HomeMy WebLinkAboutResolution - 2004-R0393 - Change Order To Contracts - Texas Department Of Health - 08_16_2004Resolution No. 2004-R 0393
August 16, 2004
Item No. 40
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LU3BOCK:
THAT the Mayor of the City of Lubbock is hereby authorized and directed to
execute for and on behalf of the City of Lubbock Change No. 02 (HIV Surveillance);
Change No. 03 (AC Family Health); and Change No. 04 (Zoonosis Control) to the
Contract with the Texas Department of Health (TDH Document No. 7560005906 2005)
approved January 8, 2004, by and between the City of Lubbock and the Texas
Department of Health, copies of said Changes No. 02, 03, and 04 and associated
documents are 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 16th day of August , 2004.
ATTEST:
--
Sc-
Rebd,ca Garza, City Secretary
APPROVED AS TO CONTENT:
Tommy Cam n, Health Director
APPROVED AS TO FORM:
G. Vandiver, Attorney of
DDres/TDHcon05changes
July 26, 2004
Resolution No. 2004-RO393
August 16, 2004
' Item No. 40
DEPARTMENT OF STATE HEALTH SERVICES
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS DSHS Document No. 7560005906 2005
COUNTY OF TRAVIS Contract Change Notice No. 02
The Department of State Health Services, hereinafter referred to as RECEIVING AGENCY, did heretofore enter into a contract in
writing with LUBBOCK CITY HEALTH DEPARTMENT hereinafter referred to as PERFORMING AGENCY. The parties thereto
now desire to amend such contract attachment(s) as follows:
SUMMARY OF TRANSACTION:
ATT NO.02 : HIV - SURVEILLANCE
All terms and conditions not hereby amended remain in full force and effect.
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
CITY OF LUBBOCK HEALTH DEPARTMENT
Authorized Contracting Entity (type above if different
from PERFORMING AGENCY) for and in behalf of:
PERFORMING AGENCY:
LUBBOCK CITY HEALT
By:
(Name and
ARTMENT
authorized to sign)
Date: August 16, 2004
RECOMMENDED:
By:
(PERFO AGENCY Director, if different
from person authorized to sign contract
A as to form /
city Attorney
RECEIVING AGENCY:
�EN . F STATE HE TH SERVICES
By:
(Signature of person authorized to sign)
Bob Burnette, Director
Procurement and Contracting Services Division
(Name and Title)
�y�
Date:
Cover Page 1
DETAILS OF ATTACHMENTS
Att/
Program ID/
Term
Financial Assistance
Direct
Total Amount
Amd
DSHS Purchase
Assistance
(DSHS Share)
No.
Order Number
Begin
End
Source of
Amount
Funds*
01A
� OC�
01/01/04
12/31/04
State 93.268
92,176.00
0.00
92,176.00
02
JHIV/SURV
09/01/04
08/31/05
50,251.00
0.00
50,251.00
C038578000
DSHS Document No.7560005906 2005 Totals
$142,427.00
$ 0.00
$142,427.00
Chan a No. 02
*Federal funds are indicated by a number from the Catalog of Federal Domestic Assistance (CFDA), if applicable. REFER TO
BUDGET SECTION OF ANY ZERO AMOUNT ATTACHMENT FOR DETAILS.
Cover Page 2
DOCUMENT NO.7560005906-2005
ATTACHMENT NO.02
PURCHASE ORDER NO. C038578000
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: BUREAU OF HIV AND STD PREVENTION
TERM: September 01, 2004 THRU: August 31, 2005
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY shall conduct active surveillance and reporting activities for human
immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS).
PERFORMING AGENCY shall comply with all applicable federal and state laws, rules,
regulations, standards, and guidelines to include:
• Chapters 81 and 85 of the Health and Safety Code;
• Relevant portions of Chapter 6A (Public Health Service) of Title 42 (The Public Health
and Welfare) of the United States Code, as amended;
• 25 TAC Chapter 97, Subchapter F;
• RECEIVING AGENCY Quality Care: TDH Standards for Public Health Services,
revised January 2004; and,
• HIV/AIDS and STD Program Operating Procedures and Standards.
