HomeMy WebLinkAboutResolution - 2009-R0435 - Contract - SPAG - TX DADS, For AAA Direct Purchase Of Service Program Grant - 10_20_2009Resolution No. 2009—RO435
October 20, 2009
Item No. 5.1.1
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 for an Area Agency on Aging Direct
Purchase of Services Program grant, and related documents. Said Contract is 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
ATTEST:
Rebecc ` arza, City Secretary
APPROVED AS TO CONTENT:
20th day of October , 2009.
TOM MARTIN, MAYOR
Randy esdell, G6mmunity Services Director
APPROVED AS TO FORM:
Chad Weaver, Assistant City Attorney
vw: ccdoc s/R E S. C ontrac t-SPA G
October 1, 2009
Resolution No. 2009—RO435
od THE SOUTH PLAINS ASSOCIATION OF GOVERNMENTS /A.r eaA gency
PA
G AREA AGENCY ON AGING )Won
Aging
�-
South Plains Association VENDOR AGREEMENT
Of Goremments
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, 2009,
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
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 older
individual which meets 33'/3 percent of the dietary reference intakes established by the
Food and Nutrition Board of the Institute of Medicine of the National Academy of
Sciences and complies with the most recent Dietary Guidelines for Americans, published
by the Secretary of Agriculture, and which is served in a congregate setting. The objective
is to reduce food insecurity and promote socialization of older individuals. 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).
Form #: AIAAA VA1.0
Ed Date: 9/8'2004
HOME DELIVERED MEALS - Hot, cold, frozen, dried, canned, fresh, or supplemental
food (with a satisfactory storage life) which provides a minimum of 33'/3 percent of the
dietary reference intakes established by the Food and Nutrition Board of the Institute of
Medicine of the National Academy of Sciences and complies with the most recent Dietary
Guidelines for Americans, published by the Secretary of Agriculture, and is delivered to an
eligible participant in their place of residence. The objective is to reduce food and help the
recipient sustain independent living in a safe and healthful environment. There are two
types of home delivered 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 individual from one location to another but does
not include any other activity.
■ Demand/Response-transportation designed to carry older individuals from specific
origin to specific destination upon request. Older individuals request the transportation
service in advance of their need, usually twenty-four to forty-eight hours prior to the
trip.
LEGAL ASSISTANCE — 60 years and older - Advice or representation by an attorney,
including assistance by a paralegal or law student under the supervision of an attorney, or
counseling or representation by a non -lawyer, where permitted by law, to older individuals
with economic and social needs. Legal assistance activities include the following:
■ Advice/Counseling - a recommendation made to an older individual regarding a course
of conduct, or how to proceed in a matter, given either on a brief or one-time basis, or
on an ongoing basis. May be given by telephone or in person.
■ Document Preparation - personal assistance given to an older individual which helps
the preparation of necessary documents relating to public entitlements, health care/long
term care, individual rights, planning/protection options, and housing and consumer
needs.
■ Representation - advocacy on behalf of an older individual in protesting or
complaining about a procedure, or seeking special considerations by appealing an
administrative decision, or representation by an attorney of an older individual or class
of older individuals in either the state or federal court systems.
■ Services identified as "Legal Assistances Services" are: Benefits Counseling, Money
Management, Representative Payee, and Guardianship.
Unit Definition:
CONGREGATE MEALS: One Meal
HOME DELIVERED MEALS: One Meal
TRANSPORTATION — Demand/Response: One One-way Trip
LEGAL ASSISTANCE: One Hour
Form#:A(AAA VALO
Ed Date: 9112064
Service Area (To be added by Vendor):
City of Lubbock
All Texas Administrative Code standards may be accessed at the Texas Secretary of State
website: www.sos.state.tx.us/tac/index.shtml.
All Older Americans Act and other required rules and regulations may be accessed at
http://www.aoa.gov/AoARoot/AoA Programs/index.aspx.
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
6.27
N/A
N/A
Home Delivered
-
N/A
N/A
Transportation
5.44
N/A
N/A
Legal Assistance
-
N/A
N/A
II. TERMS OF THE AGREEMENT
A. The Vendor agrees to and/or understands:
1. Provide services in accordance with current or revised TDADS policies and standards
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. Email roster(s) and support documentation required by the AAA by close of business
on the 2°d working day of the each month following the last day of the month in which
services were provided. If the 2°d working day falls on a SPAG holiday the
information shall be delivered by the close of business on the preceding business day.
