: 04
CHANGE NO: 02
EQUIPMENT LIST
No, of Unit
Item Description Units cost Extension
1 Projector 1 600 $ 600.00
-------------
TOTAL $ 600.00
-------------
Items may be brand name, if specified, or equivalent.
DOCUMENT 40. C4000133
ATTACHMENT NO. 05
PERFORMING AGENCY: LUBBOCK CTT'Y' HEALTH 7�EPAR€ 'MENT
RECEIVING AGENCY PROGRAM; TUBERCULOSIS ELIMINATION 0IVIS.,0'N
TERM: September 1, 993
SECTION i. SCOPE OF WORK;
Ti-ROUGH August 31, 1994
Funds provided bv this Attachmen- will be used its accordacce _,n try the
Cooperative Agreement for the Tu berculos;s Prevention and Control Pro e(ot
which is adopted by reference in its entirety. PERFORMING AGENCY will develop
and carry out expanded outreach services to individuals of ;uen:3ied
sub -groups who have tuberculosis or are at high risk of develcpinq
tuberculosis, To implement this program PERFORMING AGENCY will:
(1) increase the individual's compliance in taking Curative therap
through motivating the individual to adhere to self medicatirr= or by
carrying out alternative methods of therapy such as directly
supervised intermittent therapy;
(2) Increase the individual's compliance in adhering to prescribed
preventive therapy;
(3) Increase the individual's ccmpliance in keeping scheduled clinic,
appointments and following other instructions to assure proper patient
Management;
(4) Improve the investigation and surveillance of individuals to prevent
them from being lost to treatment and follow-up;
(5) Develop a tuberculosis registry and/or information system by which
high risk sub -groups in the county(ies)/area can be effectively
monitored for the purpose of best utilizing outreach resources and
program assessment; and,
(6) Develop records and periodic reports as specified by the Tuberculosis
Elimination Division as required by the Centers for Disease Control
federal grant to RECEIVING AGENCY. The reports include, but are not
limited to, a written quarterly narrative and statistical report
evaluating progress in meeting the objectives of this project.
PERFORMING AGENCY agrees to comply with Sectioii 317 of the Public Heal&
Services Act, as amended.
PERFORMING AGENCY will provide an estimated 225 clients with
services/units of service in or benefiting the county(ies)/area defined as:
LUBBOCK.
SECTION II. LEGAL AUTHORITY TO CONTRACT.
Chapters 12 and 121, Health and Safety Code.
-1-
SECT15N III. SPECIAL
General Provisions, Reports and Inspection Article, is amended to include the
fGrlow Eirg:
PERFORMING AGENCY will sub -snit a programmatic report no later than Septem-
ber 30. 1994, for the pariod ,of Januar,* 1, 1993 through December 31, 1993'
that included the infcrmat cn listed below:
- Number of oatients who started Directly Observed Therapy (DOT)
during calendar year 1993. (January 1, 1993 through December 31, 1993)
- Number who started D 17 in clinic.
-- Number who started COT in field.
- Number of t-imes per week DOT was administered.
- Statement of activities in jails, nursing homes; homeless
shelters. :rug treatment centers and community based organizations
during calendar year 1993.
Results of any skin test screening conducted or reported to
have been conducted regarding the number tested, the number read
and the number of positive skin tests for the following during
calendar year 1993:
- Schools - Jails
- Homeless Shelters - Nursing Homes
- Drug Treatment Centers - MHMR Facilities
- Number of patients whose tuberculosis medications were prescribed
by private physicians and by the local health department during
calendar year 1993.
-- Number of Nonetuberculous Mycobacteria (NTM) cases being provided
drugs in the clinic in calendar year 1993.
Outreach workers employed under this Attachment should be recruited from the
same linguistic, cultural, social and ethnic groups as the patients for whom
outreach activities are directed.
-2-
SECTION IV. BUCGET:
Personnel $14,290.00
Fringe Benefits 3,573.00
Travel 1,375.00
Equipmert .00
Supplies .00
Contractual .00
Other .00
Total Direct Costs $19,238.00
Indirect 835.00
TOTAL $20,073.00
Financial status reports (FSRs) are due the 30th of December, March,
June, September and the 15th of October.
Total reimbursements will not exceed $20,073.00.
*Indirect cost is based on UGCMA, Table 1.
