HomeMy WebLinkAboutResolution - 2020-R0203 - Contract HHS000780500002, Community Health WorkersResolution No. 2020-R0203
Item No. 7.16
June 23,2020
KRSOLUTIOIN
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor orthe City of Lubbock is hereby authorized and directed to execute for
and on behalf of the City of Lubbock. Health and Human Services Commission Contract
No. HHS000780500002. for Community Hcallli Workers to increase linkage and
retention in substance use. mental health, and medical services for I'exas residents living
with substance use disorders, and all related documents. 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 June 23,2020
DANIEL M. POPE, MAYOR
ATTEST:
cca Garza. City Secretary
APPROVED AS TO CONTENT:
Bill Hovvijijon. l/cputy City^^y^agSr
APPROVED AS I () FORM:
Ryan . Assistant City Attorney
RLS.l il ts Conlract No, HHSO()()7S()500()l)2
6,9.20
Resolution No. 2020-RO203
SIGNATURE DOCUMENT FOR
IIEAJ.TII AND HUMAN SERVICES COMMISSION
CONTRACT No. HHS000780500002
I. PURPOSE
The HEALTH AND HUMAN SERVICES COMMISSION ("System Agency'), a pass -through entity,
and CITY OF LUBBOCK ("Performing Agency') (each a "Party" and collectively the
"Parties") enter into the following contract for COMMUNITY HEALTH WORKERS (CHW)
to increase linkage and retention in substance use, mental health, and medical services for Texas
residents living with substance use disorders (SUD) (the "Contract") pursuant to the provisions of
"The Interagency Cooperation Act;" Chapter 771 of the Texas Government Code.
II. LEGAI. AUTHORITY
This Contract is authorized by and in compliance with the provisions of Texas Health and Safety
Code, Chapter 12, and 1001; and Texas Government Code Chapters 531, and 2155.
III, DURATION
The Contract is effective July 1. 2020. and terminates on August 31, 2021 unless renewed,
extended, or terminated pursuant to the terms and conditions of the Contract. The System
Agency, at its own discretion, may extend this Contract subject to terms and conditions mutually
agreeable to both Parties.
IV. BUDGET'
A. The total amount of this Contract will not exceed $730,800.00.
B. System Agency Share total reimbursements will not exceed $696,000.00 for the period
from July I. 2020 through August 31, 2021, as follows:
1. Fiscal Year 2020 is allocated S232,000.00 for the term of July 1, 2020 through
August 31, 2020;
2. Fiscal Year 2021 is allocated $464 000.00 for the term of September 1, 2020 through
August 31, 2021:
C. For each Fiscal Year, Grantee is required to provide, a five percent (5%) match
requirement. In accordance with Attachment B, Grantee's budgeted match requirement
are as followed:
I. Fiscal Year 2020. Jul) I. 2020 through August 31. 2020 - $11,600.00.
2. Fiscal Year 2021. September I, 2020 through August 31, 2021 - $23,200.00
D. Total Contract Value will not exceed S730,800.00 for the period from July I, 2020
through August 31, 2021. as follows:
I. Fiscal Year 2020, July I, 2020 through August 31, 2020 - $243,600.00.
2. Fiscal Year 2021, September I, 2020 through August 31, 2021 - $487,200.00
All expenditures under the Contract will be in accordance with A'I'TACIIM ENT B- BuncEl',
V. REPORTING REQUIREMENTS
Performing Agency shall submit all documents identified below, in accordance with
ATTACHMENT A, S"1'A"I'EAIENT OF WORK:
A. Oriented Values and Principles Written Policy
13. Behavioral Health Disparities Impact Statement
C. Policies and Procedures
D. Quarterly report
E. Financial Status Report (FSR)
F. Invoices in CM13HS
G. CMBHS Security Attestation Form
11. Performance Measures
I. Contract Cluscoul Document
V1. CONTRACT REPRESENTATIVES
The following will act as the Representative authorized to administer activities under this
Contract on behalfol'thcir respective Party.
System Aeencv
I lealth and I luman Services Commission
P.O. Box 149347
Austin. T'X 78714
Attention: Denise Collins, Contract Manager
Grantee
City of Lubbock
P.O. BOX 2000
Lubbock, TX 79401
Attention: Daniel Pope. Mayor
Vll. LEGAI. NOTICES
Any legal notice required under this Contract shall be deemed delivered when deposited by the
System Agency either in the United States mail, postage paid, certified, return receipt requested; or
with a common carrier, overnight, signature required. to the appropriate address below:
System Aeencv
Health and Human Services Commission
1100 W. 491h Street, MC 1911
Austin, TX 78756
Attention: General Counsel
Grantee
City of Lubbock
Address: P.O. Box 2000
City and Zip: I..ubbock.'I'X 79457
Point of ContacE Katherine Wells
Director of Public I lealth
Telephone: 806-775-1_941
•-Mail Address: k�eclls(ii`mylubbock.us
Notice given by Performing Agency will be deemed effective when received by the System
Agency. hither Party may change its address for notice by written notice to the other Party.
SIGNATURE PAGE FOLLOWS
SIGNATURE PAGE FOR SYSTEM AGENCY CONTRACT No.
HEALTH AND HUMAN SERVICES COMMISSION
Name:
Title:
Date of execution:
CITY oFLUBB K
Name: Daniel M. Pope
Title: Mayor
Date ofexecution: June 23 2020
THE. FOLLOWING ATTACHMENTS TO SYSTEM AGENCY CONTRACT NO.
HHS000780500002 ARE HEREBY INCORPORATED BY REFERENCE:
ATTACHMENTA
STATEMENTOF WORK
ATTACHMEN'1'A-I
STATEMENT OF WORK SUPPLEMENTAL
ATTACHMENT
BUDGET
A'1'TACHMENrC
UNIFORM TERMS AND CONDITIONS
AT'"IACIIMF.NTD
GENERAL AFFIRMATIONS
AT'"1'ACHMENT F.
SPECIAL CONDITIONS
A ITACHMENTF
FEDERAL ASSURANCES AND CERTIFICATIONS
A'1"1'ACHMEN,rG
DATA USE AGREEMENT
A'I'TACHMENTH
NON-EXCLUSIVE LIST OF APPLICABLE LAWS
ATTACHMENT I
FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT
(FFATA)
A'I"rACHMENT5 FOLLOW
DocuSign Envelope ID: DDFOCOGD-95EO-4FBB-8212-8A95AOFFS984
SIGNATURE PAGE FOR SYSTEM AGENCY CONTRACT NO. HHS000780500002
HEALTH AND HUMAN SERVICES COMMISSION CITY OF LUBBOCK
DocuSignetl by: Fi-
MgaWreocuSigned by:
L
Tai.ea %fia NAt p6ft,
i ' afore se"UF
Name: Trina Ita
Title: Associate Commissioner
Date of Execution: July 7, 2020
Name: Daniel Pope
Title: Mayor
Date of Execution: July 7, 2020
THE FOLLOWING ATTACHMENTS TO SYSTEM AGENCY CONTRACT No. RHS000780500002
THE FOLLOWING ATTACHMENTS TO SYSTEM AGENCY CONTRACT NO.
