HomeMy WebLinkAboutResolution - 2020-R0029 - CSBG For Community Health Center Of Lubbock - 01/28/2020 Resolution No. 2020-R0029
Item No. 6.7
January 28, 2020
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, Community Development Block Grant Funding
Agreement 15154, and all related documents, between the City of Lubbock and the
Community Health Center of Lubbock, for the funding to provide dental services to the
underserved. Said Contract 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 January 28, 2020
i
DANIEL M. POPE, MAYOR
ATTEST:
Rebe tAG rza, City Secret
APPROVED AS TO CONTENT:
Karen Murfee, Community De lopment Director
APPROVED AS TO FORM:
K ili Leisure, Assistant City Attorney
ccdocs,-RES CBDG Contract 15154—Community Health Center of Lubbock
01 14.20
Resolution No. 2020-R0029
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING AGREEMENT
BETWEEN
THE CITY OF LUBBOCK
AND
COMMUNITY HEALTH CENTER OF LUBBOCK
This Community Development Block Grant Program Funding Agreement(the"Agreement"),
Contract No. 15154, is made by and between the City of Lubbock, a State of Texas home rule
municipal corporation(the "City") and Community Health Center of Lubbock,
(the "Grantee"), (each a"Party,"and collectively the "Parties") acting by and through the
Parties' representative officers and officials, and is hereby entered into by the Parties on this
28th day of January ,2020 (the "Effective Date").
RECITALS
WHEREAS, the Grantee is obligated to do and perform certain services in its undertaking of a
Community Development Block Grant (CDBG) Program pursuant to the Housing and
Development Act of 1975, as amended; and
WHEREAS,the Grantee operates a non-profit center offering services to families and individuals
throughout Lubbock County, Texas.
WHEREAS, the Grantee and the services it provides have been found to meet the criteria for
funding under provision 24 CFR 570.201; and
WHEREAS, the Grantee proposes to use the funds in order provide dental services for the
underserved in the City (the "Program"); and
WHEREAS,the Grantee's services benefit residents in and around Lubbock,Texas and constitute
a valuable public service, and the City Council of the City (the "City Council") has declared the
services provided by the City to be a public purpose; and
WHEREAS,the accomplishment of the above public purpose is the predominate purpose of this
Agreement; and
WHEREAS, the continuing supervision by the City and State together with statutory and
contractual requirements provide sufficient assurance that the public purpose of this Agreement
will be accomplished; and
WHEREAS, the City Council has found that the City has the special expertise, knowledge, and
experience necessary for the operation of the Program; and, that the City will receive adequate
consideration in the form of substantial public benefit; and NOW,THEREFORE:
THE PARTIES,FOR GOOD AND VALUABLE CONSIDERATION,AGREE AS FOLLOWS:
2019 .2020 CDBG Funding Agreement Page
AGREEMENT
Article 1. SCOPE OF SERVICE
A. The City's Responsibilities
1. The City agrees to provide the Grantee with funding from the U.S. Department of Housing
and Urban Development (HUD) not to exceed the amount as stated in the attached
EXHIBIT A, to be distributed and used according to the provisions of this Agreement.
2. The Funding will be limited to the City's performance of the Program, including the
satisfaction of expenses incurred by the City in its performance of the Program.
3. The City's awarding of the Funding under this Agreement is contingent upon the City's
receipt of adequate funds to meet the City's liabilities under this Agreement. If adequate
funds are not made available to the City so that it cannot award the Funding,then the City
shall notify the City in writing within a reasonable time after such fact is determined, the
City shall terminate this Agreement, and the City will not be directly or indirectly liable
for failure to award the Funding to the City under this Agreement.
4. The City shall not be liable to the City for any cost incurred by the City which has been
paid to the City, which is subject to be paid to the City, which has been reimbursed to the
City, or which is subject to reimbursement to the City by any source other than the City or
the City.
5. The City shall not be liable for any cost incurred by the City which is not an allowable cost
as set forth in this Agreement or under 24 CFR §570.207.
6. The City shall not be liable to the City for any cost incurred by the City or for any
performance rendered by the City which is not strictly in accordance with the terms of this
Agreement.
7. The City shall not be liable to the City for any cost incurred by the City in the performance
of this Agreement which has not been billed to the City by the City within sixty (60) days
following the termination of this Agreement.
8. The City shall not be liable for any cost incurred or performance rendered by the City
before the commencement or after termination of this Agreement.
9. The City may, at its sole discretion and convenience, review any work specifications prior
to the beginning of a procurement process under this Agreement, and the City may inspect
any construction for compliance with work specifications prior to the release of the
Funding.
2019--2020 CDBG Funding Agreement Page 2
B. The Grantee's Responsibilities
1. The Grantee will be responsible for administering the Program in a manner satisfactory to
the City and in compliance with this Agreement and with any and all statutory standards
related to the Funding.
2. The Grantee certifies that all of its activities carried out for the Program through the
Funding will satisfy 24 CFR Part 570, including, but not limited to: CDBG's eligible
activities under the applicable uniform administrative requirements described in 2 CFR
Part 200 "Uniform Administrative Requirements, Cost Principles and Audit Requirements for
Federal Awards". The Grantee agrees to repay any and all of the Funding that does not
satisfy the regulations required under this provision.
3. The Grantee shall perform all activities related to the Program in accordance with its
budget; all applicable laws and regulations; and, with the assurance, certifications, and all
other terms, provisions, and requirements set forth in this Agreement.
4. Upon the City's request while this Agreement is in effect, the Grantee shall submit to the
City any and all reports, documents, or information on the Grantee's performance of the
Funding or the Program contemplated under this Agreement.
5. In addition to the limitations on liability otherwise specified in this Agreement, it is
expressly understood and agreed to by the Parties that if the Grantee fails to submit to the
City in a timely and satisfactory manner any reports, documents, or information requested
by the City under this Agreement, the City may, at its sole discretion, withhold all, or any
part of, the Funding. If the City withholds all, or any part of, the Funding, it shall notify
the Grantee in writing of its decision and the reasons therefor. Any Funding withheld
pursuant to this paragraph may be held by the City until such time as the obligations for
which the Funding is being withheld is fulfilled by the Grantee to the satisfaction of the
City.
G. The Grantee shall refund to the City any Funding that has been paid to the Grantee by the
City for which the City determines is a result of overpayment of the Funding to the Grantee,
or for which the City determines any of the Funding has not been spent by the Grantee
strictly in accordance with the terms of this Agreement. Such refund shall be made by the
Grantee to the City within thirty (30) working days after such refund is requested by the
City.
