HomeMy WebLinkAboutResolution - 2017-R0402 - Grant Agreement-SPAG - 11/02/2017Resolution No. 2017-RO402
Item No. 6.1.1
November 2, 2017
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, an Area Agency on Aging Direct Purchase of Services
Program Grant Agreement and related documents from the State of Texas, acting by and
through the Texas Department of Aging and Disability Services and the South Plains
Association of Governments (SPAG), for funds passed through the U.S. Department of
Health and Human Services to the State of Texas. Said Grant Agreement will be used to
provide an integrated service delivery system to meet the needs of older individuals and their
caregivers, and the grant funds will be used only for the purposes for which they are
intended under the grant. Said Grant Agreement 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 November 2 2017
DANIEL M. POPE, MAYOR
ATTEST:
APPROVED AS TO
APPROVED AS TO FORM:
0
City
IC
ccdocs/RES. Grant Agreement — 2018 SPAG Aging Grant
October 16, 2017
Resolution No. 2017-RO402
_14111141 ®
1323 58th St, PO Box 3730, Freedom Station
Lubbock, TX 79452-3730 ea // A g enc y
ti
SPAG (806) 687-0940 oil Aging
South Naha Amiation 806 765-9544
of Governments ( )
1-888-418-6564
DIRECT PURCHASE OF SERVICE APPLICATION INFORMATION
The South Plains Association of Governments Area Agency on Aging (SPAG AAA) is designated by
the Texas Health and Human Services Commission (HHSC) to be the focal point for services to persons
age 60 or older within the AAA's region. The SPAG AAA administers services funded by the Older
Americans Act (OAA) with emphasis placed on frail, rural, low income and minority individuals. The
AAA purchases various short-term services for eligible clients. Services are purchased from
appropriate Subrecipients that have completed a Direct Purchase of Service (DPS) Application form,
and have executed a Subrecipient Agreement with the AAA.
Eligibility to Apply: Organizations eligible to apply include private non-profit, private for -profit, and
local city/county governmental entities, which have the capacity to meet the requirements of service
delivery under DPS procedures.
Debarred/Suspended Parties: Debarred or suspended parties are ineligible to apply for funding and are
excluded from participation in this program.
Definition of Direct Purchase of Service (DPS): DPS is a contracting methodology for the purchase of
services by the AAA on a client -by -client basis in lieu of annualized contracting, or a fixed sum basis.
It is a procurement methodology, which provides flexibility in the purchasing of services for
participants in the OAA Programs.
Application Process: Interested parties may apply for consideration for participation in the Subrecipient
pool by submitting a completed and signed direct purchase of service application, including all required
attachments, and certification regarding debarment. If the application is approved by the AAA, a
Subrecipient Agreement may be executed.
South Plain Association of Governments Area Agency on Aging
Subrecipient Application August 29, 2017
04 The South Plains Association of Governments Area Agency on Aging AreaAgency
Direct Purchase of Service
SPAG Fiscal Year 2017 Vendor Application/Renewal Update WonAging
im- rare ono.
as
Please type or clearly print application information.
City of Lubbock
Vendor Name/Legal Entity
DBA (if applicable)
Address:
2001 19th Street (Lubbock Adult Activity Center), Parks Administration, 1611 10th Street, Lubbock, TX 79401
Mailing Address (complete even if same as above):
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 (check one):
Governmental Agency aPrivate Non -Profit Private For Profit
■City Government
Authorizing Official:
Daniel M. Pope
Email Address:
Billing Contact Person and billing address:
County Government Other:
Title:
Nancy Neill, City of Lubbock, PO Box 2000, 79456
Email Address:
elephone:
776-2050
Indoor Recreation Coordinator
Telephone:
nneillnm lubbock.us 806 775-2685
Number of Years Organization has been in business: Is Organization Bonded?
(Attach certificate of bonding Insurance)
38 Years Yes ■ No
Does Organization have liability insurance?
