HomeMy WebLinkAboutResolution - 2006-R0438 - Change To DSHS Contract Immunization Branch Locals - TX Dept. Of State Health - 09_13_2006Resolution No. 2006-RO438
September 13, 2006
Item No. 5.12
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 Change No.2 to the DSHS
Contract No. 7560005906 2007 Immunization -Branch -Locals and any associated
documents, by and between the City of Lubbock and the Texas Department of State
Health Services, and any related documents. Said Change No. 2 and any associated
documents are attached hereto and incorporated in this Resolution as if fully set forth
herein and shall be included in the minutes of the City Council.
Passed by the City Council this 13th day of September '2006.
p�-
DAVID A. M LLER, MAYOR
ATTEST:
Rebe1cca Garza, City Secretary
APPROVED AS TO CONTENT:
,.'I- ' 140� (A��
Tommy CaQen, Public Health Director
APPROVED AS TO FORM:
11
Vandiver, Attorney o
ddres/DS HSlmmunizationBranchConChange2Res
August 31, 2006
Resolution No. 2006-RO438
, September 13, 2006
Item No. 5.12
DEPARTMENT OF STATE HEALTH SERVICES
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS DSHS Document No. 756Q 5906 2007
COUNTY OF TRAVIS Contract Change Notice No. 02
The Department of State Health Services, hereinafter referred to as DSHS, did heretofore enter into a contract in writing with
LUBBOCK CITY HEALTH DEPARTMENT hereinafter referred to as Contractor. The parties thereto now desire to amend such
contract attacnment(s) as toiiows:
SUMMARY OF TRANSACTION:
ATT NO. 03 : IMMUNIZATION BRANCH - LOCALS
All terms and conditions not hereby amended remain in full force and effect.
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
CITY OF LUBBOCK HEALTH DEPARTMENT
Authorized Contracting Entity (type above if different
from Contractor) for and in behalf of:
CONTRACTOR:
LUBBOCK CITY HEALTH DEPARTMENT
By. —�
(Signature of p son authorized to sign)
DAVID A. MILLER, MAYOR
(Name and Title)
Date:
September 13, 2006
RECOMME ED:
By:
(rector, t ifferent
erson authorized to sign contract
DSHS:
DEPARTMENT OF STATE HEALTH SERVICES
By:
(Signature of person authorized to sign)
Bob Burnette, Director
Client Services Contracting Unit
(Name and Title) r �,
Date: 'it) I [ /� J W
Ap roved as to for
ity Att l n
t Cover Page 1
v w t_:NL u - xev. uiue
ATTEST:
Rebdcca Garza, City cretary
DETAILS OF ATTACHMENTS
Att/
DSHS Program ID/
Term
Financial Assistance
Direct
Total Amount
Amd
DSHS Purchase
Assistance
(DSHS Share)
No.
Order Number
Begin
End
Source of
Amount
Funds*
01
RLSS/LPHS
09/01/06
08/31/07
State 93.991
108,204.00
0.00
108,204.00
0000320351
02
HIV/SURV
09/01/06
08/31/07
State
50,251.00
0.00
50,251.00
0000321081
03
IMM/LOCALS
09/01/06
08/31/07
State 93.268
138,264.00
0.00
138,264.00
0000320750
DSHS Contract No.7560005906 2007 Totals
$296,719.00
$ 0.00
$296,719.00
Chan a No. 02
*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. 7560005906-2007
PROGRAM ATTACHMENT NO. 03
PURCHASE ORDER NO.0000320750
CONTRACTOR: LUBBOCK CITY HEALTH DEPARTMENT
DSHS PROGRAM: IMMUNIZATION BRANCH
TERM: September 01, 2006 THRU: August 31, 2007
SECTION I. STATEMENT OF WORK:
Resolution No. 2006-R0438
September 13, 2006
Item No. 5.12
Contractor shall provide essential public health services as specified in Contractor's
approved 2004 Interlocal Application for Immunization Services, ILA I04 0003.1, dated
June 16, 2003, incorporated herein by reference and made part of this Program
Attachment. Any revisions to these documents shall be approved by the DSHS Program
and transmitted in writing to Contractor.