7. The Grantee shall submit to the City a request for an environmental assessment to be
prepared and approved on individual construction sites prior to the beginning of any project
if applicable.
S. The Grantee shall submit to the City a request for a review of all work specifications prior
to the beginning of the procurement process.
2019 2020 CDBC Funding Agreement FfApt 3
9. The Grantee will have Match funds ready and available prior to the start of any project, if
applicable. Failure to have Match funds ready and available may delay or cancel such
project.
10. The Grantee will certify eligibility by completion of Self Certification form to verify low
mod clientele participates in the program.
11. The Grantee agrees that any interests or assets obtained with the Funding shall revert back
to the City in the event that the Grantee dissolves, files for bankruptcy, or goes out of
business for any reason.
C. Grantee's Match
The CDBG funds must be supplemented with additional funds from sources other than CDBG.
This project must provide 25% or more of the total project costs from non-CDBG sources.
Matching funds may include donations, or other grants.
D. National Objective
The Grantee agrees that all activities funded with 2019-2020 CDBG Funds and carried out under this
Agreement will meet the following CDBG program national objectives as defined in 24 CFR
570.208(a):
1)benefits low-and moderate-income persons
E. Performance Monitoring
1. General Monitoring. The City will monitor the Grantee's performance under this
Agreement in order to ensure that the Grantee complies with the terms of this Agreement
and all other applicable laws and regulations related to this Agreement and the Funding
provided through this Agreement (the "Monitoring"). The Monitoring will be based on a
risk analysis and a monitoring plan developed at the beginning of the fiscal year, and will
take place on a monthly and quarterly basis as described below. Substandard performance
as determined by the City will constitute non-compliance with this Agreement. if action to
correct such substandard performance is not taken by the Grantee within a reasonable
period of time after being notified by the Grantee in writing, the City may suspend or
terminate this Agreement.
2. On-site Monitoring. The number of on-site Monitoring visits will be determined by the
City. The City will send a Monitoring notification letter sent to the Grantee at least fifteen
(15) days before a Monitoring visit. The City must provide a written response to the
Monitoring report within thirty(30)days that describes how the City will resolve the issues
raised by the City in the Monitoring report. The Grantee must confirm receipt of the
Monitoring report within thirty (30) days if no actionable issues were identified in the
Monitoring report. The City reserves the right to conduct a spot check of Grantee's facility
where program takes place, at any given time without notice.
2019 2020 CDBG Funding Agreement Ppge 4
Article 2. TIME OF PERFORMANCE
Services of the Grantee shall start on the first (1St) day of October, 2019, and end on the thirtieth
(30th) day of September, 2020 (the "Term"). The Term and the provisions of this Agreement shall
be extended to cover any additional time period during which the City remains in control of the
CDBG Funding period or other CDBG assets, including Program income.
Article 3. BUDGET
The Funding made available to the Grantee under this Agreement shall be specifically drawn from
the sources listed in this section(the"Budget"). The Funding made available to the City under this
Agreement shall be drawn from several fiscal year allocations by HUD to the City. In the budget
listed below,the fiscal year of a HUD allocation to the City is listed to the left of the funding under
that allocation that is made available to the Grantee for the Project under this Agreement. The
Funding made available to the Grantee under this Agreement shall be directly linked to the specific
funding year and amount listed in the attached EXHIBIT A.
Article 4. PAYMENT
A. The Payment
The Funding shall be disbursed on a monthly basis based on the Grantee's submission to the City
of a written request for reimbursement, with such request being in a form acceptable to the City
(the"Payment"). Expenses eligible for Payment to the Grantee by the City shall be those expenses
that have been incurred or paid for by the City prior to the City's submission to the City of a request
for Payment. In its request to the City for the Payment, the Grantee shall submit detailed
documentation to the City that clearly shows the source of the expenses incurred or paid for by the
Grantee that are the subject of the Grantee's request for Payment. Such source documentation
includes, but is not limited to, time sheets, paycheck stubs, receipts, invoices, billing statements,
or other verification in support of all expenditures incurred by the Grantee in its performance of
the Program.
B. Not To Exceed
The total amount of the Funding to be paid by the City under this Agreement shall not exceed the
amount as stated in the attached EXHIBIT A, for the Project. Any drawdowns on the Payment
and any expenses for the general administration of the Program shall be made against the line item
budgets specified in this Agreement and in accordance with the Grantee's performance of
Program.
C. 2 CFR Part 200
Every Payment may be contingent upon certification of the Grantee's financial management
system in accordance with the standards specified in 2 CFR Part 200.
Article 5. SPECIAL CONDITIONS
None.
Article 6. GENERAL CONDITIONS
2019- 2020 CDBG Funding Agreement Page 5
A. General Compliance
1. The Grantee agrees to comply with the requirements of 24 CFR Part 570 (the HUD
regulations concerning Community Development Block Grants (CDBG)), including
subpart K of these regulations; except that: (1) the Grantee does not assume the City's
environmental responsibilities described in 24 CFR 570.604; and,(2)the Grantee does not
assume the City's responsibility for initiating the review process under the provisions of
24 CFR Part 52.
2. The Grantee also agrees to comply with all other applicable Federal, State and local laws,
regulations, and policies governing the CDBG Funding provided under this Agreement.
The Grantee further agrees to utilize the CDBG Funding under this agreement to
supplement, rather than supplant, funds otherwise available.
3. The Grantee shall comply with all applicable Federal laws, regulations, and requirements
and all provisions of this Agreement, which include compliance with the provisions of the
HCD Act and all rules, regulations, guidelines, and circulars promulgated by the various
Federal departments, agencies, administrations, and commissions relating to the CDBG
Program. The applicable laws and regulations include, but are not limited to: 24 CFR Part
570; 2 CFR Part 200; OMB Circular A-128, "Audits of State and Local Governments;"
The Davis-Bacon Fair Labor Standards Act; The Contract Work Hours and Safety
Standards Act of 1962; Copeland "Anti-Kickback" act of 1934; Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970, as amended (URA); Title
VI of the Civil Rights Act of 1964, (Public Law 88-352 implemented in 24 CFR Part 1);
Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (Public Law 90-234 and
Executive Order 11063 as amended by Executive Order 12259 (implemented in 24 CFR
Part 107); Section 104(b) and 109 of the HCD Act of 1974; Section 3 of the Housing and
Urban Development Act of 1968; Equal employment opportunity and minority business
enterprise regulations established in 24 CFR Part 570.904; Non-discrimination in
employment, established by Executive Order 11246 (as amended by Executive Orders
11375 and 12086); Section 504 of the Rehabilitation Act of 1973 Uniform Federal
accessibility Standards; The Architectural Barriers Act of 1968; The Americans With
Disabilities Act (ADA) of 1990; The Age Discrimination Act of 1975, as amended;
National Environmental Policy of 1969 (42 USC 4321 et seq.), as amended; Lead Based
paint regulations established in 24 CFR Parts 35, 570.608, and 24 CFR 982.401; Asbestos
guidelines established in CPD Notice 90-44; HUD Environmental Criteria and Standards
(24CFR Part 51); The Energy Policy and Conservation Act (Public Law 94-163) and 24
CFR Part 39; Historic Preservation Act of 1966, as amended, and related laws and
Executive Orders; Executive Order 11988, floodplain management, 1977 (42 FR 26951 et
seq.); and, Flood Disaster protection Act of 1973.
