Loading...
HomeMy WebLinkAboutResolution - 2012-R0462 - Contract - SPAG - Funds From US DHHS - Aging And Disability Services - 12_06_2012Resolution No. 2012-RO462 December 6, 2012 Item No. 5.2.2. RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor of the City of Lubbock 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 funds passed through the U.S. Department of lealth and Human Services to the Texas Department of Aging and Disability Services or an Area Agency on Aging Direct Purchase of Services Program grant and any ssociated documents. Said Contract is attached hereto and incorporated in this resolution jp if fully set forth herein and shall be included in the minutes of the City Council. rassed by the City Council this on December 6, 2012 G -MlfiERTSON, MAYOR ATTEST: KebeciLa Garza, City Sec eta APPROVED AS TO C N/TENT: 1 i � 'e Truesdell, community Services Director APPROVED AS TO FORM: II I had Weaver, Assistant City Attorney es.SPAG 12-13 1.12 12 Ord The South Plains Association of Governments Area Agency on Aging /Area Agency Direct Purchase of Service SP G Fiscal Year 2013 Vendor Application/Renewal Update J_'7�onAging Sw � rn+I..ri�ur 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 1611 10th Street, Lubbock, TX 79401 Mailing Address: PO Box 2000, Lubbock, TX 79457 Tax Identification Number (SSN or Federal ID): Fax Number (including area code): 17560005906 806-775-2686 Type of Provider: Governmental Agency FiPrivate Non -Profit Private For Profit pCity Government ©County Government Other: Authorizing Official: Title: Glen C. Robertson Mayor Email Address: Telephone: s:rohertsonAirnvlubbock.us 806-775-2010 Billing Contact Person and billing address: Title: Nancy Neill, City of Lubbock, PO Box 2000, 79457 Indoor Recreation Coordinator Email Address: Telephone: nneiIIf mv1ubbock.us 806-775-2685 Number of Years Organization has been in business: is Organization Bonded? 33 Years TaYes Lj No Has anyone involved in the direct provision of client services If Yes, Explain: been convicted of a felony (In -home Services only)? Yes a No Does Organization have liability insurance? of all insurances) _ Yes -_-- No r 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. OPS Application Page 1 1; 2. 3. 4. Service and Bidding Information: Proposed Service: Conareaate B. Service Area: City of Lubbock C. Proposed DADS A&I AAA cost per unit: Whole cost per unit: $ 6.94 $ 6.96 A. Proposed Service: Home Delivered Meals B. Service Area: NIA C. Proposed DADS A&I AAA cost per unit: Whole cost per unit: $ NIA $ NIA Proposed Service: Transportation B. Service Area: City of Lubbock C. Proposed DADS A&I AAA cost per unit: Whole cost per unit: $ 7,70 $ 7.91 A. Proposed Service: B. Service Area: C. Proposed DADS A&I AAA cost per unit: Whole cost per unit: S Signature: I, Nancy Neill certify that the information provided in this application is true and Printed Name correct to the best of my knowledge. LS Monday, October 01, 2012 A ized Signature Date DPS Application Page 2 1� 4 IN lub,li'ock 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 #791-000-230-0001 which expires on 10101/13. 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. r �y/V By: Leisa Hutcheson Risk Management Coordinator Date: September 30, 2012 city of )bock TE%AS PARKS AND RECREATION DATE October 1, 2012 TO South Plains Association of Government FROM City of Lubbock — Senior Center Programs SUBJECT FY 2012-2013 Operating Hours and Holidays for SPAG Grant Number of Days and Hours Name of Sites Serving Days of Operation Lubbock Senior Center 249 M-F 8:00 am - 5:00 pm Rawlings Community Center 249 M-F 8:30 am - 4:00 pm Simmons Senior Center 249 M-F 8:30 am - 4:00 pm Trejo Supercenter 249 M-F 8:30 am - 4:00 pm Homestead Senior Program 249 M-F 10:00 am - 1:00 pm Holidays Observed Dates Thanksgiving Day November 22, 2012 Day After Thanksgiving November 23, 2012 