DSHS may renew this Program Attachment for 1 (one) additional year term at DSHS's
sole discretion. "
Contractor shall implement an immunization program for children, adolescents, and
adults, with special emphasis on accelerating interventions to improve the immunization
coverage of children two years of age or younger (less than 36 months of age).
Contractor shall incorporate traditional and non-traditional systematic approaches
designed to eliminate barriers, expand immunization delivery, and establish uniform
policies.
Contractor shall be enrolled as a provider in the Texas Vaccines for Children Program
(TVFC) and adhere to the TVFC Operations Manual and policy guidelines provided by
DSHS.
Contractor shall report all reportable conditions as specified in 25 Texas Administrative
Code (TAC) Part I §§97.1 - 97.6 and §§97.101 - 97.102.
Contractor shall report all vaccine adverse event occurrences in accordance with the
National Childhood Vaccine Injury Act of 1986.
Contractor shall inform and educate the public about vaccines and vaccine -preventable
diseases.
Contractor shall develop policies and plans that support individual and community -based
immunization strategies and evaluate the effectiveness, accessibility, and quality of
personal and population -based immunization services and program activities.
ATTACHMENT — Page 1
Contractor shall ensure a health care workforce that is knowledgeable about vaccines,
vaccine safety, vaccine -preventable diseases, and delivery of immunization services.
Contractor shall comply with written policies and procedures provided by DSHS in
managing vaccines supplied through the TVFC program, including guidelines for proper
storage and handling of vaccines and for safeguarding vaccine in the event of natural
disaster.
Contractor shall implement DSHS's new vaccine management system, the Pharmacy
Inventory Control System (PICS), as the system becomes available throughout the state
in FY 2007. Implementation will include using PICS in Contractor clinics, promoting the
use of the system in non -health department TVFC provider offices, and performing
updates to the system on behalf of TVFC provider offices that submit monthly doses
administered and vaccine accounting reports in hardcopy.
Contractor shall maintain an accurate, up-to-date list of clinics and sites where public
sector (free or low cost) immunization services are offered in the jurisdiction served by
the Contractor.
Contractor shall not charge a fee for vaccines supplied through the TVFC program. All
TVFC-supplied vaccines shall be used solely for purposes of this Program Attachment
and shall not be sold to agencies or individuals.
In accordance with 25 TAC § 1.91, Contractor shall not collect vaccine administration
fees from Medicaid and Children's Health Insurance Program (CHIP) recipients. Vaccine
administration fees collected from non -Medicaid patients shall not exceed those
established in Section Two, Part Four of the TVFC Operations Manual. Fee schedules
shall not be based on vaccine type, formulation, or dose in series.
Contractor shall not deny vaccinations to recipients because they do not reside within
Contractor's jurisdiction or because of an inability to pay an administration fee.
All equipment and vaccine used by Contractor which are provided by DSHS shall be
accounted for as public property. The DSHS Program will investigate equipment or
vaccine loss, destruction, spoilage, or other waste and may require Contractor to replace
or reimburse the DSHS Program. This provision does not waive any other remedies
legally available to DSHS regarding contract breaches.
Contractor shall provide to the DSHS Program periodic electronic data transfers of all
vaccines administered in a format that is compatible for inclusion in the statewide
immunization registry, ImmTrac, and in accordance with the schedule provided by
DSHS.
Contractor shall comply with all applicable federal and state laws, rules, regulations,
standards, and guidelines in effect on the beginning date of this Program Attachment
ATTACHMENT — Page 2
unless amended. The following documents are incorporated by reference and made a part
of this Program Attachment.
