HomeMy WebLinkAboutResolution - 2015-R0389 - Agreement - TXADS & SPAG - HHS Grant Funding - 12/03/2015Resolution No. 2015-R0389
Item No. 5. 1.1
December 3, 2015
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 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
for said grant, and related documents. Said grant 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 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 this 3rd day of December _ , 2015.
I -'�Ze
GL C. ROBERTSON, MAYOR
ATTEST:
Rebe ca Garza, City Secret
APPROVED AS TO CONTENT:
Bridget Faulkenberry, Parks and Recreation Director
APPROVED AS TO FORM:
Laur,A. Pratt, Assistant City Attorney
RES.. SPAG Grant 15-16 11 12.15
11.12.15
Resolution No. 2015-RO389
4d The South Plains Association of Governments Area Agency on Aging //AreaAgency
SPAG Direct Purchase of Service
SS
Fiscal Year 2016 Vendor Application/Renewal Update Won
Aging
Prins Asmcimfm
of rmommam
Please type or clearly print application information.
City of Lubbock
Vendor Name/Legal Entity
DBA (if applicable)
Physical Address:
2001 19th Street (Lubbock Senior 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 Private Non -Profit Private For Profit
■City Government County Government Other:
Authorizing Official:
Title:
Glen C. Robertson
Mayor
Email Address:
Telephone:
obertson n mvlubbock.us
(806) 775-2010
Billing Contact Person and billing address:
Title:
Nancy Neill, City of Lubbock, PO Box 2000, 79456
Indoor Recreation Coordinator
Email Address:
Telephone:
nneillna mylubbock.u,
(806) 775-2685
Number of Years Organization has been in business:
Is Organization Bonded?
(Attach certificate of bonding insurance)
36 Years
❑ Yes ■ No
,Has anyone involved in the direct provision of client services
If Yes, Explain:
been convicted of a felony (In-home Services
only)? NotApplicable
NotApplicable
® Yes ® No
Does Organization have liability insurance?
Attach a copy of all applicable State and Federal
(Attach certificate of all insurances)
■ Yes El No
licenses and /or certifications for your business.
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
1;
2.
3.
4.
Service and Bidding Information:
A. Proposed Service:
Congregate Meals
B. Service Area:
0-,,,LzY DP L 156CC�L,
C. Proposed DADS A&I AAA cost per unit: Whole cost per unit:
G C no @ 7 A
A. Proposed Service:
Home Delivered Meals
B. Service Area:
N/A
C. Proposed DADS A&I AAA cost per unit: Whole cost per unit:
A. Proposed Service:
Transportation
B. Service Area:
%t -LY 6F- U15150 C,
C. Proposed DADS A&I AAA cost per unit: Whole cost per unit:
$ 7.47 $ 8.30
A. Proposed Service:
N/A
B. Service Area:
N/A
C. Proposed DADS A&I AAA cost per unit: Whole cost per unit:
Signature:
I, Glen C. Robertson certify that the information provided in this application is true and
Printed Name
correct to the best of my knowledge.
Thursday, October 01, 2015
Auth rized Signature Date
DPS Application
Page 2
Attest:
Reb cca Garza
Ci y Secretary
Approved as to Content:
Bridget Faulkenberry
Parks and Recreation Dir ctor
Approved as to Form:
It
Lada Pratt
Assistant City Attorney
ity
Lubbock
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 #791-000-230-0001 which expires on 10/01/16. The current
net asset balance of the self-insurance fund is $6,885,448. The existing cash asset
balance is $10,589,353 as of the date stated below.
t1iney Morrison
Risk Management Coordinator
Date: September 30, 2015
ca�_ 4.