ATTACHMENT A
ATTACHMENT A-1
ATTACHMENT B
ATTACHMENT C
ATTACHMENT D
ATTACHMENT E
ATTACHMENT F
ATTACHMENT G
ATTACHMENT H
ATTACHMENTI
ATTACHMENT
STATEMENT OF WORK
STATEMENT OF WORK SUPPLEMENTAL
BUDGET
UNIFORM TERMS AND CONDITIONS - GRANT
CONTRACT AFFIRMATIONS
SPECIAL CONDITIONS
FEDERAL ASSURANCES AND CERTIFICATIONS
DATA USE AGREEMENT
NON-EXCLUSIVE LIST OF APPLICABLE LAWS
FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT
(FFATA)
INDIRECT COST RATE LETTER
ATTACHMENTS FOLLOW
ATTEST:
1 6 cca Gar/a, City Secrctai -
APPROVED AS TO CONTENT:
Bill I low • n, t cp�citYM6�?
APPROVED AS TO FORM:
R an rook , Assistam City Attorney
DocuSign Envelope ID: DDFOCOCO-95EO-4FBB-8212-8A95AOFF6984
OMB Number: 4040-0007
Expiration Date: 02/28/2022
ASSURANCES - NON -CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND
IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances.
If such is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
1. Has the legal authority to apply for Federal assistance
and the institutional, managerial and financial capability
(including funds sufficient to pay the non -Federal share
of project cost) to ensure proper planning, management
and completion of the project described in this
application.
2. Will give the awarding agency, the Comptroller General
of the United States and, if appropriate, the State,
through any authorized representative, access to and
the right to examine all records, books, papers, or
documents related to the award; and will establish a
proper accounting system in accordance with generally
accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding
agency.
5. Will comply with the Intergovernmental Personnel Act of
1970 (42 U.S.C. §§4728-4763) relating to prescribed
standards for merit systems for programs funded under
one of the 19 statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to
nondiscrimination. These include but are not limited to:
(a) Title Vl of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color
or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C.§§1681-
1683, and 1685-1686), which prohibits discrimination on
the basis of sex; (c) Section 504 of the Rehabilitation
Act of 1973, as amended (29 U.S.C. §794), which
prohibits discrimination on the basis of handicaps; (d)
the Age Discrimination Act of 1975, as amended (42 U.
S.C. §§6101-6107), which prohibits discrimination on
the basis of age; (e) the Drug Abuse Office and
Treatment Act of 1972 (P.L. 92-255), as amended,
relating to nondiscrimination on the basis of drug
abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) §§523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290
ee- 3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title Vlll of the Civil
Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other
nondiscrimination provisions in the speck statute(s)
under which application for Federal assistance is being
made; and, Q) the requirements of any other
nondiscrimination statute(s) which may apply to the
application.
Will comply, or has already complied, with the
requirements of Titles II and III of the Uniform
Relocation Assistance and Real Property Acquisition
Policies Act of 1970 (P.L. 91-646) which provide for
fair and equitable treatment of persons displaced or
whose property is acquired as a result of Federal or
federally -assisted programs. These requirements
apply to all interests in real property acquired for
project purposes regardless of Federal participation in
purchases.
8. Will comply, as applicable, with provisions of the
Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328)
which limit the political activities of employees whose
principal employment activities are funded in whole
or in part with Federal funds.
Previous Edition Usable Standard Form 424E (Rev. 7-97)
Authorized for Local Reproduction Prescribed by OMB Circular A-102
DocuSign Envelope ID: DDFOCOCD-95EO-4FBB-8212-8A95AOFFB984
9. Will comply, as applicable, with the provisions of the Davis -
Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract
Work Hours and Safety Standards Act (40 U.S.C. §§327-
333), regarding labor standards for federally -assisted
construction subagreements.
10. Will comply, if applicable, with flood insurance purchase
requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973 (P.L. 93-234) which requires
recipients in a special flood hazard area to participate in the
program and to purchase flood insurance if the total cost of
insurable construction and acquisition is $10,000 or more.
11. Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91-190) and
Executive Order (EO) 11514; (b) notification of violating
facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in
floodplains in accordance with EO 11988; (e) assurance of
project consistency with the approved State management
program developed under the Coastal Zone Management
Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of
Federal actions to State (Clean Air) Implementation Plans
under Section 176(c) of the Clean Air Act of 1955. as
amended (42 U.S.C. §§7401 et seq.); (g) protection of
underground sources of drinking water under the Safe
Drinking Water Act of 1974, as amended (P.L. 93-523);
and, (h) protection of endangered species under the
Endangered Species Act of 1973, as amended (P.L. 93-
205).
12. Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. §§1271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
—DmuSigir" by:
V&4AuU f
APPLICANT ORGANIZATION
13. Will assist the awarding agency in assuring compliance
with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U.S.C. §470). EO 11593
(identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of
1974 (16 U.S.C. §§469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of
human subjects involved in research, development, and
related activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of
1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et
seq.) pertaining to the care, handling, and treatment of
warm blooded animals held for research, teaching, or
other activities supported by this award of assistance.
16. Will comply with the Lead -Based Paint Poisoning
Prevention Act (42 U.S.C. §§4801 et seq.) which
prohibits the use of lead -based paint in construction or
rehabilitation of residence structures.
17. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMB Circular No. A-133,
"Audits of States, Local Governments, and Non -Profit
Organizations."
18. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.
19. Will comply with the requirements of Section 106(g) of
the Trafficking Victims Protection Act (TVPA) of 2000, as
amended (22 U.S.C. 7104) which prohibits grant award
recipients or a sub -recipient from (1) Engaging in severe
forms of trafficking in persons during the period of time
that the award is in effect (2) Procuring a commercial
sex act during the period of time that the award is in
effect or (3) Using forced labor in the performance of the
award or subawards under the award.
TITLE
Mayor
DATE SUBMITTED
city of Lubbock I July 1,
Standard Form 4248 (Rev. 7-97) Back
DocuSign Envelope ID: DDFOCOCD-95EO-4FBM212-SA95AOFF8984
CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any
person for influencing or attempting to influence an officer or employee of an 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. the undersigned shall complete and submit Standard
Form-LLL, "Disclosure of Lobbying Activities " in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents
for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification
is a material representation of fact upon which reliance was placed when this transaction was made or
entered into. Submission of this certification is a prerequisite for making or entering into this transaction
imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be
subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief, that:
If any 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 commitment providing for the United States to insure or
guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying
Activities," in accordance with its instructions. Submission of this statement is a prerequisite for making or
entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the
required statement shall be subject to a civil penalty of not less than $10,000 and not more than $100,000
for each such failure_
• APPLICANTS ORGANIZATION
City of Lubbock
• PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE
Prefix: I * First Name: an Middle Name:
" Last Name: I Pope Suffix:
*Title: I Mayor
SIGNATURE, oocuftned by* " DATE: PU Y
DocuSign Envelope ID: DDFOCOCD-95EO-4FB6-8212-8A95AOFFB984
DATA USE AGREEMENT
BETWEEN THE
TEXAS HEALTH AND HUMAN SERVICES SYSTEM
AND
CONTRACTOR
This Data Use Agreement ("DUA") is effective as of the date of the Base Contract into which it is
incorporated ("Effective Date"), by and between the Texas Health and Human Services System, which
includes the Texas Health and Human Services Commission and the Department of State Health Services
("HHS") and Contractor (the "Base Contract").