• Contractor's approved 2004 Interlocal Application for Immunization Services;
• Human Resources Code §42.043, VTCA;
• Education Code §§38.001-38.002, VTCA;
• Health and Safety Code §12.032, §§81.023 and 161.001-161.009, VTCA;
• 25 TAC Chapter 97;
• 25 TAC, Chapter 96;
• 25 TAC, Chapter 100;
• 42 USC §§247b and 300 as-25;
• Omnibus Budget Reconciliation Act of 1993, 26 USC §4980B;
• DSHS's Standards for Public Health Clinic Services, revised August 31, 2004;
• DSHS's Vaccine -Preventable Disease Surveillance guidelines,
http://www.dshs. state.tx .us/immunize/vpd—main. shtm;
• DSHS's TVFC Operations Manual,
http://www.dshs.state.tx.us/immunize/tvfc/tvfc—manual.shtrn;
• Centers for Disease Control and Prevention's Advisory Committee on
Immunization Practices (ACID) guidelines, including the statement:
"Immunization of Health -Care Workers",
http://www.cdc.gov/nip/ACIP/default.htm; and,
• Standards for Child and Adolescent Immunization Practices, February 8, 2002,
recommended by the National Vaccine Advisory Committee, approved by the
United States Public Health Service, and endorsed by the American Academy of
Pediatrics, http://www.cdc.gov/nip/publications/pink/appendices/H/standards-
pediatric.pdf.
This Contract is contingent upon the continued availability of funding. If funds become
unavailable through lack of appropriations, budget cuts, transfers of funds between
programs or health and human services agencies, amendment to the Appropriations Act,
health and human services agencies consolidation, or any other disruptions of current
appropriated funding for this Contract, DSHS may restrict, reduce, or terminate funding
under this Contract.
PERFORMANCE MEASURES
All activities shall be performed in accordance with Contractor's Annual Plan and
detailed budget, as approved by DSHS, based on the 2004 Interlocal Application for
Immunization Services, ILA I04 0003.1, dated June 16, 2003. The following
performance measure(s) will be used, in part, to assess Contractor's effectiveness in
providing the services described in this Program Attachment, without waiving the
enforceability of any of the terms of the Contract:
Contractor shall submit to the DSHS Program the monthly reports of doses
administered and the monthly biological order form in a format provided by DSHS
ATTACHMENT — Page 3
and in accordance with the schedule provided to Contractor by DSHS. Reports
should be submitted to:
Department of State Health Services
Immunization Branch (Mail Code 1946)
1100 W. 49`h Street
Austin, TX 78756
Contractor shall implement an immunization reminder and recall system to notify
parents or guardians of children less than 36 months of age when immunizations are
due or past due. The notifications may be automated or manual and may consist of
mail or telephone contacts.
Contractor shall utilize the AFIX (Assessment, Feedback, Incentives, and eXchange)
methodology to conduct quality assurance site -visits for all sub -contracted entities
and non -local health department Women, Infant and Children (WIC) clinics.
Assessment shall be done using the DSHS Immunization Quality Assurance Site
Visit tool and the Clinic Assessment Software Application (CASA), as specified by
the DSHS Program. Contractor shall submit assessment results to the appropriate
DSHS Regional Immunization Program manager within two (2) weeks after
completion.
Contractor shall recruit and enroll providers into the Texas Vaccines for Children
(TVFC) program and recruit and register providers to use the statewide registry,
ImmTrac, to look up child records at every visit and to report immunizations
administered as required by law.
Contractor shall perform all the activities associated with the following Objectives stated
in the 2007 renewal application:
1. Develop a comprehensive plan to assure that immunization services and
ACID -recommended vaccines are available to medically underserved and/or
under -immunized children and adults living in areas where coverage is low
(pockets of need);
2. Work with local WIC programs for assessment of children's immunization
status and referral of under -vaccinated WIC enrollees for vaccination at their
medical home.