B. "Independent Contractor"
Nothing contained in this Agreement is intended,or shall be construed in any manner,to create
or establish the relationship of employer and employee between the Parties. The Grantee shall
at all times remain an "independent contractor" with respect to the services to be performed
2019 2020 CDBG Funding Agreement Page 6
under this Agreement. The City shall be exempt from payment of all Unemployment
Compensation, FICA, retirement, life, medical insurance, and Workers' Compensation
insurance as the Grantee is an independent contractor.
C. Indemnity and Release
1. THE GRANTEE SHALL INDEMNIFY AND HOLD HARMLESS, TO THE FULLEST EXTENT
PERMITTED BY LAW, THE CITY, AND THE CITY'S RESPECTIVE OFFICERS, EMPLOYEES,
ELECTED OFFICIALS,AND AGENTS,FROM AND AGAINST ANY AND ALL LOSSES,DAMAGES,
CLAIMS, OR LIABILITIES, OF ANY KIND OR NATURE, WHICH ARISE DIRECTLY OR
INDIRECTLY, OR ARE RELATED, IN ANY WAY, MANNER, OR FORM, TO THE ACTIVITIES
CONTEMPLATED HEREUNDER.
2. THE GRANTEE SHALL PAY TO THE CITY,THE CITY'S RESPECTIVE OFFICERS,EMPLOYEES,
ELECTED OFFICIALS,AND OR AGENTS,AS APPLICABLE,ALL ATTORNEYS'FEES INCURRED
BY ENFORCING THE GRANTEE'S INDEMNITY HEREIN.
3. THE GRANTEE, AND ITS RESPECTIVE OFFICERS, EMPLOYEES, ELECTED OFFICIALS, AND
AGENTS SHALL NOT BE LIABLE, AND THE CITY HEREBY RELEASES THE CITY, AND ITS
RESPECTIVE OFFICERS,EMPLOYEES,ELECTED OFFICIALS,AND AGENTS,FOR,FROM,AND
AGAINST ANY LOSSES,DAMAGES,CLAIMS,OR LIABILITIES TO THE GRANTEE.
4. THE INDEMNITY AND RELEASE PROVIDED HEREIN SHALL SURVIVE THIS AGREEMENT.
D. Right to Exercise
The City reserves the right to exercise any right or remedy available to it by law, contract,
equity, or otherwise, including without limitation, the right to seek any and all forms of relief
in a court of competent jurisdiction. Further, the City shall not be subject to any arbitration
process prior to exercising its unrestricted right to seek judicial remedy. The remedies set forth
herein are cumulative and not exclusive, and may be exercised concurrently. To the extent of
any conflict between this provision and another provision in,or related to,this Agreement,the
former shall control.
E. Workers' Compensation
If applicable, the Grantee shall provide Workers' Compensation insurance coverage for all of
its employees involved in the performance of this Agreement.
F. Insurance and Bonding
The Grantee shall carry sufficient insurance coverage to protect Agreement assets from loss
due to theft, fraud, and/or or undue physical damage, and as a minimum, shall purchase a
blanket fidelity bond covering all employees in an amount equal to cash advances from the
City.
2019-2020 CDRG Funding Agreement f ALpr'
G. Grantor Recognition
The Grantee shall insure recognition of the role of the grantor agency in providing services
through this Agreement. All activities, facilities,and items utilized pursuant to this Agreement
shall be prominently labeled as to the Funding source. In addition, the Grantee will include a
reference to the Funding in all publications made possible under this Agreement.
H. Amendments
1. The City or the Grantee may amend this Agreement at any time, provided that such
amendments make specific reference to this Agreement and are executed in writing, signed
by a duly authorized representative of both Parties,and approved by the City Council. Such
amendments shall neither invalidate this Agreement nor relieve or release the City or the
Grantee from its obligations under this Agreement.
2. The City may, in its discretion, amend this Agreement to conform with Federal, State, or
local governmental guidelines, policies, and available funding amounts, or for any other
reason. If such amendments result in a change in the Funding, the scope of services, or the
schedule of the activities to be undertaken as part of this Agreement, such modifications
will be incorporated only by written amendment signed by both Parties.
I. Suspension or Termination
1. In accordance with 2 CFR Part 200 Either Party may terminate this Agreement by giving
written notice to the other Party of such termination and specifying the effective date
thereof at least thirty (30) days before the effective date of such termination. Partial
termination of this Agreement may only be undertaken with the prior approval of the City.
In the event of any termination for convenience, all finished or unfinished documents,data,
studies, surveys, maps, models, photographs, reports, or other materials prepared by the
Grantee under this Agreement shall, at the option of the City, become the property of the
City, and the Grantee shall be entitled to receive just and equitable compensation for any
work completed on such documents or materials prior to the termination.
2. The City may terminate this agreement if the Grantee fails to comply with any terms of
this Agreement, whole or in part which include (but are not limited to) the following:
a) Failure to comply with any of the rules, regulations or provisions referred to herein, or
such statutes, regulations, executive orders and HUD guidelines, policies or directives
as may become applicable at any time;
b) Failure, for any reason, of the Grantee to fulfil in a timely and proper manner its
obligations under this Agreement;
c) Ineffective or improper use of CDBG funds provided under this agreement; or
2019-2020 CDBC Funding Agreement p2gr N
d) Submission by the Grantee to the City of reports that are incorrect or incomplete in any
material respect.
3. The City may suspend or terminate this Agreement if the City reasonably believes that the
Grantee is in noncompliance with any requirement of this Agreement, then the City may
withhold up to fifteen percent(15%)of the Funding until such time as the Grantee is found
to be, or is otherwise adjudicated, to be in compliance.