(Attach certificate of all insurances) Attach a copy of all applicable State and Federal
licenses and /or certifications for your business.
■ Yes El No
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.
DPS Application
Page 1
Attest:
Garza
Approved as to Content:
Bridget Faulkenberry
Parks and Recreation
Approved as to Form:
4siJussn Pr itt
tant City Attorney
1;
2.
3.
4.
Service and Bidding Information:
Proposed Service:
Conareaate Meals
B. Service Area:
Ct` Lf�-,)K
C. Proposed HHSC OAAA cost per unit: Whole cost per unit:
$ 7.70 $ 8.48
A. Proposed Service:
Home Delivered Meals
B. Service Area:
N/A
C. Proposed HHSC OAAA cost per unit:
Proposed Service:
B. Service Area:
C-�� (Dv-- W e)�ot
C. Proposed HHSC OAAA cost per unit:
$ 8.66
A. Proposed Service:
N/A
B. Service Area:
N/A
Proposed HHSC OAAA cost per unit:
Signature:
Whole cost per unit:
Whole cost per unit:
$ 9.62
Whole cost per unit:
1, Daniel M. Pope, Mayor , certify that the information provided in this application is true and
Printed Name
correct to the best of my knowledge.
November 2, 2017
Authorized Signature Date
DPS Application
Page 2
City of
bock
TEXAS
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 #791-00-02-30-0008 which expires on 10/01/18. The current
net asset balance of the self-insurance fund is $10,605,382. The existing cash asset
balance is $12,840,264 as of the date stated below.
L y Morrison
Risk Manager
Date: September 30, 2017
DATE October 1, 2017
TO South Plains Association of Government
FROM City of Lubbock — Senior Center Programs
SUBJECT FY 2017-18 Operating Hours and Holidays for SPAG Grant
Number of
Name of Sites
Serving Days
Lubbock Adult Activity Center
251
Rawlings Community Center
251
Simmons Senior Center
251
Trejo Supercenter
251
Homestead Senior Program
251
Holidays Observed
Dates Observed
Thanksgiving Day
November 23; 2017
Day After Thanksgiving
November 24, 2017
Christmas Eve
December 22, 2017
Christmas Day
December 25, 2017
New Year's Day
January 1, 2018
Martin Luther King, Jr. Day
January 15, 2018
Good Friday
March 30, 2018
Memorial Day
May 28, 2018
4th of July
July 4, 2018
Labor Day
September 3, 2018
Days and Hours
of Operation
M-F 8:00 am - 5:00 pm
M-F 8:30 am - 4:00 pm
M-F 8:30 am - 4:00 pm
M-F 8:30 am - 4:00 pm
M-F 10:00 am - 1:00 pm
rya grlc
SOUTH PLAINS ASSOCIATION OF GOVERNMENTS
artAgingAREA AGENCY ON AGING
SUBRECIPIENT AGREEMENT
City of Lubbock, hereinafter referred to as Subrecipient, and South Plains Association of Governments
Area Agency on Aging (AAA) do hereby agree to provide services effective beginning October 1, 2017,
in accordance with the Older Americans Act of 1965 (OAA), as amended, regulations of the Health and
Human Services Commission (HHSC), 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 HHSC 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
Subrecipient.
1. SCOPE OF SERVICES
A. The Subrecipient agrees to provide the following service(s) as identified below to program
participants authorized by the AAA staff, in accordance with the Subrecipient 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 331/3 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 #: AIAAA_VA2.0
Edition Date: 9/19/11
• Fixed Route - transportation service that operates in a predetermined route that has permanent
transit stops, which are clearly marked with route numbers and departure schedules. The fixed -
route does not vary and the provider strives to reach each transit stop at the scheduled time. The
older individual does not reserve a ride as in a demand -response system; the individual simply
goes to the designated location and at the designated time to gain access to the transit system.