3. Build and participate in a variety of partnerships with community -based
organizations and human service agencies (internal and external to your Local
Health Department [LHD]) to promote best practices, specific activities, and
special projects to increase vaccination coverage levels for children 0 through
35 months;
4. Ensure that expired, wasted, and unaccounted for vaccines do not exceed 5%
for DTaP, Hib, hepatitis B, IPV, MMR, PCV7, varicella, hepatitis A, and
combination vaccines in LHD clinics;
5. Effectively utilize ImmTrac in LHD clinics;
ATTACHMENT - Page 4
6. Increase the number of registered provider sites actively reporting
immunizations to ImmTrac;
7. Promote the effective use of ImmTrac by private providers;
8. Increase the number of children less than six years of age who participate in
ImmTrac;
9. Ensure that ImmTrac data are complete, current, and accurate;
10. Increase TVFC provider enrollment;
11. Provide educational opportunities to public and private providers on vaccine
recommendations, the Standards for Child and Adolescent Immunization
Practices and the Standards for Adult Immunization Practices, reporting of
vaccine -preventable diseases, recordkeeping, the use of Vaccine Information
Statements (VIS), the TVFC program, and the ImmTrac registry;
12. Complete 100% of quality assurance follow-up visits assigned by DSHS
Austin or Health Service Region Staff;
13. Provide immunization services and ACID -recommended vaccines to ensure
that children are fully vaccinated;
14. Promote adult immunization among adults in the general population and
among health care workers;
15. Conduct educational, promotional, and outreach activities for the general
public to enhance immunization awareness;
16. Investigate and document 90% of reportable suspected vaccine -preventable
disease cases within 30 days of notification in accordance with DSHS's
Vaccine -Preventable Disease (VPD) Surveillance Guidelines;
17. Implement a comprehensive Perinatal Hepatitis B program that accomplishes
the following:
a. Increase by 5% the number of hepatitis B surface antigen -positive
(HBsAg+) pregnant women identified;
b. Increase by 5% the number of infants born to HBsAg+ pregnant
women that are identified;
c. Increase by 5% the number of these infants that receive one dose of
hepatitis B vaccine and HBIG within 12 hours of birth and no later
than seven days after birth;
d. Increase by 5% the number of these infants that complete the hepatitis
B vaccine series and receive post -vaccination serologic testing; and,
e. Increase by 5% the number of susceptible household and sexual
contacts of HBsAg+ pregnant women that complete the hepatitis B
vaccine series.
18. Assure that rubella susceptible women identified in public health clinics are
offered MNIR;
19. Complete 100% of child-care facility and Head Start assessments assigned by
DSHS; and,
20. Complete 100% of public and private school assessments and retrospective
and validation surveys assigned by DSHS.
ATTACHMENT — Page 5
Activities may be subsequently amended as directed by the Centers for Disease Control
and Prevention (CDC) and DSHS. The DSHS Program must approve, in writing, any
revisions to the Contractor's Annual Plan.
SECTION II. SPECIAL PROVISIONS:
Contractor shall comply with Texas Health and Safety Code, Chapters 81 and 161.
Funds shall not be used for purchase of vaccines, inpatient care, construction of facilities,
or debt retirement in accordance with the DSHS 2004 Interlocal Application for
Immunization Services, dated June 16, 2003.
Travel expenses shall be reimbursed according to Contractor's written travel policy
submitted with the 2007 renewal application. If no written travel policy was submitted,
travel expenses shall be reimbursed according to current state travel regulations. In no
case shall reimbursement exceed the reimbursement for hotel, per diem and mileage
allowed under the current Appropriations Act.