5[ fiYiA r
-r-Y 2064P
4 �r�
Crto
Lubbo- ck
TEXAS
PARKS AND RECREATION
DATE October 1, 2016
TO South Plains Association of Government
FROM City of Lubbock - Senior Center Programs
SUBJECT FY 2015-16 Operating Hours and Holidays for SPAG Grant
Holidays Observed
Number of
Name of Sites
Serving Days
Lubbock Senior Center
252
Rawlings Community Center
252
Simmons Senior Center
252
Trejo Supercenter
252
Homestead Senior Program
252
Holidays Observed
Dates
Thanksgiving Day
November 26, 2015
Day After Thanksgiving
November 27, 2015
Christmas Eve
December 24, 2015
Christmas Day
December 25, 2015
New Year's Day
January 1. 2016
Martin Luther King, Jr. Day
January 18, 2016
Good Friday
March 25, 2016
Memorial Day
May 30, 2016
4th of July
July 4, 2016
Labor Day
September 5, 2016
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
/AreaAgency SOUTH PLAINS ASSOCIATION OF GOVERNMENTS
WOn
Aging AREA AGENCY ON AGING
VENDOR AGREEMENT
City of Lubbock, hereinafter referred to as Vendor, and South Plains Association of Governments Area Agency
on Aging (AAA) do hereby agree to provide services effective beginning October 1, 2015, in accordance with
the Older Americans Act of 1965 (OAA), as amended, regulations of the Department of Aging and Disability
Services (DADS), 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 DADS 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 Vendor.
1. SCOPE OF SERVICES
A. The Vendor agrees to provide the following service(s) as identified below to program participants
authorized by the AAA staff, in accordance with the vendor 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.
Unit Definition:
Form #: AIAAA VA2.0
Edition Date: 9/19/11
CONGREGATE MEALS: One Meal
TRANSPORTATION — Demand/Response: One One-way Trip
Service Area (To be filled in by provider. Please type or print neatly):
(,i 1TY Ul�_ W O BC;l/1
All Texas Administrative Code standards are located at the Texas Secretary of State website:
vN�',, . sos. state.tx. us.
All Older Americans Act and other required rules and regulations are located at
http://,%,ww.aoa.acl.gov/AoA Prog rams/OAA! Introduction. asp x.
Tar eg tina: 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:
Fixed Rate
Service (include rate)
Variable Rate Cost
(identify range) Reimbursement
Congregate 6.98
Transportation 7.47
Forth #. AIAAA VA2.0
Edition Date: 9/1911 I
2. TERMS OF AGREEMENT
A. The Vendor agrees to:
1. provide services in accordance with current or revised DADS policies and standards and the OAA.
2. submit billings with appropriate documentation as required by the AAA by the close of business on
the 2"1 working day of each month following the last day of the month in which services were
provided.
a. If the 2"d 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.
c. No reimbursement for services provided will be made if vendor payment invoices are not
submitted to the AAA within 45 days of service delivery.
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 Vendor'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. Vendor
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 Vendor 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 vendor'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 DADS 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 Vendor further agrees:
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. Vendor is an independent provider, NOT an agent of the AAA. Thus, the Vendor indemnifies, saves
and holds harmless the South Plains Association of Governments AAA against expense or liability of
Form #: AIAAA VA2.0
Edition Date: 9/19/11
any kind arising out of service delivery performed by the Vendor. Vendor must immediately notify
the AAA if the Vendor becomes involved in or is threatened with litigation related to program
participants receiving services funded by the AAA.
4. Employees of the Vendor 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:
1. review program participant intake and assessment forms completed by the Vendor, 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 Vendor 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 Vendor 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 DADS, reimburse the
Vendor 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
Vendor's invoice.
Fonn #: AIAAA_VA2.0
Edition Date: 9/19/11
3. ASSURANCES
The Vendor 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. Title IX of the Education Amendments of 1972 (20 U.S.C. §§1681-1688)
F. Food Stamp Act of 1977 (7 U.S.C. §200 et seq.)
G. Drug Free Workplace Act of 1988
H. Texas Senate Bill 1 - 1991, as applicable
I. DADS administrative rules, as set forth in the Texas Administrative Code, to the extent applicable to this
Agreement
J. 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
K. Centers for Medicare and Medicaid Services (CMS) State Medicaid Director Letter SMDL 409-001
regarding Individuals or Entities Excluded from Participation in Federal Health Care Programs