Unit Definition:
CONGREGATE MEALS: One Meal
TRANSPORTATION — Demand/Response: One One-way Trip
Service Area (To be failed in by provider. Please type or print neatly):
01 k 0f::- Lv t9__;'&Ocj<
All Texas Administrative Code standards are located at the Texas Secretary of State website:
http://texreg.sos.state.tx.us/public/readtac$ext.viewtac.
All Older Americans Act and other required rules and regulations are located at:
https://www.aci.gov/node/75.
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
N/A
N/A
$7.70
Transportation — D/R
N/A
N/A
$8.66
2. TERMS OF AGREEMENT
A. The Subrecipient agrees to:
1. provide services in accordance with current or revised HHSC 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 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 following business day.
b. The AAA cannot guarantee payment of a reimbursement request received for more than 45
calendar days of service delivery.
Form #: AIAAA VA2.0 2
Edition Date: 9/19/11
c. No reimbursement for services provided will be made if Subrecipient payment invoices are
not submitted to the AAA within 45 days of service delivery.
d. Reimbursement checks must be cashed or deposited within 30 days from date received.
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 Subrecipient'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. Subrecipient agrees to expend all program income to expand or enhance
the program/service under which it is earned.
4. notify the AAA Director immediately if, for any reason, the Subrecipient 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 Subrecipient'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 HHSC 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 Subrecipient further agrees:
l . 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. Subrecipient is an independent provider, NOT an agent of the AAA. Thus, the Subrecipient
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
Subrecipient. Subrecipient must immediately notify the AAA if the Subrecipient becomes
involved in or is threatened with litigation related to program participants receiving services
funded by the AAA.
4. Employees of the Subrecipient 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:
Form #: AIAAA_VA2.0
Edition Date: 9/19/11
1. review program participant intake and assessment forms completed by the Subrecipient, 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 Subrecipient 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 Subrecipient 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.
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 HHSC, reimburse
the Subrecipient 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 Subrecipient's invoice.
3. ASSURANCES
The Subrecipient 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. Food Stamp Act of 1977 (7 U.S.C. §200 et seq.)
F. Drug Free Workplace Act of 1988
G. Texas Senate Bill 1 - 1991, as applicable
H. HHSC administrative rules, as set forth in the Texas Administrative Code, to the extent applicable
to this Agreement
1. Certification Regarding Debarment - 45CFR §92.35 Subawards to debarred and suspended
parties; this document is required annually as long as this agreement is in effect
J. 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
K. HHSC Information Letter 11-07 — Obligation to Identify Individuals or Entities Excluded from
Participation in Federal Health Care Programs
4. ATTACHMENTS
A. Description of Assurance A — H listed in section 3 of this document.
B. List of Focal Points in the AAA planning and service area.
Form #: AIAAA_VA2.Ox 4
Edition Date: 9/19/11
5. SIGNATURES
For the faithful performance of the terms of this agreement, the parties affix their signatures and bind
themselves effective October 1, 2017.
Authorized Subrecipient Signature
Daniel M. Pope
Print Name
Mayor
Title
November 2 2017
Date
P
Authorized Signature
South Plains Association of Governments
(Agency)
P.O. Box 3730 — Freedom Station
(Address)
Lubbock Texas 79452
(City, State, Zip)
September 30, 2017
(Date)
Form #: AIAAA_VA2.0
Edition Date: 9/19/11
Attest:
QAJ�O,ze
Reb cca Garza
4-*
Ci Secretary
Approved as to
Bridget Faulkenberry
Parks and Recreation Director
Approved as to
City Attorney
ASSURANCES ATTACHMENT
A. Title VI of the Civil Rights Act of 1964 (42 U.S.C. §2000d et.sea.), which prohibits any
person from being excluded from participation in, denied the benefits of, or subjected to
discrimination under any program or activity receiving Federal financial assistance.
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 sea.), 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. Age 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. Food Stamp Act of 1977 (7 U.S.C. §200 et sea.), 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.
F. Drug Free Workplace Act of 1988, which requires that all organizations receiving federal
grants, regardless of amount granted, maintain a drug -free workplace.