4. The City may terminate this Agreement in the event of an emergency or disaster, whether,
an act of God, natural or manmade, by giving twenty-four(24) hour notice. The City may
give said notice verbally to the Grantee. Any expenditure incurred prior to receiving notice
will be reimbursed; however, in no event shall the City pay any expenses incurred after
notice of termination is received by the Grantee.
Article 7. ADMINISTRATIVE REQUI_REMENTS
A. Financial Management
1. Accounting Standards. The Grantee agrees to comply with 2 CFR Part 200, and agrees to
adhere to the accounting principles and procedures required therein, utilize adequate
internal controls, and to maintain necessary source documentation for all costs incurred
under this Agreement.
2. Cost Principles. The Grantee shall administer its program in conformance with 2 CFR Part
200, "Uniform Administrative Requirements, Cost Principles and Audit Requirements for
Federal Award", which shall be applied to all direct or indirect costs incurred by the
Grantee under this Agreement.
B. Documentation and Record-Keeping
1. Records to be Maintained. The Grantee shall maintain all records required by the Federal
regulations specified in 24 CFR Part 570.506 that are pertinent to the activities to be funded
under this Agreement. Such records shall include but not be limited to:
a) Records demonstrating that each activity meets one of the National Objectives of
the CDBG Program, benefiting low to moderate income (LMI) persons or, low to
moderate income area(LMA) by census tracts;
b) Records required to determine the eligibility of activities;
c) Financial records as required by 24 CFR Part 570.502;
d) Records required to document the acquisition, improvement, use or disposition of
real property acquired or improved with CDBG assistance;
2019 2020 CDBG Funding Agreement Page 9
e) Records documenting compliance with the fair housing and equal opportunity
components of the CDBG program;
f) Other records necessary to document compliance with Subpart K or 24 CFR Part
570,
2. Retention. The Grantee shall retain all financial records, supporting documents and all
records pertinent to the Agreement, including but not limited to client data of no less than
five (5) years. The retention period begins on the date of the submission to the City's
annual performance and evaluation report to HUD in which activities assisted under this
Agreement are reported on for the final time. Expenditures under this Agreement for a
period of five(5) years after the termination of all activities funded under this Agreement.
Records for non-expendable property acquired with the Funding shall be retained for five
(5)years after final disposition of such property. Records for any displaced person must be
kept for five (5) years after the displaced person has received final payment.
Notwithstanding the above, if there is any litigation, claim, audit, negotiation or other
action that involves any of the records cited herein and that has started before the expiration
of the five (5) year period, then such records must be retained until the completion of the
actions and resolution of all issues, or the expiration of the five (5) year period, whichever
occurs later.
3. Client Data. The Grantee shall maintain client data that demonstrates its client eligibility
for the Funding and services provided under this Agreement. Such data shall include, but
not be limited to: client name or identifier; client address; client income level; age, gender,
race, ethnicity or other determination of client eligibility; and, a description of the service
provided to the client related to this Agreement. Such information shall be made available
to the City for review upon request.
4. Disclosure. The Grantee understands that client information collected under this
Agreement is private, and the use or disclosure of such information, when not directly
connected with the administration of the City or Grantee's responsibilities related to this
Agreement, is prohibited unless written consent is obtained from such client receiving
service(s) and in the case of a minor, that of a responsible parent or guardian, unless
otherwise required by law.
5. Property Records. The Grantee shall maintain a real property inventory that clearly
identifies any property purchased, improved,or sold under this Agreement or that is related
to the Funding. Any such property shall throughout the Term remain in compliance with
all eligibility criteria and shall conform with the "changes in use" restrictions specified in
24 CFR Parts 570.503(b)(8).
6. Close-Outs. The Grantee's obligation to the City under this Agreement shall not end until
all close-out requirements under this Agreement are completed pursuant to applicable
Federal regulations and law. Activities during this close-out period shall include, but are
not limited to: making final payments;disposing of Program assets(including the return of
2019-2020 CDBC Funding Agreement Page 10
accounts receivable to the City); final close-out reports; and, determining the custodianship
of records, Notwithstanding the foregoing, the terms of this Agreement shall remain in
effect during any period that the City has control of the CDBG funds, including program
income.
7. Audits&Inspections. All of the Grantee's records related to this Agreement shall be made
available at any time during normal business hours as often as the City or its designee
deems necessary to monitor, audit (if required), examine, or make excerpts or transcripts
of any data relevant to this Agreement in order for the City to produce an audit report. Any
deficiencies noted in an audit report must be fully cleared by the Grantee within thirty(30)
days after receipt by the City. Failure of the Grantee to comply with the above audit
requirements will constitute a violation of this Agreement and may result in the
withholding of Funding. The Grantee hereby agrees to have an annual internal audit
conducted in accordance with current City policy concerning Grantee audits and, if
required, a regular audit under Title 2 CFR Part 200 "Uniform Administrative
Requirements, Cost Principles and Audit Requirements for Federal Awards".
C. Reporting and Payment Procedures
1. Payment Procedures. The City will pay to the Grantee Funds based upon information
submitted by the Grantee and consistent with any approved budget and City policy
concerning the Payments. Payment will be made for eligible expenses actually incurred by
the Grantee, and not to exceed actual cash requirements. Payments will be adjusted by the
City in accordance with advance fund and program income balances available in the
Grantee's accounts. 1n addition, the City reserves the right to liquidate any part of the
Funding for costs incurred by the City on behalf of the Grantee.
2. Performance and Financial Reports. Throughout the Term, the Grantee shall submit
monthly reports to the City, in a format, content and frequency as required by the City. A
monthly Performance Report,a Financial Report,and a narrative for the Grantee's Program
activity and shall include the amount of all of the Grantee's expenditures for each of its
Program activities. The Grantee shall submit such reports, demographics and narratives no
later than the tenth (10th) day of each month. The End of Year report is due no later than
October 10, 2020. Reporting will continue from the start of Program activity through the
end of the Program year.
D. Procurement
Compliance, The Grantee shall comply with Title 2 CFR Part 200, "Uniform Administrative
Requirements, Cost Principles and Audit Requirements for Federal Awards"and the City policy
concerning the purchase of equipment and shall maintain inventory records of all non-
expendable personal property procured with CDBG funds. All Program assets purchased
with Funding, including unexpended program income, property, or equipment, shall revert to
the City upon the termination of this Agreement.
