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HomeMy WebLinkAboutResolution - 2006-R0062 - Contract - SPAG - TX Department Of Aging And Disability Services Funding - 02/09/2006Resolution No. 200640062 February 9, 2006 Item No. 5.14 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 with the South Plains Association of Governments (SPAG) for pass through funds from the Texas Department of Aging and Disability Services and any associated documents, a copy of which Contract is attached hereto and which shall be spread upon the minutes of this Council and as spread upon the minutes of this Council shall constitute and be a part hereof as if fully copied herein in detail. Passed by the City Council this 9"' day of February 2006. ATTEST: e e ca Garza, City Secretary APPROVED AS TO CONTENT: Ra dy Trues 11, Community Services Director APPROVED AS TO FORM: M. Knight,`Arsg-istant City Attorney as/CityAtt/John/Resolutions/SPAG.TXDEPT of Aging2006.res January 20, 2006 i Area Agency Wan�gh% The South Plaids Association of Governments Area Agency on Aging VENDOR AGREEMENT CONTRACT NO. •r 6732 - SPAG 1" PbiwsGowr10 or „�Asses n City of Lubbock , hereinafter referred to as Vendor, and The South Plains Association of Governments Area Agency on Aging (AAA,) do hereby agree to provide services effective beginning October 1, 2005, in accordance with the Older Americans Act of 1965 (OAA), as amended, Texas Department of Aging and Disability Services (DADS), the AAA Direct Purchase of Services program and the stated Scope of Department of Aging 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 (age 60 and older). This agreement provides a mechanism for the creation of an individualized network of community resources on a client -by -client basis through the Older Americans Act, as amended, and the Texas Department of Aging and Disability Services' AAA Access and Assistance guidelines. The purpose of this system of Access and Assistance is to develop cooperative working relationships with other 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, gaps in services, and facilitates the ability of people who need services to easily find the most appropriate Vendor. I. SCOPE OF SERVICES A. The Vendor agrees to provide the following service(s) to clients authorized by the AAA staff as identified below in accordance with the vendor application, all required assurances, licenses, certifications and rate setting documents, as applicable. Service: CONGREGATE MEALS TRANSPORTATION Service Definition: CONGREGATE MEAL - A hot or other appropriate meal served to an eligible person which meets one-third (1/3) of the recommended dietary allowances (RDA) as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences and complies with the Dietary Guidelines for Americans, published by the Secretary and the Secretary of Agriculture, and which is served in a congregate setting. There are two types of congregate meals: - Standard meal - A regular meal from the standard menu that is served to the majority or all of the participants. • Therapeutic meal or liquid supplement - A special meal or liquid supplement that has been prescribed by a physician and is planned specifically for the participant by a dietician (e.g., diabetic diet, renal diet, pureed diet, tube feeding). TRANSPORTATION - Taking an older person from one location to another. This does not include any other activity. Demand/Response-transportation designed to carry older persons from specific origin to specific destination upon request. Clients request the transportation service in advance of their need, usually twenty-four to forty-eight hours prior to the trip. Unit Definition: CONGREGATE MEALS: One Meal. TRANSPORTATION: One, One-way Trip. Form #:AIAAA VA1.0 SPAG Ed Date: 9/8/2004 1 of 5 ^^- Service Area: City of Lubbock All Texas Administrative Code standards may be accessed at the Texas Secretary of State website: www.sos.state.tx.us I All Older Americans Act and other required rules and regulations may be accessed at www.aoa.gov/about/legbudz/oaa/legbudg oaa.asR Targeting: Services are designed to identify eligible clients, with an emphasis on high -risk clients and serving older individuals with greatest economic and social need, low-income minorities and those residing in rural areas, as identified in the Older Americans Act. B. Services & Reimbursement Methodology: Service Fixed Rate (include rate) Variable Rate (identify range) Cost Reimbursement Congregate Meals 4.45 Transportation - 4.64 IL TERMS OF THE AGREEMENT A. The Vendor agrees to and/or understands: 1. Provide services in accordance with current or revised DADS policies and the OAA. 2. Target services to older individuals with greatest economic and social need, including low-income minorities and older individuals residing in rural areas as applicable. 