G. 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 2016-2017
CENTER:
Bailey County Commissioners Court (A-020)
DIRECTOR:
Judy Coffman
BOOKKEEPER:
Judy Coffman
ADDRESS:
300 South First Street Room 110
CITY:
Muleshoe, Texas 79347
PHONE:
(806) 272-3647 E-mail: _icoffman@co.bailey.tx.us
DAYS & HRS. OPEN:
Mon. -Fri. 8:30-12:00, 1:00-5:00 Fax: (806) 272-4656
SERVICES:
TRANS.
COUNTY:
Bailey
CENTER:
Bailey County Senior Citizens Assoc., Inc. (A-007)
DIRECTOR:
Geraldine Redwine
ASSISTANT:
Geraldine Redwine
ADDRESS:
319 S. Main St / PO Box 292
CITY:
Muleshoe, Texas 79347
PHONE:
(806) 272-4969E-mail: muleshoesenior@outlook.com
DAYS & HRS. OPEN:
Mon. — Fri. 8:00 — 4:00 Fax: (806) 272-4460
SERVICES:
CONG.
COUNTY:
Bailey Miles 156.72
CENTER:
Cochran Co. Senior Citizens Assoc., Inc. (A-045)
DIRECTOR:
Reynalda Alvarado
BOOKKEEPER:
Reynalda Alvarado
ADDRESS:
120 W. Wilson
CITY:
Morton, Texas 79346
PHONE:
(806) 266-5121 E-mail: ccsci@windstream.net
DAYS & HRS. OPEN:
Mon. — Fri. 8-4 Fax #: 266-9027
SERVICES:
CONG., TRANS.
COUNTY:
Cochran Miles 119.62
Updated 09/07/2017
CENTER:
DIRECTOR:
BOOKKEEPER:
ADDRESS:
CITY:
PHONE:
Director Cell phone
DAYS & HRS. OPEN:
SERVICES:
COUNTY:
CENTER:
DIRECTOR:
BOOKKEEPER:
ADDRESS:
CITY:
PHONE:
DAYS & HRS. OPEN:
SERVICES:
COUNTY:
CENTER:
DIRECTOR:
BOOKKEEPER:
ADDRESS:
CITY:
PHONE:
DAYS & HRS. OPEN:
SERVICES:
COUNTY:
Crosby Co. Senior Citizens Assoc., Inc. (A-050)
Lenette Fowler
Lenette Fowler
119 North Berkshire
Crosbyton, Texas 79322
(806) 675-2107
(806) 928-1586
E-mail: CrosbyCountySeniors@windstream.net
Mon. —Fri. 8-3
CONG., H.D.
Crosby Miles 84
Garza County Trailblazers, Inc. (A-070)
JoAnn Rathbun
LaGayluah McReynolds
205 E. 10th
Post, Texas 79356
(806) 495-2998 E-mail:garzatrailblazers@yahoo.com
Mon. — Fri. 8-1
CONG., H.D.
Garza miles 76.32
Hale Center Senior Citizens Assoc., Inc. (A-075)
Susan Suniga
Susan Suniga
P.O. Box 205 (416 West 2nd St.)
Hale Center, Texas 79041
(806) 839-2428 E-mail: hcsrcenter@sbcglobal.net
Mon. — Fri. 8-3
CONG., H.D., TRANS.
Hale Miles 75.36
CENTER:
Hockley County Senior Citizens Assoc., Inc. (A-085)
DIRECTOR:
Ashley Scifres
BOOKKEEPER:
Olga Gonzales
ADDRESS:
1202 Houston
CITY:
Levelland, Texas 79336
PHONE:
(806) 894-2228 E-mail: hcsca@aol.com
DAYS & HRS. OPEN:
Mon. — Fri. 8-4:30
SERVICES:
CONG., H.D., TRANS.