Christmas Eve December 24, 2012 Christmas Day December 25, 2012 New Year's Day January 1, 2013 Martin Luther King, Jr. Day January 21, 2013 Good Friday March 29, 2013 Memorial Day May 27, 2013 4th of July July 4, 2013 Labor Day September 2, 2013 Area Agency Resolution No. 2012-RO462 Aging SOUTH PLAINS ASSOCIATION OF GOVERNMENTS Wn" S AREA AGENCY ON AGING VENDOR AGREEMENT 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, 2012, in accordance with the Older Americans Act of 1965 (OAA), as amended, regulations of the 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 (60 years of age or older) and their caregivers. This agreement provides a mechanism for the creation of an individualized network of community resources accessible to a program participant in compliance with the OAA and DADS AAA Access and Assistance guidelines. The purpose of the system of Access and Assistance is to develop cooperative working relationships with 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, identifies 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) as identified below to program participants authorized by the AAA staff, 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 dietitian (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. There are two types of transportation services: • 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. Form 0: AIAAA VA2.0 Edition Date: 9/19/11 Unit Definition: CONGREGATE MEALS One Meal TRANSPORTATION -- Demand/Response: One One-way Trip Service Area (To be filled in by provider. Please ON or print neatly): Gtr%e OF L 45iaoC11C All Texas Administrative Code standards are located at the Texas Secretary of State website: www.sos.state.tx.Lis. All Older Americans Act and other required rules and regulations are located at http://www.aoa.Gov/AoARoot/Abotit/ALithorizin,u Statutes/index.aspx. Targeting: AAA services are designed to identify eligible program participants, with an emphasis on high -risk program participants and to serve older individuals with greatest economic and social need, low-income minorities and those residing in rural areas, as required by the OAA. B. Services & Reimbursement Methodology: Service Fixed Rate (include rate) Variable Rate (identify range) Cost Reimbursement Congregate 6.95 N/A N/A Transportation 7.24 N/A N/A 2. TERMS OF AGREEMENT A. The Vendor agrees to: 1. provide services in accordance with current or revised DADS policies and standards and the OAA. 2. submit billings with appropriate documentation as required by the AAA by the close of business on the 2nd working day day of each month following the last day of the month in which services were provided. a. If the 2nd working_day falls on a weekend or holiday, the information shall be delivered by the close of business on the preceding business day. b. The AAA cannot guarantee payment of a reimbursement request received for more than 45 calendar days of service delivery. c. No reimbursement for services provided will be made if vendor payment invoices are not submitted to the AAA within 45 days of service delivery. 3. encourage program participant contributions (program income) on a voluntary and confidential basis. Such contributions will be properly safeguarded and accurately accounted for as receipts and expenditures on Vendor's financial reports if contributions 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. Form #: AIAAA_VA2.0 2 Edition Date: 9it9/11 4. notify the AAA Director immediately if, for any reason, the Vendor becomes unable to provide the service(s). 5. maintain communication and correspondence concerning program participants' status. 6. establish a method to guarantee the confidentiality of all information relating to the program participant 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 program participant case records or other information relating to program participants served under this agreement. 