2014-2020CDBG Funding Agreement Pape 11
1. CFR Standards. Unless specified otherwise within this Agreement, the Grantee shall
procure all materials, property, or services in accordance with the requirements of 2 CFR
Part 200.
2. Travel. The Grantee shall obtain written approval from the City for any travel outside the
metropolitan area that is financed in any way through the Funding under this Agreement.
E. Use and Reversion of Assets
The use and disposition of real property and equipment under this Agreement shall be in
compliance with the requirements of 2 CFR Part 200 and 24 CFR Part 570.502, 570.503, and
570.504, as applicable, which include but are not limited to the following:
1. Any Subrecipient used by the Grantee shall transfer to the Grantee all CDBG funds on
hand and any accounts receivable attributable to the use of the Funding under this
Agreement at the time of expiration, cancellation, or termination of this Agreement.
2. Real property under the Grantee's control that was acquired or improved, in whole or in
part, with the Funding in excess of twenty-five thousand dollars ($25,000) shall be used to
meet one of the CDBG National Objectives pursuant to 24 CFR Part 570.208 until five(5)
years after the expiration of this Agreement,or such longer period of time as the City deems
appropriate. If the Grantee fails to use CDBG-assisted real property in a manner that meets
a CDBG National Objective for the prescribed period of time, then the Grantee shall pay
to the City an amount equal to the current fair market value of the property less any portion
of the value attributable to expenditures of non-CDBG funds for acquisition of, or
improvement to, the property. Such payment shall constitute Program income to the City.
The Grantee may retain real property acquired or improved under this Agreement after the
expiration of the five (5) year period, or such longer period of time as the City deems
appropriate.
3. In all cases in which equipment acquired, in whole or in part, with the Funding under this
Agreement is sold, the proceeds shall be Program income to reflect the extent to that funds
received under this Agreement were used to acquire the equipment. Equipment not needed
by the Grantee for activities under this Agreement shall be (a) transferred to the City for
the CDBG program, or(b) retained after compensating the City for an amount equal to the
current fair market value of the equipment less the percentage of non-CDBG funds used to
acquire the equipment.
Article 8. RELOCATION, REAL PROPERTY ACQUISITION AND ONE-FOR-ONE
HOUSING REPLACEMENT
The City agrees to comply with the Uniform Relocation Assistance and Real Property
Acquisition Policies Act of 1970, as amended(URA),and implementing regulations at 49 CFR
Part 24 and 24 CFR 570.606(b); the requirements of 24 CFR 570.606(c) governing the
Residential Antidisplacement and Relocation Assistance Plan under Section 104(d) of the
HCD Act;and,the requirements in 570.606(d)governing optional relocation policies.The City
2019—2020 CDBG Funding Agreement Page 12
may preempt the optional policies. The City shall provide relocation assistance to persons,
families, individuals, businesses, nonprofit organizations, and farms that are displaced as a
direct result of acquisition, rehabilitation, demolition, or conversion for a CDBG-assisted
project. The City also agrees to comply with all applicable City ordinances, resolutions, and
policies concerning the displacement of persons from their residences.
Article 9. PERSONNEL & PARTICIPANT CONDITIONS
A. Civil Rights
1. Compliance, The Grantee agrees to comply, and to require its subcontractors to comply,
with Title VI of the Civil Rights Act of 1964 as amended; Title V111 of the Civil Rights
Act of 1968 as amended; Section 104(b) and Section 109 of Title I of the Housing and
Community Development Act of 1974 as amended; Section 504 of the Rehabilitation Act
of 1973;the Americans with Disabilities Act of 1990;the Age Discrimination Act of 1975;
Executive Order 11063;and,with Executive Order 11246 as amended by Executive Orders
11375 and 12086.
2. Nondiscrimination. The Grantee agrees to comply with the non-discrimination in
employment and contracting opportunities laws, regulations and executive orders
referenced in 24 CFR Part 570.607, as revised by Executive Order 13279. The Grantee
will not discriminate against any employee or applicant for employment because of race,
color, creed, religion, ancestry, national origin, sex, disability, or other handicap, age,
marital or familial status, or status with regard to public assistance. The City will take
affirmative action to insure that all employment practices are free from such discrimination.
Such employment practices include,but are not limited to,the following: hiring,upgrading,
demotion,transfer, recruitment or recruitment advertising, layoff, termination,rates of pay
or other forms of compensation, and selection for training, including apprenticeship. The
City agrees to post in conspicuous places, available to employees and applicants for
employment, notices to be provided by the contracting agency setting forth the provisions
of this nondiscrimination clause.
3. Land Covenants. This Agreement is subject to the requirements of Title VI of the Civil
Rights Act of 1964 and 24 CFR 570.601-602. In regard to the sale, lease, or other transfer
of land acquired, cleared, or improved with assistance provided under this Agreement, the
Grantee shall cause or require a covenant running with the land to be inserted in the deed
or lease for such transfer, prohibiting discrimination as herein defined, in the sale, lease or
rental, or in the use or occupancy of such land, or in any improvements erected or to be
erected thereon, providing that the City and the United States are beneficiaries of and
entitled to enforce such covenants. The Grantee, in undertaking its obligation to carry out
the Program assisted hereunder, agrees to take such measures as are necessary to enforce
such covenant, and will not itself so discriminate.
4. Section 504, The Grantee agrees to comply with any Federal regulations issued pursuant
in compliance with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 1" 794),
which prohibits discrimination against the individuals with disabilities or handicaps in any
2019 -2020 CDBG Funding Agreement Page 13
Federally assisted program. The City shall provide the Grantee with any guidelines
necessary for compliance with the regulations in force during the term of this Agreement.
5. Reports. The Grantee shall maintain a report that documents the race and ethnicity of its
employees. The Grantee shall provide the City a copy with said report upon execution of
this Agreement.
6. Policies. The Grantee shall maintain current copies of its fair housing and equal
opportunity policies. The Grantee shall provide a copy of said policies to the City
immediately upon request.
B. Affirmative Action
Approved Plan. The Grantee agrees they shall be committed to carry out pursuant to the City's
specifications an Affirmative Action Program in keeping with the principles as provided in the
President's Executive Order 11246 of September 24, 1965. If the Grantee receives Federal
funds through the City, then the Grantee shall be required to develop a written Affirmative
Action Program to insure that equal opportunity is provided in all aspects of its employment.