Monthly billings must be submitted on a State of Texas Voucher Request form no later
than the close of the following month. Vouchers may be emailed to
invoices@ dshs.state.tx.us, faxed to (512) 458-7442, or mailed to:
Texas Department of State Health Services
Fiscal/Claims Processing Unit/Grants (G-206)
ATTN: Randall Childers
1100 W. 49 h Street
Austin, TX 78756
Contractor is required to complete and submit the following tri-annual reports utilizing a
format provided by the DSHS Program:
Report Type
Reporting Period
Report Due Date
Programmatic
9/1/06 — 12/31/06
1/30/07
Programmatic
1/l/07 — 4/30/07
5/30/07
Programmatic/Final
5/1/07 — 8/31/07,
10/15/07
Tri-annual reports should be submitted electronically to the appropriate DSHS Regional
Immunization Program Manager identified on the reporting form.
For immunization activities performed under this Program Attachment, General
Provisions, General Business Operations of Contractor Article, Overtime
Compensation Section, is replaced with the following paragraphs:
Contractor is authorized to pay employees who are not exempt under the Fair
Labor Standards Act (FLSA), 29 USC, Chapter 8, §201 et seq., for overtime or
compensatory time at the rate of time and one-half per FLSA.
ATTACHMENT — Page 6
Contractor is authorized to pay employees who are exempt under FLSA on a
straight time basis for work performed on a holiday or for regular compensatory
time hours when the taking of regular compensatory time off would be disruptive
to normal business operations.
Authorization for payment under this provision is limited to work directly related
to immunization activities and shall be in accordance with the amount budgeted in
this contract Attachment. Contractor shall document proper authorization or
approval for any work performed by exempt or non-exempt employees in excess
of forty (40) hours per work week.
ATTACHMENT — Page 7
SECTION III. BUDGET:
PERSONNEL
FRINGE BENEFITS
TRAVEL
EQUIPMENT
SUPPLIES
CONTRACTUAL
OTHER
TOTAL DIRECT CHARGES
INDIRECT CHARGES
TOTAL
Total reimbursements will not exceed $138,264.00.
$95,337.00
42,345.00
0.00
0.00
0.00
0.00
582.00
$138,264.00
$0.00
$138,264.00
Financial status reports are due the 30th of December, 30th of March, 30th of June, and the 30th
of October.
ATTACHMENT — Page 8
CERTIFICATION REGARDING LOBBYING Resolution No. 2006-RO438
CERTIFICATION FOR CONTRACTS, GRANTS, September 13, 2006
LOANS AND COOPERATIVE AGREEMENTS Item No. 5.12 ,
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 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 it's
instructions.
(3) The undersigned shall require that the language of this certification be included in the
award documents for all subawards at all tiers (including subcontracts, subgrants,
and contracts under grants, loans and cooperative agreements) and that all
subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when
this transaction was made or entered into. Submission of this certification is a prerequisite
for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code.
Any person who fails to file the required certification shall be subject to a civil penalty of not
less than $10,000 and not more than $100,000 for each such failure.
September 13, 2006
Date
DAVID A. MILLER, MAYOR
Print Name of Authorized Individual
7560005906 2007-03
Application or Contract Number
LUBBOCK CITY HEALTH DEPARTMENT
Organization Name and Address
1902 TEXAS AVE
LUBBOCK, TX 79411-2117
1100 West 49th Street
Austin, Texas 78756-3199
Department of State Health Services
FINANCIAL STATUS REPORT
FSR269A Fiscal Division/Accounts Payable
Phone (512) 458-7435
Contractor Name: LUBBOCK CITY HEALTH DEPARTMENT
DSHS Program: IMM/LOCALS
DSHS Document # Year Attachment #
Payee Acct. No.:
7560005906 2007 03
Payee Vendor ID No.: 17560005906001
Basis: I l Cash I ] Accrual
Payee Name: CITY OF LUBBOCK
Address: PO BOX 2000
City, ST, Zip: LUBBOCK, TX 79408-2000
Contract Term: (Month/Day/Year)
From:09/01/2006 To: 08/31/2007
Period Covered by this Report:
From: 09/01/2006 To: 11/30/2006
PO Number: 0000320750
Final Report? I ] Yes [ X No
(i) Budget Categories
(ii)
Approved
Budget
Project Cost per General Ledger
(v)
Remaining
Budget
Balance
(ii minus iv)
(iii)
This Period
(iv)
Cumulative
a. Personnel [ ]
95,337.00
b. Fringe Benefits [ ]
42,345.00
c. Travel [ ]
0.00
d. Equipment (]
0.00
e. Supplies (]
0.00
f. Contractual (]
0.00
g.Other [ ]
582.00
h. Total Direct Charges
138,264.00
i. Indirect Charges [ ]
0.00
'. Total Charges
138,264.00
LESS:k. Program Income Collected
1. Non-DSHS Funding
in. ADVANCE:Received (Col. iii)/ Repaid (Col, ivy
Balance Owed Col. v
n. Total Reimbursement Requested
o. Total Reimbursement Received
Prepared by:
Title: Phone #:
CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and
complete and that all outlays and unliquidated obligations are for the purposes set forth in the award
documents.
