HomeMy WebLinkAboutResolution - 2004-R0454 - Contract Change Order With Texas Department Of Health - 09_16_2004Resolution No. 2004-RO454
September 28, 2004
Item No. 10
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 Change No. 06 to a Contract
with the Texas Department of Health (TDH Document No. 7560005906 2005) for
Immunization Division - Local and any associated documents by and between the City of
Lubbock and the Texas Department of Health, a copy of which Contract Change No. 06
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 2&h day of September '2004.
McDOUGAL, MAYOR
ATTEST:
. QaA:��
Reb cca Garza, City Secretary
APPROVED AS TO CONTENT:
cf;��e 1,0&
Tommy C en, Health Director
APPROVED AS TO FORM:
G. Vandiver, Attorney of Counsel
DDres/TDHcon05Chg6Res
September 1, 2004
F Resolution No. 2004-RO454
September 28, 2004
Item No. 10
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS TDH Document No. 7560005906 2005
COUNTY OF TRAVIS Contract Change Notice No. 06
The Texas Department of Health, 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
aesire to amenu sucn contract attacnment(s) as toitows:
SUMMARY OF TRANSACTION:
ATT NO. 01B : IMMUNIZATION DIVISION - LOCALS
All terms and conditions not hereby amended remain in full force and effect.
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
CITY OF LUBBOCK HEALTH DEPARTMENT
Authorized Contracting Entity (type above if different
from PERFORMING AGENCY) for and in behalf of:
PERFORMING AGENCY:
LUBBOCK CITY HEAL
0
sign)
(Name and Title)
Date: September 28, 2004
RECOMMENDED:
By:
(PERFORMIN A ENCY Director, if different
from person authorized to sign contract
Aouroved as to fo c
City Attorney
RECEIVING AGENCY:
TEX PAART OF HEA TH
i
By:
(Signature of person authorized to sign)
Bob Burnette, Director
Procurement and Contracting Services Division
(Name and Title) �p
Date:
i7►`
- Rev
Cover Page 1
DETAILS OF ATTACHMENTS
Att/
TDH Program ID/
Term
Financial Assistance
Direct
Total Amount
Amd
TDH Purchase Order
Assistance
(TDH Share)
No.
Number
Begin
End
Source of
Amount
Funds*
01B
IMM/LOCALS
01/01/04
12/31/04
State 93.268
138,264.00
0.00
138,264.00
0000001776
02
HIV/SURV
09/01/04
08/31/05
50,251.00
0.00
50,251.00
C038578000
03
ACFH/POP
09/01/04
08/31/05
93.994
45,977.00
0.00
45,977.00
C038805000
04
ZOONOSIS
09/01/04
08/31/05
10,886.00
0.00
10,886.00
C038061000
05
OPHP/LPHS
09/01/04
08/31/05
118,559.00
0.00
118,559.00
C039236000
TDH Document No.7560005906 2005 Totals
$363,937.00
$ 0.00
$363>937.00
Change No. 06
*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
TEXAS DEPARTMENT OF HEALTH
RECEIVING AGENCY PROGRAM: IMMUNIZATION DIVISION
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
CONTRACT TERM: 01101/2004 THRU: 12/31/2004 BUDGET PERIOD: 01/01/2004 THRU 12/31/2004
TDH DOC. NO. 7560005906 200501B CHG. 06
REVISED CONTRACT BUDGET
FINANCIAL ASSISTANCE
OBJECT CLASS CATEGORIES
CURRENT APPROVED
BUDGET (A)
CHANGE
REQUESTED (B)
NEW OR REVISED
BUDGET (C)
Personnel
Fringe Benefits
Travel
Equipment
Supplies
Contractual
Other
Total Direct Charges
Indirect Charges
TOTAL
PERFORMING AGENCY SHARE:
Program Income
Other Match
RECEIVING AGENCY SHARE
PERFORMING AGENCY SHARE
$62,667.00
$31,333.00
$94,000.00
20,593.00
10,296.00
30,889.00
1,200.00
600.00
1,800.00
0.00
0.00
0.00
3,020.00
1,511.00
4,531.00
4,696.00
(4,696.00)
0.00
0.00
7,044.00
7,044.00
$92,176.00
$46,088.00
$138,264.00
0.00
0.00
0.00
$92,176.00
$46,088.00
$138,264.00
0.00
0.00
0.00
0.00
0.00
0.00
$92,176.00
$46,088.00
$138,264.00
$0.00
$0.00
$0.00
Detail on Indirect Cost Rate Type:
Rate 0.00 Base $0.00 Total $0.00
Budget Justification: Increase is to budget remainder of funds to enable contractor to continue services through the end of the
contract term.
Form No. GC-9
Financial status reports are due the 30th of April, 30th of July, 30th of October, and the 30th of March.
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS,
LOANS AND COOPERATIVE AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief that:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or an
employee of any agency, a member of Congress in connection with the awarding of any
federal contract, the making of any federal grant, the making of any federal loan, the
entering into of any cooperative agreement, and the extension, continuation, renewal,
amendment, or modification of any federal contract, grant, loan, or cooperative
agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a member of Congress, an officer or employee of Congress, or an
employee of a member of Congress in connection with this federal contract, grant,
loan, or cooperative agreement, the undersigned shall complete and submit Standard
Form-111, "Disclosure Form to Report Lobbying," in accordance with it's
instructions.
(3) The undersigned shall require that the language of this certification be included in the
award documents for all subawards at all tiers (including subcontracts, subgrants,
and contracts under grants, loans and cooperative agreements) and that all
subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when
this transaction was made or entered into. Submission of this certification is a prerequisite
for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code.
Any person who fails to file the required certification shall be subject to a civil penalty of not
less than $10,000 and not more than $100,000 for each such failure.
September 28, 2004
Sign ture Date
mw wzm�L
Print Name of Authorized Individual
7560005906 2005-01
Application or Contract Number
LUBBOCK CITY HEALTH DEPARTMENT
Organization Name and Address
1902 TEXAS AVENUE
LUBBOCK, TX 79408-0000