4. (a) The AAA cannot guarantee payment of reimbursement requests received
or 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.
(b) If a request for revised documentation is necessary these revisions will be due by
the IOth working day of each month and funding will be delayed. A letter to the
director and the board president will be sent if the AAA is not receiving required
documentation. The letter will indicate the reason for the delay and a corrective
action plan will be required. These actions will further delay the funding request.
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,
Form #: AIAAA VAI.O
Ed Date: 9,8i2004
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 appropriate
services, as applicable.
7. Notify the AAA Access and Assistance division immediately 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 Services program, the South Plains Association of
Governments Area Agency on Aging agrees to:
1. Review 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.
Form #:AIAAA VA1.0 4
Ed Date: 9+8 2004
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 45
days of receipt of invoice.
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.
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 Subawards to debarred and suspended parties; this document is required
annually as long as this agreement is in affect.
F. Independent Audit
A 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 S
Ed Date: 9 8i2004
IV. ATTACHMENTS
A. List of Focal Points in the South Plains Association of Governments AAA Region.
B. Vendor Application and all other applicable State and Federal license and/or Certifications
that regulate your business
C. Signed Certification Regarding Debarment
D. Signed Affirmative Action Plan indicating compliance with the Civil Rights Act of 1964
E. Rate Setting Documents, if applicable
F. Senior Center Operations contract, if applicable
V. SIGNATURES
For the faithful performance of the terms of this agreement, the parties affix their signatures and bind
themselves effective:9.
City of Lubbock Sou lain tion of Governments
Legal Name of Vendor a of a Age cy on Aging
Jae,
Signature Signature
Tom Martin, Mayor
Printed/Typed Name of Signer
Tim Pierce
Printed/Typed Name of Signer
October 20, 2009 October 29, 2009
Date Date
Attest: ApproveA as to Cont t: Ap v as to orm:
Reb a Garza Randy truesdell Chad Weaver
City Secretary Community Services Director City Attorney
Form #: AIAAA_VALO 6
Ed Date: 98.%2004
Attachment Resolution No. 2009—R0435
��Area Agency The South Plains Association of Governments Area Agency on Aging ?�
Direct Purchase of Service SPAG
)WonAging Fiscal Year 2010 Vendor Application/Renewal Update
South Plains Association
of Gwemnwts
Please type or clearly print application information.
City of Lubbock
Vendor Name/Legal Entity
DBA (if applicable)
Physical Address:
2001 19th Street (Lubbock Senior Center) Parks Administration 1010 9th 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
806-775-2685
Type of Provider:
Governmental Agency Private Non -Profit Private For Profit
City Government County Government Other:
Authorizing Official:
Title:
Tom Martin
Mayor
Email Address:
Telephone:
tmartin@mylubbock.us
806-775-2303
Billing Contact Person and billing address:
Title:
Nancy Neill
Indoor Recreation Coordinator
Email Address:
Telephone:
nneill@mylubbock.us
806-775-2685
Number of Years Organization has been in business:
Is Organization Bonded?
(Attach certificate of bonding ins.)
30 Years
El 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
ElYes El No
licenses and /or 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.
DIPS Application
Page 1
1;
2.
Service and Bidding Information:
A. Proposed Service:
Congregate meals
B. Service Area:
C. Proposed AAA cost per unit:
$ 6.27
A. Proposed Service:
ransportation
B. Service Area:
C. Proposed AAA cost per unit:
$ 5.44
A. Proposed Service:
Standard cost per Unit:
$ 6.90
Standard cost per Unit:
$ 6.04
B. Service Area:
C. Proposed AAA cost per unit: Standard cost per Unit:
4. A. Proposed Service:
B. Service Area:
C. Proposed AAA cost per unit: Standard cost per Unit:
Signature:
4 j (Q,t-, 0C , certify that the information provided in this application is true and
Prated Name
correct to the best of my knowledge.
Authorized Signre Date
DPS Application
Page 2
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 One Beacon America Insurance
Company under policy #791-000-230 which expires on 10/01/10. The current net
asset balance of the self-insurance fund is $3,397,295. The existing cash asset
balance is $8,650,340 as of the date stated below.
By:
Leisa Hutcheson
Director of Risk Management
Date: September 30, 2010
Resolution No. 2009-R0435
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 (TDADS)) 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
whom 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? Yes X 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.