Signature of Authorized Certifying Official
Date Submitted:
Typed or Printed Name and Title of Certifying Official
Telephone
DSHS Form GC-4a (269a) Revised 6/04
1100 West 49th Street
Austin, Texas 78756-3199
Department of State Health Services
FINANCIAL STATUS REPORT
FSR269A Fiscal Division/Accounts Payable
Phone (512) 458-7435
Contractor Name: LUBBOCK CITY HEALTH DEPARTMENT
DSHS Program: IMM/LOCALS
DSHS Document # Year Attachment #
Payee Acct. No.:
7560005906 2007 03
Payee Vendor ID No.: 17560005906001
Basis: [ [ Cash [ I Accrual
Payee Name: CITY OF LUBBOCK
Address: PO BOX 2000
City, ST, Zip: LUBBOCK, TX 79408-2000
Contract Term: (Month/Day/Year)
From:09/01/2006 To: 08/31/2007
Period Covered by this Report:
From: 12/01/2006 To: 02/28/2007
PO Number: 0000320750
Final Report? [ [ Yes [ X No
(i) Budget Categories
00
Approved
Budget
Project Cost per General Ledger
(v)
Remaining
Budget
Balance
(ii minus iv)
(iii)
This Period
(iv)
Cumulative
a. Personnel [ ]
95,337.00
b. Fringe Benefits [ ]
42,345.00
c. Travel [ ]
0.00
d. Equipment [ ]
0.00
e. Supplies [ ]
0.00
f. Contractual [ ]
0.00
g.Other [ ]
582.00
h. Total Direct Charges
138,264.00
i. Indirect Charges [ ]
0.00
'. Total Charges
138,264.00
LESS:k. Program Income Collected
( }
}
1. Non-DSHS Funding(
}
m. ADVANCE:Received (Col. iii)/ Repaid (Col. ivy
Balance Owed Col. v
( }
n. Total Reimbursement Requested
o. Total Reimbursement Received
Prepared by:
Title: Phone #:
CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and
complete and that all outlays and unliquidated obligations are for the purposes set forth in the award
documents.