L. DADS 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.
5. SIGNATURES
For the faithful performance of the terms of this agreement. the parties affix their signatures and bind themselves
effective Oct,ober 0
Authorized endor Signature
Glen C. Robertson
Print Name
MAYOR
Title
October 1, 2015
Date
Form #: AIAAA VA2.0
Edition Date 9.119/11
Authorized Signature
South Plains Association of Governments
(Agency)
P.O. Box 3730 — Freedom_ Station
(Address)
Lubbock, Texas 79452
(City, State, Zip)
ber 1, 2015
(Date)
Attest:
R ecca Garza
City Secretary
Approved as to Content:
ali� a u
Bridget Faulkenberry
Parks and Recreation Director
Approved as to ,
a ra Pratt
Assistant City Attorney
ASSURANCES ATTACHMENT
A. Title VI of the Civil Rights Act of 1964 (42 U.S.C. §2000d el.sey.), 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. X794), 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. Aize 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. Title IX of the Education Amendments of 1972 (20 U.S.C. §§1681-1688), which prohibits
the use of federal money to support sexually discriminatory practices in education
programs such as sexual harassment and employment discrimination, and to provide
individual citizens effective protection against those practices.
F. Food Stamp Act of 1977 (7 U.S.C. §200 el sec/.), 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.
G. Drug Free Workplace Act of 1988, which requires that all organizations receiving federal
grants, regardless of amount granted, maintain a drug-free workplace.
H. 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 2015-2016
CENTER:
DIRECTOR:
BOOKKEEPER:
ADDRESS:
CITY:
PHONE:
DAYS & HRS. OPEN:
SERVICES:
COUNTY:
CENTER:
DIRECTOR:
ASSISTANT:
ADDRESS:
CITY:
PHONE:
DAYS & HRS. OPEN:
SERVICES:
COUNTY:
CENTER:
DIRECTOR:
BOOKKEEPER:
ADDRESS:
CITY:
PHONE:
DAYS & HRS. OPEN:
SERVICES:
COUNTY:
Bailey County Commissioners Court (A-020)
Shelby Acosta
Shelby Acosta
300 South First Street Room 110
Muleshoe, Texas 79347
(806) 272-3647 E-mail: bcaaing(a,fivearea.com
Mon. - Fri. 8:30-12:00, 1:00-5:00 Fax: (806) 272-4656
TRANS.
Bailey
Bailey County Senior Citizens Assoc., Inc. (A-007)
Laverne Winn H — (806)272-4491
Rhonda King
319 S. Main St / PO Box 292
Muleshoe, Texas 79347
(806) 272-4969 E-mail: seniors(i),fivearea.com
Mon. — Fri. 8:00 — 4:00 Fax: (806) 272-4460
CONG.
Bailey Miles 156.72
Cochran Co. Senior Citizens Assoc., Inc. (A-045)
Reynalda Alvarado
Reynalda Alvarado
120 W. Wilson
Morton, Texas 79346
(806) 266-5121 E-mail: ccsci(a�windstream.net
Mon. — Fri. 8-4 Fax #: 266-9027
CONG., TRANS.
Cochran Miles 119.62
Updated 9-16-2014
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:
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(i�windstream.net
Mon. —Fri. 8-3
CONG., H.D.
Crosby Miles 84
Garza County Trailblazers, Inc. (A-070)
Tonya Rudd
Tonya Rudd
205 E. 10th
Post, Texas 79356
(806) 495-2998 E-mail:garzatrailblazers iDyahoo.com
Mon. — Fri. 8-1
CONG., H.D.
Garza miles 76.32
CENTER:
Hale Center Senior Citizens Assoc., Inc. (A-075)
DIRECTOR:
Vickie Rosales
BOOKKEEPER:
Vickie Rosales
ADDRESS:
P.O. Box 205 (416 West 211 St.)
CITY:
Hale Center, Texas 79041
PHONE:
(806) 839-2428 E-mail: hcsrcenter(&,sbcglobal.net
DAYS & HRS. OPEN:
Mon. — Fri. 8-3
SERVICES:
CONG., H.D., TRANS.
