HomeMy WebLinkAboutResolution - 2022-R0379 - Contract HHS001081400001 with Texas Health and Human ServicesResolution No. 2022-R0379
Item No. 5.18
September 13, 2022
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the acts of the Mayor of the City of Lubbock in executing, on behalf of the City of
Lubbock, Amendment No. 1 to the Health and Human Services Commission (HHSC) Contract
No. HHS001081400001, under the Prevention and Behavioral Health Promotion Grant
Programs Contract, by and between the City of Lubbock and the State of Texas acting by and
through HHSC, and related documents are hereby ratified in full. Said Amendment 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 on September 13, 2022
ATTEST:
Reb4ca Garza, City Sec
APPROVED AS TO CONTENT:
Bill rt weon, Deputy Ci ager
APPROVED AS TO FORM:
Ry 13 ke, A sistant City Attorney
RES.HHSC Contract No. HHS001081400001 Amendment 1 Ratification
9.7.22
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A-B3A1-784688EEA360
Resolution No. 2022-R0379
HEALTH AND HUMAN SERVICES COMMISSION
CONTRACT No. HHS001081400001
AMENDMENT No. 1
The HEALTH AND HUMAN SERVICES COMMISSION ("HHSC" or "System Agency") and CITY OF
LUBBOCK ("Grantee"), who are collectively referred to herein as the "Parties" to that certain
Prevention and Behavioral Health Promotion Grant Programs Contract, effective September 1,
2021, and denominated HHSC Contract No. HHS001081400001 ("Contract"), now desire to
amend the Contract.
WHEREAS, the Parties desire to revise various content, outlined below, of the original
Contract and its Attachments; and
WHEREAS, the Parties desire to add additional funding in State Fiscal Years 2023 and 2024
to the Community Coalition Partnership-COVID (SA/CCP-COV) Program;
Now, THEREFORE, the Parties hereby amend the Contract as follows:
1. ARTICLE IV ("BUDGET") of the Contract Signature document is hereby amended to add
State -allocated funding $259,616.00 in the CCP-COV Program, in State Fiscal Year
("FY") 2023 through FY2024. The CCP-COV Program new Total Contract Value is
$468,407.00.
SECTIONS C.2. and C.3. of ARTICLE IV ("Budget") of the Contract Signature document
are hereby deleted in their entirety and replaced as follows:
2. Fiscal Year 2023 allocations are as follows:
Program ID
FY23 HHSC Share
FY23 Match
Total Contract
Value
SA/YPS
$0.00
$0.00
$0.00
SA/YPU
$0.00
$0.00
$0.00
SA/YPI
$0.00
$0.00
$0.00
SA/CCP
$250,000.00
$12,500.00
$262,500.00
SA/CCP-COV
$208,791.00
$0.00
$208,791.00
SA/PRC
$250,000.00
$12,500.00
$262,500.00
Total
$708,791.00
$25,000.00
1 $733,791.00
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A-B3A1-784688EEA360
3. Fiscal Year 2024 allocations are as follows:
Program ID
FY24 HHSC Share
FY24 Match
Total Contract
Value
SA/YPS
$0.00
$0.00
$0.00
SA/YPU
$0.00
$0.00
$0.00
SA/YPI
$0.00
$0.00
$0.00
SA/CCP
$250,000.00
$12,500.00
$262,500.00
SA/CCP-COV
$50,825.00
$0.00
$50,825.00
SA/PRC
$250,000.00
$12,500.00
$262,500.00
Total
$550,825.00
$25,000.00
$575,825.00
2. ARTICLE IX ("ADDITIONAL GRANT INFORMATION") of the Contract Signature
document is deleted in its entirety and replaced with the following:
A. Grantee Data Universal Numbering System:
Federal Award Identification Number (FAIN):
Assisted Listing Name:
Assisted Listing Number:
Federal Award Date:
Federal Award Period:
Name of Federal Awarding Agency:
Awarding Official Contact Person:
B. Grantee Data Universal Numbering System:
Federal Award Identification Number (FAIN):
Assisted Listing Name:
Assisted Listing Number:
Federal Award Date:
Federal Award Period:
Name of Federal Awarding Agency:
Awarding Official Contact Person:
58213893
B08TIO83478-01
Block Grants for Prevention and
Treatment of Substance Abuse
93.959
2/02/2021
10/1/2020 — 9/30/2022
Department of Health and
Human Services
Wendy Pang, Grants
Management Specialist Center
for Substance Abuse Treatment,
wendv.Dan2a,sam hsa.hhs.eov.
(240) 276-1419
58213893
B08TIO83969
Block Grants for Prevention and
Treatment of Substance Abuse
93.959
05/17/2021
09/01/2021— 9/30/2025
Department of Health and
Human Services
Wendy Pang, Grants
Management Specialist Center
for Substance Abuse Treatment,
wendy.p and sam hsa. h hs.g ov,
(240) 276-1419
3. ATTACHMENT A, GENERAL STATEMENT OF WORK, is hereby deleted and replaced in its
entirety with REVISED ATTACHMENT A, REVISED GENERAL STATEMENT OF WORK
(SEPTEMBER 2022).
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A-B3A1-784688EEA360
4. SECTION IX, "DELIVERABLE AND REPORTING REQUIREMENTS," of ATTACHMENT A-2
(COMMUNITY COALITION PARTNERSHIP STATEMENT OF WORK) is hereby deleted in its
entirety and replaced with the following:
A. Grantee shall submit the CCP program report.'deliverables in accordance with
Revised Attachment C, Revised Deliverables and Performance Measures
(September 2022).
B. The CCP program deliverables described above are as follows:
1. Quarterly Reports: Using approved System Agency template, the Grantee will
document accomplishments and barriers during the implementation of
programmatic activities.
C. The CCP-COV program deliverables described above are as follows:
1. Quarterly Reports: Using approved System Agency template, the Grantee will
document accomplishments, barriers, and evaluation strategies during the
implementation of programmatic activities and projects for the CCP-COV
program.