PERFORMING AGENCY shall perform all activities in accordance with PERFORMING
AGENCY'S Inter -Local Application For State HIV/AIDS Surveillance Services ILA HIV/SURV
0011.1 dated March 19, 2004, activities work plan and any revisions, and detailed budget as
approved by RECEIVING AGENCY Program. All of the above -named documents are
incorporated herein by reference and made a part of this contract Attachment. All revisions to
these documents shall be approved by RECEIVING AGENCY Program and transmitted in
writing to PERFORMING AGENCY.
The activities required to carry out these projects are outlined in the Centers for Disease Control
and Prevention (CDC) Guidelines for HIV/AIDS Surveillance, April 1996, and RECEIVING
AGENCY Program's grant applications and awards by CDC which are the basis for this contract
Attachment. Copies have been provided to RECEIVING AGENCY Program.
Within thirty (30) days of receipt of an amended standard(s) or guideline(s), PERFORMING
AGENCY shall inform RECEIVING AGENCY Program, in writing, if it will not continue
performance under this contract Attachment in compliance with the amended standard(s) or
ATTACHMENT — Page 1
guideline(s). RECEIVING AGENCY may terminate the contract Attachment immediately or
within a reasonable period of time as determined by RECEIVING AGENCY.
PERFORMING AGENCY shall immediately comply with all applicable policies adopted by
RECEIVING AGENCY Program.
PERFORMING AGENCY shall be responsible to RECEIVING AGENCY Program for the
design, maintenance and evaluation of an active surveillance system for HIV/AIDS cases. For
the purpose of this contract Attachment, HIV infection and AIDS are as defined by the Centers
for Disease Control and Prevention of the United States Public Health Service in accordance
with the Health and Safety Code §81.101. The publication designating the most current
definition may be requested from RECEIVING AGENCY.
PERFORMING AGENCY shall perform the following:
1. REPORTING
a. Maintain a current list of key reporting sources in the PERFORMING
AGENCY'S geographic area and visit key reporting sources at least yearly to
establish and maintain communication about reporting rules and regulations and
available public health services.
b. Collect reports of HIV and AIDS cases diagnosed and/or treated within
PERFORMING AGENCY'S geographic area.
C. Ensure that HIV/AIDS case reports are accurate, complete and submitted to
RECEIVING AGENCY Program within 45 days of receipt of the initial
laboratory or morbidity report.
d. Download and mail electronic and hard copy case reports to the RECEIVING
AGENCY Program weekly by Friday close of business unless prior arrangements
have been made with the RECEIVING AGENCY Program.
e. Conduct Incidence Surveillance activities in cooperation with the contractor
identified to coordinate Incidence Surveillance by RECEIVING AGENCY
Program.
2. REGISTRY MAINTENANCE
a. Maintain a case file on all confirmed and suspected cases of HIV infections and AIDS
diagnosed and/or treated within PERFORMING AGENCY'S geographic area.
b. Follow-up pediatric HIV exposed cases every six (6) months until the case has
met the CDC surveillance definition of presumptively or definitely infected or
uninfected.
ATTACHMENT — Page 2
C. Review HIV cases at a minimum of once yearly to identify and update registry
with AIDS defining conditions.
3. SYSTEM EVALUATION
a. Review and provide appropriate follow-up on all suspected HIV/AIDS cases
identified by RECEIVING AGENCY Program's alternate record review systems
in order to enhance case ascertainment and validate the effectiveness of local
surveillance efforts.
b. Track reporting by local sources in order to monitor the level of compliance to
reporting laws and level of case ascertainment.
C. Conduct prescribed weekly, monthly, quarterly and annual analyses to monitor
trends in the data and evaluate data quality.
4. EPIDEMIOLOGIC INVESTIGATIONS
a. Initiate epidemiologic investigations on newly reported No Identified Risk (NIR)
cases and cases of public health importance within three (3) days of receipt of
case report through contact with appropriate health care provider or the review of
medical records.
b. A determination of the need for public health follow-up will be made on all HIV
positive test results within three (3) business days of the receipt of the test results.
If no clear determination can be made within the three (3) business days, the HIV
test results should be sent to a Disease Intervention Specialist (DIS) for
investigation.