COUNTY:
Hale Miles 75.36
CENTER:
Hockley County Senior Citizens Assoc., Inc. (A-085)
DIRECTOR:
Susan Sprowls
BOOKKEEPER:
Olga Gonzales
ADDRESS:
1202 Houston
CITY:
Levelland, Texas 79336
PHONE:
(806) 894-2228 E-mail: hcsca(&Daol.com
DAYS & HRS. OPEN:
Mon. — Fri. 8-4:30 (Smyer: Tues & Fri, 8-3)
SERVICES:
CONG., H.D., TRANS.
COUNTY:
Hockley
Updated 9-16-2014
CENTER:
Lorenzo Senior Citizens Assoc., Inc. (A-095)
DIRECTOR:
Christina Edwards
BOOKKEEPER:
Christina Edwards
ADDRESS:
P.O. Box 571 (606 6th St.)
CITY:
Lorenzo, Texas 79343
PHONE:
(806) 634-5957 E-mail: lorenzosca(a�windstream.net
DAYS & HRS. OPEN:
Mon. —Fri. 8-2
SERVICES:
LONG., 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 (1010 9" St.)
CITY: Lubbock, Texas 79457
PHONE: (806) 775-2678
E-mail:jmclellan(a,mail.ci.lubbock.tx.us
nneill(-@,mylubbo ck.us &
p.ibrown(a,mylubbock.us
nancy.m.neill ibmmail.com
DAYS & HRS. OPEN: Mon. —Fri. 8-5 Fax: 775-2686
SERVICES: CONG., TRANS.
COUNTY: Lubbock
Mae Simmons — 767-2708, Traci Crawford (2004 Oak Avenue 79404),
Copper Rawlings — 767-2704, Herminia Martinez (213 401h Street 79404), (40"' & Ave. B),
Maggie Treio — 767-2705, Cecilia Gonzalez (3200 Amherst 79415),
Homestead - 687-7898, Jesse Madrid and (5401 56th Street 79414);
Lubbock Senior Center — 767-2710, Paula Brown (2001 19th Street, 79401) FAX 765-0820
Gloria Gutierrez Transportation Director
CENTER:
DIRECTOR:
BOOKKEEPER:
ADDRESS:
CITY:
PHONE:
DAYS & HRS. OPEN:
SERVICES:
COUNTY:
Lynn County Pioneers
Bianca Baker
Bianca Baker
P.O. Box 223 (1600 S. 3rd St.)
Tahoka, Texas 79373
(806) 561-5264
Mon. —Fri. 9-3
CONG., H.D.
Lynn Miles 54.52
(A-110)
E-mail: lcp(i�door.net
Fax: 561-5571
(No Cong. in O'Donnell)
Updated 9-16-2014
CENTER:
Senior Citizens Assoc. of S. Dickens County (A-130)
DIRECTOR:
Linda Alexander
BOOKKEEPER:
Jean Hoover
ADDRESS:
210 Burlington
CITY:
Spur, Texas 79370
PHONE:
(806) 271-4472 E-mail: _sscaosdc(a,caprock-spur.com
DAYS & HRS. OPEN:
Mon. —Fri. 8-3
SERVICES:
LONG., H.D.
COUNTY:
Dickens 154.00
CENTER:
Slaton Senior Citizens Assoc., Inc. (A-135)
DIRECTOR:
Charlotte O'Connell
BOOKKEEPER:
Charlotte O'Connell
ADDRESS:
230 West Lynn
CITY:
Slaton, Texas 79364
PHONE:
(806) 828-3784 E-mail: coconnell(i ,door.net
DAYS & HRS. OPEN:
Mon. —Fri. 8-4 slatonseniors(a,door.net
SERVICES:
LONG., H.D.
COUNTY:
Lubbock 28.52
CENTER:
Yoakum County Senior Citizens Assoc., Inc. (A-150)
DIRECTOR:
Pat Castillo
BOOKKEEPER:
Pat Castillo
ADDRESS:
500 N. Ave. C
CITY:
Denver City, Texas 79323
PHONE:
(806) 592-8000 E-mail: Pat - ycsc60(Dwindstream.net
Fax:
(806) 592-2835
DAYS & HRS. OPEN:
Mon. —Fri. 9-2
SERVICES:
CONG., H.D.