3. a) Email roster(s) documentation as required by the AAA by the close of business on the 2nd day of each month following the last day of the month in which services were provided. If the 2nd day falls on a weekend or SPAG holiday, the information shall be delivered by the close of business on the preceding business day. b) Submit appropriate documentation as required by the AAA by the close of business on the 9th day of each month following the last day of the month in which services were provided. If the 9th day falls on a SPAG holiday, the information shall be delivered by the close of business on the preceding business day. 4. The AAA cannot guarantee payment of a reimbursement request received for more than 30 calendar days of service delivery. No reimbursement for services provided will be made if vendor payment invoices are not submitted to the AAA within the 30 days of service delivery. 5. Encourage client contributions (program income) on a voluntary and confidential basis. Such contributions will be properly safeguarded and accurately accounted for as receipts and expenditures on its financial reports if they are not required to be forwarded to the AAA. Client contributions (program income) will be reported fully, as required, to the AAA. Vendor agrees to expend all program income to expand or enhance the program/service under which it is earned. 6. Refer Medicaid eligible clients to the Health and Human Services Commission, and/or the Medicaid participating suppliers/vendors for the purpose of securing Form # A I AAA V A I.0 SPAG Ed Date: 9/8/2004 2 of 5 - --- - appropriate services, as applicable. 7. Notify the AAA Access and Assistance division within 24 hours if, for any reason, the Vendor becomes unable to provide the service(s). 8. Maintain communication and correspondence concerning clients' status. 9. Establish a method to guarantee the confidentiality of all information relating to the client 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 client case records or other information relating to clients served under this agreement. 10. 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 contract year. 11. Make available at reasonable times and for required periods those client 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). 12. This agreement may be terminated for cause or without cause upon the giving of 30 days advance written notice. 13. This agreement does not guarantee a total level of reimbursement other than for individual units/services authorized; contingent upon receipt of funds. 14. It is an independent provider, NOT an agent of the AAA. Thus the Vendor _ indemnifies, saves and holds harmless the South Plains Association of Governments - Area Agency on Aging against expense or liability of any kind arising out of service delivery performed by the Vendor, and to immediately notify the Area Agency on Aging if the Vendor becomes involved in or is threatened with litigation related to Access Assistance participants. 15. Employees shall not solicit nor accept gifts or favors of monetary value by or on behalf of clients as a gift, reward or payment. B. Through the Direct Purchase of Service program, the South Plains Association of Governments Area Agency on Aging agrees to: 1. Review original client intake and assessment forms completed by the Vendor, as applicable, to determine client eligibility. Service authorization is based on client need and the availability of funds. Original client intake and assessment forms will be housed at the South Plains Association of Governments - Area Agency on Aging, 2. Provide timely written notification to Vendor of client's eligibility and authorization to receive services. 3. Maintain communication and correspondence concerning the clients' status. 4. Provide timely technical assistance to Vendor as requested and as available. 5. Conduct quality -assurance procedures, which may include on -site visits, to ensure quality services are being provided. 6. Provide written policy, procedures and standard documents concerning client authorization to release information (both a general and medical/health related release), ability to contribute to the cost of services provided, complaints/ grievances and appeals to all clients. 7. Reimburse the Vendor based on the agreed reimbursement methodology, approved rate(s), service(s) authorized, and Section II.A.