Loading...
HomeMy WebLinkAboutResolution - 2006-R0562 - Contract - SPAG - Pass Through Funds, TDADS - 11_21_2006Resolution No. 2006—RO562 November 21, 2006 Item No. 5.17 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 21st day of November , 2006. ATTEST: 4Gc� Reb&ca Garza, City Secretary APPROVED AS T ONTENT: Randy Truesdell, Community Services Director APPROVED AS TO FORM: G. Vandiver, Attorney of gs/ccdocs/res. SPAG-TXDept-Aging.2007 10/16/06 Resolution No. 2006-RO562 The South Plains Association of Governments{ Area Agency . Area Agency an Aging an Aging VENDOR AGREEMENT SPAG South plain, Issoc Jen of 6maime os City of Lubbock , hereinafter referred to as Vendor, and The South Plains Association of Governments Area Agency on A in AAA do hereby agree to provide services effective beginning October 1, 2006, 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. 1, 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 # A I AAA _VA I.0 SPAG Ed Date: 9/8/2004 1 of 5 10/512GO5 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 All Older Americans Act and other required rules and regulations may be accessed at www,aoa.aov/about/letzbudeoaa/legbudg oaa.asp 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 5.01 Trans. D/R 4.72 II. 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. 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. 5. Refer Medicaid eligible clients to the Health and Human Services Commission, and/or the Medicaid participating suppliers/vendors for the purpose of securing Form # A1AAA_VA1.0 SPAG Ed Date: 918/2004 2 of 5 10/5/2005 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 Agin agrees to: I . 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_VAI.0 SPAG Ed Date: 9/8/2004 3 of 5 10/512005 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 government 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. IV, DAYS & HOURS OF OPERATION Lubbock Senior Center - 19th 8:00a.m. - 5:00p.m. Copper Rawlings, Maggie Trejo, Mae Simmons 8:30a.m. - 4:30p.m Homestead 9:00a.m. - 3:00p.m. V. ATTACHMENT List of Focal Points in the South Plains Association of Governments AAA Region Form #:AIAAA_VAI.0 SPAG Ed irate: 9/812004 4 of 5 1015/2005 VI. SIGNATURES For the faithful performance of the terms of this agreement, the parties affix their signatures and bind themselves effective October 1. 2006. City of Lubbock Legal Name of Contracted Provider INPON 1 David A. Miller, Mayor Printed/Typed Name of Signer November 21, 2006 Date Attest: Reb6cca Garza City Secretary Approved as to Form ohn Kni for City Attorney South Plains Association of Governments Name of Area Agency on Aging Signature Tim C. Pierce Printed/Typed Name of Signer 1 -4 +- (0 (- Date Form #:AIAAA VA1.0 SPAG Ed Date: 4/6/2004 5 Of 5 10/5/2005 Resolution No. 2006-RO562 6tJDGFT WORKRHFFT Page t Budget Worksheet FFY 2007 RUDGET WORKSHFFT A B C D E F G H 2 AAA/Region Name- South Plains Association of Governments Contract Number: A-100 Provider Name: City of Lubbock Service:) Congregate Meals Period covered in YTD: 10/01105 - 05131106 New Contract Year: 1 October 1 , 2006 - September 30, 2007 NOTE: You must identify the number of months the YTD actual expenses are based on in Column D, under "Annualized Exp. Months YTD Based on." The worksheet is currently set at 8 months. 3 4 5 6 7 8 _.. - Annualized Exp.- YTD Actual Months YTD Based on s .. 9 - -- _ Percent Difference 10 Cost Area Budgeted for Reason for Difference/Explanafion (If Over Routine Inflation Percentage - 1.64%) 11 Expenses 8 New Contract Yr. (Budget to Annualized) ) 12 46 Insurance _ - - - - - 47 Security _ 48 Janitorial fie air Taxes _ _ 491 50 51 52 IT01al _ 6. Trans ortation/Travel 53 54 55 Mileage Reimbursement - - _ _ - - Delivery-- - 56 Gas & Oil - 57 58 Repairs insurance 59 6U 61 Depreciation/Lease Interest Ta s & Licenses _ _ _ - - - - 62 63 Total ..: ., . Advertising 2,400.00 3,600.00 Willi 7. Administrative 3,600.00 & General _ _ 0A0% 64 65 66 Printin _ - 67 C© i 