COUNTY:
Hockley
Updated 09/07/2017
CENTER:
Lorenzo Senior Citizens Assoc., Inc. (A-095)
DIRECTOR:
Christina Edwards
BOOKKEEPER:
Christina Edwards
ADDRESS:
P.O. Box 571 (606 61h St.)
CITY:
Lorenzo, Texas 79343
PHONE:
(806) 634-5957 E-mail: lorenzosca@windstream.net
DAYS & HRS. OPEN:
Mon. —Fri. 8-2
SERVICES:
CONG., H.D.
COUNTY:
Crosby 49.94
CENTER:
Lubbock - City of Lubbock (A-100)
DIRECTOR:
Johnny McLellan, Supervisor: 775-2678
Nancy Neill, 775-2685
ADDRESS:
P.O. Box 2000 (1611 10 St.)
CITY:
Lubbock, Texas 79457
PHONE:
(806) 775-2678
E-mail:.imclellan@mail.ci.lubbock.tx.us
nneill@mylubbock.us &
p.ibrown@mail.ci.lubbock.tx.us
nancy.m.neill@gmail.com
DAYS & HRS. OPEN: Mon. —Fri. 8-5 Fax: 775-2686
SERVICES: CONG., TRANS.
COUNTY: Lubbock
Mae Simmons — 767-2708, Shameca Wilson (2004 Oak Avenue 79404),
Copper Rawlings — 767-2704, Herminia Martinez (213 40" Street 79404), (4o" & Ave. B),
Maggie Treio — 767-2705, Cecilia Gonzalez (3200 Amherst 79415),
Homestead - 687-7898, Nancy Dubose (5401 56`h Street 79414);
Lubbock Senior Center — 767-2710, Paula Brown (2001 1911 Street, 79401) FAX 765-0820
Gloria Gutierrez Transportation Director
CENTER: Lynn County Pioneers (A-110)
DIRECTOR: Sandra Norwood
BOOKKEEPER: Sandra Norwood
ADDRESS: P.O. Box 223 (1600 S. 31 St.)
CITY: Tahoka, Texas 79373
PHONE: (806) 561-5264 E-mail: lynncopioneers@gmail.com
DAYS & HRS. OPEN: Mon. —Fri. 9-3 Fax: 561-5571
SERVICES: CONG., H.D. (No Cong. in O'Donnell)
COUNTY: Lynn Miles 54.52
Updated 09/07/2017
CENTER:
DIRECTOR:
BOOKKEEPER:
ADDRESS:
CITY:
PHONE:
DAYS & HRS. OPEN:
SERVICES:
COUNTY:
CENTER:
DIRECTOR:
BOOKKEEPER:
ADDRESS:
CITY:
PHONE:
DAYS & HRS. OPEN:
SERVICES:
COUNTY:
CENTER:
DIRECTOR:
ASSISTANT DIRECTOR:
BOOKKEEPER:
ADDRESS:
CITY:
PHONE:
Fax:
DAYS & HRS. OPEN:
SERVICES:
COUNTY:
LEGEND
Senior Citizens Assoc. of S. Dickens County (A-130)
Linda Alexander
Jean Hoover
210 Burlington
Spur, Texas 79370
(806) 271-4472 E-mail: sscaosdc@caprock-spur.com
Mon. —Fri. 8-3
CONG., H.D.
Dickens 154.00
Slaton Senior Citizens Assoc., Inc. (A-135)
Charlotte O'Connell
Charlotte O'Connell
230 West Lynn
Slaton, Texas 79364
(806) 828-3784 E-mail: coconnell@door.net
Mon. —Fri. 8-4 slatonseniors@door.net
LONG., H.D.
Lubbock 28.52
Yoakum County Senior Citizens Assoc., Inc. (A-150)
Becky Riley
Amber Cline
Shelia Hinson
709 W. Broadway (Box 519)
Denver City, Texas 79323
(806) 592-8000 E-mail: ycsc60@windstream.net
(806) 592-2835
Mon. —Fri. 9-2
CONG., H.D.