Signature of Authorized Certifying Official
Date Submitted:
Typed or Printed Name and Title of Certifying Official
Telephone
DSHS Form GC 4a (269a) Revised 6/04
1100 West 49th Street
Austin, Texas 78756-3199
Department of State Health Services
FINANCIAL STATUS REPORT
FSR269A Fiscal Division/Accounts Payable
Phone (512) 458-7435
Contractor Name: LUBBOCK CITY HEALTH DEPARTMENT
DSHS Program: IMM/LOCALS
DSHS Document # Year Attachment #
Payee Acct. No.:
7560005906 2007 03
Payee Vendor ID No.: 17560005906001
Basis: I 1 Cash I 1 Accrual
Payee Name: CITY OF LUBBOCK
Address: PO BOX 2000
City, ST, Zip: LUBBOCK, TX 79408-2000
Contract Term: (Month/Day/Year)
From:09/01/2006 To: 08/31/2007
Period Covered by this Report:
From: 03/01/2007 To: 05/31/2007
PO Number: 0000320750
Final Report? I 1 Yes I X No
(i) Budget Categories
Approved
Budget
Project Cost per General Ledger
(v)
Remaining
Budget
Balance
(ii minus iv)
(iii)
This Period
(iv)
Cumulative
a. Personnel [ ]
95,337.00
b. Fringe Benefits [ ]
42,345.00
c. Travel [ ]
0.00
d. Equipment [ ]
0.00
e. Supplies [ ]
0.00
f. Contractual [ ]
0.00
g.Other [ ]
582.00
h. Total Direct Charges
138,264.00
i. Indirect Charges [ ]
0.00
'. Total Charges
138,264.00
LESS:k. Pro am Income Collected
( )
)
1. Non-DSHS Funding(
)
m. ADVANCE:Received (Col. iii)/ Repaid (Col. ivy
Balance Owed Col. v
( )
n. Total Reimbursement Requested
o. Total Reimbursement Received
Prepared by:
Title: Phone #:
CERTIFICATION:I certify to the best of my knowledge and belief that this report is correct and
complete and that all outlays and unliquidated obligations are for the purposes set forth in the award
documents.
Signature of Authorized Certifying Official
Date Submitted:
Typed or Printed Name and Title of Certifying Official
Telephone
DSHS Form GC-4a (269a) Revised 6/64
1100 West 49th Street
Austin, Texas 78756-3199
Department of State Health Services
FINANCIAL STATUS REPORT
FSR269A Fiscal Division/Accounts Payable
Phone (512) 458-7435
Contractor Name: LUBBOCK CITY HEALTH DEPARTMENT
DSHS Program: IMM/LOCALS
DSHS Document # Year Attachment #
Payee Acct. No.:
7560005906 2007 03
Payee Vendor H) No.: 17560005906001
Basis: ] 1 Cash ] 1 Accrual
Payee Name: CITY OF LUBBOCK
Address: PO BOX 2000
City, ST, Zip: LUBBOCK, TX 79408-2000
Contract Term: (Month/Day/Year)
From: 09/01 /2006 To: 08/31 /2007
Period Covered by this Report:
From: 06/01/2007 To: 08/31/2007
r-poNumber: 0000320750
Final Report? I XYes [ ] No
(i) Budget Categories
(ii)
Approved
Budget
Project Cost per General Ledger
(v)
Remaining
Budget
Balance
(ii minus iv)
(iii)
This Period
(iv)
Cumulative
a. Personnel [ ]
95,337.00
b. Fringe Benefits [ ]
42,345.00
c. Travel [ ]
0.00
d. Equipment [ ]
0.00
e. Supplies [ ]
0.00
f Contractual [ ]
0.00
g.Other [ ]
582.00
h. Total Direct Charges
138,264.00
i. Indirect Charges [ ]
0.00
'. Total Charges
138,264.00
LESS:k. Pro am Income Collected
( )
1. Non-DSHS Funding(
)
m. ADVANCE:Received (Col. iii)/ Repaid (Col. ivy
Balance Owed Col. v
( )
n. Total Reimbursement Requested
o. Total Reimbursement Received
Prepared by:
Title: Phone #:
CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and
complete and that all outlays and unliquidated obligations are for the purposes set forth in the award
documents.
Signature of Authorized Certifying Official
Date Submitted:
Typed or Printed Name and Title of Certifying Official
Telephone
DSHS Form GC-4a (269a) Revised 6/04
TEXAS DEPARTMENT OF STATE HEALTH SERVICES
WUARDO 1. SANCHEZ, M.D., M.P.H.
COMMISSIONER
411,
Dear Contractor:
OFAT
1100 W. 49`b Sbvd • Austin, Texas 78756
1-888-963-7111 • http:Nwww.dshs.state.bc.us
Enclosed are two copies of your Department of State Health Services (DSHS) contract with contract
attachment(s). Please sign and return both copies to this unit as soon as possible. Your contract will
be signed by DSHS and returned to your agency. Changes made to any portion of the contract documents
me considered a counter-offer and are not valid without DSHS written concurrence.