ARTICLE 1. PURPOSE; APPLICABILITY; ORDER OF PRECEDENCE
The purpose of this DUA is to facilitate access to, creation, receipt, maintenance, use, disclosure or
transmission of Confidential Information with Contractor, and describe Contractor's rights and obligations
with respect to the Confidential Information and the limited purposes for which the Contractor may create,
receive, maintain, use, disclose or have access to Confidential Information. This DUA also describes
HHS's remedies in the event of Contractor's noncompliance with its obligations under this DUA. This
DUA applies to both HHS business associates, as "business associate" is defined in the Health Insurance
Portability and Accountability Act (HIPA& and contractors who are not business associates, who create,
receive, maintain, use, disclose or have access to Confidential Information on behalf of HHS, its programs
or clients as described in the Base Contract, As a best practice, HHS requires its contractors to comply with
the terms of this DUA to safeguard all types of Confidential Information.
As of the Effective Date of this DUA, if any provision of the Base Contract conflicts with this
DUA, this DUA controls.
ARTICLE 2. DEFINITIONS
For the purposes of this DUA, capitalized, underlined terms have the following meanings:
"Authorizer) Purvose" means the specific purpose or purposes described in the Base Contract for
Contractor to fulfill its obligations under the Base Contract, or any other purpose expressly authorized by
HHS in writing in advance.
"Authorized User" means a person;
(1) Who is authorized to create, receive, maintain, have access to, process, view, handle,
examine, interpret, or analyze Confidential Information pursuant to this DUA;
(2) For whom Contractor warrants and represents has a demonstrable need to create, receive,
maintain, use, disclose or have access to the Confidential Information; and
(3) Who has agreed in writing to be bound by the disclosure and use limitations pertaining to
the Confidential Information as required by this DUA.
"Breach" means an impermissible use or disclosure of electronic or non -electronic sensitive personal information by an
unauthorized person orforan unauthorized purpose that compromises the security or privacy ofConfidential Information
such that the use or disclosure poses a risk of reputation) harm, theft of financial information, identity theft, or medical
identity theft. Any acquisition, access, use, disclosure or loss of Confidential Information other than as permitted by this
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DUA shall be presumed to be a Breach unless Contractor demonstrates, based on a risk assessment, that there is a low
probability that the Confidential Information has been compromised.
"Confidential Information" means any communication or record (whether oral, written, electronically
stored or transmitted, or in any other form) provided to or made available to Contractor or that Contractor
may create, receive, maintain, use, disclose or have access to on behalf of HHS that consists of or
includes any or all of the following:
(1) Education records as defined in the Family Educational Rights and Privacy Act, 20 U.S.C.
§ 1232g; 34 C.F.R. Part 99
(2) Federal Tax Information as defined in Internal Revenue Code §6103 and Internal Revenue
Service Publication 1075;
(3) Personal Identifying Information (PII) as defined in Texas Business and Commerce Code,
Chapter 521;
(4) Protected Health Information (PILI) in any form including without limitation, Electronic
Protected Health Information or Unsecured Protected Health Information as defined in 45
C.F.R. § 160.103;
(5) Sensitive Personal Information (SPI) as defined in Texas Business and Commerce Code,
Chapter 521;
(6) Social Security Administration Data, including, without limitation, Medicaid information
means disclosures of information made by the Social Security Administration or the
Centers for Medicare and Medicaid Services from a federal system of records for
administration of federally funded benefit programs under the Social Security Act, 42
U.S.C., Chapter 7;
(7) All privileged work product;
(8) All information designated as confidential under the constitution and laws of the State of
Texas and of the United States, including the Texas Health & Safety Code and the Texas
Public Information Act, Texas Government Code, Chapter 552.
"Destray", "Destruction", for Confidential Information, means:
(1) Paper, film, or other hard copy media have been shredded or destroyed such that the
Confidential Information cannot be read or otherwise cannot be reconstructed. Redaction is specifically
excluded as a means of data destruction.
(2) Electronic media have been cleared, purged, or destroyed consistent with NIST Special
Publication 800-88, "Guidelines for Media Sanitization," such that the Confidential Information cannot be
retrieved.
"Discover, -Discovery" means the first day on which a Breach becomes known to Contractor, or, by
exercising reasonable diligence would have been known to Contractor.
"Leizally Authorized Representative" of an individual, including as provided in 45 CFR 435.923
(authorized representative); 45 CFR 164.502(g)(1) (personal representative); Tex. Occ. Code § 151.002(6);
Tex. H. & S. Code § 166.164 (medical power of attorney); and Texas Estates Code § 22.031 (representative).
"Required by Law" means a mandate contained in law that compels an entity to use or disclose
Confidential Information that is enforceable in a court of law, including court orders, warrants, subpoenas
or investigative demands.
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"Subcontractor" means a person who contracts with a prime contractor to work, to supply commodities,
or to contribute toward completing work for a governmental entity.
"Workforce" means employees, volunteers, trainees or other persons whose performance of work is under
the direct control of a party, whether or not they are paid by that party.
ARTICLE 3. CONTRACTOR'S DUTIES REGARDING CONFIDENTIAL INFORMATION
Section 3.01 Obligations of Contractor
Contractor agrees that:
(A) With respect to PHI, Contractor shall:
(1) Make PHI available in a designated record set if requested by HHS, if Contractor maintains
PHI in a designated record set, as defined in HIPAA.
(2) Provide to HHS data aggregation services related to the healthcare operations Contractor
performs for HHS pursuant to the Base Contract, if requested by HHS, if Contractor provides data
aggregation services as defined in HIPAA.
(3) Provide access to PHI to an individual who is requesting his or her own PHI, or such
individual's Lep-ally Authorized Representative, in compliance with the requirements of HIPAA.
(4) Make PHI available to HHS for amendment, and incorporate any amendments to PHI that
HHS directs, in compliance with HIPAA.
(5) Document and make available to HHS, an accounting of disclosures in compliance with
the requirements of HIPAA.
(6) If Contractor receives a request for access, amendment or accounting of PHI by any
individual, promptly forward the request to HHS or, if forwarding the request would violate HIPAA,
promptly notify HHS of the request and of Contractor's response. HHS will respond to all such requests,
unless Contractor is Required by Law to respond or HHS has given prior written consent for Contractor to
respond to and account for all such requests.
(B) With respect to ALL Confidential Information, Contractor shall:
(1) Exercise reasonable care and no less than the same degree of care Contractor uses to protect
its own confidential, proprietary and trade secret information to prevent Confidential Information from
being used in a manner that is not expressly an Authorized Purpose or as Required by Law. Contractor will
access, create, maintain, receive, use, disclose, transmit or Destroy Confidential Information in a secure
fashion that protects against any reasonably anticipated threats or hazards to the security or integrity of such
information or unauthorized uses.