-3-
DOCUMENT NO. C4000133
ATTACHMENT NO. 06
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: BUREAU OF WOMEN, INFANTS, AND CHILDREN'S NUTRITION
TERM: October 1, 1993
SECTION I. SCOPE OF WORK:
THROUGH September 30, 1994
PERFORMING AGENCY will provide supplemental food vouchers, nutrition
education, and immunizations 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 vouchers and nutrition education 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 the United States Department of Agriculture
(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 Procedures 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
medical 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 vouchers furnished by the RECEIVING AGENCY to
qualified participants who will use such vouchers to obtain specified
food items from participating vendors; maintain complete accountability
and security of all food vouchers received from the RECEIVING AGENCY; and
be held financially responsible for all unaccounted for food vouchers
-1-
and/or those issued to ineligible participants. The PERFORMING AGENCY
will also be held financially accountable for unauthorized infant formulas
issued to participants.
F. Review the immunization record of WIC program applicants/participants and
provide immunizations as needed in accordance with Immunization Policies
provided by RECEIVING AGENCY to PERFORMING AGENCY using staff funded under
this Attachment.
PERFORMING AGENCY will comply with all applicable laws, regulations, stan-
dards, 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 Reauthorization Act of 1989, Public Law
101-147
4. Uniform Federal Assistance Regulations 7 CFR Parts 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 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 the
Civil Rights Act of 1964 (42 USC 2000d et.seq.), Title IX of the Educa-
tion Amendments of 1972 (20 USC 1681 et.seq.), Section 504 of the Reha-
bilitation Act of 1973 (29 USC 794), Age Discrimination Act of 1975 (42
USC 6101 et.seq.); all provisions required by implementing the regula-
tions of the Department of Agriculture; Department of Justice Enforcement
Guidelines, 28 CFR Parts 50.3 & 42; and Food & Nutrition Service (FNS)
directives and guidelines, to the effect that, no person will, on the
grounds of race, color, national origin, sex, age, or disability, be
excluded from participation 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.
-2-
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
Agriculture, Food and Nutrition Service, will have the right to seek
judicial enforcement of this assurance. This assurance is binding on the
PERFORMING 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 assur-
ance 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 monitor-
ing, nutrition education, general administrative support, start-up costs,
outreach, applicant screening, and food voucher 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 vouchers each month plus
infants who do not receive any food vouchers 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.
-3-
PARTICIPANTS SERVED PER MONTH MAXIMUM REIMBURSEMENT
First 500 participants served
$
8.57
per
participant
Next 1000 participants served
$
7.02
per
participant
Next 8500 participants served
$
4.70
per
participant
All additional participants served
$
3.97
per
participant
PERFORMING AGENCY agrees that:
(1) not less that 20% of total administrative costs will be separately
identified and documented as expenditures directly related to nutrition
education. Nutrition education expenditures must be supported by
documentation of participant attendance or non-attendance.
(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 monthly reimbursement to
PERFORMING AGENCY by an additional $1.50 per each pregnant and breast-
feeding woman participating in the PERFORMING AGENCY's Program. The
RECEIVING AGENCY encourages the PERFORMING AGENCY to target these monies
to promote breastfeeding among WIC clients'through initiatives such as
Peer Counseling.
(4) To encourage expansion, RECEIVING AGENCY will further increase the
maximum monthly reimbursement in an amount equivalent to the RECEIVING
AGENCY's prorata share of facilities rental costs associated with the
opening of additional WIC clinics by the PERFORMING AGENCY for the first
six (6) months of operation or the end of this Attachment's term, which
ever occurs first. The funding applies only to sites newly opened
during the Attachment period. To qualify for reimbursement, the site
must be approved by RECEIVING AGENCY and constitute an addition to the
number of sites operated by PERFORMING AGENCY as opposed to the reloca-
tion of an existing clinic.
(5) PERFORMING AGENCY will review immunization records of WIC program
applicants/participants and their siblings, and provide needed immuniza-
tions to such children in the WIC applicant family, and report the number
of immunizations administered each month. These activities will be
accomplished using staff funded under this Attachment. PERFORMING
AGENCY will be reimbursed an amount not to exceed $81,900.96 for
actual costs associated with performing these tasks in accordance with
the Clinic Checklist (budget plan) submitted by PERFORMING AGENCY to
RECEIVING AGENCY.
(6) RECEIVING AGENCY will identify annually to PERFORMING AGENCY an amount of
funds that must be spent for breastfeeding promotion. The breastfeeding
allocation of funds to the PERFORMING AGENCY will be based on the
PERFORMING AGENCY's proportional share of the statewide combined total of
-4-
pregnant and breastfeeding participants as reported to the RECEIVING
AGENCY.