DSHS has new General Provisions that impact the attached contracts. Please review changes
carefWly.
DSHS has a policy to not pay for reimbursements, or invoices, submitted or postmarked more than 60
days after the end of the contract's program attachment term, unless otherwise specified in the contract.
Additional information regarding this policy is available on the DSHS website at
h=,11W ww. dshs. state. tx. us.
PT,E NTZ,Return both copies of the contract to the Department of State Health SerWees,1100
W. 490 St, Ausdri TX 78756-3199, Attention: Client Ser►dees Contracting Unit Contracts returned to
any other addressee may result In contract delays.
Please reference the DSHS contract's document number, and program
correspondence. If you have questions, please contact the Client
cscy.customersugggrt@.dghs.state.tK.us or (512) 458-7470.
Bob Burnette, Director
Client Services Contracting Unit
Enclosures
attachment number in all future
Services Contracting Unit at
An Equal Employment Opportunity Employer
CITY OF LUBBOCK
MEMO
TO: LEE ANN DUMBAULD, CITY MANAGER
FROM: TOMMY CAMDEN, HEALTH DEPARTMENT DIRECTOR
SUBJECT: AGENDA COMMENTS - September 13, 2006 CITY COUNCIL MEETING
DATE: AUGUST 31, 2006
ITEM# / SUBJECT:
Consider a resolution authorizing and directing the Mayor to execute for and on behalf of
the City of Lubbock, a Change No. 2 to the DSHS Contract No. 760005906 2007
Immunization -Branch -Locals and any associated documents by and between the City of
Lubbock and the Texas Department of State Health Services.
BACKGROUND/ DISCUSSION:
Immunization/Locals (Change 02%Attachment 03) $138,264.00 total. No change from
FY06 in level of funding. Contract period is between September 1, 2006 thru August 31,
2007.
This contract provides for salaries and fringe benefits for three positions including a
Registered Nurse, a Licensed Vocational Nurse and a Secretary to run the program. The
City of Lubbock provides an immunization clinic with the fewest barriers to service.
Activities include providing immunizations at the Health Department clinic; outreach
activities for infants, children and high risk adults in their homes, correctional facilities, at
day care centers, the South Plains Mall, health fairs and senior citizen centers; and
investigation and initiation of control measures for vaccine -preventable diseases.
A partial listing of the activities associated with 2007 Objectives of the grant include:
• Developing a comprehensive plan to assure that immunization services and
vaccines are available to medically underserved and/or under -immunized
children and adults living in areas where coverage is low (pockets of need);
Building and participating in a variety of partnerships with community -based
organizations and human service agencies to promote best practices and to
increase vaccination coverage levels for children 0 through 35 months;
• Conduct educational, promotional, and outreach activities for the general
public to enhance immunization awareness;
• Complete 100% of child-care facility and Head Start assessments assigned by
DSHS; and,
Agenda Comments--DSHS Contracts 2006-07 Immunizations
• Complete 100% of public and private school assessments and retrospective and
validation surveys assigned by DSHS.
FISCAL IMPACT
The total amount approved for the entire contract year amounts to $138,264.00, which is
level funding, compared to the previous contract year in FY06. Contributions to the grant
account in the General Fund for the grant is estimated to be $5,000.
SUMMARY/RECOMMENDATION:
These programs fulfill the Core Missions of Public Health —those of Disease Prevention,
Laboratory Support, and Health Education. Without the funding from the Department of
State Health Services contract, our local public health efforts would be greatly impaired
and the risk of illness in Lubbock citizens would increase. Therefore, Tommy Camden,
Health Director, and Health Department staff recommends approval of the resolution.
Agenda Comments--DSHS Contracts 2006-07 Immunizations