COUNTY:
Yoakum 159.94
LEGEND
CONG. — Congregate Meals (on-site)
H.D. - Home Delivered Meals
TRAN. - Transportation Service
Updated 9-16-2014
Certification Regarding Debarment
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARY EXCLUSION FOR COVERED CONTRACTS AND GRANTS
Federal Executive Order 12549 requires the Texas Department of Aging and Disability
Services (TDADS)) to screen each covered potential vendor/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 vendor/grantee
must also screen each of its covered sub vendors/providers.
In this certification "vendor/grantee" refers to both vendor/grantee and sub-vendor/sub-
grantee: "contract/grant" refers to both contract/grant and subcontract/sub-grant.
By signing and submitting this certification the potential vendor/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 vendor/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 Department of Aging and Disability Services may pursue
available remedies, including suspension and/or debarment.
2. The potential vendor/grantee shall provide immediate written notice to the person to
whom this certification is submitted if at any time the potential vendor/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 vendor/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 Department of
Aging and Disability Services, as applicable.
Do you have or do you anticipate having sub vendors/sub-grantees under this
proposed contract? Yes X No
7. The potential vendor/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.
b. A vendor/grantee may rely upon a certification of a potential sub vendor/sub-grantee
that is not debarred, suspended, ineligible, or voluntarily excluded from the covered
contract/grant, unless the vendor/grantee knows that the certification is erroneous. A
vendor/grantee must, at a minimum obtain certifications from its covered sub
vendors/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 by this certification
document. The knowledge and information of a vendor/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
vendor/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, and/or the Texas Department of Aging and Disability Services
may pursue available remedies, including suspension and/or debarment.
CERTIFICATION REGARDING DEBARMENT
Page 3
Indicate which statement applies to the covered potential vendorgrantee:
X The potential vendor/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 vendor/grantee is unable to certify one or more of the terms in this
certification. In this instance, the potential vendor/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 VENDOR/GRANTEE City of Lubbock
VENDOR ID NO./FEDERAL EMPLOYER'S ID NO. 1-75-6000590-6
G
S natur of Authorized Representative
Laura Pratt
Printed/Typed Name of Authorized Representative
Assistant City Attorney October 1, 2015
Title of Authorized Representative Date
This certificate is for FY 2016, period beginning October 1, 2015 and ending
September 30, 2016.
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 Department of Aging and Disability Services 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 $25,000) 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 Department of Aging
and Disability Services or federal fiinding 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 Department of Aging and
Disability Services 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.
10/13/15 2:20 PM
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
2. Total Number of Anticipated Meals to be Provided by Funding Source
Other Funds
DADS A&I AAA 17.377 Eligible Meals 7,550 Other Sources 5 0
Other Funds -
Non -Eligible
Program Income 5,033 Meals 0 Other Sources 6 0
3 Whole Unit Rate (Line 1 divided by Line 2)
Reimbursement Calculation
4. Projected NSIP per Meal Value
DADS AW AAA
0.69
5. Rate Less NSIP per Meal Value $ 6.74
6. Mandatory Local Match of 10'0 $ 0.67
" If Applicable, Match Reduction
From the In-kind Match
Certification form
Required Cash Match
$ (0.22)
$ 0.45
7. Proposed Meal Rate (Line 3 minus Line 6) $ 6.98
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.
City of Lubbock
Legal Name,@f Contracted P ider
Signature
Area Agency on Aging of South Plains
Name of Area Agency on Aging
Ti C ierc
P me yped Mme of Sign. �
Signature
June 30, 2015
Date
Glen C. Rob=on
Printed/Typed Name of Signer
October 1, 2015
Date
1. $ 222,529.15
2. 29.960
3. $ 743
Attest:
,04,f) A , - jll��
Re ecca Garza
Ci y Secretary
Approved as to ontent:
-if 3�;;
Bridget Faulkenberry
Parks and Recreation Director
Approved as rm:
Laur Pratt
Assistant City Attorney
10/13/15 2:20 PM
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 Glen C. Robertson
Name of Contracted Provider Printed/Ty ed Name of ' ner
October 1, 2015
7 Date s' ature
Signer Authority: L-; Sole Proprietor ❑ Association Officer
(check one) Partner ❑ Board Member
[ orporate Officer ❑ Governmental Official
Attest:
R ecca Garza
C y Secretary
Approved as toContent:
M, %A-I�
Bridget Faulkenberry
Parks and Recreation Direc r
Approved as
4
LauYa Pratt
Assistant City Attorney
10113115 2:20 PM
AAA Name: Area Agency on Aging of South Plains
Congregate Meals
IN-KIND MATCH CERTIFICATION
Provider: City of Lubbock
In-kind Contribution(s): $5,459
For any item identified below, you must maintain support documentation.