1. Women- and Minority-Owned Business (W.MBE). The Grantee will use its best efforts to
afford small businesses, minority- and women-owned business enterprises and women's
business enterprises the maximum practicable opportunity to participate in the performance
of this Agreement. The terms"small business" means a business that meets the criteria set
forth in section 3(a)of the Small Business Act, as amended (15 U.S.0 632), and "minority
and female business enterprise" means a business at least fifty-one percent (51%) owned
and controlled by minority group members or women. For the purpose of the term
"minority group members" means Afro-Americans, Spanish-speaking, Spanish-surnamed
or Spanish-heritage Americans, Asian-Americans, and American Indians. The City
Grantee may rely on written representations by businesses regarding their status as
minority- and women-owned business enterprises in lieu of an independent investigation.
2. Access to Records. The City shall furnish and cause any Grantee or subcontractor to furnish
all information and reports required hereunder and will permit access to its books, records,
and accounts by the City, HUD or its agent, or other authorized Federal officials for
purposes of investigation to ascertain compliance with the rules, regulations, and
provisions stated herein.
3. Notifications. The City will send to each labor union or representative of workers with
which it has a collective bargaining agreement or other contract or understanding, a notice,
to be provided by the agency contracting officer, advising the labor union or worker's
representative of the City's commitments hereunder, and shall post copies of the notice in
conspicuous places available to employees and applicants for employment.
4. Subcontract Provisions. The City will include the provisions of the Civil Rights and
Affirmative Action sections of this Agreement, in every subcontract or purchase order,
2019 2020 CDBG Funding Agreement Page 14
specifically or by reference, so that such provisions will be binding upon each Grantee or
subcontractor.
C. Employment Restrictions
1. Prohibited Activity. The Grantee is prohibited from using the Funding provided herein or
personnel employed in the administration of the Program for political activities, inherently
religious activities; sectarian activity, religious activity, lobbying, political patronage, or
nepotism.
2. Labor Standards.
a) The Grantee agrees to comply with the requirements of the Secretary of Labor in
accordance with the Davis-Bacon Act as amended, the provisions of Contract Work
Hours and Safety Standards Act,the Copeland"Anti-Kickback" Act(40 U.S.C. 327 et
seq.) and all other applicable Federal, State, and local laws and regulations pertaining
to labor standards insofar as those acts apply to the performance of this Agreement.
The Grantee agrees to comply with the Copeland Anti-Kick Back Act (18 U.S.C. 874
et seq.) and it's implementing regulations of the U.S. Department of Labor Act at 29
CFR Part 5. The Grantee shall maintain documentation that demonstrates compliance
with hour and wage requirements of this part. Such documentation shall be made
available to the City for review upon request.
b) The Grantee agrees that, except with respect to the rehabilitation or construction of
residential property containing less than eight (8) units, all contractors engaged under
contracts in excess of two thousand dollars ($2,000) for construction, renovation, or
repair work financed in whole or in part with assistance provided under this Agreement,
shall comply with Federal requirements adopted by the City pertaining to such
contracts and with the applicable requirements of the regulations of the Department of
Labor, under 29 CFR Parts 1, 3, 5 and 7 governing the payment of wages and ratio of
apprentices and trainees to journey workers; provided, that if wage rates higher than
those required under the regulations are imposed by State or local law, nothing
hereunder is intended to relieve the Grantee of its obligation, if any,to require payment
of the higher wage. The Grantee shall cause or require to be inserted in full, in all such
contracts subject to such regulations, provisions meeting the requirements of this
paragraph.
D. "Section 3" Clause
1. Compliance. Compliance with the provisions of Section 3 of the HUD Act of 1968, as
amended and as implemented by the regulations set forth in 24 CFR 135, and all applicable
rules and orders issued hereunder prior to the execution of this Agreement, shall be a
condition of the Federal financial assistance provided under this Agreement, and binding
upon the City, the Grantee, any of Subrecipient, and subcontractor. The Grantee certifies
and agrees that no contractual or other legal incapacity exists which would prevent
compliance with these requirements.
2019-2020 CDBG Funding Agreement Page 15
2. "Section 3" Paragraph. The Grantee further agrees to comply with these "Section 3"
requirements and to include the following language in all subcontracts executed under this
Agreement:
"The work to be performed under this contract is a project assisted under a program
providing direct Federal financial assistance from HUD and is subject to the requirements
of Section 3(of the Housing and Urban Development Act of 1968),as amended,(12 U.S.C.
1701). Section 3 requires that, to the greatest extent feasible, opportunities for training
and employment be given to low-and very low-income residents of the project area,and
contracts for work in connection with the project be awarded to business concerns that
provide economic opportunities for low- and very low-income persons residing in the
metropolitan area in which the project is located."
3. Training & Employment. The Grantee will ensure that opportunities for training and
employment arising in connection with a housing rehabilitation (including reduction and
abatement of lead-based paint hazards), housing construction, or other public construction
project are given to low- and very low-income persons residing within the metropolitan
area in which the Project is located. Where feasible,the Grantee agrees that priority should
be given to low- and very low-income persons within the service area of the Project or the
neighborhood in which the Project is located,and to low-and very low-income participants
in other HUD programs.
4. Award of Contracts. The Grantee agrees to award contracts for work undertaken in
connection with a housing rehabilitation(including reduction and abatement of lead-based
paint hazards), housing construction, or other public construction project are given to
business concerns that provide economic opportunities for low- and very low-income
persons residing within the metropolitan area in which the Project is located. Where
feasible, the Grantee agrees that priority should be given to business concerns which
provide economic opportunities to low- and very low-income residents within the service
area or the neighborhood in which the Project is located, and to low- and very low-income
participants in other HUD programs.
5. Notifications. The Grantee agrees to send to each labor organization or representative of
workers with which it has a collective bargaining agreement or other contract or
understanding, if any, a notice advising said labor organization or worker's representative
of its commitments under this Section 3 clause and shall post copies of the notice in
conspicuous places available to employees and applicants for employment or training.
6. Subcontracts, The Grantee will include this Section 3 clause in every subcontract and will
take appropriate action pursuant to the subcontract upon a finding that the subcontractor is
in violation of regulations issued by the grantor agency. The Grantee will not subcontract
with any entity where it has notice or knowledge that the latter has been found in violation
of regulations under 24 CFR 135 and will not allow any subcontract unless the entity
provides a preliminary statement of ability to comply with the requirements of this
Agreement and all other applicable law.
2019--2020 CriBG Funding Agreement Page 16
E. Assignability
The Grantee shall not assign or transfer any interest in this Agreement without the prior written
consent of the City. Claims for money due or to become due to the City from the Grantee under
this Agreement may be assigned to a bank,trust company,or other financial institution without
such approval. Notice of any such assignment or transfer shall be furnished promptly to the
City.