7. 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 vendor's fiscal year. 8. make available at reasonable times and for required periods all fiscal and program participant 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). 9. if applicable, comply with the DADS process for Centers for Medicare and Medicaid Services (CMS) screening for excluded individuals and entities involved with the delivery of the Legal Assistance and Legal Awareness services. B. The Vendor further agrees: 1. The agreement may be terminated for cause or without cause upon the giving of 30 days advance written notice. 2. The agreement does not guarantee a total level of reimbursement other than for individual units/services authorized; contingent upon receipt of funds. 3. Vendor is an independent provider, NOT an agent of the AAA. Thus, the Vendor indemnifies saves and holds harmless the South Plains Association of Governments AAA against expense or liability of any kind arising out of service delivery performed by the Vendor. Vendor must immediately notify the AAA if the Vendor becomes involved in or is threatened with litigation related to program participants receiving services funded by the AAA. 4. Employees of the Vendor will not solicit or accept gifts or favors of monetary value by or on behalf of program participants as a gift, reward or payment. C. Through the Direct Purchase of Services program, the South Plains Association of Governments AAA agrees to: review program participant intake and assessment forms completed by the Vendor, as applicable, to determine program participant eligibility. Service authorization is based on program participant need and the availability of funds. 2. provide timely written notification to Vendor of program participant's eligibility and authorization to receive services. 3. maintain communication and correspondence concerning the program participants' 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 and if applicable, CMS exclusion reviews are conducted. Form #: AIAAA VA2.0 Edition Date: 9/l9/11 6. provide written policies, procedures, and standard documents concerning program participant authorization to release information (both a general and medical/health related release), client rights and responsibilities, contributions, and complaints/grievances and appeals to all program participants. 7. contingent upon the AAA's receipt of funds authorized for this purpose from DADS, reimburse the Vendor based on the agreed reimbursement methodology, approved rate(s), service(s) authorized, and in accordance with subsection (A)(2) of this document, within 45 days of the AAA's receipt of Vendor's invoice. 3. ASSURANCES The Vendor shall comply with: A. Title VI of the Civil Rights Act of 1964 (42 U.S.C. §2000d et. seq. ) B. Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. §794) C. Americans with Disabilities Act of 1990 (42 U.S.C. §12101 et seq.) D. Age Discrimination in Employment Act of 1975 (42 U.S.C. §§6101-6107) E. Title IX of the Education Amendments of 1972 (20 U.S.C. §§1681-1688) F. Food Stamp Act of 1977 (7 U.S.C. §200 et seq.) G. Drug Free Workplace Act of 1988 H. Texas Senate Bill 1 - 1991, as applicable I. DADS administrative rules, as set forth in the Texas Administrative Code, to the extent applicable to this Agreement J. 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 effect K. Centers for Medicare and Medicaid Services (CMS) State Medicaid Director Letter SMDL #09-001 regarding Individuals or Entities Excluded from Participation in Federal Health Care Programs L. DADS Information Letter 11-07 — Obligation to Identify Individuals or Entities Excluded from Participation in Federal Health Care Programs 4. ATTACHMENTS A. Description of Assurances A — H listed in section 3 of this document. B. List of Focal Points in the AAA planning and service area. Form #: AIAAA VA2.0 Edition Date: 9/19/11 5. SIGNATURES For the faithful performance of the terms of this agreement, the parties affix their signatures and bind them;4utl�ori;;Kendor cSignature 2012. 