200.00 300.00 300.00 0.00% 68 Office Supplies _ 69 Contractual Agreements .00 264.00 264.00 0.04 70 71 Postage Telecommunications _ _ - - 72 Liability Insurance 73 Interest-Wk . Capital L al Fees _ - - - - - - -- - 74 75 Accounting Fees _ 76 77 Consulting Fees Other Fees lain)_ _ - 78 _ _ Audit 79 80 Other Misc. (Explain) _ - - Total 2,776.00 4,164.001 4,164,00 0.007% Page 2 Budget Worksheet FFY 2007 RUDGFT WORKRHFFT A B C D F F G H 2 AAA/Region Name: South Piains Association of Governments Contract Number: !A-100 Provider Name: City of Lubbock Service:', Congregate Meals_ Period cove red in YTD: 10/01105 - 05131106 New Contract Year October 1 , 2006 - September 30, 2007 f.-. _ , , .._.... ... . - • _. .. NOTE: You must identify the number of months the YTD actual expenses are based on in Column D, under "Annualized Ex . Months YTD Based on." The worksheet is currently set at 8 months. . .., -- 3 5 6 7 8 9 Annualized Exp. 10 _ _. _ YTD Actual Months YTD Based on Budgeted g Exp., for Percent Difference - - - Reason for DifterencelExplanation 11 Cost Area Expenses 8 New Contract Yr- (Budget to Annualized) (If Over Routine Inflation Percentage - 1.64%) 12 81 82 Total of all Cost Areas 178,735.33 268,103.00 258,534.00 -3.57% Total Number of !Weals 83 Provided 30,516 45,7-1 Increase in contracted meals. Also, estimated meals Total Numbef of based on one year actual of 46,994 instead of annualized 84 Anticipated Meals 46,994 2.67% 45,774. 85 -- - Budgeted Cost per Meal $5.50 86 87 Reason for Difference/Explanation 88 FY06 VS FY07 FY06 FY07 Difference Percentage Difference If Over Routine Inflation Percentage -1.64% 89 Whole Unit Rate 4.88 5.50 0.62 12.70% Increase of expenses 90 - 91 - 92 Proposed Meals * Calculated Units 93 _ Funding Source Pro used Meals Calculated Rate Revenue 94 DADS III 23,402 5.01 117,244 95 DADS -Title XX 4.88 0 Proposed Meals * Calculated Units 96 DADS -Title XIX 5.50 0 Proposed Meals * Calculated Units 97 Program Income 12,746 5.50 70.103 Proposed Meals * Calculated Units 98 Local Funds - Eligible Meals 10,846 5.50 59,653 Proposed Meals' Calculated Units 5,9 Other Funds - Non -Eligible Meals 5.50 0 Proposed Meals * Calculated Units 100 Local Funds - Required Match NA 0.49 11,467 DADS Proposed Meals +Title XX Pro osed Meals *Calculated Rate 101 Local Funds - Cap Limit Exceeded DADS & Title XX NA 0.13 0 DADS Proposed Meals +Title XX Proposed Meals *Calculated Rate 102 Local Funds - Cap Limit Exceeded Title XIX NA - 0 DADS Title XIX Proposed Meals *Calculated Rate 103 46,9941 258.467 1041 105 106 _ Page 3 Budget Worksheet FFY 2007 Resolution No. 2006—RO562 BUDGET WORKSHEET CALCULATION OF THE PER MEAL UNIT RATE 1. Total Budgeted Expenses for Contract Year 2. Total Number of Anticipated Meals to be Provided Title III 23,402 Title XX 0 Title XIX 0 Program Income 12,746 Other Eligible 10,846 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 $ 0.49 7. Proposed Meal Rate (Line 3 minus Line 6) Rate Cap Applicable to Title III and XX Common Providers Only 8. Excess of Cap Rate Reduction 9. Title III/Title XIX Negotiated Unit Rate (Line 7 minus Line 8) Title III & Title XX $ 4.90 Title XIX N/A NIA $ 0.49 NIA $ 5.01 $ 5.50 $ 4.88 $ 5.92 $ (0.13) $ - $ 4.88 $ 5.50 `" 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 Contract d Provider r� .---- Signature South Plains Association of Governments Name of Area Agency on Aging Tim C. Pierce Prin yped me igner Signature 12-/4-/a" Date David A. Miller, Mayor Printed[Typed Name of Signer November 21, 2006 Date Department on Aging and Disabilities Services Title XIX and XX Printed/Typed Name of Signer Signature Date 1. $ 258,534.00 2. 