C. Assist RECEIVING AGENCY Program with other epidemiologic investigations
as deemed necessary by RECEIVING AGENCY Program or CDC.
5. ' CONFIDENTIALITY
a. Store all case files and computer diskettes containing patient information in a
locked file cabinet when not in use. The locked file cabinet and surveillance
computer shall be kept in a locked room with limited, controlled access.
b. Utilize passwords to access computer databases containing HIV/AIDS case data.
Passwords shall be changed monthly and known only to surveillance personnel.
ATTACHMENT — Page 3
C. Limit the number of persons who have keys to registry files to persons directly
involved in case reporting and the HIV/STD Program Manager in the geographic
area of the PERFORMING AGENCY.
d. Require a statement of confidentiality to be signed by all personnel having access
to HIV/AIDS case files and computer diskettes kept on file by PERFORMING
AGENCY.
e. PERFORMING AGENCY may release demographic analyses of local data as
public information as long as it complies with the Texas Department of Health,
Bureau of HIV and STD Prevention Policy No. 020.061 "Publication or Release
of HIV/STD Data".
RECEIVING AGENCY reserves the right, where allowed by legal authority, to redirect funds in
the event of financial shortfalls. RECEIVING AGENCY Program will monitor PERFORMING
AGENCY'S expenditures on a quarterly basis. If expenditures are below that projected in
PERFORMING AGENCY'S total contract amount as shown in SECTION III. BUDGET,
PERFORMING AGENCY'S budget may be subject to a decrease for the remainder of the
Attachment term. Vacant positions existing after ninety (90) days may result in a decrease in
funds.
PERFORMING AGENCY shall authorize its staff to attend training, conferences, and meetings
for which funds were budgeted and approved by RECEIVING AGENCY Program.
PERFORMANCE MEASURES
The following performance measures will be used to assess, in part, PERFORMING AGENCY'S
effectiveness in providing the services described in this contract Attachment, without waiving
the enforceability of any of the other terms of the contract:
PERFORMING AGENCY shall enter no less than 90% of all new disease reports
received by the PERFORMING AGENCY as morbidity into the HIV/AIDS Reporting
System within 24 hours of the receipt of the disease report.
PERFORMING AGENCY shall ensure transfer of collected HIV/AIDS case information
to RECEIVING AGENCY Program weekly by the close of business each Friday.
PERFORMING AGENCY may send a written request to RECEIVING AGENCY
Program to extend the timetable for transferring data. Any such agreement shall be in
writing and signed by both parties.
PERFORMING AGENCY shall have no less than 90% of the HIV/AIDS cases reports
completed with legitimate answers to the three (3) questions: 1) was patient informed of
HIV status; 2) were partner services needed; and 3) are additional referral services
needed. If the percentage of case reports with these three (3) questions completed drops
ATTACHMENT — Page 4
below 80%, the PERFORMANCE AGENCY must prepare and submit a plan to the
RECEIVING AGENCY Program addressing how the completion percentage will be
improved.
PERFORMING AGENCY shall make a determination of how the need for public health
follow-up will be made on 95% of all HIV positive test results within three (3) business
days of the receipt of the test results. If no clear determination can be made within the
three (3) business days, the HIV test results should be sent to a Disease Intervention
Specialist (DIS) for investigation.
RECEIVING AGENCY Program will provide HIV/AIDS case reporting activities for
cases diagnosed in the following geographic area(s): Lubbock.
PERFORMING AGENCY shall complete and submit quarterly activity reports
demonstrating PERFORMING AGENCY'S conduct of HIV/AIDS case -finding
activities. These reports shall be submitted to RECEIVING AGENCY Program on the
20th calendar day of December 2004, March 2005, June 2005 and October 2005, in a
format provided by RECEIVING AGENCY Program.
SECTION II. SPECIAL PROVISIONS:
General Provisions, Assurances Article, is revised to include the following:
PERFORMING AGENCY shall comply with all federal and state non-discrimination
statutes, regulations, and guidelines. PERFORMING AGENCY shall provide services
without discrimination on the basis of race, color, national origin, age, disability,
ethnicity, gender, religion, or sexual orientation.