F. Subcontracts
1. Approvals. The Grantee shall not enter into any subcontracts with any agency or individual
in the performance of this Agreement without the written consent of the City prior to the
execution of such subcontract.
2. Monitoring, The City will monitor the performance of the Grantee. All subcontracted
services on a risk analysis basis to assure contract compliance. Results of monitoring
efforts shall be summarized in written reports and supported with documented evidence of
follow-up actions taken to correct areas of noncompliance. Substandard performance as
determined by the City will constitute noncompliance with this agreement. If action to
correct such substandard performance is not taken by the Grantee within a reasonable time
after being notified, Agreement suspension or termination will take place.
3. Content. The Grantee shall cause all of the provisions of this Agreement in its entirety to
be included in and made a part of any subcontract executed in the performance of this
Agreement.
4. Selection Process. The City shall insure that all subcontracts entered into in the
performance of this Agreement shall be awarded on a fair and open competition basis.
Executed copies of all subcontracts shall be forwarded to the City along with
documentation concerning the selection process.
5. Suspension and Disbarment. The Grantee shall not enter into any subcontracts with an
agency, business, or individual that has been suspended, disbarred, or otherwise excluded
from Federal grants.The Grantee shall maintain records demonstrating that it has reviewed
potential subcontractors against the debarred and excluded list prior to committing any of
the Funding to a subcontract.
G. Hatch Act
The Grantee agrees that no Funding or personnel employed under this Agreement shall be in
any way or to any extent engaged in the conduct of political activities in violation of Chapter
15 of Title V U.S.C.
2019--2020 CDBG Funding Agreement Fuge 1�
H. Conflict of Interest
The Grantee agrees to abide by the provisions of 24 CFR 84.42 and 570.611, which include
but are not limited to:
1. The Grantee shall maintain a written code of conduct to govern the performance of its
officers, employees or agents engaged in the award and administration of contracts
supported by Federal funds.
2. No covered persons who exercise or have exercised any functions or responsibilities with
respect to CDBG-assisted activities, or who are in a position to participate in a decision-
making process or gain inside information with regard to such activities, may obtain a
financial interest in any contract, or have a financial interest in any contract, subcontract,
or agreement with respect to the CDBG-assisted activity, or with respect to the proceeds
from the CDBG-assisted activity, either for themselves or those with whom they have
business or immediate family ties, during their tenure or for a period of one (l) year
thereafter. For purposes of this paragraph, a "covered person" includes any person who is
an employee, agent, consultant, officer, or elected or appointed official of the City, the
Grantee, or any designated public agency.
I. Lobbying
The Grantee hereby certifies that:
1. No Federal appropriated funds have been paid or will be paid, by or on behalf of it, 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 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,
it will complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying,"
in accordance with its instructions.
3. It will require that the language of Article 10.13.2 of this Agreement 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.
2019—2020 Cb BG Funding Agreement Page 1$
J. Lobbying Certification
Any person who fails to file the required certification imposed by 31 USC 1352 shall be subject
to a civil penalty of not less than ten thousand dollars($10,000)and not more than one hundred
thousand dollars ($100,000) for each such failure. Submission of such certification is a
prerequisite for making or entering into this Agreement, and the certification is a material
representation of fact upon which reliance was placed when this transaction was made or
entered into.
K. Copyright
If this Agreement results in any copyrightable material or inventions,the City reserves the right
to royalty-free, non-exclusive, and irrevocable license to reproduce, publish, or otherwise use
and to authorize others to use, the work or materials for government purposes.
L. Religious Organization
The Grantee agrees that the Funding provided under this Agreement will not be utilized for
religious activities,to promote religious interests, or for the benefit of a religious organization
prohibited by 24 CFR 570.2000), such as worship, religious instruction or proselyzation.
Article 10. ENVIRONMENTAL CONDITIONS
A. Air and Water
The Grantee agrees to comply with the following requirements insofar as they apply to the
performance of this Agreement:
- National Environmental Policy Act, 42 U.S.C. Part 55.
- Clean Air Act, 42 U.S.C., 7401, et seq;
- Federal Water Pollution Control Act, as amended; 33 U.S.C. 1251, et seq., as amended;
1318 relating to inspection, monitoring, entry, reports, and information; other requirements
specified in said Section 114 and Section 308, and all regulations and guidelines issued
thereunder; and, Environmental Protection Agency (EPA) regulations pursuant to 40 C.F.R.,
Part 50, as amended.
B. Flood Disaster Protection
In accordance with the requirements of the Flood Disaster Protection Act of 1973 (42 USC
4001), the Grantee shall assure that, for activities located in an area identified by Federal
Emergency Management Agency (FEMA) as having special flood hazards, flood insurance
under the National Flood Insurance Program is obtained and maintained as a condition of
financial assistance for acquisition or construction purposes, including rehabilitation.
2019 2020 CbBG Funding Agreement Page 19
C. Lead-Based Paint
The Grantee agrees that any construction or rehabilitation of residential structures with
assistance provided under this Agreement shall be subject to HUD Lead-Based Paint
Regulations at 24 CFR 570.608, and 24 CFR Part 35, Subpart B. Such regulations pertain to
all CDBG-assisted housing and require that all owners,prospective owners, and tenants of
properties constructed prior to 1978 be properly notified that such properties may include
lead-based paint.
Such notification shall point out the hazards of lead-based paint and explain the symptoms,
treatment and precautions that should be taken when dealing with lead-based paint poisoning
and the advisability and availability of blood lead level screening for children under seven.
The notice should also point out that if lead-based paint is found on the property, abatement
measures may be undertaken. The regulations further require that, depending on the amount
of Federal funds applied to a property, paint testing, risk assessment, treatment and/or
abatement may be conducted.
D. Asbestos
The Grantee agrees to comply with the Texas Asbestos Health Protection Act set forth at
Article 4477-3a Section 12 of the Texas Civil Statutes and the National Emission Standard for
Asbestos Regulations set forth at 40 CFR Part 61.
E. Historic Preservation
The Grantee agrees to comply with the Historic Preservation requirements set forth in the
National Historic Preservation Act of 1966, as amended (16 U.S.C. 470) and the procedures
set forth in 36 CFR, Part 800, Advisory Council on Historic Preservation Procedures for
Protection of Historic Properties, insofar as they apply to the performance of this Agreement.
In general, this requires concurrence from the State Historic Preservation Officer for all
rehabilitation and demolition of historic properties that are fifty (50) years old or older or that
are included on a Federal, State, or local historic property list.