71-1% Print Name Title October 1 2012 Date Authorized Signature South Plains Association of Governments Agency P.O. Box 3730 — Freedom Station Address Lubbock, Texas 79452 City, State, Zip October 1.2012 Date Form #: AIAAA VA2.0 Edition Date: 9119l11 Attest: Approved to ontent: Reb cca Garza RanAy Truesdel City Secretary Community Services Director Ap,pKoyed as Form: Chad Weaver Assistant City Attorney ASSURANCES ATTACHMENT A. Title VI of the Civil Rights Act of 1964 (42 U.S.C. §2000d et.seq.), which prohibits discrimination because of race, color religion sex or nations origin in all employment practices including hiring, firing, promotion, compensation and other terms, privileges and conditions of employment. B. Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. §794), which states that employers may not refuse to hire or promote handicapped persons solely because of their disability. C. Americans with Disabilities Act of 1990 (42 U.S.C. § 12101 et seg. , which prohibits a covered entity from discriminating against a qualified individual on the basis of disability in regard to job application procedures, the hiring, advancement, or discharge of employees, employee compensation, job training, and other terms, conditions, and privileges of employment. D. Aize Discrimination in Employment Act of 1975 (42 U.S.C. §6101-6107), prohibits discrimination on the basis of age in programs and activities receiving federal financial assistance. E. Title IX of the Education Amendments of 1972 (20 U.S.C. U1681-1688) which prohibits the use of federal money to support sexually discriminatory practices in education programs such as sexual harassment and employment discrimination, and to provide individual citizens effective protection against those practices. F. Food Stamp Act of 1977 (7 U.S.C. §200 et seq.), whose purpose is to strengthen the agricultural economy; to help to achieve a fuller and more effective use of food abundances; to provide for improved levels of nutrition among low-income households through a cooperative Federal -State program of food assistance to be operated through normal channels of trade; and for other purposes. G. Drug Free Workplace Act of 1988, which requires that all organizations receiving federal grants, regardless of amount granted, maintain a drug -free workplace. H. Texas Senate Bill 1 - 1991, as applicable, which refers to proper reporting of contributions as addressed in OAA §315 and TAC, Title 40, §85.201. FOCAL POINTS FOR THE SOUTH PLAINS ASSOCIATION OF GOVERNMENTS REGION FY 2012-2013 CENTER: Abernathy Sr. Citizens Association, Inc. (A-005) DIRECTOR: Louise Thomason H — 298-4055/ C — 789-5165 BOOKKEEPER: Louise Thomason ADDRESS: 717 Avenue C CITY: Abernathy, Texas 79311 PHONE: (806) 298-2842 E-mail: abernathysrcenter(a),erfwireless.net DAYS & HRS. OPEN: Tues. & Thurs. 8:00-12:00, 1:00-4:00, Wed. 8:00-4:00 SERVICES: COUNTY: Lubbock CENTER: Anton Sr. Citizens Association, Inc. (A-015) DIRECTOR: Carol Rendon BOOKKEEPER: Carol Rendon ADDRESS: Box 378 (201 Main Street) CITY: Anton, Texas 79313 PHONE: (806) 997-2781 E-mail: antonsrnwindstream.net DAYS & HRS. OPEN: Mon. —Fri. 8-2 SERVICES: CONG., H.D. COUNTY: Hockley CENTER: Bailey County Commissioners Court (A-020) DIRECTOR: Shelby Carpenter BOOKKEEPER: Shelby Carpenter ADDRESS: 300 South First Street Room 110 CITY: Muleshoe, Texas 79347 PHONE: (806) 272-3647 E-mail: bcadni!Afivearea.com DAYS & HRS. OPEN: Mon. - Fri. 8:30-12:00, 1:00-5:00 Fax: (806) 272-4656 SERVICES: TRANS. Cell: (806) 729-0680 COUNTY: Bailey CENTER: Bailey County Senior Citizens Assoc., Inc. (A-007) DIRECTOR: Laverne Winn H — (806)272-4491 C — (806) 946-8809 BOOKKEEPER: Brittany Gibbs ADDRESS: 319 S. Main St / PO Box 292 CITY: Muleshoe, Texas 79347 PHONE: (806) 272-4969 E-mail: seniors akfivearea.com DAYS & HRS. OPEN: Mon. — Fri.. 8:00 — 4:00 Fax: (806) 272-4460 SERVICES: LONG. COUNTY: Bailey FOCAL POINTS UPDATED 10/15/2012 CENTER: Brownfield Senior Citizens, Inc. (A-025) DIRECTOR: Betty Charlebois BOOKKEEPER: ADDRESS: P.O. Box 1021 (500 W. Bridges) CITY: Brownfield, Texas 79316 PHONE: (806) 637-6933 E-mail: bfldsrcitAyahoo.cotn DAYS & HRS. OPEN: Mon. - Fri. 8:30-2:00 SERVICES: CONG., H.D., TRANS. COUNTY: Terry CENTER: Cochran Co. Senior Citizens Assoc., Inc. (A-045) DIRECTOR: Nancy Luper C - (806) 523-3362 BOOKKEEPER: Nancy Luper ADDRESS: 120 W. Wilson CITY: Morton, Texas 79346 PHONE: (806) 266-5121 E-mail: ccsciC)yalornet.com DAYS & HRS. OPEN: Mon. — Fri. 8-4 Fax #: 266-9027 SERVICES: CONG., TRANS. COUNTY: Cochran CENTER: Crosby Co. Senior Citizens Assoc., Inc. (A-050) DIRECTOR: Donna Arnold BOOKKEEPER: Donna Arnold ADDRESS: 119 North Berkshire CITY: Crosbyton, Texas 79322 PHONE: (806) 675-2107 (806) 454-0189 (Donna's cell) E-mail: CrosbyCountySeniors(-?a,windstream.net DAYS S HRS. OPEN: Mon. —Fri. 8-3 SERVICES: CONG., H.D. COUNTY: Crosby CENTER: Floydada Senior Citizens, Inc. (A-055) DIRECTOR: Sylvia Bueno BOOKKEEPER: Sylvia Bueno ADDRESS: P.O. Box 573 (301 E. Georgia St.) CITY: Floydada, Texas 79235 PHONE; (806) 983-2032 E-mail: senior.citizens(ii),att.net DAYS & HRS. OPEN: Mon. — Fri. 8-2 SERVICES: CONG., H.D. COUNTY: Floyd FOCAL PC-)NTS UPDATED 10/15/2012 CENTER: Garza County Trailblazers, Inc. (A-070) DIRECTOR: Ila Workman BOOKKEEPER: Ila Workman ADDRESS: 205 E. 10th CITY: Post, Texas 79356 PHONE: (806) 495-2998 E-mail: garzatrailblazers(?a,yahoo.com DAYS & HRS. OPEN: Mon. — Fri. 8-2 SERVICES: CONG., H.D. COUNTY: Garza CENTER: Hale Center Senior Citizens Assoc., Inc. (A-075) DIRECTOR: Vickie Rosales BOOKKEEPER: Vickie Rosales ADDRESS: P.O. Box 205 (416 West 2°1 St.) CITY: Hale Center, Texas 79041 PHONE: (806) 839-2428 E-mail: hcsrcenter cx sbcglobal.net DAYS & HRS. OPEN: Mon. —Fri. 8-3 SERVICES: CONG., H.D., TRANS. COUNTY: Hale CENTER: Hockley County Senior Citizens Assoc., Inc. (A-085) DIRECTOR: Susan Sprowis BOOKKEEPER: Olga Gonzales ADDRESS: 1202 Houston CITY: Levelland, Texas 79336 PHONE: (806) 894-2228 E-mail: hcsca(a,aol.com DAYS & HRS. OPEN: Mon. — Fri. 8-4:30 (Smyer: Tues & Fri, 8-3) SERVICES: CONG., H.D., TRANS. COUNTY: Hockley CENTER: Lorenzo Senior Citizens Assoc., Inc. (A-095) DIRECTOR: Christina Edwards BOOKKEEPER: Christina Edwards ADDRESS: P.O. Box 571 (606 6th St.) CITY: Lorenzo, Texas 79343 PHONE: (806) 634-5957 E-mail: lorenzosca(a&,,windstream.net DAYS & HRS. OPEN: Mon. —Fri. 8-3 SERVICES: CONG., H.D. COUNTY: Crosby FOCAL POINTS UPDATED 10/15/2012 CENTER: Lubbock - City of Lubbock (A-100) DIRECTOR: Johnny McLellan, Supervisor: 775-2678 Nancy Neill, 775-2685 ADDRESS: P.O. Box 2000 (1010 9th St.) CITY: Lubbock, Texas 79457 PHONE: (806) 775-2678 E-mail: j_mclellan(),mail.ci.lubbock.tx.us nneill(a',,mylubbocLus & p i brown(a),mail.ci.lubbock. tx.us DAYS & HRS. OPEN: Mon. —Fri. 8-5 Fax: 775-2686 SERVICES: CONG., TRANS. COUNTY: Lubbock Mae Simmons — 767-2708, Traci Crawford (2004 Oak Avenue 79404), Copper Rawlings — 767-27C4, Herminia Martinez (213 40th Street 79404), (40" & Ave. B), Maggie Tre'o — 767-2705, Cecilia Mendoza (3200 Amherst 79415), Homestead - 687-7898, (5401 56t, Street 79414); Lubbock Senior Center — 767-2710, Paula Brown (2001 19`h Street 79401) FAX 765-0820 CENTER: Lynn County Pioneers (A-110) DIRECTOR: Bianca Baker BOOKI{EEPER: Bianca Baker ADDRESS: P.O. Box 223 (1600 S. 3' St.) CITY: Tahoka, Texas 79373 PHONE: (806) 561-5264 E-mail: lcp(adoor.net DAYS & HRS. OPEN: Mon. —Fri. 9-3 Fax: 561-5571 SERVICES: CONG., H.D. ( No Cong. in O'Donnell) COUNTY: Lynn CENTER: Motley County Sr. Citizens Association, Inc. (A-112) DIRECTOR: Tommye Keith BOOKI{EEPER: Tommye Keith ADDRESS: P. O. Box 184 (621 Stewart