(2) Establish, implement and maintain appropriate procedural, administrative, physical and
technical safeguards to preserve and maintain the confidentiality, integrity, and availability of the
Confidential Information, in accordance with applicable laws or regulations relating to Confidential
Information, to prevent any unauthorized use or disclosure of Confidential Information as long as
Contractor has such Confidential Information in its actual or constructive possession.
(3) Implement, update as necessary, and document privacy, security and Breach notice policies
and procedures and an incident response plan to address a Breach, to comply with the privacy, security and
breach notice requirements of this DUA prior to conducting work under the Base Contract. Contractor
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shall produce, within three business days of a request by HHS, copies of its policies and procedures and
records relating to the use or disclosure of Confidential Information.
(4) Obtain HHS's prior written consent to disclose or allow access to any portion of the
Confidential Information to any person, other than Authorized Users, Workforce or Subcontractors of
Contractor who have completed training in confidentiality, privacy, security and the importance of promptly
reporting any Breach to Contractor's management and as permitted in Section 3.01(A)(3), above. Contractor
shall produce evidence of completed training to HHS upon request. HHS, at its election, may assist
Contractor in training and education on specific or unique HHS processes, systems and/or requirements.
All of Contractor's Authorized Users, Workforce and Subcontractors with access to a state computer system
or database will complete a cybersecurity training program certified under Texas Government Code Section
2054.519 by the Texas Department of Information Resources.
(5) Establish, implement and maintain appropriate sanctions against any member of its
Workforce or Subcontractor who fails to comply with this DUA, the Base Contract or applicable law.
Contractor shall maintain evidence of sanctions and produce it to HHS upon request.
(6) Obtain prior written approval of HHS, to disclose or provide access to any Confidential
Information on the basis that such act is Required by Law, so that HHS may have the opportunity to object
to the disclosure or access and seek appropriate relief. If HHS objects to such disclosure or access,
Contractor shall refrain from disclosing or providing access to the Confidential Information until HHS has
exhausted all alternatives for relief.
(7) Certify that its Authorized Users each have a demonstrated need to know and have access
to Confidential Information solely to the minimum extent necessary to accomplish the Authorized Purpose
and that each has agreed in writing to be bound by the disclosure and use limitations pertaining to the
Confidential Information contained in this DUA. Contractor and its Subcontractors shall maintain at all
times an updated, complete, accurate list of Authorized Users and supply it to HHS upon request.
(8) Provide, and shall cause its Subcontractors and agents to provide, to HHS periodic written
confirmation of compliance with controls and the terms and conditions of this DUA.
(9) Return to HHS or Destroy, at HHS's election and at Contractor's expense, all Confidential
Information received from HHS or created or maintained by Contractor or any of Contractor's agents or
Subcontractors on HHS's behalf upon the termination or expiration of this DUA, if reasonably feasible and
permitted by law. Contractor shall certify in writing to HHS that all such Confidential Information has
been Destroyed or returned to HHS, and that Contractor and its agents and Subcontractors have retained no
copies thereof. Notwithstanding the foregoing, Contractor acknowledges and agrees that it may not DestCDY
any Confidential Information if federal or state law, or HHS record retention policy or a litigation hold
notice prohibits such Destruction. If such return or Destruction is not reasonably feasible, or is
impermissible by law, Contractor shall immediately notify HHS of the reasons such return or Destruction
is not feasible and agree to extend the protections of this DUA to the Confidential Information for as long
as Contractor maintains such Confidential Information.
(10) Complete and return with the Base Contract to HHS, attached as Attachment 2 to this DUA,
the HHS Security and Privacy Initial Inquiry (SPI) at httVs:flhhs,texas.govllaws-
regl,lations/forms/rrriscellaneous/hhs-information-security privacy-initial-ingairv-spi. The SPI identifies
basic privacy and security controls with which Contractor must comply to protect Confidential Information.
Contractor shall comply with periodic security controls compliance assessment and monitoring by HHS as
required by state and federal law, based on the type of Confidential Information Contractor creates, receives,
maintains, uses, discloses or has access to and the Authorized Purpose and level of risk. Contractor's
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security controls shall be based on the National Institute of Standards and Technology (N1ST) Special
Publication 800-53. Contractor shall update its security controls assessment whenever there are significant
changes in security controls for HHS Confidential Information and shall provide the updated document to
HHS. HHS also reserves the right to request updates as needed to satisfy state and federal monitoring
requirements.
(11) Comply with the HHS Acceptable Use Policy (AUP) and require each Subcontractor and
Workforce member who has direct access to HHS Information Resources, as defined in the AUP, to execute
an HHS Acceptable Use Agreement.
(12) Only conduct secure transmissions of Confidential Information whether in paper, oral or
electronic form. A secure transmission of electronic Confidential Information in motion includes secure
File Transfer Protocol (SFTP) or encryption at an appropriate level as required by rule, regulation or law.
Confidential Information at rest requires encryption unless there is adequate administrative, technical, and
physical security as required by rule, regulation or law. All electronic data transfer and communications of
Confidential Information shall be through secure systems. Contractor shall provide proof of system, media
or device security and/or encryption to HHS no later than 48 hours after HHS's written request in response
to a compliance investigation, audit, or the Discovery of a Breach. HHS may also request production of
proof of security at other times as necessary to satisfy state and federal monitoring requirements.
Deidentification of Confidential Information in accordance with HIPAA de -identification standards is
deemed secure.
(13) Designate and identify a person or persons, as Privacy Official and Information Security
Official, each of whom is authorized to act on behalf of Contractor and is responsible for the development
and implementation of the privacy and security requirements in this DUA. Contractor shall provide name
and current address, phone number and a -mail address for such designated officials to HHS upon execution
of this DUA and prior to any change. Upon written notice from HHS, Contractor shall promptly remove
and replace such official(s) if such official(s) is not performing the required functions.
(14) Make available to HHS any information HHS requires to fulfill HHS's obligations to
provide access to, or copies of, Confidential Information in accordance with applicable laws, regulations or
demands of a regulatory authority relating to Confidential Information. Contractor shall provide such
information in a time and manner reasonably agreed upon or as designated by the applicable law or
regulatory authority.
(15) Comply with the following laws and standards if applicable to the type of Con rdential
Information and Contractor's Authorized Purpose:
• Title 1, Part 10, Chapter 202, Subchapter B, Texas Administrative Code;
• The Privacy Act of 1974;
• OMB Memorandum 17-12;
• The Federal Information Security Management Act of 2002 (FISMA);
• The Health Insurance Portability and Accountability Act of 1996 (HIPAA);
• Internal Revenue Publication 1075 — Tax Information Security Guidelines for Federal, State
and Local Agencies;
• National Institute of Standards and Technology (MIST) Special Publication 800-66 Revision 1
— An Introductory Resource Guide for Implementing the Health Insurance Portability and
Accountability Act (HIPAA) Security Rule;
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• NIST Special Publications 800-53 and 800-53A — Recommended Security Controls for Federal
Information Systems and Organizations, as currently revised;
• NIST Special Publication 800-47 — Security Guide for Interconnecting Information
Technology Systems;
• NIST Special Publication 800-88, Guidelines for Media Sanitization,
• NIST Special Publication 800-111, Guide to Storage of Encryption Technologies for End User
Devices containing PHI;
• Family Educational Rights and Privacy Act
• Texas Business and Commerce Code, Chapter 521;
• Any other State or Federal law, regulation, or administrative rule relating to the specific HHS
program area that Contractor supports on behalf of HHS.