2. CCP-COV Final Projects Report: Using approved System Agency template, the
Grantee will provide a summative description and evaluation of the CCP-COV
environmental and systemic change projects and stress -reducing and trauma -
healing activities to be completed by the end of FY24 (August 31, 2024). The
number of required environmental and systemic change projects by the end of the
funding period is a minimum of 2 per coalition receiving CCP-CO V funding.
5. ATTACHMENT B, FISCAL REQUIREMENTS, is hereby deleted and replaced in its entirety
with REVISED ATTACHMENT B, REVISED FISCAL REQUIREMENTS (SEPTEMBER 2022).
6. ATTACHMENT B-1, APPROVED CATEGORICAL BUDGET, is hereby deleted and replaced
in its entirety with REVISED ATTACHMENT B-1, APPROVED REVISED CATEGORICAL
BUDGET (SEPTEMBER 2022).
7. ATTACHMENT C, DELIVERABLES AND PERFORMANCE MEASURES, is hereby deleted and
replaced in its entirety with REVISED ATTACHMENT C, REVISED DELIVERABLES AND
PERFORMANCE MEASURES (SEPTEMBER 2022).
8. ATTACHMENT D, HHSC UNIFORM TERMS AND CONDITIONS —GRANT VERSION 2.16.1,
MARCH 26, 2019, is hereby deleted and replaced in its entirety with ATTACHMENT D-1,
HHS UNIFORM TERMS AND CONDITIONS — GRANT VERSION 3.2 (JULY 2022).
9. ATTACHMENT E, CONTRACT AFFIRMATIONS V.1.7, NOVEMBER 2020, is hereby deleted
and replaced in its entirety with ATTACHMENT E-1, HHS CONTRACT AFFIRMATIONS,
VERSION 2.2 (EFFECTIVE MAY 2022).
10. ATTACHMENT G-1, ASSURANCES -NON -CONSTRUCTION PROGRAMS [OMB NUMBER:
4040-00071 (2022) is hereby incorporated into the Contract and requires the Grantee to
complete the new assurances/certifications in order to meet the ongoing federal
requirement.
DocuSign Envelope ID: 89F4E5FE-64A4.4C4A-B3A1-784688EEA360
11. This Amendment shall take effect on September 1, 2022, provided that all Parties have
signed it before the conclusion of said date.
12. Except as modified by this Amendment, all terms and conditions of the Contract shall
remain in full force and effect.
13. Any further revisions to the Contract shall be by written agreement of the Parties.
SIGNATURE PAGE FOLLOWS.
SIGNATURE PAGE FOR AMENDMENT NO.1
HHSC CONTRACT NO. HHS001081400001
HEALTH AND HUMAN SERVICES CITY OF LUBBOCK
COMMISSION
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A-B3A1-784688EEA360
By�Decusgned by:
o a C,, lVJ,S
1477 CA4134DO418
Sonja Gaines
SG
August 26, 2022
Date of Signature:
ByL�uSigned by:
FDE&CSSaAE411-
Tray Payne
Mayor
August 26, 2022
Date of Signature:
THE FOLLOWING DOCUMENTS ARE ATTACHED HERETO AND HEREBY INCORPORATED AS PART
OF THE CONTRACT:
• REVISED ATTACHMENT A: REVISED GENERAL STATEMENT OF WORK (SEPTEMBER
2022);
• REVISED ATTACHMENT B: REVISED FISCAL REQUIREMENTS (SEPTEMBER 2022);
• REVISED ATTACHMENT B-1: APPROVED REVISED CATEGORICAL BUDGET (SEPTEMBER
2022);
• REVISED ATTACHMENT C: REVISED DELIVERABLES AND PERFORMANCE MEASURES
(SEPTEMBER 2022);
• ATTACHMENT D-1: HHS UNIFORM TERMS AND CONDITIONS — GRANT VERSION 3.2
(JULY 2022);
• ATTACHMENT E-1: HHS CONTRACT AFFIRMATIONS, VERSION 2.2 (EFFECTIVE MAY
2022);
• ATTACHMENT G-1: ASSURANCES -NON -CONSTRUCTION PROGRAMS [OMB NUMBER
4040-00071(2022); AND
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A B3A1-784688EEA360
REVISED ATTACHMENT A:
REVISED GENERAL STATEMENT OF WORK
(SEPTEMBER 2022)
I. PURPOSE
A. To provide prevention and behavioral health promotion strategies for programs
referenced in Contract Signature Document. Grantee is required to adhere to the
requirements within the Prevention and Behavioral Health Promotion (PBHP) Program
Guidance document (hereafter referred to as the "Program Guide"):
hgps://hhs.texas.gov/about-hhs/process-improvement/iml2roviniz-services-
texans/behavioral-health-services/substance-use-misuse-prevention .
II. GOAL
To prevent substance use and misuse and promote behavioral health and wellness in youth,
families, and communities across Texas. Grantees will implement the following strategies
as outlined in the Program Guide:
A. Prevention Education;
B. Information Dissemination;
C. Positive Alternatives;
D. Problem Identification and Referral;
E. Community -Based Processes; and
F. Environmental and Social Policies.
III. GENERAL RESPONSIBILITIES
Grantee shall:
A. Provide prevention services and activities in accordance with the rules in Title 26 of
the Texas Administrative Code (TAC), Chapter 321(A) and as outlined in this
agreement and the Program Guide.
B. Submit Implementation Plans as set forth in Revised Attachment C: Revised
Deliverables and Performance Measures (September 2022) for review and approval
by System Agency detailing how all required services and strategies will be
implemented locally. The Implementation Plan virtual forms can be located at the
following links:
a. YP Fall Semester (due 9/ 1);
b. YP Spring Semester (due 1/15);
c. YP Summer Term (due 5/15); and
d. CCP and PRC Annual (due 9/1).
C. Develop policies and procedures as required by 1 TAC § 392.511 and outlined within
the Program Guide, "Policy and Procedures Guidance" and make them available for
inspection by the System Agency.