Street) CITY: Matador, Texas 79244 PHONE: (806) 347-2496 E-mail: mesenior(ca caprock-spur.com DAYS A HRS. OPEN: Monday - Friday 8-3 SERVICES: CONG., H.D. COUNTY: Motley FOCAL POINTS UPDATED 10/15/2012 CENTER: Senior Citizens Assoc. of S. Dickens County (A-130) DIRECTOR: Beverly Watson BOOKKEEPER: Jean Hoover ADDRESS: 210 Burlington CITY: Spur, Texas 79370 PHONE: (806) 271-4472 E-mail: sscaosdc(a7caprock-spur.com DAYS & HRS. OPEN: Mon. —Fri. 8-3 SERVICES: CONG., H.D. COUNTY: Dickens CENTER: Slaton Senior Citizens Assoc., Inc. (A-135) DIRECTOR: Charlotte O'Connell BOOKKEEPER: Charlotte O'Connell ADDRESS: 230 West Lynn CITY: Slaton, Texas 79364 PHONE: (806) 828-3784 E-mail: coconnell(a,door.net DAYS & HRS. OPEN: Mon. —Fri. 8-4 slatonseniors(a),door.net SERVICES: LONG., H.D. COUNTY: Lubbock CENTER: Yoakum County Senior Citizens Assoc., Inc. (A-150) DIRECTOR: Elsie White BOOKKEEPER: Pat Castillo ADDRESS: 412 West 50' St., #8 CITY: Denver City, Texas 79323 PHONE: (806) 592-8000 E-mail: Pat - ycsc69*,windstream.net DAYS & HRS. OPEN: Mon. —Fri. 9-2 SERVICES: CONG., H.D. COUNTY: Yoakum Fax: (806) 592-2835 T.Fc_F,Nn CONG. - Congregate (on -site) Meals H.D. - Home Delivered Meals SCO. - Senior Center Operations B.C. - Benefits Counseling TRAN. - Transportation Services FOCAL POINTS UPDATED 10/15/2012 Schedule of Providers' Board Meetings Abernathy The board meets quarterly, but not on specific dates -- Except for the annual meeting on the last Wednesday of Sept. Anton The board meets quarterly, but not on specific dates — Except for meetings in Nov. and Dec. to elect officers Bailey Co. The Commissioners' Court meets 2"d Monday of each month The Board of Directors for home delivered meals meets 2 times a year, but not on specific dates Bailey Co. Sr. The board meets on 2"d Wednesday of each month Brownfield The board meets on 2"d Thursday of each month Cochran Co. The board meets on lst Tuesday of every other month — With a meeting in December to elect officers Crosby Co. The board meets the 2"d Friday of each month. Annual meeting held the last week in October Floydada The board meets on 2"d Tuesday of each month Garza Co. The board meets on 3rd Tuesday of each month Hale Center The board meets on 2"d Monday of Jan., April, July & Oct. Hockley Co. The board meets on 4th Wednesday of each month Lorenzo The board meets on 2nd Monday of every other month Lynn Co. The board meets quarterly but not on specific dates Motley Co. The board meets quarterly but not on specific dates S. Dickens Co. The board holds 6 meetings per year (one every 2 months) But not on specific dates, and called meetings as needed. FOCAL PANTS UPDATED 10/15/2012 Slaton The board meets 2od Thursday of each month. Called meetings as needed, Yoakum The board meets on 4tn Wednesday of each month FOCAL POINTS UPDATED 10/15/2012 Certification Regarding Debarment CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION FOR COVERED CONTRACTS AND GRANTS Federal Executive Order 12549 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: l . 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 5. The potential vendor/grantee further agrees by submitting this certification that it will include this certification titled "Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion for Covered Contracts and Grants" without modification, in all covered subcontracts and in solicitations for all covered subcontracts. 6. A vendor/grantee may rely upon a certification of a potential sub vendor/sub-grantee that is not debarred, suspended, ineligible, or voluntarily excluded from the covered contract/grant, unless the vendor/grantee knows that the certification is erroneous. A vendor/grantee must, at a minimum obtain certifications from its covered sub vendors/sub-grantees upon each subcontract's/sub-grant's initiation and upon each renewal. 