Yoakum 159.94
CONG. — Congregate Meals (on -site)
H.D. - Home Delivered Meals
TRAN. - Transportation Service
Updated 09/07/2017
Certification Regarding Debarment
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARY EXCLUSION FOR COVERED CONTRACTS AND GRANTS
Federal Executive Order 12549 requires the Texas Health and Human Services Commission
(HHSC) to screen each covered potential subrecipient/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 subrecipient/grantee must
also screen each of its covered sub-subrecipients/providers.
In this certification "subrecipient/grantee" refers to both subrecipient/grantee and sub-
subrecipient/sub-grantee: "contract/grant" refers to both contract/grant and subcontract/sub-
grant.
By signing and submitting this certification the potential subrecipient/grantee accepts
the following terms:
1. The certification herein below is a material representation of fact upon which reliance
was placed when this contract/grant was entered into. If it is later determined that the
potential subrecipient/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 Health and Human Services Commission may
pursue available remedies, including suspension and/or debarment.
2. The potential subrecipient/grantee shall provide immediate written notice to the
person to whom this certification is submitted if at any time the potential
subrecipient/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 subrecipient/grantee agrees by submitting this certification that, should
the proposed covered contract/grant be entered into, it shall not knowingly enter 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 Health and
Human Services Commission, as applicable.
Do you have or do you anticipate having sub-subrecipients/sub-grantees under
this proposed contract? X- YES NO
5. The potential subrecipient/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 subrecipient/grantee may rely upon a . certification of a potential sub-
subrecipient/sub-grantee that is not debarred, suspended, ineligible, or voluntarily
excluded from the covered contract/grant, unless the subrecipient/grantee knows that
the certification is erroneous. A subrecipient/grantee must, at a minimum, obtain
certifications from its covered sub-subrecipients/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 required by this
certification document. The knowledge and information of a subrecipient/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
subrecipient/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, or the Texas Health and Human Services Commission may
pursue available remedies, including suspension and/or debarment.
CERTIFICATION REGARDING DEBARMENT
Page 3
Indicate which statement applies to the covered potential subrecipient/grantee:
The potential subrecipient/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 subrecipient/grantee is unable to certify one or more of the terms in this
certification. In this instance, the potential subrecipient/grantee must attach an
explanation for each of the above terms to which he/she is unable to make
certification. Attach the explanation(s) to this certification.
NAME OF POTENTIAL SUBRECIPIENT/GRANTEE:
M
SUBRECIPIENT'S VENDOR ID NO./FEDERAL EMPLOYER'S ID NO.:
1,
I- -1 15 - (�,000 6Ci0 - Co
Representative
�J
Printed/Typed Na f Authorized Repr sentative
ASS i . &-ri Attd2') Q1 October 1 2017
Title of Authorized Representative Date
This certification is for FFY 2018 period beginning October 1, 2017 and ending
September 30, 2018.
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 Health and Human Services Commission 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 $100,000) 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 Health and Human
Services Commission 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 Health and Human Services
Commission 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.
9/8/17 10:34 AM
Provider Name: City of Lubbock
AAA Name: Area Agency on Aging of South Plains
Congregate Meals
BUDGET WORKSHEET CALCULATION OF THE PER MEAL UNIT RATE
1. Total Budgeted Expenses for Contract Year 1. $ 255,107.95
2. Total Number of Anticipated Meals to be Provided by Funding Source
Other Funds
HHS OAAA 18,060 Eligible Meals 0 Other Sources 5 0
Other Funds -
Non -Eligible
Program Income 3,907 Meals 8,133 Other Sources 6 0 2. 30,100
3. Whole Unit Rate (Line 1 divided by Line 2) 3. $ 8.48
Reimbursement Calculation
HHS OAAA
4. Projected NSIP per Meal Value 0.69
5. Rate Less NSIP per Meal Value $ 7.79
6. Mandatory Local Match of 10% $ 0.78
** If Applicable, Match Reduction
From the In -kind Match
Certification form $
Required Cash Match $ 0.78
7. Proposed Meal Rate (Line 3 minus Line 6) $ 7.70
** If any portion of the required match is in -kind, you must complete an In -Kind 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.