D. Follow the National Standards for Culturally and Linguistically Appropriate Services
in Health and Health Care (The National CLAS Standards, 2013) and demonstrate
HHSC Solicitation No. HHS0010814
HHSC Contract No. HHS001081400001
Amendment No. I
Revised Attachment A: Revised General Statement of Work (September 2022)
Page 1 of 6
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A-B3A1-784688EEA360
REVISED ATTACHMENT A:
REVISED GENERAL STATEMENT OF WORK
(SEPTEMBER 2022)
good -faith efforts to reach out to under -served populations as detailed within the
Program Guide, "Adherence to CLAS Standards."
E. Secure and maintain community agreements with partners that adhere to the Program
Guide, "Community Agreements" (CAs). CAs may include a Memorandum of
Understanding (MOU), a Letter of Agreement (LOA), Memorandum of Agreement
(MOA) or other agreement as approved by System Agency.
F. Appropriate level staff shall participate in System Agency meetings, trainings, and
state -scheduled calls per requirements in the Program Guide, "Required HHS
Meetings and Communication."
G. Submit additional documentation as requested by the System Agency.
H. Post in a prominent location, legible prohibitions against firearms, weapons, alcohol,
and illegal drugs, illegal activities, and violence at program sites that do not have the
existing prohibitions posted.
I. Conduct and document quarterly fidelity and quality assurance checks of all required
activities.
J. System Agency requires all deliverables excluding the CMBHS deliverables be
submitted within Globalscape EFT, and/or any alternative method required by System
Agency. Grantee is required to maintain access to required systems or platforms for
the term of this Contract.
IV. STAFFING AND STAFF COMPETENCY REQUIREMENTS
A. Grantee shall designate two media representatives to assist with the statewide media
campaign as described in the Program Guide. Grantee's participation is required.
B. The Prevention Program Director and all other prevention program staff must complete
the general required trainings as specified in the Program Guide, Section General Staff
Training Requirements. All training and certification documentation must be
maintained within the employees' file for System Agency review upon request.
V. CRIMINAL BACKGROUND VERIFICATION REQUIREMENTS
Grantee shall establish and adhere to policies on conducting criminal background checks
of potential employees, volunteers, and/or subcontractors, which at a minimum must
include:
A. A pre -employment criminal background check for any individual that will have direct
contact with youth, families, or other participants;
B. Standards detailing hiring decisions for employees with a background check finding;
and,
C. Requirements for employees to report post -employment instances that would
negatively impact subsequent background checks.
HHSC Solicitation No. HHS0010814
HHSC Contract No. HHS001081400001
Amendment No. 1
Revised Attachment A: Revised General Statement of Work (September 2022)
Page 2 of 6
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A B3A1-784888EEA380
REVISED ATTACHMENT A:
REVISED GENERAL STATEMENT OF WORK
(SEPTEMBER 2022)
VI. CONSENT
Grantees are required to obtain consent from participants and their parents/legal guardians
in accordance with applicable laws. This includes obtaining consent for any youth
prevention program services as well as any activities, including Positive Alternatives, that
occur off -site or involve participant travel. Grantee will document consent using a form or
process created by Grantee. Grantee will maintain all relevant consent documentation on
file.
VII. DOCUMENTATION OF STRATEGIES AND SERVICES
Grantee shall utilize the Prevention Activity Tracking Tool (PATT), or other electronic
tools as required by the System Agency, to document prevention activities as outlined in
the Program Guide, "Documentation of Strategies and Services."
VIII. CLINICAL MANAGEMENT FOR BEHAVIORAL HEALTH SERVICES
(CMBHS) COMPONENTS
A. Grantee shall use the CMBHS components/functionality specified below, in
accordance with the System Agency instructions:
1. Request/maintain user access for appropriate staff, (including access control and
credential maintenance);
2. Provider detail;
3. Performance Measures;
4. Financial Status Reports (FSR);
5. Invoices; and
6. Curriculum Outcome Measures (YPS, YPU, and YPI Programs only).
B. Designate a Security Administrator and a back-up Security Administrator. The Security
Administrator is required to implement and maintain a system for management of user
accounts/user roles to ensure that all the CMBHS user accounts are current.
C. Notify the CMBHS Helpdesk within 10 business days of any change to the designated
Security Administrator or the back-up Security Administrator.
D. In addition to CMBHS Helpdesk notification, Grantee shall submit a signed CMBHS
Security Attestation Form and a list of Grantee's employees, contracted laborers and
sub -Grantees authorized to have access to secure data. The CMBHS Security
Attestation Form shall be submitted electronically on or before the 15th day of
September and March 15th, to the designated folder in Globalscape EFT.
E. Establish and maintain a security policy that ensures adequate system security and
protection of confidential information.
F. Ensure that access to CMBHS is restricted to only authorized users. Grantee shall,
within 24 hours, remove access to users who are no longer authorized to have access
to secure data.
G. Attend System Agency training on CMBHS documentation.
HHSC Solicitation No. HHS0010814
HHSC Contract No. HHS001081400001
Amendment No. 1
Revised Attachment A: Revised General Statement of Work (September 2022)
Page 3 of 6
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A-B3A1-784688EEA360
REVISED ATTACHMENT A:
REVISED GENERAL STATEMENT OF WORK
(SEPTEMBER 2022)
H. Use other CMBHS components and meet CMBHS training requirements per request
by the System's Agency. (The use of CMBHS is not limited to the components and
functionality listed above.)
IX. DELIVERABLE AND REPORTING REQUIREMENTS
A. Grantee shall submit all required reports of monitoring activities to System Agency by
the applicable due dates outlined in Revised Attachment C, Revised Deliverables
and Performance Measures (September 2022).