(3) and (4) of this document within 30 days of receipt of invoice. Form #:AIAAA VA1.0 SPAG Ed Date: 9/8/2004 3 of 5 tnicilnnc 8. Reimburse the Vendor upon receipt of a properly prepared vendor payment invoice, identified in Section II.B.(7), contingent upon the AAA's receipt of funds authorized for this purpose from DADS. III. ASSURANCES A. Americans with Disabilities Act of 1990 — The VENDOR shall comply with the requirements established under the Americans with Disabilities Act in meeting statutory deadlines established under the Act as they pertain to operations for employment, public accommodations, transportation, state and local goverrunent operations and telecommunications. B. Section 504 of the Rehabilitation Act of 1973 — The VENDOR shall provide that each program activity, when viewed in its entirety is readily accessible to and usable by persons with disabilities in keeping with 45 CFR, Part 84.11, et. seq., and as provided for in Section 504 of the Rehabilitation Act of 1974, as amended. When structural changes are required, these changes shall be in keeping with 45 CFR, Part 74. The VENDOR shall ensure that benefitis and services available under the agreement are provided in a non-discriminatory manner as required by the VI of the Civil Rights Act of 1964, as amended. C. Age Discrimination in Employment Act of 1967 — The VENDOR shall comply with Age Discrimination in Employment Act of 1967 (29 USC 621, et. seq.). D. Drug Free Workplace The VENDOR shall comply with the Drug -Free Workplace Act of 1988, and Texas Senate Bill 1 - 1991, as applicable. E. Certification Regarding Debarment 45CFR §92.35 Sub awards to debarred and suspended parties; this document is required annually as long as this agreement is in affect. F. Independent Audit VENDOR receiving more than $500,000 in federal or state funding from all sources will provide an audit in accordance with the standards for financial and compliance audits contained in the Standards for Audit of Governmental Organizations, Programs, Activities and Functions, issued by the U.S. General Accounting Office; the Single Audit Act of 1984, including all updates and revisions; the provisions of OMB Circular A-133, Audits of States, Local Governments, and Nonprofit Organizations, as applicable, and the Uniform Grant Management Standards. Form #:AIAAA VA1.0 SPAG Ed Date: 9/8l2004 4 of 5 10/5/2005 IV. SIGNATURES For the faithful performance of the terms of this agreement, the parties affix their signatures and bind themselves effective October 1, 2005. City of Lubbock Legal Name of.Contracted Provider Signature McDougal, Mayor Name of Signer South Plains Association of Governments Name of Are Agency on Aging Signature Tim C. Pierce Printed/Typed Name of Signer Date Date Attest: Reb ca Garza sty secretary Approved as to Form ohn Kni ff ity Attorney Forth #:AIAAA VAI.0 SPAG Ed Date: 9/8/2004 5 of 5 MICMAC �" //Area Agency SPAGIZon Aging South Plains Association of Gmmaenh 1323 58th St, PO Box 3730, Freedom Station Lubbock, TX 79452-3730 (806)687-0940 (806)765-9544 1-888-418-6564 DIRECT PURCHASE OF SERVICE APPLICATION INFORMATION The South Plains Association of Governments Area Agency on Aging (SPAG AAA) is designated by the Texas Department of Aging and Disability Services (DADS) to be the focal point for services to persons 60 or older within the AAA's region. The SPAG AAA administers services funded by the Older Americans Act (OAA) with emphasis placed on frail, rural, low income and minority individuals. The AAA purchases various short-term services for eligible clients. Services are purchased from appropriate vendors that have completed a Direct Purchase of Service (DPS) Application form, and have executed a Vendor agreement with the AAA. Eligibility to Apply: Organizations eligible to apply include private non-profit, private for -profit, and local city - county governmental entities, which have the capacity to meet the requirements of service delivery under DPS procedures. Debarred/Suspended Parties: Debarred or suspended parties are ineligible to apply for funding and are excluded from participation in this program. Definition of Direct Purchase of Service (DPS): DPS is a contracting methodology for the purchase of A services by the AA on a client -by -client basis in lieu of annualized contracting, or a fixed sum basis. It is a procurement methodology, which provides flexibility in the purchasing of services for participants in the OAA Programs. Application Process: Interested parties may apply for