Article 11. SEVERABILITY
If any provision of this Agreement is held invalid, the remainder of the Agreement shall not be
affected thereby, and all other parts of this Agreement shall nevertheless be in full force and effect.
Article 12. SECTION HEADINGS AND SUBHEADINGS
The section headings and subheadings contained in this Agreement are included for convenience
only and shall not limit or otherwise affect the terms of this Agreement.
2019 2020 CDBG Funding Agreement Page 20
Article 13. WAIVER
The Grantee's failure to act with respect to a breach by the Subrecipient does not waive its right
to act with respect to subsequent or similar breaches. The failure of the Grantee to exercise or
enforce any right or provision shall not constitute a waiver of such right or provision.
Article 14. CHAPTER 2270, SUBTITLE F,TITLE 10, TEXAS GOVERNMENT CODE
The City warrants that it is in compliance with Chapter 2270, Subtitle F, Title 10 of the Texas
Government Code by verifying that it does not boycott Israel, and that it will not boycott Israel
during the term of this Agreement.
Article 15. ENTIRE AGREEMENT
This Agreement constitutes the entire agreement between the Parties for the use of funds received
under this Agreement and it supersedes all prior or contemporaneous communications and
proposals, whether electronic, oral, or written between the City and the Grantee, and any
Subrecipient, with respect to this Agreement.
IN WITNESS HEREOF,THE PARTIES HAVE EXECUTED AND ENTER INTO THIS
AGREEMENT ON THE EFFECTIVE DATE
[Signature Page to Follow]
2019—2020 CDBG Funding Agreement Page 21
SIGNATURES
FOR: THE CITY OF LUBBOCK FOR: Community Health Center of
Lubbock
DANIEL A POPE, MAYOR Michael Sullivan, Chief Executive Officer
'-60�t4-'
Bertha Martinez, B ent
FED. I.D. 475-2424925
ATTEST:
Re"carza, rty ecretary
APPROVED AS TO CONTENT:
Karen Murfee, Community Develo ent Director
APPROVED AS TO FORM:
Kelli leisure, Assistant City Attorney
2019 2020 CDBG Funding Agreement Page 22
FY 2019-2020
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)
EXHIBIT A
GRANTEE- COMMUNITY HEALTH CENTER OF LUBBOCK
TERM- October 1, 2019 September 30,2020
PROGRAM- CHCL Arnett Benson Clinic Dental Service Expansion
ALLOCATION- $ 50,000
MATCH- (25%of allocation)$12,500
PROGRAM DELIVERY-
Needy Dental Services for the underserved/low income
• Will self-certify clients
• Provide access to dental care at 3301 Clovis Road, Lubbock Tx 79415,to the underserved/low income for
services they may not receive anywhere else.
LEVEL OF ACCOMPLISHMENT-In addition to the normal administrative services required as part of this Agreement,
the Grantee agrees to provide the following levels of program services in its performance of the Program.
Activity Timeline Accomplishments
Program October- September October I, 2019 -- 1,200 patients served
September 30,2020
Monthly Reports and Reimbursement Request are due by the I&'of each month
Year End and Outcome Report due no later than September 30, 2020
BUDGET- Line Item Amount
Utilities $16,740
Telephone $8,260
Dental Supplies $25,000
CONTACT INFORMATION
Communication and details concerning this Agreement shall be directed to the following:
For the City: For the Grantee:
Community Development Michael Sullivan-CEO
City of Lubbock Barbra Moore-Finance Director
P.O. Box 2000 Bertha Martinez--Board President
Lubbock,TX 79457 1610 5'h Street
Lubbock,Texas 79401
CERTIFICATE OP INTERESTED PARTIES FORM 1295
loll
Complete Nos.1-4 and 6 it there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2020-575125
Community Health Center of Lubbock
Lubbock,TX United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form Is 01/08/2020
being filed.
City of Lubbock Date Acknowledged:
3 Provide the Identification number used by the governmental entity or state agency to track or identify the contract,and provide a
description of the services,goods,or other property to be provided under the contract.
15154
Medical Dentalldental services
Nature of Interest
4 Name of Interested Party City,State Count ry{place of business} (check applicable)
Controlling J Intermediary
5 Check only if there Is NO interested Party. ❑X
6 UNSWORN DECLARATION
My address is l`)�
(street) (city) (state) (zip code) (country)
1 declare under`penalty of 1perjury
that the foregoing is true and correct. 1
Executed in �"` �"" ` County, State of 1'� Vt� ,on the today of W ,20 10 .
(month) (year)
Signature of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.3a6aaf7d
CERTIFICATE OF INTERESTED PARTIES FORM 1295
loll
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos,1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2020-575125
Community Health Center of Lubbock
Lubbock,TX United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the orm s 01/06/2020
being filed.
City of Lubbock pate Acknowledged,
3 Provide the identification number used by the governmental entity or state agency to track or Identify the contract,and provide a
description of the services,goods,or other property to be provided under the contract.
15154
Medical Dental/dental services
Nature of interest
4 Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling intermediary
5 Check only if there Is NO Interested Party.
6 UNSWORN DECLARATION
p
My name is ��lJf tUYt it ][l��l��l�, and my date of birth is
My address is L����1 __
(street) (city) (state) (zip code) (country)
I declare under penalty of 1perjury that the foregoing is true and correct. `j" /A
Executed in �"4 �` �' County, State of l>{05 .__.,on the day of 20_L�_.
(month) (year)
Signature of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1,1.3a6aaf7d
CERTIFICATE OF INTERESTED PARTIES FORM 1295
lofl
Complete Nos.1-4 and 6 if there are interested parties. OFFICE= USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2020-575125
Community Health Center of Lubbock
Lubbock,TX United States Date Filed:
2 Name of governmental entity or state agency that Is a party tot the contract for which the form Is 01/08/2020
being filed.
City of Lubbock Date Acknowledged:
3 Provide the Identification number used by the governmental entity or state agency to track or identify the contract,and provide a
description of the services,goods,or other property to be provided under the contract.
15154
Medical Dentalldental services
Nature of interest
4 Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
5 Check only if there Is NO Interested Party.
X
6 UNSWORN DECLARATION
My address is �o ` �'1 1. TTS_. ALf�-J ` w .
(street) (city) (slate) (zip oode) (country)
I declare under penaltyof perjury that the foregoing is true and correct. f�!r, n
Executed in L"A` County, Stale of Vt--I 5 ,on the�wday of� ,2Q[�v .
(month) (year)
Signature of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.3a6aaf7d