B. The following reports must be submitted to System Agency via Globalscape EFT
(https:Hsftp.hhs.texas.gov) by the required due dates and report name described in the
Revised Attachment C, Revised Deliverables and Performance Measures
(September 2022):
1. In addition to Clinical Management for Behavioral Health Services (CMBHS),
Grantees are required to submit data, reports, performance measures, and any other
requested information into data systems designated by the System Agency.
2. Grantee will notify the System Agency of any staffing changes within ten (10)
business days of a revision using the System Agency process outlined in the
Program Guide.
3. Grantee shall submit a Financial Status Report (FSR) for each awarded program.
4. Grantee shall submit a General Ledger for each awarded program to support each
Program's FSR.
5. Grantee shall submit monthly invoices in Clinical Management for Behavioral
Health Services (CMBHS) for each awarded program.
6. Grantee shall submit annual Contract Closeout documentation for each awarded
program. This documentation is required each fiscal year. Final Contract Closeout
is due October 15.
7. Grantee shall submit a CMBHS Security Attestation Form twice a fiscal year.
8. Grantee will report the performance measures for the previous month's activities in
CMBHS by the 15th of the current month for each awarded program.
9. Grantee's duty to submit documents will survive the termination or expiration of
this Contract.
X. PERFORMANCE MEASURE DEFINITIONS AND GUIDANCE
A. Grantee shall reference Program Guide, "Performance Measure Definitions and
Guidance," for the YP, PRC, and CCP performance measure definitions and guidance
regarding the data to report.
HHSC Solicitation No. HHS0010814
HHSC Contract No. HHS001081400001
Amendment No. 1
Revised Attachment A: Revised General Statement of Work (September 2022)
Page 4 of 6
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A B3A1-784688EEA360
REVISED ATTACHMENT A:
REVISED GENERAL STATEMENT OF WORK
(SEPTEMBER 2022)
B. Grantee shall report the performance measures required by each funded program
documented in Revised Attachment C, Revised Deliverables and Performance
Measures (September 2022).
C. System Agency will monitor Grantee's performance of the requirements herein, as well
as in Revised Attachment C, Revised Deliverables and Performance Measures
(September 2022).
XI. SYSTEM AGENCY INFORMATION
Name:
Marcellus Crayton
Email:
Marcellus.Crayton02@hhs.texas.gov
Address:
909 W. 45th Street, Bldg. 552 MC 2058
city/zip:
Austin, TX 78751
XII. RENEWALS
No renewal options are available for this Contract.
XIII. PROCUREMENT INFORMATION
This Contract is awarded from the System Agency's Request for Application, No.
HHS0000776, posted on March 11, 2019. Grantee is awarded the following contracts as a
result of the RFA:
Fiscal Year
Program
Contract Number
FY2020-2021
SA/Prevention
HHS001081400001
FY2022-2024
SA/Prevention
HHS001081400001
XIV. GRANTEE INFORMATION
Grantee TIN: 17560005906
HHSC Solicitation No. HHS0010814
HHSC Contract No. HHS001081400001
Amendment No. 1
Revised Attachment A: Revised General Statement of Work (September 2022)
Page 5 of 6
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A-B3A1-784688EEA360
REVISED ATTACHMENT A:
REVISED GENERAL STATEMENT OF WORK
(SEPTEMBER 2022)
Subrecipient
Contract Determination:
Cost Reimbursement
Payment Method:
HHSC Solicitation No. HHS0010814
HHSC Contract No. HHS001081400001
Amendment No. I
Revised Attachment A: Revised General Statement of Work (September 2022)
Page 6 of 6
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A-B3A1-784888EEA380
jml, v xoED ATTACHMENT B:
REVISED FISCAL REQUIREMENTS
(SEPTEMBER 2022)
Grantee shall ensure compliance to the fiscal requirements of the Contract, as follows:
A. This Contract is funded from the United States Health & Humans Services (HHS),
Substance Abuse and Mental Health Services Administration (SAMSHA), Block Grants
for Prevention and Treatment of Substance Abuse (SABG), Assistance Listing Number
(ALN) 93.959;
B. Compliance with the SABG Code of Federal Regulation (CFR), 45 CFR Part 96, Subpart
C, as applicable, is required;
C. Compliance with the following Grant requirements, located at System Agency'swebsite,
https://hhs.texas. ov/doing-business-hhs/ rg ants, is required.
1. Electronic Code of Federal Regulations (2 CFR 200);
2. Federal Uniform Grant Guidance;
3. Grant Technical Assistance guide; and
4. Texas Grant Management Standards.
D. Access the Transactions List report in CMBHS to identify the amount of federal funds
allocated to this award for each transaction.
E. Grantee is required to contribute five (5%) percent matching of funds. However, the CCP-
COV Program is funded by COVID-19 supplemental funding, which does not require a
matching of funds.
F. Any unexpended balance associated with any other System Agency -funded contract may
not be applied to this Contract.
G. Compliance to the following Invoicing and Payment requirements:
1. Submit monthly invoices to the System Agency utilizing CMBHS. Monthly invoices
required for all Programs awarded funding. All invoices shall be submitted by the
deadlines established in Revised Attachment C, Revised Deliverables and
Performance Measures (September 2022).
2. Be paid monthly and in accordance with services performed under this Contract.
3. After the closure of each Fiscal Year documented in Section H (below), System Agency
shall conduct Contract close-out activities. Grantee shall ensure all invoices for each
year (September — August) are submitted in CMBHS by October 15th. Invoices
submitted after October 15th may be denied.
H. The Contract Fiscal Year allocation information is as follows:
1. System Agency Share total reimbursements will not exceed $1,968,407.00 for the
period from September 1, 2021, through August 31, 2024, as follows:
i. Fiscal Year 2022, September 1, 2021 through August 31, 2022:
$708,791.00;
HHSC Solicitation No. HHS0010814
HHSC Contract No. HHS001081400001
Amendment No. 1
Revised Attachment B: Revised Fiscal Requirements (September 2022)
Page 1 of 3
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A-B3A1-784888EEA360 ED ATTACHMENT B'
a.� .