46,994 3. $ 5.50 Attest: becca Garza City Secretary Approved as to Form John Kni t for City Attorney Approved as to Content 36hnny McLellan Recreational Services Mgr Budget Worksheet IFFY 2007 Per Meal Unit Rate Calculation Resolution No. 2006—Ro562 BUDGET WORKSHEET CERTIFICATION AS SIGNER OF THIS BUDGET W©RKSHEET, 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 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 November 21, 2006 Date David A. Miller, Mayor Printed/Typed Name of Signer Signature Signer Authority: r Sole Proprietor r Association Officer (check one) r Partner r Board Member r Corporate Officer r Governmental Official Attest: Approved as to Form Approved as to Content Rebecca Garza 4ohn Knight Johnny NtcLellan City Secretary for City Attorney Recreational Services Manager Budget Worksheet FFY 2007 Budget Worksheet Certification (DEFINITIONS: (tern Line -Item number & inclusions Cost Area I Line -Item 'Name YTD Expenses I Actual Expenditures Annualized Exp. Enter the number of months included in the YTD Expenses (Column B) Budgeted Exp. for New Contract Year Your agency/service budget for FY07 % Difference Bud. Vs calculation to give percent of increase/decrease in current year Ann, I bud et vs last year's actuals Description 1. detail reason for incr/decr based on variance, 2. indicate the FTEs for both salaries & contract staff, specify individual items that are included in each line -item 3. within reason, list description/purpose, cost, & position attending for both 4. conferences and training. Please be as specific/clear as possible while being short and to the point. The text will wrap so you should have plenty of space. The print will adjust to as many pages as necessary. The third sheet in this workbook is a narrative sheet should 5. you need additional space for line -item clarification. Resolution No. 2006-RO562 BUDGET WORKSHEET A B C C I E I F G H I J 1 Services Other Than Nutrition 2 AAA Name',. South Plains Association of Governments Contract Number: A-100 3 Provider Name: JCity of Lubbock _ Period covered in YTL) 110101/05 - 05/31106% Service:I Transportation - Demand Response 4 New Contract Year: October 1 , 2006 - September 30, 2007 6 NOTE: You must identiH the number of months the YTD actual expenses are based on in Column D, 7 under "Annualized Exn_ Months YTD Based on." The worksheet is currently set at S months. 9 10 - -- --- Annualized Enp. - YTD Actual Months YTD Based on Budgeted Exp. for Percent Difference Cost Area Experms 8 New Contract Yr- (Budget to Annualized) -- Reason for DtfFer enee (If Over Routine Inflation Percentage - I r>4%) 11 12 13 1. Personnet 14 15 Salaries, PR Taxes $ Benefits 20,211.33 30,317.00 30,790.00 1.56% - - - Contract staff, Compensation _ 16 Total 20 211.33 30 317.00 30 790.00 1.56% 17 18 - 2. Professional Development -- -- 19 conference - - 20 _ Dues 21 Materials 22 Total 24 :,.,�i-��3-.,...�..�..,�.'..�.; •..�.,_.a� t. - _.ate-��..� _...�,':. _ _ ie.. `ij�lilifiiin'YNfild Mitllrti 4. E ul ment 25 Depreciation -- -- - - - 26 Interest 27 Lowing 28 29 - Maintenance _ Total - 30 31 5.Occu Brit lBuildin - 32 33- 34 35 Rent - - s - - - - - - - - D -atlon Mortgage Interest 36 Insurance ._._ 371 seawd 38 Janitorial - - 39 -Repair 40 41 Taxes Total - 42 43 6. Transportation/Travel - 44 45 MIL"Ve Reimbursement _ 7,500.00 _ ---- 46 Gas S oil 5,000:00 7 500.00 _ - - - - 47 Repairs 48 Insurance - 49 50 Depreai -%/Lease Interest-- Tags & Licenses Total — 5i 52 5,000.00 7,500.00 1 7,500.00 1 0-00./0 53 Page 3 Budget Worksheet FFY 2005 BUDGET WORK5HEET A B C D E F G H I J 2 AAA Name: South 'Plains Association of Govemments Contract Number: A-100 3 Provider Name: City of Lubbock Service: Transportation - Demand Response October 1 , 2006 - September 30, 2007 4 Period covered in YTD: 10/01/05 - 05/31106% New Contract Yaw. 6 NOTE: You must identify the number of months the YTD actual expenses are based on in Column 0, 7 under "Annualized Exp. Months YT0 Based on " The workshest Is cunrentlly setat 8 months. Annualized YTD Actual Months YTD Based on I Budgeted Exp. for Percent Difference Reason for DiNerenee (If Over Routine Inflation Percentage - 1.64%) 10 11 Cost Area Expenses S New Contract Yr. (Budget to Annualized) 54 - 7. Administrative &General 55 Advertisin 200.00 300.00 300.00 0.00% 