consideration for participation in the vendor pool by submitting a completed and signed direct purchase of service application, including all required attachments, and certification regarding debarment. If the application is approved by the AAA, a vendor agreement may be executed. Texas Department of Aging and Disavbility Services Vendor Application.xls 1.0 March 1, 2005 ��Area Agency The South Plains Association of Governments Area Agency on Aging f)-a Direct Purchase of Service SP jZon Aging Fiscal Year 2006 Vendor Application/Renewal Update J—A_ Please type or clearly print application information. City of Lubbock Vendor Name/Legal Entity DBA (if applicable) Physical Address: 2001 19th Street Lubbock TX 79401 Mailing Address: PO Box 2000 Lubbock TX 79457 Tax Identification Number (SSN or Federal ID): Fax Number (including area code): 17560005906 806 775-2686 Type of Provider: MGovernmental Agency OPrivate Non -Profit MPrivate For Profit City Government County Government QOther: Authorizing Official: Title: Marc McDougal Mayor EmailAddress: Telephone: MMcDougal@mail.ci.lubbock.tx.us (806) 775-2023 Bitting Contact Person and billing address: Title- Titlo- Johnny Johnny McLellan Recreational Services Manager Email Address: Telephone: imclellan mail.ci.lubbock.tx.us 806 775-2678 Number of Years Organization has been in business: Is Organization Bonded (Attach certificate of bonding ins.) 26 Years 0 Yes No Has anyone involved in the direct provision of client services If Yes, Explain: been convicted of a felony (In -home Services only)? Yes 0 No Does Organization have liability insurance? Attach certificate of all insurances) Attach a copy of all applicable State and Federal Yes 1-1 No licenses and for 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 2 3 4 Service and Bidding information: A. Proposed Service: Congregate Meals 8. Service Area: City of Lubbock C. Proposed AAA cost per unit: Standard cost per Unit: $ 4.45 $ 4.88 A. Proposed Service: Transportation - Demand Response B. Service Area: City of Lubbock C. Proposed AAA cost per unit: Standard cost per Unit: $ 4.64 $ 5.16 A. Proposed Service: B. Service Area: C. Proposed AAA cost per unit: Standard cost per Unit: A. Proposed Service: B. Service Area: C. Proposed AAA cost per unit: Standard cost per Unit: DPS Application Page 2 Additional Attachments: Affirmative Action Plan (only if your organization has 50 or more employees and at least $50,000 in federal contracts) © Signed Certification Regarding Debarment Signature: I Marc McDougal, Mayor certify that the information provided in this application is true and Printed Name correct to the best of my knowledge. Date Attest: OAAO�' ReSeccaGarza _____ City Secretary Approved as to Content 40eMcLellan Recreational Services Manager Approved as to Form 1 oro hn Kgh �ty Attorney DPS Application Page 3 BUDGET WORKSHEET Provider Name: City of Lubbock Contract Number/Service: A4001 Congregate Period covered In YTD: May 31 2006 New Contract Year: October 1 , 2006 - September 30, 2006 NOTE: You must Identify the number of months the YTO actual expenses are based on in Column D, under "Annualized Exo. Months YTO Based on." The worksheet is currently set at 8 months. Annualized Exp. YTD Actual Months YTD Based on I Budgeted Exp. for Percent Difference Reason for Difference/Explanation Cost Area Expenses 8 New Contract Yr. (Budget to Annualized) (If Over Routine Inflation Percentage - 1.85%) 1. Personnel Salaries, PR Taxes & Benefits 92,725.00 139,087.50 140,391.17 0.94% Contract staff, Compensation - Total 92 725.00 139 087.50 140 391.17 0.94% 2. Professional Develo meth Conference - Dues 440.00 660.00 660.00 0.00% Materials - Totai 440.00 660.00 660.00 0.00% 3. MeaWFood Raw Food - Nutrition Supplement - Freight - Storage - ConsumableS - Conbaded Meals/Food 4,000.00 6,000.00 6,000.00 0.00% Other 99 900.00 149 850.00 1 168 750.00 1 5.94% increase in cost of contracted meals. Estimated cost of Total 103 900.00 155 850.00 164 750.00 5.71 % 4. E ui nt Depreciation - Interest - Leasing - Maintenance - - Total 6. Occupanc lBuildin Rent - utilities - Depreciation - Mortgage Interest - Insurance - Security - Cong Page 1 Budget Worksheet FFY 2006 BUDGET WORKSHEET Provider Name: City of Lubbock I Contract Number/Service: A-100/ Congregate Period Covered in YTD: May 31 2006 New Contract Year: October 1 , 2006 - September 30, 2000 NOTE: You must iden§N the number of months the YTD actual expenses are based on in Column D, under "Annualized Exa. Months YTD Based on." The worksheet is currently set at 8 months. Annualized Exp. YTD Actual