ITEM DATE OF RECEIPT VALUE
RSVP Volunteers @ Lubbock Senior Center
3 Volunteers X 1 hr/day X 251 days X $7.25/hour Min Wage $5,459
TOTALS $5
Note: All contributions must meet the requirements of IRS Publication 561
http:// pubr'irs-pdf'p561.pdf
Examples of Documentation Include:
Rent: 1. Letter of Agreement with Owner
2• Adequate Valuation of Property on a Current Basis (this should be reviewed at least every two years
and if senior center, based on property value and center participation)
Labor: 1. Minimum wage
2• Documented prevailing wage in the Area. For prevailing wage information visit the Texas Workforce
Commission's website at Imp: x8ww.Eracer1com
All in-kind labor must be required for the service to be provided. If you would not hire someone to perform the labor if it
were not in-kind then you cannot count it.
Utilities: 1. Copy of Bill
2. Agreement of Amount Paid if Partial
City of Lubbock
Name of Contracted Provider
October 1, 2015
Date
Glen C. RobelISQU
Print y d Name of Signer
Signature
Attest:
A�
TR ecca Garza
C' Secretary
Approved as to ontent:
Bridget Faulkenberry
Parks and Recreation Direct r
Approved as to Worm:
La a Pratt
Assistant City Attorney
10/13/15 2:21 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
DADS A&I AAA - 10 %
Program
Match Required 3,145
Income
DADS A&I AAA - 25 %
Local Funds -
Match Required 0
Eligible Trips
Other Funds -
DADS A&I AAA - Full Unit
Non -Eligible
Rate 0
Trips
3. Cost per unit (Line 1 divided by Line 2) - Full Unit Rate
145 Other Sources 6
2,999 Other Sources 7 0
Other Sources 8 0
Reimbursement Calculation for Contracts Requiring Unit Rate Match Reduction
1 $ 52.198.31
2. 6,289
3. $ 8.30
4. Mandatory Local Match of 10% $ 0.83
" If Applicable, Match Reduction From the In-kind Match Certification form $
Required Match 4. $ 0.83
5.Full Unit Rate Less Required Match (Line 3 minus Line z 5. $ 7.47
4. Mandatory Local Match of 25% $ 2.08
If Applicable, Match Reduction From the In-kind Match Certification form $
Required Match 4. $ 2.08
5.Full Unit Rate Less Required Match (Line 3 minus Line 5. $ 6.22
"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
$ 8.30
Contractor Initial AAA Initial
City of Lubbock
Legal Name of Con ed Provider
Signature
Glen C. Robertson
Printed/Typed Name of Signer
10/01/15
Date
enc m o outh Plains
Na a of ency n Aging
Sign
Tim C. Pierce
Printed/Typed Name of Signer
06/30/15
Date
Attest:
Re ecca Garza
City Secretary
Approved as to Content:
Bridget Faulkenberry
Parks and Recreation Director
Approved as W-Fprm:
Laa Pratt
Assistant City Attorney
10/13/15 3:13 PM
Provider Name: City of Lubbock
AAA Name: Area Agency on Aging of South Plains
Transportation
BUDGET WORKSHEET CERTIFICATION
AS SIGNER OF THIS BUDGET WORKSHEET, 1 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
October 1, 2015
Date
Signer Authority: F� Sole Proprietor
(check one) ❑ Partner
Corporate Officer
Glen Robertgon--
Printed yped Na of Signer
Signature
® Association Officer
Board Member
Governmental Official
Attest:
R becca Garza
City Secretary
Approved as
Bridget Faulkenberry
Parks and Recreation D
Approved as to Form:
Z,!�. &L
Lauri Pratt
Assistant City Attorney