General Provisions, Records Retention Article, is revised to include the following:
All records pertaining to this contract Attachment shall be retained by PERFORMING
AGENCY and made available to RECEIVING AGENCY, the Comptroller General of
the United States, the Texas State Auditor, or any of their authorized representatives, and
in accordance with RECEIVING AGENCY'S General Provisions.
Due to the sensitive and highly personal nature of HIV/AIDS-related information,
PERFORMING AGENCY shall require its personnel to adhere strictly to the General
Provisions, Confidentiality of Protected Health Information Article. This Article is revised to
include the following:
Neither PERFORMING AGENCY, nor any subrecipient, shall transfer a client or patient
record through any means, including electronically, to another entity or person, or
subrecipient without written consent from the client or patient, or someone authorized to
act on his or her behalf; however, RECEIVING AGENCY may require PERFORMING
ATTACHMENT — Page 5
AGENCY, or any subrecipient, to transfer a client or patient record to RECEIVING
AGENCY if the transfer is necessary to protect either the confidentiality of the record or
the health and welfare of the client or patient.
RECEIVING AGENCY -shall have access to a client or patient record in the possession
of PERFORMING AGENCY, or any subrecipient, under authority of the Health and
Safety Code, Chapters 81 and 85, and the Medical Practice Act, Texas Occupations
Code, Chapter 159. In such cases, RECEIVING AGENCY shall keep confidential any
information obtained from the client or patient record, as required by the Health and
Safety Code, Chapter 81, and Texas Occupations Code, Chapter 159.
ATTACHMENT — Page 6
FINANCIAL ASSISTANCE
CURRENT
OBJECT CLASS CATEGORIES
NEW OR REVISED
APPROVED
CHANGES
BUDGET
BUDGET
REQUESTED
a. PERSONNEL . ...............................
27,789.00
0.00
27,789.00
b. FRINGE BENEFITS ..........................
12,506.00
0.00
12,506.00
c. TRAVEL ...................................
4,678.00
0.00
4,678.00
d. EQUIPMENT ................................
0.00
0.00
0.00
e. SUPPLIES .................................
5,278.00
0.00
5,278.00
f. CONTRACTUAL .............................
0.00
6.00
0.00
g. OTHER ....................................
0.00
0.00
0.00
h. TOTAL DIRECT CHARGES .....................
50,251.00
0.00
50,251.00
i. INDIRECT CHARGES .........................
0.00
0.00
0.00
'. TOTAL ....................................
50,251.00
0,00
50,251.00
k. RECEIVING AGENCY SHARE ...................
50,251.00
0.00
50,251.00
1. PERFORMING AGENCY SHARE (Includes m. PI)
0.00
0.00
0.00
m. PROGRAM INCOME:
0.00
0.00
0.00
m.2. Program Income (projected).........
0.00
0.00
0.00
m.3.Other Match .........................
0.00
0.00
0.00
CONTRACT TERM
Begin Date ....................................
9/l/2004
End Date ......................................
8/31/2005
DETAIL ON INDIRECT COST:
TYPE OF RATE PROVISIONAL ................
PREDETERMINED .............
FINAL .....................
FIXED ......................
RATE ......................................
0.00000
0.00000
0.00000
BASE ......................................
0.00
0.00
0.00
TOTAL INDIRECT CHARGES ....................
0.00
0.00
0.00
Financial status reports are due the 30th of December, 30th of March, 30th of June, and the 30th of November.
Resolution No. 2004—RO393
August 16, 2004
s Item No. 40
DEPARTMENT OF STATE HEALTH SERVICES
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS DSHS Document No. 7560005906 2005
COUNTY OF TRAVIS Contract Change Notice No. 03
The Department of State Health Services, hereinafter referred to as RECEIVING AGENCY, did heretofore enter into a contract in
writing with LUBBOCK CITY HEALTH DEPARTMENT hereinafter referred to as PERFORMING AGENCY. The parties
thereto now desire to amend such contract attachment(s) as tollows:
SUMMARY OF TRANSACTION:
ATT NO. 03 : AC FAMILY HEALTH - POPULATION BASED
All terms and conditions not hereby amended remain in full force and effect.