Months YTD Based on Budgeted Exp. for Percent Difference Reason for Difference/Explanation Cost Area Expenses 8 New Contract Yr. (Budget to Annualized) (If Over Routine Inflation Percentage-1.85%) ;Janitorial - Repair - Taxes - Total - - - S. Trans rtation/Travel Mileage Reimbursement - Delivery - Gas & Oil - Repairs - Insurance - Depreciation/Lease - Interest - Tags & Licenses - - Total 7. Administrative 3 General Advertising 2,400.00 3,600.00 3,600.00 0.00% Printing - Copying - Office supplies 200.00 300.00 300.00 0.00% Contractual Agreements 176.00 264.00 264.00 0.00% Postage - Telecommunications - Liability Insurance - Interest-Wkg. Capital - Legal Fees - Accounting Fees - Consulting Fees - Other Fees (Explain) - Audit - Other Misc. (Explain) - 1 2.776.001 199 841.00 4,164.001 299 761.50 4164.00 1 309 965.17 Total 0.00% 1 3.40% Total of all Cost Areas Gong Page 2 Budget Worksheet FFY 2006 BUDGET WORKSHEET Provider Name: City of Lubbock Contract Number/Service: A-1001 Congregate Period covered In YTD: May 31 2005 New Contract Year: October 1 , 2006 - September 30, 2006 NOTE: You must identify the number of months the YTD actual expenses are based on in Column D, under "Annualized Exo. Months YTD Based on," The worksheet is currently set at 8 months. Annualized Exp. YTO Actual Months YTD Based on Budgeted Exp. for Percent Difference Reason for Difference/Explanation Cost Area Expenses 1 8 1 New Contract Yr. I (Budget to Annualized) (If Over Routine Inflation Percentage -1 Provided Total Number of Anticipated Meals Funding Source DADS III DADS - Title XX DADS -Title XIX :Program Income .Local Funds - Eligible Meals Other Funds - Non -Eligible Meals Local Funds - Required Match Local Funds - Cap Limit Exceeded DADS S Title XX Local Funds - Cap Limit Exceeded Title XIX 0.90% Cost Der Meal Proposed Meals Calculated Rate Revenue 25,870 4.45 115,122 Proposed Meals' Calculated Units 4.45 0 Proposed Meals ' Calculated Units 4.88 0 Proposed Meats' Calculated Units 13,686 4.88 66,788 Proposed Meals' Calculated Units 23,944 4.88 116.847 Proposed Meals • Calculated Units 4.88 0 Proposed Meals • Calculated Units NA 0.43 11,124 DADS Proposed Meats +Title XX Proposed Meals *Calculated Rate NA - 0 DADS Proposed Meats +Title XX Proposed Meals 'Calculated Rate NA - 0 DADS Title XIX Proposed Meals 'Calculated Rate r� 63,500 309,880 Cong Page 3 Budget Worksheet FFY 2006 BUDGET WORKSHEET CALCULATION OF THE PER MEAL UNIT RATE 1.Total Budgeted Expenses for Contract Year 23otal Number of Anticipated Meals to be Provided Title III 25,870 Title XX 0 Title XIX 0 Program Income 13,686 Other Eligible 23,944 Non -Eligible 0 3. Cost per meal (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 Match Title III & Title XX 0.59 $ 4.29 $ 0.43 $ 0.43 7.Proposed Meal Rate (Line 3 minus Line 6) $ 4.45 Rate Cap Applicable to Title III and XX Common Providers Only $ 4.88 8" Excess of Cap Rate Reduction $ - 9. Title III/Title XIX Negotiated Unit Rate $ 4.45 (Line 7 minus Line 8) Title XIX N/A N/A $ 4.88 $ 5.92 $ 4.88 ''If any portion of the required match is in -kind, you must complete an In -Kind Match Certification form. City of Lubbock Legal Name of Contracted Provider Tim C. Pierce P " /Typ N 7 Signer Signature to Marc McDougal, Mayor Printed/Typed Name of Signet Date Department on Aging and Disabilities Services Title XIX and XX Printed/Typed Name of Signer Signature Date 1. $ 309,965.17 2. 63,500 3. $ 4.88 Attest: jeRb'cc aGarza Secretary Approved as to Form olm Kni C ity Attorney Approved as to Content Joluni cLellan Recreational Services Manager Cong Page 4 Budget Worksheet FFY 2006 Per Meal Unit Rate Calculation 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. 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 Cong 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 ti 9-0"/ Date Marc McDougal, Mayor Printed/Typed Name of Signer Signer Authority: r Sole Proprietor r Association Officer (check one) r Partner r Board Member (— Corporate Officer f,R Governmental Official Approved as to Form Approved as to Content Attest: R ecca Garza _ ohn K City Secretary rug ohnn cLellan /,;"ty Attorney Recreational Services Manager Page 5 Budget Worksheet FFY 2006 Per Meal Unit Rate Calculation BUDGET WORKSHEET Provider Name: City of Lubbock Contract Number/Service: A-100 / Transportation Period covered in YTD: May 31, 2005 New Contract Year. October 1 , 200S - September 30, 2006 NOTE: You must identify the number of months the YTD actual expenses are based on In Column D, under "Annualized ExD. Months YTD Based on." The worksheet it currently