REVISED FISCAL REQUIREMENTS
(SEPTEMBER 2022)
ii. Fiscal Year 2023: September 1, 2022, through August 31, 2023:
$708,791.00; and
iii. Fiscal Year 2024: September 1, 2023, through August 31, 2024:
$550,825.00.
2. For each Fiscal Year noted immediately above, Grantee's match requirement is as
follows:
i. Fiscal Year 2022: September 1, 2021, through August 31, 2022: $25,000.00;
ii. Fiscal Year 2023: September 1, 2022, through August 31, 2023: $25,000.00; and
iii. Fiscal Year 2024: September 1, 2023, through August 31, 2024: $25,000.00
3. The total amount of this Contract, including applicable match will not exceed
$2,043,407.00 as documented below:
i. Fiscal Year 2022: September 1, 2021, through August 31, 2022:
$733,791.00;
ii. Fiscal Year 2023: September 1, 2022, through August 31, 2023:
$733,791.00; and
iii. Fiscal Year 2024: September 1, 2023, through August 31, 2024:
$575,825.00.
4. All Grantees awarded funding for a CCP Program are receiving Substance Abuse Block
Grant (SABG) Supplemental funding for the COVID-19 activities referenced in
Attachment A-2, Community Coalitions Partnership Statement of Work. The CCP-
COV Program funding is referenced in Article IV ("Budget') of the Contract Signature
Document.
I. The Cost Reimbursement Budget information is as follows:
1. The Cost Reimbursement budget documents all approved and allowable expenditures;
Grantee shall only utilize the funding detailed in Revised Attachment B-1, Approved
Revised Categorical Budget (September 2022), for approved and allowable costs. If
Grantee requests to utilize funds for an expense not documented on the approved
budget, Grantee shall notify, in writing, the System Agency assigned contract manager
and request approval prior to utilizing the funds. System Agency shall provide written
notification regarding if the requested expense is approved.
2. If needed, Grantee may further revise Revised Attachment B-1, Approved
Revised Categorical Budget (September 2022), which documents the approved
budget for each allocated Program. The requirements for each allocated Program are
as follows:
i. Grantee may transfer funds from the budget categories only, with the
exception of the "Equipment" category. Grantee may transfer up to ten (10%)
percent of the allocated fiscal year Program amount without System Agency's
approval. Budget revisions exceeding the ten (10%) percent requirement require
System Agency's written approval.
ii. Grantee may request revisions to the approved budget categories that
exceed the ten (10%) percent requirement, excluding "Equipment" and
"Indirect Cost" categories, by submitting a written request to the assigned
contract manager. This change is considered a minor administrative change
HHSC Solicitation No. HHS0010814
HHSC Contract No. HHS001081400001
Amendment No. 1
Revised Attachment B: Revised Fiscal Requirements (September 2022)
Page 2of3
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A B3A1-784688EEA360 x-MviuED ATTACHMENT B:
REVISED FISCAL REQUIREMENTS
(SEPTEMBER 2022)
and does not require an amendment, in accordance with Section 4.A.
("Minor Administrative Changes") of Attachment F, HHSC
Additional Provisions. System Agency will provide written notification
of the approval or denial of the request. The budget revisions are not
authorized, and funds cannot be utilized until Grantee receives written
approval.
iii. Grantee may request transferring funds between awarded Programs by
submitting a written request to the assigned Contract Manager. This change
is considered a minor administrative change and does not require an
amendment, in accordance with Section 4.A. ("Minor Administrative
Changes") of Attachment F, HHSC Additional Provisions. System
Agency will provide written notification of the approval or denial of the
request. The budget revisions are not authorized, and funds cannot be
utilized until Grantee receives written approval.
iv. Grantee may revise the Cost Reimbursement budget `Equipment' and/or
`Indirect Cost' categories, however a formal Amendment is required.
Grantee shall submit to the assigned contract manager a written request to
revise the budget, which includes a justification for the revisions. The
assigned Contract Manager shall provide written notification stating if the
requested revision is approved. If the revision is approved, the budget
revision is not authorized, and funds cannot be utilized until the
Amendment is executed and signed by both parties.
3. The budgeted indirect cost amount is provisional and subject to change. The
System Agency reserves the right to negotiate Grantee's indirect cost amount,
which may require Grantee to provide additional supporting documentation to
the assigned contract manager.
4. Grantee shall submit annual categorical budgets for Fiscal Years 2023-2024 on
the System Agency -approved template in accordance with the deadlines
documented in Revised Attachment C, Revised Deliverables and
Performance Measures (September 2022). System Agency will provide
written notification of the annual budget approval.
5. The approved fiscal year Categorical Budget for all awarded Program services
is referenced in Revised Attachment B-1: Approved Revised Categorical
Budget (September 2022).