(16) Be permitted to use or disclose Confidential Information for the proper management and
administration of Contractor or to carry out Contractor's legal responsibilities, except as otherwise
limited by this DUA, the Base Contract, or law applicable to the Confidential Information, if:
(a) Disclosure is Required by Law;
(b) Contractor obtains reasonable assurances from the person to whom the information is
disclosed that the person shall:
1. Maintain the confidentiality of the Confidential Information in accordance with
this DUA;
2. Use or further disclose the information only as Required by Law or for the
Authorized Purpose for which it was disclosed to the person; and
3. Notify Contractor in accordance with Section 4.01 of a Breach of Confidential
Information that the person Discovers or should have Discovered with the exercise of
reasonable diligence.
(C) With respect to ALL Confidential Information. Contractor shall NOT:
(1) Attempt to re -identify or further identify Confidential Information that has been
deidentified, or attempt to contact any persons whose records are contained in the Confidential Information,
except for an Authorized Purposewithout express written authorization from HHS.
(2) Engage in prohibited marketing or sale of Confidential Information.
(3) Permit, or enter into any agreement with a Subcontractor to, create, receive, maintain, use,
disclose, have access to or transmit Confidential Information, on behalf of HHS without requiring that
Subcontractor first execute either the Form Subcontractor Agreement, Attachment 1, or Contractor's own
Subcontractor agreement that ensures that the Subcontractor shall comply with the same safeguards and
restrictions contained in this DUA for Confidential Information. Contractor is directly responsible for its
Subcontractors' compliance with, and enforcement of, this DUA.
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ARTICLE 4. BREACH NOTICE, REPORTING AND CORRECTION REQUIREMENTS
Section 4.01. Cooperation and Financial Responsibility.
(A) Contractor shall, at Contractor's expense, cooperate fully with HHS in investigating,
mitigating to the extent practicable, and issuing notifications as directed by HHS, for any Breach of
Confidential Information.
(B) Contractor shall make Confidential Information in Contractor's possession available
pursuant to the requirements of HIPAA or other applicable law upon a determination of a Breach.
(C) Contractor's obligation begins at the Discovery of a Breach and continues as long as related
activity continues, until all effects of the Breach are mitigated to HHS's satisfaction (the "incident response
period").
Section 4,02. Initial Breach Notice.
For federal information obtained from a federal system of records, including Federal Tax Information and
Social Security Administration Data (which includes Medicaid and other governmental benefit program
Confidential Information), Contractor shall notify HHS of the Breach within the first consecutive clock
hour of Discovery. The Base Contract shall specify whether Confidential Information is obtained from a
federal system of records. For all other types of Confidential Information Contractor shall notify HHS of
the Breach not more than 24 hours after Discovery, or in a timeframe otherwise approved by HHS in
writing. Contractor shall initially report to HHS's Privacy and Security Officers via email at:
privacy0,HHSC.state.tx.us and to the HHS division responsible for the Base Contract.
Contractor shall report all information reasonably available to Contractor about the Breach.
Contractor shall provide contact information to HHS for Contractor's single point of contact who will
communicate with HHS both on and off business hours during the incident response period.
Section 4.03 Third Business Day Notice: No later than 5 p.m. on the third business day after Discovery,
or a time within which Discovery reasonably should have been made by Contractor of a Breach of
Confidential Information, Contractor shall provide written notification to HHS of all reasonably available
information about the Breach, and Contractor's investigation, including, to the extent known to Contractor:
a. The date the Breach occurred;
b. The date of Contractor's and, if applicable, Subcontractor's Discovery;
c. A brief description of the Breach, including how it occurred and who is responsible (or
hypotheses, if not yet determined);
d. A brief description of Contractor's investigation and the status of the investigation;
e. A description of the types and amount of Confidential Information involved;
f. Identification of and number of all individuals reasonably believed to be affected, including
first and last name of the individual and if applicable, the Legally authorized representative, last
known address, age, telephone number, and email address if it is a preferred contact method;
g. Contractor's initial risk assessment of the Breach demonstrating whether individual or other
notices are required by applicable law or this DUA for HHS approval, including an analysis of
whether there is a low probability of compromise of the Confidential Information or whether any
legal exceptions to notification apply;
h. Contractor's recommendation for HHS's approval as to the steps individuals and/or Contractor
on behalf of individuals, should take to protect the individuals from potential harm, including
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Contractor's provision of notifications, credit protection, claims monitoring, and any specific
protections for a Legally Authorized Representative to take on behalf of an individual with
special capacity or circumstances;
i. The steps Contractor has taken to mitigate the harm or potential harm caused (including without
limitation the provision of sufficient resources to mitigate);
j. The steps Contractor has taken, or will take, to prevent or reduce the likelihood of recurrence
of a similar Breach;
k. Identify, describe or estimate of the persons, Workforce, Subcontractor, or individuals and any
law enforcement that may be involved in the Breach;
1. A reasonable schedule for Contractor to provide regular updates regarding response to the
Breach, but no less than every three (3) business days, or as otherwise directed by HHS in
writing, including information about risk estimations, reporting, notification, if any, mitigation,
corrective action, root cause analysis and when such activities are expected to be completed;
and
m. Any reasonably available, pertinent information, documents or reports related to a Breach that
HHS requests following Discovery.
Section 4.04, Investigation, Response and Mitigation.
(A) Contractor shall immediately conduct a full and complete investigation, respond to the
Breach, commit necessary and appropriate staff and resources to expeditiously respond, and report
as required to HHS for incident response purposes and for purposes of HHS's compliance with
report and notification requirements, to the satisfaction of HHS.
(B) Contractor shall complete or participate in a risk assessment as directed by HHS following
a Breach, and provide the final assessment, corrective actions and mitigations to HHS for review
and approval.
(C) Contractor shall fully cooperate with HHS to respond to inquiries and/or proceedings by
state and federal authorities, persons and/or individuals about the Breach.
(D) Contractor shall fully cooperate with HHS's efforts to seek appropriate injunctive relief or
otherwise prevent or curtail such Breachor to recover or protect any Confidential Information,
including complying with reasonable corrective action or measures, as specified by HHS in a
Corrective Action Plan if directed by HHS under the Base Contract.
Section 4.05. Breach Notification to Individuals and Reporting to Authorities.
(A) HHS may direct Contractor to provide Breach notification to individuals, regulators or
third -parties, as specified by HHS following a Breach.