set at 8 months. Annualized Exp. YTD Actual Months YTD Based on Budgeted Exp. for Percent Difference Reason for Difference Cost Area Expenses 8 New Contract Yr. (Budget to Annualized) (If Over Routine Inflation Percentage-1.85%) 1. Personnel Salaries, PR Taxes 8 Benefits 19,980.00 29,970.00 29,582.36 -1.29% Contract staff, Compensation - Total 19 980.00 29 970.00 29 582.36 -1.29% 2. Professional Development Conference - Dues - Materials - Total - - - 3. E ui ment Depreciation - Interest - Leasing - Maintenance - Total - - - 4.Occu nc /Buildin Rent - Utilities - Depreciation - Mortgage Interest - Insurance - Security - Janitorial - Repair - Taxes - - - - Total S. Trans rtationlTravef Mileage Reimbursement - Delivery - Trans Page 1 Budget Worksheet FFY 2005 BUDGET WORKSHEET Provider Name: City of Lubbock Contract Number/Service: A-100 / Transportation Period covered in YTD: May 31 2005 New Contract Year. October 1 , 2005 - September 30, 2006 NOTE: You must ldentlfir the number of months the YTO actual expenses are based on in Column D, under "Annualized Ex Months YTD Based on." The worksheet Is currently set at 8 months. Annualized Exp. YTD Actual Months YTD Based on Budgeted Exp. for Percent Difference Reason for Difference ;;:CostArea Expenses 8 New Contract Yr. (Budget to Annualized) (If Over Routine Inflation Percentage-1.85%) 8 Oil 4,000.00 6,000.00 6,000.00 0.00% Repairs - Insurance - Depreciation/Lesse - Interest - Tags 8 Licenses - Totai 1 4,000.001 6,000.001 6,060.00 1 0.00% 6. Administrative & General Advertising 200.00 300.00 300.00 0.00% Printing - Copying 80.00 120.00 120.00 0.00% Office Supplies 80.00 120.00 120.00 0.00% Contractual Agreements - Postage - Telecommunications - Liability Insurance - IMerest Wkg. Capital - Legal Fees - Accounting Fees - Consulting Fees - Other Fees (Explain) - Audit - Other Misc. (Explain) - Total 360.00 54o.00l 540.00 0.0% Total of all Cost Areas 24 340.00 36 510.00 1 36122.36 -1.06% Total Number of Units Provided 5,093.00. 79639.50 Total Number of ,Anticipated Units 7,000 -8.37% Budgeted Cost per Unit $5.16 Enter the Total Number of Anticipated Units or the Proposed units by Funding Source Trans Page 2 Budget Worksheet FFY 2005 BUDGET WORKSHEET Funding Source AAAIDADS - Match Required AAA/DADS -Full Unit Rate Program Income Local Funds - Other Eligible Source 5 Source 6 Local Funds - Required Match Proposed Units Calculated Rate 2,000 4.64 5.16 560 5.16 4,440 5.16 5.16 5.16 NA 0.52 7,000 Revenue 9,280 Proposed Units' Calculated Units 0 Proposed Units' Calculated Units 2,890 Proposed Units' Calculated Units 22,910 Proposed Units *Calculated Units 0 Proposed Units' Calculated Units 0 Proposed Units' Calculated Units 1,040 DADS/AAA Proposed Units *Calculated Rate 36,120 Trans Page 3 Budget Worksheet FFY 2005 BUDGET WORKSHEET CALCULATION OF THE UNIT RATE 17otal Budgeted Expenses for Contract Year 1. $ 36,122.36 2.Total Number of Anticipated Units to be Provided AAA/DADS - Match Program Required 2,000 Income 560 Source 5 0 AAA/DADS - Full Unit Local Funds - Rate 0 Other Eligible 4,440 Source 6 0 2. 7,000 3. Cost per unit (Line 1 divided by Line 2) - Full Unit Rate 3. $ 5.16 Reimbursement Calculation for Contracts Requiring Unit Rate Match Reduction 4. Mandatory Local Match of 10% $ 0.52 If Applicable, Match Reduction From the In -kind Match Certification form $ - Required Match 4. $ 0.52 5.Full Unit Rate Less Required Match (Line 3 minus Line 5. $ 4.64 "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 $ 5.16 Contractor Initial AAA Initial Contract Reimbursed at the Full Cost Per Unit Less Required Match. $ 4.64 Contractor Initial AAA Initial City of Lubbock South Plains Association of Governments Legal Name of C tract rovider N e Area enc on ing zo�/ Wh9fure Signet e Marc McEfou_gal, Ma 10- —liZ' Date Tim C. Pierce Printedt[yped N 1me of ner Date Attest: Approved as to Forjn Rebedca Garza City Secretary ohn Knig ity Attorney Approved as to Content 4o6y Leellan Recreational Services Manager t Trans Page 4 9udget WorWeet FFr 2005 Rate CakuMm Certification Regarding Debarment CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION FOR COVERED CONTRACTS AND GRANTS Federal Executive Order 125.49 requires the Texas Department of Aging and Disability Services (DADS)) to screen each covered potential vendor/grantee to determine whether each has a right to obtain a contract/grant in accordance with federal regulations on debarment, suspension, ineligibility, and voluntary exclusion. Each covered vendor/grantee must also screen each of its covered sub vendors/providers. In