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
CITY OF LUBBOCK HEALTH DEPARTMENT
Authorized Contracting Entity (type above if different
from PERFORMING AGENCY) for and in behalf of:
PERFORMING AGENCY:
(Name and Title)
Date: August 16, 2004
RECOMMENDED:
AAYI Al
By:e A 4A)11� &4q
(PERFORMIN GENACY Director, if different
from person authorized to sign contract
RECEIVING AGENCY:
DEPARTMENT OF STATE HEALTH SERVICES
By:
(Si a of rson author o sign
Bob Burnette, Director
Procurement and Contracting Services Division
(Name and Title)
Date: (' - .26 - 0 '1
KR PCSD - Rev. 6/04
G
A P as to form A` :
_C.
C i �y HL W t 'y �S, Uty Se=tary� r
Cover Page 1
DETAILS OF ATTACHMENTS
Att/
DSHS Program ID/
Term
Financial Assistance
Direct
Total Amount
Amd
DSHS Purchase
Assistance
(DSHS Share)
No.
Order Number
Begin
End
Source of
Amount
Funds*
OIA
IMM/LOCALS
01/01/04
12/31/04
State 93.268
92,176.00
0.00
92,176.00
0000001776'
02
HIV/SURV
09/01/04
08/31/05
50,251.00
0.00
50,251.00
C038578000
03
ACFH/POP
IC038805000
09/01/04
08/31/05
93.994
45,977.00
0.00
45,977.00
DSHS Document No.7560005906 2005 Totals
$188,404.00
$ 0.00
$188,404.00
Change No. 03
*Federal funds are indicated by a number from the Catalcg of Federal Domestic Assistance (CFDA), if applicable. REFER TO
BUDGET SECTION OF ANY ZERO AMOUNT ATTACHMENT FOR DETAILS.
Cover Page 2
DOCUMENT NO.7560005906-2005
ATTACHMENT NO.03
PURCHASE ORDER NO. C038805000
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: ASSOCIATE COMMISSIONER FOR FAMILY
HEALTH
TERM: September 01, 2004 THRU: August 31, 2005
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY shall perform public health preventive services related to women,
children, and their families in order to address local health needs; to build the local public health
infrastructure; and to improve the health status of women, children, and families.
PERFORMING AGENCY shall comply with all applicable federal and state laws, rules,
regulations, standards, and guidelines in effect on the beginning date of this contract Attachment
unless amended. The following documents are incorporated by reference and made part of this
contract Attachment:
• RECEIVING AGENCY Family & Community Health Services Grants FY2005
Competitive Request for Proposal (RFP) for Title V Population -Based projects,
• PERFORMING AGENCY FY2005 Component II, Attachment C application and any
revisions;
• RECEIVING AGENCY'S Texas Department of Health (TDH) Standards for Public
Health Clinic Services, revised January 31, 2004;
• RECEIVING AGENCY'S Quality Assurance (QA) Title V - Population Based On -Site
Evaluation Report (designed to be used with QA Core Tool), which requires monthly
time sheets to document staff time on work plan activities, invoices of all expenditures,
logs of dated activities with sign -in sheets for public presentations; and,
• Title V Policy and Procedures Manual revised for FY2005.
Within thirty (30) days of receipt of an amended standard(s) or guideline(s), PERFORMING
AGENCY shall inform RECEIVING AGENCY Program, in writing, if it will not continue
performance under this Attachment in compliance with the amended standard(s) or guideline(s).
RECEIVING AGENCY may terminate the Attachment immediately or within a reasonable
period of time as determined by RECEIVING AGENCY.
ATTACHMENT — Page 1
PERFORMING AGENCY shall implement its approved work plan in consultation with
RECEIVING AGENCY'S Public Health Region (PHR) Title V Coordinator and Central Office
Program Manager.
RECEIVING AGENCY'S PHR Director, as coordinator of regional services, will assist
RECEIVING AGENCY staff in providing direction to PERFORMING AGENCY.
RECEIVING AGENCY personnel will provide technical assistance and training to
PERFORMING AGENCY, as needed. PERFORMING AGENCY shall cooperate with
RECEIVING AGENCY staff to attain the goals of unified community health assessment, policy
development, coordinated services, and quality assurance and to prevent unnecessary duplication
of services.