(7) Any 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.
(8) 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.
(9) RECEIVING AGENCY reserves the right to grant exceptions to the above
funding formula(s) to serve the best interest of the Texas WIC Program.
PERFORMING AGENCY agrees to break out separately on the face of the claim for
reimbursement (State of Texas Purchase Voucher, TDH Form B-13) 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, 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.)
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 Operations, 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.
Immunization Encounter Form and Immunization Dose Forms.
General Provisions, EQUIPMENT AND SUPPLIES Article, is amended by adding the
-5-
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 cost 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.
Project #75
Lubbock County Health Department
Lubbock, Texas
Exhibit A
FY94 Plan To Allocate Direct Costs
Approved Categories
Personnel Costs
Personnel Benefits
Travel Costs
Equipment Purchase
Outreach
Space Rentals
Communications and Utilities
Printing and Reproduction
Supplies
Postage and Shipping
Other Expenses:
1. Nutrition Education Material/Supplies
2. Equipment Repairs
3. Furniture and Equipment Rental
4. Professional Dues and Subscriptions
5. Custodial Maintenance Fees
6. Advertising and Promotion
7. Miscellaneous Expenses
0
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
CONTRACT CHANGE NOTICE NO. 6
STATE OF TEXAS TDH Document No. C4OOO133
COUNTY OF TRAVIS
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.
Att. No. O5A — Amendment for Tuberculosis Elimination Division to fund
expanded outreach services to individuals of identified
sub —groups who have tuberculosis or are at high risk of
developing tuberculosis.
All terms and conditions not hereby amended remain in full force and effect
EXECUTED IN DUPLICATE ORIGI4ALS ON THE DATES SHOWN.
CITY OF LUBBOCK
Authorized Contracting Entity (type above
if different from PERFORMING AGENCY)
for and in behalf of:
LUBBOCK CITY HEATH DEPARTM
PERFVENay;(Sigon authori
to sign contracts)
David R. Langston, Mayor
------- ---------------------------
(Name and Title)
pp
Date: ---- - 2�-I y------------------------
RECOMMENDE
(PERFORMING AGENCY tcr,
if different from on
authorized to sign contract)
Cover - Page I
TEXAS DEPARTMENT OF HEALTH
RECEIVING AGENCY /
, it
BY: TY�wV -----------------
ture of person authorized
to sign contracts)
Linda Farrow, Chief
Bureau of Financial Services
(Name and '+it'e)
Date:
APPROVED AS ORM:
By: ---�----------
-----------------
Of i'e of General C nsel
DETAILS OF ATTACHMENTS
Att/;
;
Financial Assistance
Am.
TDH
Term ;
Source
of
Direct
Total Assistance
No. ;Program
;
Begin
End
Fundst
Amount
Assistance
Amount (TDH Share'
01
Y16C/FHS-LHS
9/
1/93;
8/31/94;
STATE
364,981.00:
32,616.00;
397,597.00`
1 I
02A
I I
I
ORP-LHS
I
9/
11/93;
1
8/31/94:
I
STATE
1 !
119,182.00;
I 1
I
43,440.00:
I
162,622.CO;
1 1
03
1 1
1
LAS-LHS
I
9/
1/93;
1
8/31/94:
I
STATE
1
.00;
I I
1
76,000.00:
I
f
76,000.00:
I
I 1
04
I I
I
NIV/EDUC-LHS
I
9/
1/93;
I
8/31/94:
1
STATE
1 I
43,471.00;
I I
I
.00;
1
1
43,411.00;
1
I I
05A ;
I I
1
TB/OUTR-LHS
I
9/
1/93;
I
8/31/94:
i
STATE
I I
; 9,668.00;
I I
I
.00;
I
1
9,668.00
I
I 1
068
I 1
1
BNS/CARD-LHS ;':0/
1
1/93'
I
9/30/94:
I
10.557
I I
STATE .00'
I I
I
uu;
I
1
.30
I
1 1
07 ;
1 1
I I
I 1
i1
1 I
I
1 I
I I
1 1
1 1
I I
1 I
I I
I I
I I
1 1
1
IMM/OPTS-LHS
I
I
I
1
I
I
1
1
1
I
I
I
I
I
I
I
9/
1/93;
1
8/31/94:
1
I
1
I
I
I
1
I
!