this certification "vendor/grantee" refers to both vendor/grantee and sub vendor/sub- grantee: "contract/grant" refers to both contract/grant and subcontract/sub-grant. By signing and submitting this certification the potential vendor/grantee accepts the following terms: 1. The certification herein below is a material representation of fact upon which reliance was placed when this contract/grant was entered into. It is later determined that the potential vendor/grantee knowingly rendered an erroneous certification, in addition to other remedies available to the federal government, the Department of Health and Human Services. United. States Department of Agriculture or other federal department or agency, or the Texas Department of Aging and Disability Services may pursue available remedies, including suspension and/or debarment. 2. The potential vendor/grantee shall provide immediate written notice to the person to which this certification is submitted if at any time the potential vendor/grantee learns that the certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 3. The words "covered contract," " debarred," "suspended," "ineligible," "participant," "person," "principal," "proposal," and "voluntarily excluded," as used in this certification have meanings based upon materials in the Definitions and Coverage sections of federal rules implementing Executive Order 12549. Usage is as defined in the attachment. 4. The potential vendor/grantee agrees by submitting this certification that, should the proposed covered contract/grant be entered into, it shall knowingly into any subcontract with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the Department of Health and Human Services, United States Department of CERTIFICATION REGARDING DEBARMENT Page 2 Agriculture or other federal department or agency, and/or the Texas Department of Aging and Disability Services, as applicable. Do you have or do you anticipate having sub vendors/sub-grantees under this proposed contract? y,_-yes no S. The potential vendor/grantee further agrees by submitting this certification that it will include this certification titled "Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion for Covered Contracts and Grants" without modification, in all covered subcontracts and in solicitations for all covered subcontracts. 6. A vendor/grantee may rely upon a certification of a potential sub vendor/sub-grantee that is not debarred, suspended, ineligible, or voluntarily excluded from the covered contract/grant, unless the vendor/grantee knows that the certification is erroneous. A vendor/grantee must, at a minimum obtain certifications from its covered sub vendors/sub-grantees upon each subcontract's/sub-grant's initiation and upon each renewal. 7. Nothing contained in all the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification by this certification document. The knowledge and information of a vendor/grantee is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 8. Except for contracts/grants authorized under paragraph 4 of these terms, if a vendor/grantee in a covered contract/grant knowingly enters into a covered subcontract/subgrant with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in the transaction, in addition to other remedies available to the federal government, Department of Health and Human Services, United States Department of Agriculture, or other federal department or agency, as applicable, and/or the Texas Department of Aging and Disability Services may pursue available remedies, including suspension and/or debarment. CERTIFICATION REGARDING DEBARMENT Page 3 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION FOR COVERED CONTRACTS AND GRANTS Indicate which statement applies to the covered potential vendor/grantee: The potential vendor/grantee certifies by submission of this certification that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this contract/grant by any federal department or agency or by the State of Texas. The potential vendor/grantee is unable to certify one or more of the terms in this certification. In this instance, the potential vendor/grantee must attach an explanation for each of the above terms to which it is unable to make certification. Attach the explanation(s) to this certification. NAME OF POTENTIAL VENDOR/GRANTEE City of Lubbock VENDOR ID NO./FEDERAL EMPLOYER'S ID NO. 17560005906 Si ature of AuthCraW lCepresentative John Knight Printed/Typed Name of Authorized Representative City Attorney ,Z-11'9 —'-�'C4 Title of Authorized Representative Date THIS CERTIFICATION IS FOR FY 