HHSC Solicitation No. HHS0010814
HHSC Contract No. HHS001081400001
Amendment No. 1
Revised Attachment B: Revised Fiscal Requirements (September 2022)
Page 3 of 3
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A-B3A1-784688EEA360
ATTACHMENT B-1
APPROVED CATEGORICAL BUDGET
PREVENTION MASTER SUMMARY PAGE
Organization Name: jCfty of Lubbock Health Department
Contract Number: IHHS001081400001
Prevention Program(s) Contracted to Provide:ICCP, CCP-COV, PRC
Region:
Fiscal Year:
Total Contract Value (System Agency+Match)1$733,791.00
Date Submitted to HHSC:
Master Budget Roll -Up
Budget Categories
System Agency Funds
Requested
Cash Match
Non System Agency
funds
Category Total
Personnel
$225,765.00
$0.00
$0.00
$225.765.00
Fringe Benefits
$97,079.00
$0.00
$0.00
$97,079.00
Travel
$57,650.00
$0.00
$0.00
$67,650.00
Equipment
$0.00
$0.00
$0.00
$0.00
Supplies
$8,325.00
$0.00
$0.00
$8,325.00
Contractual
$256,150.00
$0.00
$0.00
$256,160.00
Other
$63,822.00
$25,000.00
$0.00
$88,822.00
Total Direct Costs
$708,791.00
$25,000.00
$0.00
$733,791.00
Indirect Costs
$0.00
$0.00
$0.00
$0.00
Totalul
$708,791.001
$25,000.001
$0.00
$733,791.00
Page 1of1
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A-B3A1-784688EEA360
CCP PROGRAM
Non -System Agency Funds
Budget Categories
System Agency
Funds Requested
Cash Match
In -Kind
Category Total
Personnel
$ 103,028.00
$ -
$ 1039028.00
Fringe Benefits
$ 44,302.00
$ -
$ 44,302.00
Travel
$ 42,448.00
$ -
$ 429448.00
Equipment
$ -
$ -
$ -
Supplies
$ 7,341.00
$ -
$ 7,341.00
Contractual
$ 46,800.00
$ -
$ 46,800.00
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A-B3A1-784688EEA360
Other
$ 6,081.00
$ 12,500.00
$ -
$ 180581.00
Total Direct Costs
$ 250,000.00
$ 12,500.00
$ -
$ 2629500.00
Indirect Costs
$ -
$ _
$
Totals
$ 250,000.00
$ 12,500.00
$ -
$ 262,500.00
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A-B3A1-784688EEA360
CCP-COV PROGRAM
Non -System Agency Funds
Budget Categories
System Agency
Funds Requested
Cash Match
In -Kind
Category Total
Personnel
$ -
$ -
$
Fringe Benefits
$ -
$ -
$
Travel
$ -
$ -
$
Equipment
$ -
$ -
$
Supplies
$ -
$
$ -
Contractual
$ 138,550.00
$ -
$ 138,550.00
DocuSign Envelope ID: 89F4E5FE-64A44C4A-B3A1-784688EEA360
Other
$ 70,241.00
$ -
$ 70,241.00
Total Direct Costs
$ 208,791.00
$ -
$ -
$ 208,791.00
Indirect Costs
$ -
$
$
Totals
$ 208,791.00
$ -
$ -
$ 208,791.00
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A-B3A1-784688EEA360
PRC PROGRAM
Non -System Agency Funds
Budget Categories
System Agency
Funds Requested
Cash Match
In -Kind
Category Total
Personnel
$ 122,737.00
$ -
$ 1229737.00
Fringe Benefits
$ 52,777.00
$ -
$ 529777.00
Travel
$ 15,202.00
$ -
$ 159202.00
Equipment
$ -
$ -
$
Supplies
$ 984.00
$ -
$ 984.00
Contractual
$ 70,800.00
$ -
$ 7%800.00
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A-B3A1-784688EEA360
Other
$ (12,500.00)
$ 12,500.00
$ -
$ -
Total Direct Costs
$ 250,000.00
$ 12,500.00
$ -
$ 2620500.00
Indirect Costs
$ -
$ -
$
Totals
$ 2609000.00
$ 12,500.00
$ -
$ 2629500.00
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A-B3A1-784888EEA360
Attachment C
Deliverables and Performance Measures
1. All ddivaWAm for the Contract me lidod in the below deliverable able; Gram - is requited to submit all ddivaablam for the Attachment A, General Stateroom M Work, Athrhmmt
B. Budget, and for all Prevenden Programs (YP's, PRC, CCP) awn" in aeomdsooe wGh the Contract Sigamme DocmnoaL
2. Grantee shall c rwe all requited ddiverablm ere submitted as follows:
n The detiverableo submitted m GlobaLSeape shall be —m the deliverable name refanced in oobmm "Report Name".
b. Reports we submitted by the due deft in cobmm "Doe Date". Note Deliverables den on the wcekend and/or boW are doe the am basmea day
c. Reports are sobmmW by the submission system doeamemod in the column "sobmisrim gstm".
d. System Agm.7 may regamt dakverablm to be sobmBted thmoyh an abomme submission systm.
3. Grantee is requital to submit perfinnno a mmmras in CMBHS for all Prevention ptog:mos awarded. Gramm shall ensure compbance to the folbwmg requaaoeatr
a. CCP, PRC and YP performance mensmm me submitted in CMBHS by the 15th of the umrem momh. Grease shall report the pmvwus wnwhe wuvd m.
b Pafatmosm will be measured m pent on the arLnvenew of the bey performance meanies.
c. Guidance mooning such performance monsoon on be found in the Program Gaidq Rafmmmce Manama Definitions and Gmdanom"
Requirement
Report Name
Doe Date
Subm;ssiooSysrem
Attach A, General
Prop Stuffing Report
Per fiscal year: September 15 and wtrhin 10 bathtw days of a
Preventon A-, Tracking Tool (PATr)
Satment of Work
A, General
CMBHS Security Ammonium Form and Listing of
Per final year:.IS° A March 156
GkrbalScape
Stm®ent of Work
thmimd Users
4 Cmegorieal Bodges, as follows:
Attach B, Badgat
Ceteogoroel Budget
: FY23 badges doe Janc 1, 2022
Glo alSeape
FY23 FY24 budget den June 1, 2023
Par final year, quarterly report schedule:
Ql rgastiog period, doe December 31st
Aftocli
Stateai A GaNwal
General Ledger (for each funded program)
Q2 reorting pperiod, due March 31'
GlobaIScape
Q3 ropmting period, due June 30th
Q4 reporting period, due October 15th
Per find yew, quarterly report schedule for Final Stang
Report (PSR) report
Ql topmost; period, due December 31m
Mach A. General
Financial Saba Repo- (FSRs) (for each funded
CMBHS
Staemmt of Work
)
Q2 rrporkog period, dun Mamh 3l'
Q3 rapmtmg paced, den Jme 30&
Q4 rvporong pared, den October 15th
Page 1 of 4
DocuSlgn Envelope ID: 89F4E5FE-64A4-4C4A-B3A1-784688EEA360
Attachment C
Deliverables and Performance Measures
Aftedi A, Gmeal
Manwun ( for each find pm8�)
Report previous month's activities due on the 15th of the cunmt
CMBHS or other sysm designated by
Stetem®t of Work
System Agency
Attach A. Cameral
(6u each funded
BZVMM Pam)
Invoices for the preview; artan tier
er 15a of the
CMBHS
Statement of Work
current mouth.