56 Priming - - - 57 Copying 80.00 120.00 120.00 0.00% 58 Office Supplies 80.00 120.00 120.00 0.00% 59 Contractual Agreements - 60 Postage _ 61 Telecommunications _ 62 _ Liability Insurance 63 Interest-Wk . Capital 64 Legal Fees _ 65 Accounting Fees _ 66 , Consult!Fees -- - - _- --- - - - 67 Other Fees laln -- 68 Audit 69 09w MiSE (Eacpiain)- -- Total 70 360.Q0 540.00 540.00 0.00% 72 73 74 Total of all Cost Areas Total Number of Units Provided Total Number of Anticipated Units 25,571,33 38 357.00 4,940.00 7,410.00 38.830.001 1.23% 7,410 0.00%75 -- --- - - Budgeted Cost per Unit $5.24 76 77 78 -- _ Reason for Difference/Explanation FY06 VS FY07 FY08 FY07 Difference Percentage Difference If Over Routine Inflation Percentage - 1.64% 79 Whole Unit Rate 5.16 5.24 0.08 1.55% 80 81 Enter the Total Number of Antici ted Units or the Pro units by F riding Source 82 1- 83 Funding Source Piroposed Units Calculated Rate Revenue 84 1AAArrDoA - Match R aired 2,202 4.72 10,343 Proposed Units ' Calculated Units - - 85 1AAAJTDoA - Full Unit Rate 5.24 0 Proposed Units . Calculated Units- 86 Program Income 570 5.24 2,967 Proposed Units' Calculated Units 87 Loral Funds 4,638 5.24 24,303 ProUnits' Calculated Units 88 Source 5 5.24 0 Pro sed Units • Calculated Units 89 Scarce 6 5.24 0 Prosad Units* Calculated Units 90 Local Funds - R uired Match NA 0.52 1.145 TDoA1AAA P sed Units 'Calculated Rate 91 7,410 1 38,828 82 93 - — - Page 4 Budget Worlcsheet FFY 2005 BUDGET WORKSHEET —[--A 1 8 1C D I E F G H I } 2 AAA NaMe7l South Plains Association of Governments Contract Number: A-100 3 Provider'Narne: I City of Lubbock 10/01/05 - 05131/06% Service: Transportation - Demand Response 4 Period covered in YTD: New Contract Year: October 1 , 200a - Se tember 30, 2007 s NOTE: You f�fu8t identity under "Annualized the number of months the YTD aetuai expenses are based on in Column D, r _ Exp. Months YTD Based on " The worksheet is currently set at 8 months. 7 8 9 10 11 Cost Area Annualized Ex . Percent Difference - Reason for Difference (Budget to Annualized) (If Over Routine Inflation Percentage - 1.64 % ) YTD Actual Months YTO Based on Expenses 8 Budgeted Exp. for New Contract Yr- 12 _ J4 Page 5 Budget Worksheet FFY 2005 Resolution No. 2006—RO562 BUDGET WORKSHEET CALCULATION OF THE UNIT RATE 1.Total Budgeted Expenses for Contract Year 1. $ 38,830,00 2.Total Number of Anticipated Units to be Provided AAA/TDoA - Match Program Required 2,202 Income 570 Source 5 0 AAA/TDoA - Full Unit Rate 0 Local Funds 4,638 Source 6 0 2. 7,410 3. Cost per unit (Line 1 divided by Line 2) - Full Unit Rate 3. $ 5.24 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 S.Full Unit Rate Less Required Match (Line 3 minus Line 5. $ 4.72 '"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 $ 5.24 tfuflirtllaur rauuar Contract Reimbursed at the Full Cost Per Unit Less Required Match. $ 4.72 Contractor Initial ^MM II tI LIG! P%P,r, ouuai City of Lubbock South Plains AssQiiation of Governments _ Legal Name of Contracted Provider ame of A a A on Aging Sign tore Signature David A. Miller, Mayor Printed/Typed Name of Signer November 21, 2006 Date Attest: Approved as to Form Re ecca Garza ohn Knight City Secretary far City Attorney Tim C. Pierce Printed/Typed Name of Signer Date Approved as to Content Johnny McLellan Recreational Services Manager Page 5 Budget Worksheet FFY 2005 Rate Calculation Resolution No. 2006-RO562 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION FOR COVERED AGREEMENTS AND GRANTS Federal Executive Order 125.49 requires the Texas Department of Aging and Disability Services (DADS)) to screen each covered potential vendor to determine whether each has a right to obtain a agreement in accordance with federal regulations on debarment, suspension, ineligibility, and voluntary exclusion. Each covered vendor roust also screen each of its covered subcontractors/providers. In this certification "vendor" refers to both vendor and subcontractor/sub-grantee: "agreement" refers to both agreement and subcontract/sub-grant. By signing and submitting this certification the potential vendor accepts the following terms: I . The certification herein below is a material representation of fact upon which reliance was placed when this agreement was entered into. It is later determined that the potential vendor 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 shall provide immediate written notice to the person to which this certification is submitted if at any time the potential vendor learns that the certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 3. The words "covered agreement," " 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 agrees by submitting this certification that, should the proposed covered agreement 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 subcontractors/sub-grantees under this proposed agreement? Xyes no 5. The potential vendor further agrees by submitting this certification that it will include this certification titled "Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion for Covered Agreements and Grants" without modification, in all covered subcontracts and in solicitations for all covered subcontracts. 6. A vendor may rely upon a certification of a potential subcontractor/sub-grantee that is not debarred, suspended, ineligible, or voluntarily excluded from the covered agreement, unless the vendor knows that the certification is erroneous. A vendor must, at a minimum obtain certifications from its covered subcontractors/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 is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. Except for agreements/grants authorized under paragraph 4 of these terms, if a vendor in a covered agreement 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 AGREEMENTS AND GRANTS Indicate which statement applies to the covered potential vendor: X The potential vendor 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 agreement by any federal department or agency or by the State of Texas. The potential vendor is unable to certify one or more of the terms in this certification. In this instance, the potential vendor 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 VENDOR ID NO.IFEDERAL EMPLOYER'S ID NO 541rature of A rized Rlhresentative John Knight Printed/Typed Name of Authorized Representative Assistant City Attorney Title of Authorized Representative City of Lubbock 17560005906 /0 / ZCC'1" Date THIS CERTIFICATION IS FOR FY 2007, PERIOD BEGINNING 10/1/2006 and ENDING 9/30/2007 CERTIFICATION REGARDING DEBARMENT Page 4 DEFINITIONS Covered Agreement 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 agreement 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 agreement for goods or services between a participant and a person under a covered grant, sub -grant, agreement 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 agreements/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 agreement. This term also includes any person who acts on behalf of or is authorized to commit a participant in a covered agreement 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 agreement 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 agreement. 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 agreements/grants for a temporary period, pending completion of • an investigation and such legal, debarment, or Program Fraud Civil Remedies Act proceedings as may ensue. A person so excluded is "suspended." VOLUNTARY EXCLUSION OR VOLUNTARILY EXCLUDED A status of nonparticipation or limited participation in covered transactions assumed by a person pursuant to the terms of a settlement. yJ�BO�� 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 #GPP06301452 which expires on 10/01/07. The current balance of the self-insurance fund is $2,332,854.00. The existing cash asset balance is $8,487,825.00 as of the date stated below. By: Leisa Hutcheson Risk Management Coordinator Date: September 30, 2005