7. Nothing contained in all the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification by this certification document. The knowledge and information of a vendor/grantee is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 8. Except for contracts/grants authorized under paragraph 4 of these terms, if a vendor/grantee in a covered contract/grant knowingly enters into a covered subcontract/subgrant with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in the transaction, in addition to other remedies available to the federal government, Department of Health and Human Services, United States Department of Agriculture, or other federal department or agency, as applicable, and/or the Texas Department of Aging and Disability Services may pursue available remedies, including suspension and/or debarment. CERTIFICATION REGARDING DEBARMENT Page 3 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. 17560005906 i Signature of Authorized Representative . Chad Weaver Printed/Typed Name of Authorized Representative Assistant City Attorney October 1, 2012 Title of Authorized Representative Date This certification is for FY 2013, period beginning October 1, 2012 and ending September 30, 2013. 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. 10111/12 9:15 AM Provider Name: City of Lubbock AAA Name: A'ea Agency on Aging of South Plains Congregate Meals 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 by Funding Source Other Funds DADS A&I AAA 14,430 Eligible Meals 15,722 Other Sources 5 0 Other Funds - Non -Eligible Program Income 6.848 Meals 0 Other Sources 6 0 3. Whole Unit Rate (Line 1 divided by Line 2) Reimbursement Calculation 4. Projected NSIP per Meal Value DADS A&I AAA 0.69 5, Rate Less NSIP per Meal Value $ 6.76 6, Mandatory Local Match of 10% $ 0.68 " If Applicable, Match Reduction From the In -kind Match Certification form Required Cash Match $ (0.16) $ 0.50 7. Proposed Meal Rate (Line 3 minus Line 6) $ 6.95 If any portion of the required match is in -kind, you must complete an in-IUnd Match Certification form. By signing below, the provider acknowledges 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 ContragWrovider i ature Area Aoencv on A4iria of South Plains Name of Area Agency on Aging Ti C Pier Pnn d/Typ N me of ner t_ d` Signature _ October 1, _2012 Date Glen C. Robertson PrintedfTyped Name of Signer October 1, 2012 Date 1. $ 275,827,39 2. 37,000 3. $ 7.45 Attest: Reb cca Garza City Secretary Approve s t o t: R , dy Truesdell Community Services Director U=� : Chad Weaver Assistant City Attorney 10/11/12 9:16 AM Provider Name: City of LubbocK AAA Name. Area Agency on Aging of South Plains Congregate. Meals BUDGET WORKSHEFT CERTIFICATION AS SIGNER OF THIS BUDGET WORKSHEET, I HEREBY CERTIFY THAT: • I have read the note below and the instructions applicable to this budget worksheet. • I have reviewed this budget worksheet after its preparation. • To the best of my knowledge and belief, this budget worksheet is true, correct and complete, and was prepared in accordance with the instructions applicable to this budget worksheet. • This budget worksheet was prepared from the books and records of the contracted provider. • 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 workshect may result in a referral for prosecution. City of Lubbock Name of Contracted Provider October 1, 2012 Date Glen C. Robertson Printed/Typed Name of Signer Signature Signer Authority: ❑ Sole Proprietor ❑ Association Officer (check one) ❑ Partner ❑ Board Member 0 Corporate Officer ❑ Governmental Official Attest: Reber a Garza City Secretary Approved s to Conte Randy Truesdell Community Services Director =a7 Form: Chad Weaver Assistant City Attorney 10/11/12 9:17 AM AAA Name: Area Agency on Aging of South Plains Congregate Meals IN -KIND MATCH CERTIFICATION Provider: Cityof Lubbock In -kind Contribution(s): $5,416 For any item identified below, you must maintain support