PERFORMANCE MEASURES
The following performance measures will be used to assess, in part, PERFORMING
AGENCY'S effectiveness in providing the services described in this contract Attachment,
without waiving the enforceability of any of the other terms of this contract.
• PERFORMING AGENCY shall submit monthly progress reports, per program policy
stated in FY2005 program manual, within thirty (30) days of the end of each month.
• PERFORMING AGENCY shall submit quarterly reports on project activities to
RECEIVING AGENCY'S PHR Title V Coordinator for review, assessment, and
transmission to Central Office within thirty (30) days of the end of each quarter.
Quarterly reports shall describe accomplishments, challenges, barriers, impact, and
progress in achieving the goals and objectives contained in PERFORMING AGENCY'S
FY2005 Title V Application work plan, and any revisions.
• The quarterly progress report shall be in the format specified by RECEIVING AGENCY
in the Title V Policy and Procedures Manual and through any amended guidelines.
• PERFORMING AGENCY shall provide public health preventative services to women,
children, and their families who live or receive services in the following counties/area:
Lubbock.
PERFORMING AGENCY shall submit a comprehensive final report on FY2005 work
plan activities on or before September 30, 2005. This final report shall include the
findings of an evaluation to determine the effectiveness of project activities in addressing
local health needs, in building the local public health infrastructure, and in improving
public health status.
SECTION II. SPECIAL PROVISIONS:
General Provisions, Reports Article, is revised to include the following:
ATTACHMENT — Page 2
PERFORMING AGENCY shall submit monthly, quarterly and year-end program and
financial reports, in the format specified by RECEIVING AGENCY Program, within
thirty (30) days of the end of each month and quarter, and within ninety (90) days of the
end of the contract Attachment term detailing the activities performed and the objectives
achieved with the funding provided under this contract Attachment. PERFORMING
AGENCY shall submit other reports as deemed necessary by RECEIVING AGENCY
Program.
General Provisions, Inspections Article, is revised to include the following:
In addition to the site visits authorized by the Inspections Article of the General
Provisions, PERFORMING AGENCY shall allow RECEIVING AGENCY to conduct
on -site quality assurance reviews as deemed necessary by RECEIVING AGENCY.
Unsatisfactory review findings may result in implementation of General Provisions,
Sanctions Article.
PERFORMING AGENCY shall notify RECEIVING AGENCY Program immediately in the
event of any significant change affecting PERFORMING AGENCY'S identity, ownership or
control, name, governing board membership, vendor identification, medical or program director,
or address. Failure to disclose the required information or inaccurate disclosure by
PERFORMING AGENCY may be treated as a material breach of this contract Attachment and
may be grounds for termination.
ATTACHMENT — Page 3
FINANCIAL ASSISTANCE
CURRENT
OBJECT CLASS CATEGORIES
NEW OR REVISED
APPROVED
CHANGES
BUDGET
BUDGET
REQUESTED
a. PERSONNEL ................................
33,638.00
0.00
33,639.00
b. FRINGE BENEFITS ..........................
12,339.00
0.00
12,339.00
c. TRAVEL ...................................
0.00
0.00
0.00
d. EQUIPMENT ................................
0.00
0.00
0.00
e. SUPPLIES .................................
0.00
0.00
0.00
f. CONTRACTUAL ..............................
0.00
0.00
0.00
g. OTHER ...................................
0.00
0.00
0.00
h. TOTAL DIRECT CHARGES .....................
45,977.00
0.00
45,977.00
i. INDIRECT CHARGES .........................
0.00
0.00
0.00
'. TOTAL ....................................
45,977.00
0.00
45,977.00
L RECEIVING AGENCY SHARE ...................
45,977.00
0.00
45,977.00
1. PERFORMING AGENCY SHARE (Includes m. PI)
0.00
0.00
0.00
m. PROGRAM INCOME:
0.00
0.00
0.00
m.2. Program Income (projected).........
0.00
0.00
0.00
m.3.Other Match .........................
0.00
0.00
0.00
CONTRACT TERM
Begin Date ....................................