(B) Contractor must comply with all applicable legal and regulatory requirements in the time,
manner and content of any notification to individuals, regulators or third -parties, or any notice
required by other state or federal authorities, including without limitation, notifications required by
Texas Business and Commerce Code, Chapter 521.053(b) and HIPAA. Notice letters will be in
Contractor's name and on Contractor's letterhead, unless otherwise directed by HHS, and will
contain contact information, including the name and title of Contractor's representative, an email
address and a toll -free telephone number, for the individual to obtain additional information.
(C) Contractor shall provide HHS with draft notifications for HHS approval prior to
distribution and copies of distributed and approved communications.
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(D) Contractor shall have the burden of demonstrating to the satisfaction of HHS that any
required notification was timely made. If there are delays outside of Contractor's control,
Contractor shall provide written documentation to HHS of the reasons for the delay.
(E) If HHS directs Contractor to provide notifications, HHS shall, in the time and manner
reasonably requested by Contractor, cooperate and assist with Contractor's information requests in
order to make such notifications.
ARTICLE 5. GENERAL PROVISIONS
Section 5.01 Ownership of Confidential Information
Contractor acknowledges and agrees that the Confidential Information is and shall remain the property of
HHS. Contractor agrees it acquires no title or rights to the Confidential Information.
Section 5.02 HHS Commitment and Obligations
HHS will not request Contractor to create, maintain, transmit, use or disclose PHI in any manner that would
not be permissible under applicable law if done by HHS.
Section 5.03 HHS Riaht to Inspection
At any time upon reasonable notice to Contractor, or if HHS determines that Contractor has violated this
DUA, HHS, directly or through its agent, will have the right to inspect the facilities, systems, books and
records of Contractor to monitor compliance with this DUA. For purposes of this subsection, HHS's
agent(s) include, without limitation, the HHS Office of the Inspector General, the Office of the Attorney
General of Texas, the State Auditor's Office, outside consultants, legal counsel or other designee.
Section 5.04 Term; Termination of DUA; Survival
This DUA will be effective on the date on which Contractor executes the Base Contract and will terminate
upon termination of the Base Contract and as set forth herein. If the Base Contract is extended, this DUA
is extended to run concurrent with the Base Contract.
(A) If HHS determines that Contractor has violated a material term of this DUA; HHS may in its
sole discretion:
(1) Exercise any of its rights including but not limited to reports, access and inspection under
this DUA and/or the Base Contract; or
(2) Require Contractor to submit to a corrective action plan, including a plan for monitoring
and plan for reporting as HHS may determine necessary to maintain compliance with this DUA; or
(3) Provide Contractor with a reasonable period to cure the violation as determined by HHS;
or
(4) Terminate the DUA and Base Contract immediately and seek relief in a court of competent
jurisdiction in Travis County, Texas.
Before exercising any of these options, HHS will provide written notice to Contractor describing the
violation and the action it intends to take.
(B) If neither termination nor cure is feasible, HHS shall report the violation to the applicable regulatory
authorities.
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(C) The duties of Contractor or its Subcontractor under this DUA survive the expiration or termination
of this DUA until all the Confidential Information is Destroyed or returned to HHS, as required by this
DUA.
Section 5.05 Injunctive Relief
(A) Contractor acknowledges and agrees that HHS may suffer irreparable injury if Contractor
or its Subcontractor fails to comply with any of the terms of this DUA with respect to the Confidential
Information or a provision of HIPAA or other laws or regulations applicable to Confidential Information.
(B) Contractor further agrees that monetary damages may be inadequate to compensate HHS
for Contractor's or its Subcontractor's failure to comply. Accordingly, Contractor agrees that HHS will, in
addition to any other remedies available to it at law or in equity, be entitled to seek injunctive relief without
posting a bond and without the necessity of demonstrating actual damages, to enforce the terms of this
DUA.
Section 5.06 Indemnification
Contractor shall indemnify, defend and hold harmless HHS and its respective Executive Commissioner,
employees, Subcontractors agents (including other state agencies acting on behalf of HHS) or other
members of HHS' Workforce (each of the foregoing hereinafter referred to as "Indemnified Party") against
all actual and direct losses suffered by the Indemnified Party and all liability to third parties arising from or
in connection with any breach of this DUA or from any acts or omissions related to this DUA by Contractor
or its employees, directors, officers, Subcontractors, or agents or other members of Contractor's Workforce.
The duty to indemnify, defend and hold harmless is independent of the duty to insure. Upon demand,
Contractor shall reimburse HHS for any and all losses, liabilities, lost profits, fines, penalties, costs or
expenses (including costs of required notices, investigation, and mitigation of a Breach, fines or penalties
imposed on an Indemnified Party by a regulatory authority, and reasonable attorneys' fees) which may be
imposed upon any Indemnified Party to the extent caused by and which results from the Contractor's failure
to meet any of its obligations under this DUA. Contractor's obligation to defend, indemnify and hold
harmless any Indemnified Party will survive the expiration or termination of this DUA.
Section 5.07 Insurance
(A) In addition to any insurance required in the Base Contract, at HHS's option, HHS may
require Contractor to maintain, at its expense, the special and/or custom first- and third -party insurance
coverages, including without limitation data breach, cyber liability, crime theft and notification expense
coverages, with policy limits sufficient to cover any liability arising under this DUA, naming the State
of Texas, acting through HHS, as an additional named insured and loss payee, with primary and
noncontributory status.
(B) Contractor shall provide HHS with written proof that required insurance coverage is in
effect, at the request of HHS.
Section 5.08 Entirety of the Contract
This DUA is incorporated by reference into the Base Contract and, together with the Base Contract,
constitutes the entire agreement between the parties. No change, waiver, or discharge of obligations arising
under those documents will be valid unless in writing and executed by the party against whom such change,
waiver, or discharge is sought to be enforced.
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Section 5.09 Automatic Amendment and Interpretation
Upon the effective date of any amendment or issuance of additional regulations to any law applicable to
Confidential Information, this DUA will automatically be amended so that the obligations imposed on HHS
and/or Contractor remain in compliance with such requirements. Any ambiguity in this DUA will be
resolved in favor of a meaning that permits HHS and Contractor to comply with laws applicable to
Confidential Information.
Section 5.10 Notices; Requests for Approval
All notices and requests for approval related to this DUA must be directed to the HHS Chief Privacy Officer
at griva2ahhsc.state.tx.us.
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ATTACHMENT 1. SUBCONTRACTOR AGREEMENT FORM
HHS CONTRACT NUMBER
The DUA between HHS and Contractor establishes the permitted and required uses and
disclosures of Confidential Information by Contractor.
Contractor has subcontracted with (Subcontractor)
for performance of duties on behalf of CONTRACTOR which are subject to the DUA.
Subcontractor acknowledges, understands and agrees to be bound by the same terms and
conditions applicable to Contractor under the DUA, incorporated by reference in this
Agreement, with respect to HHS Confidential Information. Contractor and Subcontractor agree
that HHS is a third -party beneficiary to applicable provisions of the subcontract.
HHS has the right, but not the obligation, to review or approve the terms and conditions of the
subcontract by virtue of this Subcontractor Agreement Form.
Contractor and Subcontractor assure HHS that any Breach as defined by the DUA that
Subcontractor Discovers shall be reported to HHS by Contractor in the time, manner and content
required by the DUA.