2006, PERIOD BEGINNING 10/1/2005 and ENDING 9/30/2006. CERTIFICATION REGARDING DEBARMENT Page 4 DEFINITIONS Covered Contract/Grant and Subcontracts/Sub-grants. (1) Any non -procurement transaction which involves federal funds (regardless of amount and including such arrangements as sub -grants) and is between the Texas Department of Aging and Disability Services or its agents/grantees and another entity. (2) Any procurement contract for goods or services between a participant and a person, regardless of type, expected to equal or exceed the federal procurement small purchase threshold fixed at 10 U.S.C. 2304(g) and 41 U.S.C. 253(g) (currently $25,000) under a grant or sub -grant. (3) Any procurement contract for goods or services between a participant and a person under a covered grant, sub -grant, contract or subcontract, regardless of amount, under which that person will have a critical influence on or substantive control over that covered transaction including: a. Principal investigators. b. Providers of audit services required by the Texas Department of Aging and Disability Services or federal funding source. C. Researchers. DEBARMENT An action taken by a debarring official in accordance with 45 CFR Part 76 (or comparable federal regulations) to exclude a person from participating in covered contracts/grants. A person so excluded is "debarred." GRANT An award of financial assistance, including cooperative agreements, in the form of money, or property in lieu of money, by the federal government to an eligible grantee. INELIGIBLE Excluded from participation in federal non -procurement programs pursuant to a determination of ineligibility under statutory, executive order, or regulatory authority, other an Executive Order 12549 and its agency implementing regulations: for example, excluded pursuant to the Davis -Bacon Act and its implementing regulations, the equal employment opportunity acts and executive orders, or the environmental protection acts and executive orders. A person is ineligible where the determination of ineligibility affects such person's eligibility to participate in more than one covered transaction. CERTIFICATION REGARDING DEBARMENT Page 5 PARTICIPANT Any person who submits a proposal for, enters into, or reasonably may be expected to enter into a covered contract. This term also includes any person who acts on behalf of or is authorized to commit a participant in a covered contract/grant as an agent or representative of another participant. PERSON Any individual, corporation, partnership, association, unit of government, or legal entity, however organized, except: foreign governments or foreign governmental entities, public international organizations, foreign government owned (in whole or part) or controlled entities, and entities consisting wholly or partially of foreign governments or foreign governmental entities. PRINCIPAL Officer, director, owner, partner, key employee, or other person within a participant with primary management or supervisory responsibilities: or a person who has a critical influence on or substantive control over a covered contract/grant whether or not the person is employed by the participant. Persons who have a critical influence on or substantive control over a covered transaction are: (1) Principal investigators. (2) Providers of audit services required by the Texas Department of Aging and Disability Services or federal funding source. (3) Researchers. PROPOSAL A solicited or unsolicited bid, application, request, invitation to consider or similar communication by or on behalf of a person seeking to receive a covered contract/grant. SUSPENSION An action taken by a suspending official in accordance with 45 CFR part 76 (or comparable federal regulations) that immediately excludes a person from participating in covered contractstgrants 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. CERTIFICATE OF SELF-INSURANCE The undersigned officer of the City of Lubbock, Texas, a Texas home rule municipality, hereby certifies that the City of Lubbock has a $500,000.00 self - insured retention for Automobile and General Liability in accordance with the laws of the State of Texas. The City of Lubbock has a policy that covers Property/Bodily Injury over $500,000.00 per occurrence with St. Paul Fire and Marine under policy policy #GPP06301452 which expires on 10/01/06. The current balance of the self- insurance fund is $2,332,854. The existing cash asset balance is $8,487,825 as of the date stated below. By: Leisa Hutcheson Risk Management Coordinator Date: September 30, 2005