1
1
1
I
I
I
STATE
1 I
68,356.00;
I I
I I
I I
I I
I I
I I
1
1 I
1 1
I I
1 1
I I
1 1
t I
I I
1
1
140,011,00;
1
I
I
1
I
!
1
1
1
1
1
I
1
I
209,367.00;
1
I
I
1
1
1
1
I
1 I
1
I I
I 1
I I
1 I
1 1
I 1
1 1
1 1
1 1
I I
I I
1
I I
I I
I I
I 1
1 I
I I
1 1
1 I
1 I
1
I 1
I I
I I
I 1
1 I
1 I
I I
I
I
I
I
I
1
I
I
I
I
I
1
I
I
I
1
{
I
1
I
I
I
1
I
I
I
I
I
I
I
I
1
I
I
I
I
I
1
1
I
I
I
I
I
I
1
1
I
1
I
I
I
I
I
i
I
I I
I 1
I 1
I I
I I
1 I
I 1
I I
I I
I I
I I
1 I
i I
l I
1 1
i I
I 1
1 1
I I
I I
1 1
I I
I 1
I I
I 1
I 1
1 I
I 1
1
I 1
I I
I
I
I
1
I
I
1
1
I
I
I
1
I
I
I
I
I
I
I
I
I
I
I
I
1
I
1
I
I
1
I
I
1
I
1
I
I
1
I
f
I
1
I
1
i
I
I
1
I
1
I I
1 I
I I
1 1
1 I
1 I
I 1
1 1
I 1
1 1
1 I
I
I
I
1
1
I
I
I
I
1
1
I
I
I
1
1
1 I
I 1
I I
1 I
I I
I I
I I
I I
I I
I I
i I
I I
1
1
I
I
I
I
I
I
I
1
1
I
1
1
I
I 1
1 I
I
1--------------------------------------------------------------------_---_-_----_---_--------------------------------
I
!
I
1
I
1 I
I I
I
I
TDH Document No. C4000103 TOTALS b 605,658,00: $ 292,067.00; $ 897,725.00
Change No. 06 ;
I I I 1 1
1 - ---- --------------1-------
------
--I---------------1-------- ------------I
zFederal 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
TEXAS DEPARTMENT OF HEALTH
Receiving Agency/Program: TB - OUTREACH-LHS
Performing Agency: LUBBOCK CITY HEALTH DEPARTMENT
TDH Document No. C4000133 Change # 6 Term: September 1, 1993 - August 31, 1994
Attachment/Amendment No 05A IAC No. ( - )
REVISED CONTRACT BUDGET
/--- ---_------------------------------------------------------- -------------- -----
' FINANCIAL ASSISTANCE
'------------------------------------------------------------------------
' ' Current Approved 'Change Requested ' New or Revised
,Object Class Categories ; Budget (a) (b) Budget (c)
' ----------------------------------------- -----------------------------------------
a. Personnel $14,290.00 ($7,500.00); $6,790.00
b. Fringe Benefits $3,573.00 ; ($1,800.00); $1,773.00 '
'--------------------------- ------- --------------------------------------------'
;c. Travel $1,375.00 ($700.00); $675.00
------------------------------------------------------------------------------------
Id. Equipment
.00
.00
.00
------------------------------------------------------------------------------
,e. Supplies
.00
.00
.00
' -----------------------------------------------------------------------------------
f. Contractual
.00
.00
.00
' --- -------------------------------------------------------------------
:g. Other
.00 ;
.00 ;
.00
'
----------- ---------------------------------------------
-----------------
h. Total Direct Charges
'
$19,238.00 ;
($10,000.00);
$9,238.00
--- -----------------------------
;i. Indirect Charges
----------------
$835.00 ;
-----------------------
($405.00);
$430.00
----------
'j. TOTAL
--- ----- --------------------------
-----------------------------------------
$20,073.00 ;
-------------
($10,405.00);
—---------------
$9,668.00
;k. RECEIVING AGENCY share
_------- —-------- —------------------------------------------
$20,073.00
($10,405.00);
------------------
—--- -----
$9,668.00
1
1. PERFORMING AGENCY share;
.00
.00
.00
(Includes m. PI)
'
-------------------------------------------------------------------------------------
;m. Program Income
'
.00
.00
.00
------------------------------------------------------------------------------------
'Detail 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.
;Decrease based on actual expenditures for term of
Attachment.
* Indirect cost is based on UGCMA,
Table 1.
Form No. GC-9
Rev. 03/91