documentation. ITEM DATE OF RECEIPT VALUE RSVP Volunteers @ Lubbock Senior Center $5,416 3 Volunteers: I hrs/day X 249 days X $7.25/hr Minumum Wage TOTAL $5,416 Note: All contributions must meet the requirements of IRS Publication 561 http://www.irs.gov/pub/irs-pdf/p561.pd Examples of Documentation Include: Rent: 1. Letter of Agreement with Owner 2. Adequate Valuation of Property on a Current Basis (this should be reviewed at least every two years and if senior center, based on property value and center participation) Labor: 1. Minimum wage 2. Documented prevailing wage in the Area. For prevailing wage information visit the Texas Workforce Commission's website at http bx%ww,tracer2.com_ All in -kind labor must be required for the service to be provided. if you would not hire someone to perform the labor if it were not in -kind then you cannot count it. Utilities: 1. Copy of Bill 2. Agreement of Amount Paid if Partial City of Lubbock Name of Contracted Provider October 1, 2012 Date Glen C. Robertson PH pe me of Signer Signature Attest: D—A&X-.e — Re ec a Garza City S&retary Approved W to Content: // Ran y Truesdel Community Services Director ApproveO as to Torm: Chad Weaver Assistant City Attorney 10/11/12 5:18 AM Provider Name: City of Lubbock AAA Name: Area Agency on Aging of South Plains Transportation 3UDGET WORKSHEET CALCULATION OF THE UNIT RATE 1.Total Budgeted Expenses for Contract Year 2. Total Number of Anticipated Units to be Provided DADS A8l AAA - 10 % Program Match Required 3,248 Income DADS AW AAA - 25 % Local Funds - Match Required 0 Eligible Trips Other Funds - DADS A&I AAA - Full Unit Non -Eligible Rate 0 Trips 3. Cost per unit (Line 1 divided by Line 2) - Full Unit Rate 175 Other Sources 6 0 2,177 Other Sources 7 0 Other Sources 8 Reimbursement Calculation for Contracts Requiring Unit Rate Match Reduction 1. $ 45,051.815 2. 5,600 3. $ 8.D4 4. Mandatory Local Match of 10% $ 0.80 " If Applicable, Match Reduction From the In -kind Match Certification form $ - Required Match 4, $ 0.80 5.Full Unit Rate Less Required Match (Line 3 minus Line 4 5. $ 7.24 4. Mandatory Local Match of 25% $ 2,01 " If Applicable, Match Reduction From the In -kind Match Certification form $ Required Match 4. $ 2,01 5.Full Unit Rate Less Required Match (Line 3 minus Line 4' 5. $ 6.03 -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 $ 8.04 Contractor Initial AAA Initial City of Lubbock Legal Nam of on Provider Signature Printed/Typed Name of Signer October 1, 2012 Date 4Fe"gency oa.,A ing of South Plains Narrie of Are i Agency on AZj ig Signatur Tim C, Pierce PrintedlTyped flame of Signer October 1, 2012 Data Attest: tReb cca Garza ecretary Approve s to Content: i Ra dy Truesdell Community Services Director AZ,wes t Form: Chad Weaver Assistant City Attorney 10111/12 9:19 AM Provider Name. City of Lubbock AAA Name: Area Agency on Aging of South Plains Transportation Ri'DGET WORKSHEET CERTIFICATION AS SIGNER OF THIS BUDGET WORKSHEET, I HEREBY CERTIFY THAT: • I have read the note below and the instructions applicable to this budget worksheet. • I have reviewed this budget worksheet after its preparation. • To the best of my !knowledge and belief, this budget worksheet is true, correct and complete, and was prepared in accordance with the instructions applicable to this budget worksheet. • This budget worksheet was prepared from the books and records of the contracted provider. • 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 prosecution. City of Lubbock Name of Contracted Provider October 1, 2012 Date Signer Authority: Sole Proprietor (check one) Partner [J Corporate Officer Glen C. Robertson Pr' tedfryped Name of Signer Signature Amociatian Officer El Board Member Governmental Official Attest: i Rebe ca Garza City Secretary Approve as to Cont R dy Truesdell Community Services Director Appr ye as to Form: Chad Weaver Assistant City Attorney