Attach A. General
Staimtmt of Work
knimot docammb (for each funded propem)
Final cloma t dommrmb doe October 15th inch fiscal year
Gkbd3cape
Annotations
A4YP SOW Reporting Requirements
A-1 YP
Due whim 20 ealmdar days after the eorrrmlum cycle has been
CMBHS or other system despaemd by
Stammmt of Work
Cumculrm Outcome Mmnues Reports
Sobmd each individual curriculum cycle and the
sanctioned artmmes
System AgemY
Virtual Form:
httpsj/fonn. COM/PegnlRapons2
YP Fall Seconder Impkmmtmm Plan. September Ist each
aspx7id-Mu5m7mCm0mxagk-
year
' 1Ta66jt7g1NpKIFoPWB7Y27hUQTdL
MFM3NVE1 W Vo3V UQyS IAyWIpHUVh
QRy4u
Virtual Four
httpsJ/foms.offimoom/Paga/RapovmPs
Attach A-1, YP
YP Spring Semester Impleosciewbon Plan. Doe January 15th
sspx7id-Mnf5m7mCm0mxeglc-
Staummt of Work
BHP YP Plow
each find year
' ITa66jj7mjhNpKtFuFWB7Y27hURUtR
W UOaTVYyOWMWUNEJG(YrEMzJW
MAu
Virtual Form:
ttps 9/forma.off oLcm/Pagn/RnpomPa
YP Srmcoer Term bnpkmmmtauon Plan. Doo May 15th each
aspx7id-Mnt5m7mCmOmxa*-
year
' ITa66j)7-ANpKeFuPWB7Y27hUQloyR
kFONUZZNVpLSjVPSU9VRjRCM3E9DW
C4u
Attanhmem
A,2, CCP Reporting Requirements
Admit A-2, CCP,
Aletds Act (CNA)
Bobtailed
GlobdSeaPe
mt
Stmmof Work
Attech A-2, CCP
LoSe Model
Submitted
GlowSeape
Statement of Work
Anwb A-2, CCP
Stetmmt of Work
Five-year Stratew Plan
Sabmrtted
GbbdSeape
Anach A-2, CCP
Statement of Work
Evaluation Plan
Submrmed
GbbdScgro
Virtual Form:
https:t/fm .offimcow/Pagm/Rmpo=Pa
A-Z CCP
Stafemmtof Work
BHP CCP Aoanel Implementation Plan
Dan September ]m each fiscd year
aspx7d-Mu6m7mCmOmxagk-
1Ta66jj7mjftK1FuPWB7Y27hUNIY5T
Q4VkdNTjdURVRP WjQ2M]hSSQAURCA
It
Per fiscal year, quarterly report schedule as fo0om-
Q1 reporting pored, due December 15th
Attach A-2, CCP
Smtmmt of Wark
Quarterly - CCP and CCP-COV
Q2 rryaaang pemod, due March 15W
GkmbdSeapa
Q3 raporhng period, due June 15th
Q4 reporung passed, due September 15th
Attach A-2, CCP
Statmmt of Wank
CP-COV Find Project Report
Due Aug st 31, 2024
GlobdScape
Attmhmmt A3.
PRC SOW Reorma Rammmmor
Ansch A3, PRC
Stalemet of Work
Report
Each Fiscal Year, dua March 3lrt
GW-lScape
Virtual Form.
ItUp I/fmms.ofocaconiPagn/Rnponto
Attach A-3, PRC
BHP PRC Amoal buplememanun Plan
Dun September Irt each Baal yaw
Page.aspx7d-Mnf5m7mCmOtaxalk-
Stotema d of Work
jr1Ta66j17mjbNpKtFoPWB7Y27hUN1Y
5TIQ4VkdNTjd MVRPWjQ2NMQmh
Nods Assessment
Each Fiscal Yen, August 31st
URC4u
GlobalSeape
Attxh A3, PRC
Statmmt of Work
Attach A3, PRC
Stnmmt of Work
ort Raped Needs Assnsmmt to websmm
Each Fiscal Year, August 3lst
GlobWScmpa
Note. Dmrvaabin into on the weekend and/or holiday um dun dam is the mad bmmns day
Page 2of4
CCP 1
CCP 2
CCP 3
CCP 4
CCP 6
CCP 6
Total CCP FTEe:
a
City of Lubbock Health Department
1
Lubbock, Hockley
Number of media awareness activities (not including social
Ila) focused on prevention and behavorial health promotion.
Number of social media messages focused on prevention
behavorial health promotion messaging and the statewide
Ila campaign.
Number of community-baaed processes focused on
tendon and behavorial health promotion.
Number of adults attending community -based processes
ised on prevention and behavorial health promotion.
Number of youth attending commun*based processes
lead on prevention and behavorial health promotion.
Number of changed policies and social norms related to
tendon and behavorial health promotion.
Number of youth attending stress reductionRrauma healing
ulties.
Number of adults attending stress reduction/trauma healing
Sept -Nov I Dec -Feb I Mar -May I Jun -Aug I Annual
1
1
1
0
3
36
36
36
36
144
68
68
68
68
272
400
400
400
400
1600
80
80
80
80
320
0
0
0
2
2
1
1
Organization Name:
Approved Performance Measures
-Note: Due to rounding, the sum of quarterly targets in the formula projections may be slightly higher or lower than the annual targets. HHSC will adjust the quarterly targets to equal the annual targets in the final contract
measures.
Compliance check measures are TBD as they are calculated based on the number of licensed tobacco retailers in each region:
1) In PRC regions with fewer than 2,400 licensed tobacco retailers, Grantee must visit a minimum of 250/a of active retailers (unduplicated) each quarter. Grantee will visit 100% of the active tobacco retailers throughout the
term of the fiscal year.