If Contractor knows or should have known in the exercise of reasonable diligence of a pattern
of activity or practice by Subcontractor that constitutes a material breach or violation of the
DUA or the Subcontractor's obligations, Contractor shall:
l . Take reasonable steps to cure the violation or end the violation, as applicable;
2. If the steps are unsuccessful, terminate the contract or arrangement with Subcontractor,
if feasible;
3. Notify HHS immediately upon Discovery of the pattern of activity or practice of
Subcontractor that constitutes a material breach or violation of the DUA and keep HHS
reasonably and regularly informed about steps Contractor is taking to cure or end the
violation or terminate Subcontractor's contract or arrangement.
This Subcontractor Agreement Form is executed by the parties in their capacities
indicated below.
CONTRACTOR
BY:
NAME:
TITLE:
DATE , 201 .
SUBCONTRACTOR
BY:
NAME•
TITLE•
DATE:
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Attachment 2-
Security and Privacy Initial Inquiry
[Attach Completed SPI Here]
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ATTACHMENT H
NON-EXCLUSIVE LIST OF APPLICABLE LAWS
Contractor is responsible for reviewing and complying with any applicable statutes, rules,
regulations, executive orders and policies. To the extent applicable to Grantee, Grantee shall comply
with the following:
a. Statutes, rules, regulations, and HHSC policy (and any of their subsequent amendments) that
collectively prohibit discrimination, exclusion from or limitation of participation in programs,
benefits or activities or denial of any aid, care, service or other benefit on the basis of race, color,
national origin, limited English proficiency, sex, sexual orientation (where applicable),
disabilities, age, substance abuse, political belief or religion:
1. Title VI of the Civil Rights Act of 1964, 42 USC §§ 2000d et seq.;
2. Title IX of the Education Amendments of 1972, 20 USC §§ 1681-1693, and 1685-
1686;
3. Section 504 of the Rehabilitation Act of 1973, 29 USC § 794(a);
4. Americans with Disabilities Act of 1990, 42 USC §§ 12101 et seq.;
5. Age Discrimination Act of 1975, 42 USC §§ 6101-6107;
6. Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and
Rehabilitation Act of 1970, 42 USC § 290dd (b)(1); 7) 45 CFR Parts 80, 84, 86 and 91;
7. U.S. Department of Labor, Equal Employment Opportunity E.O. 11246;
8. Tex. Labor Code Chapter 21;
9. Food Stamp Act of 1977 (7 USC §§ 2011 et seq.);
10. Executive Order 13279, 45 CFR Part 87 or 7 CFR Part 16 regarding equal treatment
and opportunity for religious organizations;
11. Drug Abuse Office and Treatment Act of 1972, 21 USC §§ 1101 et seq., relating to
drug abuse;
12. Public Health Service Act of 1912, §§ 523 and 527, 42 USC § 290dd-2, and 42 CFR
pt. 2, relating to confidentiality of alcohol and drug abuse patient records;
13. Title VIII of the Civil Rights Act of 1968, 42 USC §§ 3601 et seq., relating to
nondiscrimination in housing; and
14. Non-discrimination Policy for HHSC Programs;
b. Immigration Reform and Control Act of 1986, 8 USC § 1324a, and Immigration Act of 1990, 8
USC 1101 et seq., as amended by Public Lawl 13-4 (March 7, 2013), regarding employment
verification; and Illegal Immigration Reform and Immigrant Responsibility Act of 1996;
c. Pro -Children Act of 1994, 20 USC §§ 6081-6084, and the Pro -Children Act of 2001, 20 USC §
7183, regarding the non-use of all tobacco products;
d. National Research Service Award Act of 1971, 42 USC §§ 289a-1 et seq., and 6601 (P.L. 93-
348 and P.L. 103-43), regarding human subjects involved in research;
e. Hatch Political Activity Act, 5 USC §§ 1501-1508 and 7324-26, which limits the political
activity of employees whose employment is funded with federal funds;
f. Fair Labor Standards Act, 29 USC §§ 201 et seq., and the Intergovernmental Personnel Act of
1970, 42 USC §§ 4701 et seq., as applicable, concerning minimum wage and maximum hours;
g. Texas Government Code Chapter 469 pertaining to eliminating architectural barriers for
persons with disabilities;
h. Texas Workers' Compensation Act, Texas Labor Code Chapters 401-406, and 28 Texas
Administrative Code (TAC) pt. 2, regarding compensation for employees' injuries;
i. The Clinical Laboratory Improvement Amendments of 1988,42 USC § 263a, regarding the
regulation and certification of clinical laboratories;
j. The Occupational Safety and Health Administration Regulations on Blood Borne Pathogens, 29
CFR § 1910.1030, or Title 25 Tex. Admin Code Chapter 96 regarding safety standards for
handling blood borne pathogens;
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k. Laboratory Animal Welfare Act of 1966, 7 USC §§ 2131 et seq., pertaining to the treatment of
laboratory animals;
1. Environmental standards pursuant to the following:
1. Institution of environmental quality control measures under the National
Environmental Policy Act of 1969, 42 USC §§ 4321-4347 and Executive Order 11514
(35 Fed. Reg. 4247), "Protection and Enhancement of Environmental Quality;"
2. Notification of violating facilities pursuant to Executive Order 11738 (40 CFR Part
32), "Providing for Administration of the Clean Air Act and the Federal Water Pollution
Control Act with respect to Federal Contracts, Grants, or Loans;"
3. Protection of wetlands pursuant to Executive Order 11990, 42 Fed. Reg. 26961;
4. Evaluation of flood hazards in floodplains in accordance with Executive Order 11988,
42 Fed. Reg. 26951 and, if applicable, flood insurance purchase requirements of Section
102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234);
5. Assurance of project consistency with the approved State Management program
developed under the Coastal Zone Management Act of 1972, 16 USC §§ 1451 et seq.;
6. Federal Water Pollution Control Act, 33 USC §§ 1251 et seq.;
7. Protection of underground sources of drinking water under the Safe Drinking Water
Act of 1974, 42 USC §§ 300f-300j;
8. Protection of endangered species under the Endangered Species Act of 1973, 16 USC
§§ 1531 et seq.;
9. Conformity of federal actions to state clean air implementation plans under the Clean
Air Act of 1955, 42 USC §§ 7401 et seq.;
10. Wild and Scenic Rivers Act of 1968, 16 USC §§ 1271 et seq., related to protecting
certain river systems; and
in. Lead -Based Paint Poisoning Prevention Act, 42 USC §§ 4821 et seq., prohibiting the use of
lead -based paint in residential construction or rehabilitation;
n. Intergovernmental Personnel Act of 1970,42 USC §§ 4278-4763, regarding personnel merit
systems for programs specified in Appendix A of the federal Office of Program Management's
Standards for a Merit System of Personnel Administration, 5 CFR Part1200 et seq;
o. Titles Il and III of the Uniform Relocation Assistance and Real Property Acquisition Policies
Act of, 42 USC §§4601 et seq (PL 91-646), relating to fair treatment of persons displaced or
whose property is acquired as a result of Federal or federally -assisted programs;
p. Davis -Bacon Act, 40 USC §§ 3141-3148;
q. Copeland Act, 40 USC §§ 276c and 18 USC § 874;
r. Contract Work Hours and Safety Standards Act, 40 USC § 3702 et seq., regarding labor
standards for federally -assisted construction subagreements;
s. National Historic Preservation Act of 1966, § 106, 16 USC § 470; Executive Order 11593; and
the Archaeological and Historic Preservation Act of 1974 (16 USC §§ 469a-1 et seq.) regarding
historic property to the extent necessary to assist HHSC in complying with the Acts;
t. Trafficking Victims Protection Act of 2000, Section 106(g) (22 USC § 7104);
u. Executive Order 13513 (Oct. 1, 2009), Federal Leadership on Reducing Text Messaging While
Driving, October 1, 2009, if required by a federal funding source of this Contract;
v. Whistleblower Protection Enhancement Act (5 U.S.C. 2302(b)(8)) and Texas Whistleblower
Act (Tex. Gov. Code Chapter 554); and
w. Requirements of any other applicable state and federal statutes, executive orders, regulations,
rules and policies.