Citv of LubbQck
Legal Name of Co tra ed Provider
Signature
Area Agency on Aging of South Plains
Name of Area Agency on Aging
jLNs Time . Pi re
rint 1°ype l,Na of Si er
Signature
September 30, 2017
Date
Daniel M. Pope, Mavor
Printed/Typed Name of Signer
November 2 2017
Date
Attest: Approved as to Conten : Approved as to Form:
fi
Reb ca Garza ridget Faulkenberry J sti Pru'
City Secretary Parks and Recreation Director stant City Attorney
9/8/17 10:34 AM
Provider Name: City of Lubbock
AAA Name: Area Agency on Aging of South Plains
Congregate Meals
BUDGET 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
November 2 2017
Date
Signer Authority:
(check one)
❑ Sole Proprietor
❑ Partner
❑ Corporate Officer
Daniel M. Pope, Mayor
Printedfryped Name of Signer
Signature
❑ Association Officer
❑ Board Member
V/ Governmental Official
Attest:
Rebecca Garza
City S retary
Approved as to
Parks and Recreation Director
Approved as to Form:
0ssis
nt tt
City Attorney
9/19/17 4:37 PM
Provider Name: City of Lubbock
AAA Name: Area Agency on Aging of South Plains
Transportation
BUDGET WORKSHEET CALCULATION OF THE UNIT RATE
1.Total Budgeted Expenses for Contract Year
2.Total Number of Anticipated Units to be Provided
HHS OAAA - 10 % Match
Program
Required 3,078
Income
HHS OAAA - 25 % Match
Local Funds -
Required 0
Eligible Trips
Other Funds -
Non -Eligible
HHS OAAA - Full Unit Rate 0
Trips
3. Cost per unit (Line 1 divided by Line 2) - Full Unit Rate
96 Other Sources 6
4,426 Other Sources 7
0 Other Sources 8 0
Reimbursement Calculation for Contracts Requiring Unit Rate Match Reduction
1. $ 73,093.84
2. 7,600
3. $ 9.62
4. Mandatory Local Match of 10% $ 0.96
** If Applicable, Match Reduction From the In -kind Match Certification form $ -
Required Match 4. $ 0.96
5.Full Unit Rate Less Required Match (Line 3 minus Line 4; 5. $ 8.66
4. Mandatory Local Match of 25% $ 2.41
** If Applicable, Match Reduction From the In -kind Match Certification form $ -
Required Match 4. $ 2.41
5.Full Unit Rate Less Required Match (Line 3 minus Line 4: 5. $ 7.21
**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
$ 9.62
Contractor Initial AAA Initial
Citv of Lubbock
Legal Name of Contracted Provider
L==�
Signature
Daniel M. Pope, Mayor
Printed/Typed Name of Signer
November 2, 2017
Date
Area Agency on in f South Plains
me o rea gene)on Aging
ig e
Tim C. Pierce
Printed/Typed Name of Signer
09/30/17
Date
Attest: Approved as to ntent: Approved as to Form:
Reb cca Garza Bridget Fauikenberry J stin rui
City'Secretary Parks and Recreation Director A sist t City Attorney
10/4/17 1:19 PM
Provider Name: City of Lubbock
AAA Name: Area Agency on Aging of South Plains
Transportation
BUDGET WO SHEET 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
November 2 2017
Date
Signer Authority: n Sole Proprietor
(check one) ❑ Partner
❑ Corporate Officer
Daniel M. Pope, Mayor
Printed/Typed Name of Signer
Signature
❑ Association Officer
EJ Board Member
VGovernmental Official
Attest:
Rebe ca Garza
City Secretary
Approved as to
Parks and Recreation Director
as to Form:
r
Jus ' ' ruitt
sista t City Attorney