2) In PRC regions with 2,400 to 4,000 licensed tobacco retailers, Grantee must visit 2,000 of the active tobacco retailers in the region, throughout the term of the fiscal year. Grantee will visit a minimum of 25 % of the active
tobacco retailers (unduplicated) each quarter.
3) In PRC reqions with more than 4,000 licensed tobacco retailers, Grantee will visit a minimum of 210 (unduplicated) tobacco retailers per month throuqhout the term of this Contract.
• -Texas School Survey measures are TBD as they are calculated based on the number of schools selected to participate in the TSS every fiscal year by the TSS contractor, Public policy Research Institute at Texas A&M
University. The TSS contractor has also asked that we stop contacting schools about the survey in the last quarter of the fiscal year.
DocuSign Envelope ID: 89F4E5FE-64A4-4C4A-B3A1-784688EEA360
OMB Number. 4040-0007
Expiration Date: 02/28/2025
ASSURANCES - NON -CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND
IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances.
If such is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
1. Has the legal authority to apply for Federal assistance
and the institutional, managerial and financial capability
(including funds sufficient to pay the non -Federal share
of project cost) to ensure proper planning, management
and completion of the project described in this
application.
2. Will give the awarding agency, the Comptroller General
of the United States and, if appropriate, the State,
through any authorized representative, access to and
the right to examine all records, books, papers, or
documents related to the award; and will establish a
proper accounting system in accordance with generally
accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding
agency.
S. Will comply with the Intergovernmental Personnel Act of
1970 (42 U.S.C. §§4728-4763) relating to prescribed
standards for merit systems for programs funded under
one of the 19 statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to
nondiscrimination. These include but are not limited to:
(a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color
or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C.§§1681-
1683, and 1685-1686), which prohibits discrimination on
the basis of sex; (c) Section 504 of the Rehabilitation
Act of 1973, as amended (29 U.S.C. §794), which
prohibits discrimination on the basis of handicaps; (d)
the Age Discrimination Act of 1975, as amended (42 U.
S.C. §§6101-0107), which prohibits discrimination on
the basis of age; (e) the Drug Abuse Office and
Treatment Act of 1972 (P.L. 92-255), as amended,
relating to nondiscrimination on the basis of drug
abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) §§523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290
se- 3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the Civil
Rights Act of 1966 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
made; and, 0) the requirements of any other
nondiscrimination statute(s) which may apply to the
application.
Will comply, or has already complied, with the
requirements of Titles II and III of the Uniform
Relocation Assistance and Real Property Acquisition
Policies Act of 1970 (P.L. 91-646) which provide for
fair and equitable treatment of persons displaced or
whose property is acquired as a result of Federal or
federally -assisted programs. These requirements
apply to all interests in real property acquired for
project purposes regardless of Federal participation in
purchases.
8. Will comply, as applicable, with provisions of the
Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328)
which limit the political activities of employees whose
principal employment activities are funded in whole
or in part with Federal funds.
Previous Edition Usable Standard Form 424E (Rev. 7-97)
Authorized for Local Reproduction Prescribed by OMB CimularA-102
DocuSign Envelope ID: 89F4E5FE-64A44C4A-B3A1-784688EEA360
9. Will comply, as applicable, with the provisions of the Davis- 13. Will assist the awarding agency in assuring compliance
Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act with Section 106 of the National Historic Preservation
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract Act of 1966, as amended (16 U.S.C. §470), EO 11593
Work Hours and Safety Standards Act (40 U.S.C. §§327- (identification and protection of historic properties), and
333), regarding labor standards for federally -assisted the Archaeological and Historic Preservation Act of
construction subagreements. 1974 (16 U.S.C. §§469a-1 et seq.).
10. Will comply, if applicable, with flood insurance purchase
requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973 (P.L. 93-234) which requires
recipients in a special flood hazard area to participate in the
program and to purchase flood insurance if the total cost of
insurable construction and acquisition is $10,000 or more.
11. Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91-190) and
Executive Order (EO) 11514; (b) notification of violating
facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in
floodplains in accordance with EO 11988; (e) assurance of
project consistency with the approved State management
program developed under the Coastal Zone Management
Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of
Federal actions to State (Clean Air) Implementation Plans
under Section 176(c) of the Clean Air Act of 1955, as
amended (42 U.S.C. §§7401 et seq.); (g) protection of
underground sources of drinking water under the Safe
Drinking Water Act of 1974, as amended (P.L. 93-523);
and, (h) protection of endangered species under the
Endangered Species Act of 1973, as amended (P.L. 93-
205).
12. Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. §§1271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.
14. Will comply with P.L. 93-348 regarding the protection of
human subjects involved in research, development, and
related activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of
1966 (P.L. 8945", as amended, 7 U.S.C. §§2131 et
seq.) pertaining to the care, handling, and treatment of
warm blooded animals held for research, teaching, or
other activities supported by this award of assistance.
16. Will comply with the Lead -Based Paint Poisoning
Prevention Act (42 U.S.C. §§4801 et seq.) which
prohibits the use of lead -based paint in construction or
rehabilitation of residence structures.
17. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMB Circular No. A-133,
"Audits of States, Local Governments, and Non -Profit
Organizations."
18. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.
19. Will comply with the requirements of Section 106(g) of
the Trafficking Victims Protection Act (TVPA) of 2000, as
amended (22 U.S.C. 7104) which prohibits grant award
recipients or a sub -recipient from (1) Engaging in severe
forms of trafficking in persons during the period of time
that the award is in effect (2) Procuring a commercial
sex act during the period of time that the award is in
effect or (3) Using forced labor in the performance of the
award or subawards under the award.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
TITLE
oocuftmd W.
(-
Mayo r
APPLICANT ORGANIZATION
DATE SUBMITTED
The city of Lubbock
August
Standard Forth 424E (Rev. 7-07) Back