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FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT (FFATA)
CERTIFICATION
The certifications enumerated below represent material facts upon which HHSC relies when reporting
information to the federal government required under federal law. If HHSC later determines that the
Contractor knowingly rendered an erroneous certification, HHSC may pursue all available remedies in
accordance with Texas and U.S. laws. Signor further agrees that it will provide immediate written notice
to HHSC if at any time Signor learns that any of the certifications provided for below were erroneous
when submitted or have since become erroneous by reason of changed circumstances. if the Signor
cannot certify all of the statements contained in this section, Signor must provide written notice to
Legal Name of Contractor:
FFATA Contact # 1 Name, Email and: Phone Number:
City of Lubbock
Linda Cuellar
LCuellar@mylubbock.us
806-775-3253
Primary Address of Contractor:
FFATA Contact #2 Name, Email and Phone Number:
1314 Avenue K
ZIP Code: 9-digits Required www.u5ps.corn
Primary DUNS Number: 9-digits Required
htt o:llwvvw .d n b , com! usl
794 1- 830 -
058 13 93
State of Texas Comptroller Vendor Identification Number (VIN)14 Digits
000 756 00 906
Printed Name of Authorized Representative
Daniel Pope
Title of Authorized Representative
Mayor
Signature of Authorized Representative
—Doeuftnod by:
vaha Pep
Date
July 7, 2020
- 1 -
DocuSign Envelope ID: DDFOCOCD-95EO-4FBB-8212-BA95AOFFB984
FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT (FFATA)
CERTIFICATION
As the duly authorized representative (Signor) of the Contractor, I hereby certifythat
the statements made by me in this certification form are true, complete and correct to
the best of my knowledge.
Did your organization have a gross income, from all sources, of less than $300,000 in
your previous tax year? ❑ Yes Q No
If your answer is "Yes," skip questions "A," "B," and "C" and finish the certification.
If your answer is "No," answer questions "A" and "B."
A. Certification Restardina Percent % of Annual Gross from Federal Awards.
Did your organization receive 80% or more of its annual gross revenue from federal
awards during the preceding fiscal year? ❑ Yes x❑ No
B. Certification Relardiniz Amount of Annual Gross from Federal Awards.
Did your organization receive $25 million or more in annual gross revenues from federal
awards in the preceding fiscal year? x❑ Yes ❑ No
If your answer is "Yes" to both question "A" and "B," you must answer question "C."
If your answer is "No" to either question "A" or "B," skip question "C" and finish the
certification.
C. Certification Reeardine Public Access to Compensation Information.
Does the public have amess to information about the highly compensated offimjVsenior
executives in your business or organization (including parent organization, all branches,
and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d)
of the Securities Exchange Act of 1934 (15 US.C. 78m(a), 78o(d)) or section 6104 of the
Intemal Revenue Gode of1986? ❑ Yes ❑ No
If your answer is "Yes" to this question, where can this information be accessed?
If your answer is "No" to this question, you must provide the names and total
compensation of the top five highly compensated officers below.
Provide compensation information here:
-2-
Certificate Of Completion
Envelope Id: DDFOCOCD95EO4FBB82128A95AOFFB984
Subject: New $730,800.00; HHS000780500002; City of Lubbock; MSS-IDD-BHS-SA
Source Envelope:
Document Pages: 97 Signatures: 6
Certificate Pages: 2 Initials: 0
AutoNav: Enabled
Envelopeld Stamping: Enabled
Time Zone: (UTC-06:00) Central Time (US S Canada)
Record Tracking
Status: Original
6/30/2020 3:31:15 PM
Signer Events
Daniel Pope
dpope@mylubbock.us
Mayor
City of Lubbock
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Tdna Ita
Tdna.lta01@hhsc.state.tx.us
Associate Commissioner
Texas Health and Human Services Commission
Security Level: Email. Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Person Signer Events
Editor Delivery Events
Agent Delivery Events
Intermediary Delivery Events
Certified Delivery Events
Carbon Copy Events
Annalee Arredondo
annalee.arredondo@hhsc.state.tx.us
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Docu
9socuRaD
Status: Completed
Envelope Originator:
Texas Health and Human Services Commission
1100 W. 49th St.
Austin, TX 78756
PCS—DocuSign@hhsc.state.b(.us
IP Address: 167.137.1.17
Holder: Texas Health and Human Services
Location: DocuSign
Commission
PCS—DocuSign@hhsc.state.tx.us
Signature
Timestamp
by:
Sent: 6/30/2020 4:04:07 PM
V°OGUSWM°
ia r6ft,
Viewed: 7/1/2020 9:50:09 AM
9F03?B03 V0F
Signed: 701202011:47:16 AM
Signature Adoption: Pre -selected Style
Using IP Address: 208.84.91.41
u81pnitlW.
Sent: 7171202011:47:21 AM
.*.Viewed:
FgnXiWOM414.
7/7/2020 12:35:13 PM
Signed: 7/7/2020 12:35:18 PM
Signature Adoption: Pre -selected Style
Using IP Address: 68.203.4.14
Signature
Status
Status
Status
Status
Status
COPIED
Timestamp
Timestamp
Timestamp
Timestamp
Timestamp
Timestamp
Sent: 6/30/2020 4:04.07 PM
Carbon Copy Events Status Timestamp
SUD Box COPIED Sent: 6/30/2020 4:04:07 PM
SubstanceAbuse.Contracts@hhsc.state.tx.us
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Denise Collins COP
E D Sent: 6/30/2020 4:04:06 PM
denise.collins0l@hhsc.state.tx.us
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Witness Events
Signature
Timestamp
Notary Events
Signature
Timestamp
Envelope Summary Events
Status
Timestamps
Envelope Sent
Hashed/Encrypted
7/7/202011:47:21 AM
Certified Delivered
Security Checked
7/7/202012:35:13 PM
Signing Complete
Security Checked
7/7/2020 12:35:18 PM
Completed
Security Checked
7/7/202012:35:18 PM
Payment Events
Status
Timestamps