5. 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
Indicate which statement applies to the covered potential vendor/grantee:
X 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. 1-75-6000590-6
Signature of Authorized Representative
Chad Weaver
Printed/Typed Name of Authorized Representative
City Attorney
Title of Authorized Representative
Date
THIS CERTIFICATION IS FOR FY 2010, PERIOD BEGINNING 10/1/2009 and ENDING
9/30/2010.
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 contracts/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.
Attachment E
Resolution No. 2009—RO435
BUDGET WORKSHEET CALCULATION OF THE PER MEAL UNIT RATE
1 Total Budgeted Expenses for Contract Year 1 $ 310,434 28
2 Total Number of Anticipated Meals to be Provided
Local Funds
DADS A&I AAA 23,350 Eligible Meals 9,950 Other Sources 5 0
Other Funds -
Non -Eligible
Program Income 11.700 Meals 0 Other Sources 6 0 2 45,000
3 Cost per meal (Line 1 divided by Line 2)
Reimbursement Calculation
DADS A&I AAA
4 Projected NSIP per Meal Value 062
5 Rate Less NSIP per Meal Value $ 628
6 Mandatory Local Match of 10% $ 063
'• If Applicable, Match Reduction
From the In -kind Match
Certification form $ -
Required Match $ 063
7 Proposed Meal Rate (Line 3 minus Line 6) $ 6.27
•• If any portion of the required match is In -kind; you must complete an In -Kind Match Certification form
3 $ 690
By signing below, you certify that all expenses and units related to services supported by the Texas Department
of Agriculture's State General Revenue funding are excluded from this rate setting process, and acknowledge that all related records
are subject to audit in accordance with contract requirements and all applicable federal and state laws.
City of Lubbock
Legal Name of Contracted Provider
Signature
South Plains Association of Governments
Name of Area Agency on Aging
Tim rce
Prinfedrrype nr�e of Si ner
b
Signal
October 29, 2009
Date
Tom Martin, Mayor
Pnntedrryped Name of Signer
October 20, 2009
Attest: Approv�'s to ontent• A ro d orm:
Reb ca Garza Ran y Truesdell had Weaver
City Secretary Community Services Director City Attorney
Attachment E
Service. Transportation
BUDGET WORKSHEET CALCULATION OF THE UNIT RATE
1 Total Budgeted Expenses for Contract Year
2 Total Number of Anticipated Units to be Provided
DADS A&1 AAA - 10 % Program
Match Required 3,520 Income 1 251 Other Sources 6
DADS A&I AAA - 25 Iu Local Funds -
Match Required 0 Eligible Trips 2.253 Other Sources 7
Other Funds -
DADS A&I AAA - Full Unit Non -Eligible
Rate 0 Trips 0 Other Sources 8
3 Cost per unit (Line 1 divided by Line 2) - Full Unit Rate
Reimbursement Calculation for Contracts Requiring Unit Rate Match Reduction
1 $ 42,453 48
0
0
0 2 7 024
3 $ 604
4 Mandatory Local Match of 10% $ 060
'• If Applicable, Match Reduction From the In -kind Match Certification form $
Required Match 4. $ 0.60
5. Full Unit Rate Less Required Match (Line 3 minus Line 41 5 $ 5,44
4. Mandatory Local Match of 25% $ 1.51
If Applicable, Match Reduction From the In -kind Match Certification form $ -
Required Match 4. $ 1 51
5.Full Unit Rate Less Required Match (Line 3 minus Line 4) 5. $ 4.53
"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 WIII Be Met Through Provision of Additional Units
$ 6.04
Contractor Initial AAA Initial
ON of Lubbock
Legal Name of Contracted Provider
--r Signature
Tom Martin, Mayor
Printed/Typed Name of Signer
,October 20, 2009
Date
Attest:
�Reecca Garza
City Secretary
Sou4ins Associ n o overn ents
Narge of Arren Agen on A g
N+ r` i,
Signature
Tim C Pierce
Printed/Typed Name of Signer
October 29, 2009
Date
ApprovPruesde
to Conten
Ra y
Community Services Director
Lpr(_ as t orm:
Chad Weaver
City Attorney
BUDGET WORKSHEET CERTIFICATION
October 01, 2009 - September 30, 2010 Transportation
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.
• I acknowledge that all books and records related to this rate setting process are
subject to audit in accordance with contract requirements and all applicable federal
and state laws.
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
lc� 01
Date
Signer Authority:
(check one)
r Sole Proprietor
r Partner
r Corporate Officer
qaA6;�
d
Printed/Type Name o .'igner
r Association Officer
r Board Member
r Governmental Official
igna ure