9/1/2004
End Date ......................................
g131/2005
DETAIL ON INDIRECT COST:
TYPE OF RATE PROVISIONAL ................
PREDETERMINED .............
FINAL ......................
FDCED......................
RATE ......................................
0.00000
0.00000
0.00000
BASE ......................................
0.00
0.00
0.00
TOTAL INDIRECT CHARGES ....................
OAO
0.00
0.00
Financial status reports are due the 30th of December, 30th of March, 30th of June, and the 30th of November.
0
DEPARTMENT OF STATE HEALTH SERVICES
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-31"
STATE OF TEXAS DSHS Document No. 7560005906 2005
COUNTY OF TRAVIS Contract Change Notice No. 04
The Department of State Health Services, hereinafter referred to as RECEIVING AGENCY, did heretofore enter into a contract in
writing with LUBBOCK CITY HEALTH DEPARTMENT hereinafter referred to as PERFORMING AGENCY. The parties
thereto now desire to amend such contract attacnment(s) as ronows:
SUMMARY OF TRANSACTION:
ATT NO. 04 : ZOONOSIS CONTROL
All terms and conditions not hereby amended remain in full force and effect.
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
CITY OF LUBBOCK HEALTH DEPARTMENT
Authorized Contracting Entity (type above if different
from PERFORMING AGENCY) for and in behalf of:
PERFORMING AGENCY:
LUBBOCK CITY ALTH DEPARTMENT
By:
('r
e o pers authorized to sign)
(Name and Title)
Date: August 16, 2004
RECOMMENDED: t
By: awL�
(PERFORMIN AGENCY Director, if different
from person authorized to sign contract
RECEIVING AGENCY:
DE P OFF ATE HEALTH SERVICES
By:
(Signature of person authorized to sign)
Bob Burnette, Director
Procurement and Contracting Services Division
(Name and Title)
Date:
PF PCSD - Rev. 6/04
q ed as to for A=:
Gi[y Attorrley
Cover Page 1
DETAILS OF ATTACHMENTS
Att/
DSHS Program ID/
Term
Financial Assistance
Direct
Total Amount
Amd
DSHS Purchase
Assistance
(DSHS Share)
No.
Order Number
Begin
End
Source of
Amount
Funds*
01 A
IMM/LOCALS
01 /01 /04
12/31 /04
State 93.268
92,176.00
0.00
92,176.00
0000001776
02
HIV/SURV
09/01/04
08/31/05
50,251.00
0.00
50,251.00
C038578000
03
ACFH/POP
IC038805000
09/01/04
08/31/05
45,977.00
0.00
45,977.00
04
ZOONOSIS
09/01/04
08/31/05
10,886.00
0.00
10,886.00
C038061000
DSHS Document No.7560005906 2005 Totals
$199,290.00
$ 0.00
$199,290.00
1:
Change No. 04
*Federal funds are indicated by a number from the Catalog of Federal Domestic Assistance (CFDA), if applicable. REFER TO
BUDGET SECTION OF ANY ZERO AMOUNT ATTACHMENT FOR DETAILS.
Cover Page 2
DOCUMENT NO. 7560005906-2005
ATTACHMENT NO. 04
PURCHASE ORDER NO. C038061000
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: ZOONOSIS CONTROL DIVISION
TERM: September 01, 2004 THRU: August 31, 2005
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY shall sterilize dogs and cats owned by the general public at no or
minimal cost.
PERFORMING AGENCY shall comply with all applicable federal and state laws, rules, and
regulations including, but not limited to, the following:
• Texas Health and Safety Code, Chapter 828, Dog and Cat Sterilization;
• Title 25, Texas Administrative Code § 169.102, Texas Department of Health (TDH)
Animal Friendly Grants.
PERFORMING AGENCY shall comply with all applicable regulations, standards, and
guidelines in effect on the beginning date of this contract.
The following documents are incorporated by reference and made a part of this contract
Attachment:
• RECEIVING AGENCY'S FY 05 Animal Friendly Spay/Neuter Project, Request for
Proposal (RFP) #RFP Z01.0081.1, issued November 19, 2003 and
• PERFORMING AGENCY'S FY 05 Animal Friendly Spay/Neuter Project, RFP #RFP
Z01.0081.1 Application and any revisions agreed upon in writing by PERFORMING
AGENCY and RECEIVING AGENCY.
Within thirty (30) days of receipt of an amended standard(s) or guideline(s), PERFORMING
AGENCY shall inform RECEIVING AGENCY Program, in writing, if it will not continue
performance under this contract Attachment in compliance with the amended standard(s) or
guideline(s). RECEIVING AGENCY may terminate the contract Attachment immediately or
within ninety (90) days.
RECEIVING AGENCY reserves the right, where allowed by legal authority, to redirect funds in
the event of financial shortfalls. RECEIVING AGENCY Program will monitor PERFORMING
AGENCY'S expenditures on a quarterly basis. If expenditures are below that projected in
ATTACHMENT — Page 1
PERFORMING AGENCY'S total contract amount, as shown in SECTION 1II. BUDGET,
PERFORMING AGENCY'S budget may be subject to a decrease for the remainder of the
Attachment Term.
PERFORMANCE MEASURES
The following performance measures report will be used to assess, in part, PERFORMING
AGENCY'S effectiveness in providing the services described in this contract Attachment,
without waiving the enforceability of any of the other terms of the contract. PERFORMING
AGENCY shall maintain the documentation used to calculate key outcome performance
measures. In accordance with the General Provisions, Reports Article, failure to submit reports
shall be cause for cancellation of the contract. The reporting periods and due dates are as
follows:
PERIOD COVERED
DUE DATE
September — November
December 31, 2004
December — February
March 31, 2005
March — May
June 30, 2005
June — August
September 30, 2005
1. Number of animals sterilized and returned to owner (indexed monthly by sex and species
per line);
2. Number of owners receiving services;
3. Number of qualified owners requesting services;
4. Names and Texas license numbers of all veterinarians performing sterilizations under this
project;
5. Total expenditures this project has incurred for the time period at issue (separating direct
and indirect costs),
6. Total amount of TDH grant funds spent on this project during this time period;
7. Amount and source of all income or funds received from sources other than TDH
Zoonosis Control Division Animal Friendly Grant which were used in this program; and
8. Estimated amount of in -kind services received.
SECTION II. SPECIAL PROVISIONS:
None.
ATTACHMENT — Page 2
FINANCIAL ASSISTANCE
CURRENT
OBJECT CLASS CATEGORIES
NEW OR REVISED
APPROVED
CHANGES
BUDGET
BUDGET
REQUESTED
a. PERSONNEL . ...............................
0.00
0.00
0.00
b. FRINGE BENWITS ..........................
0.00
0.00
0.00
c.TRAVEL..................................
0.00
0.00
0.00
d. EQUIPMENT ................................
0.00
0.00
0. 00
e. SUPPLIES .................................
0.00
0.00
0.00
f. CONTRACTUAL .............................
10,886.00
0.00
10,886.00
g. OTHER ....................................
0.00
0.00
0.00
h. TOTAL DIRECT CHARGES .....................
10,886.00
0.00
10,886.00
'. INDIRECT CHARGES .........................
0.00
0.00
0.00
'. TOTAL ....................................
10,886.00
0.00
10,886.00
k. RECEIVING AGENCY SHARE ...................
10,886.00
0.00
10,886.00
1. PERFORMING AGENCY SHARE (Includes m. PI)
0.00
0.00
0.00
m. PROGRAM INCOME:
0.00
0.00.
0.00
m.2. Program Income (projected).........
0.00
0.00
0.00
m.3.Other Match .........................
0.00
0.00
0.00
CONTRACT TERM
Begin Date ....................................
9/1/2004
End Date ......................................
8/31/2005
DETAIL ON INDIRECT COST:
TYPE OF RATE PROVISIONAL ................
PREDETERMINED .............
FINAL ......................
FDCED......................
RATE ......................................
0.00000
0.00000
0.00000
BASE ......................................
0.00
0.00
0.00
TOTAL INDIRECT CHARGES ....................
0.00
0.00
0.00
Financial status reports are due the 30th of December, 30th of March, 30th of June, and the 30th of November.