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HomeMy WebLinkAboutResolution - 2017-R0080 - Lutheran Social Services - 02/23/2017Resolution No. 2017-R0080 Item No. 6.1.2 February 23, 2017 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute for and on behalf of the City of Lubbock, Contract No. 13247 and all related documents by and between the City of Lubbock and Lutheran Social Services of the South, for funding out of the Comprehensive Energy Assistance Program to provide utility assistance to low-income families and individuals. 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 February 23, 2017 __L__ - DANIEL M. POPE, MAYOR ATTEST: Reb cca Garza, City Secreta APPROVED AS TO CONTENT: i Bil4HrEton,AssistantOwManager APPROVED AS TO FORM: Just' r itt, As 'start City Attorney ccdocsRES Contract 13247 - Lutheran Social Services of the South Comprehensive Energy Assistance Program January 18, 2017 Resolution No. 2017-R0080 ENERGY AND COMMUNITY DEVELOPMENT BLOCK GRANT L STATE OF TEXAS § COUNTY OF LUBBOCK CES OF This Contract entered into this 23rd day of February 2017, by and between the CITY OF LUBBOCK (herein called "City") and LUTHERAN SOCIAL SERVICES OF THE SOUTH non-profit enter (herein called "Contractor"). I. WHEREAS, the City is obligated to do and perform certain services in its administration of the Comprehensive Energy Assistance Program (CEAP); and WHEREAS, the Contractor operates a non-profit center offering services to low-income individuals in the County of Lubbock; and WHEREAS, the services provided by the Contractor benefit citizens of the County of Lubbock and constitute a valuable public service; and WHEREAS, the City Council of the City of Lubbock has declared programs of the Lutheran Social Services to be a public purpose and the provision of these services to be a predominate purpose of this transaction; and WHEREAS, the Contractor and the services it provides have been found to meet the criteria for funding under the RFP; and WHEREAS, the accomplishment of the above public purpose is the predominant purpose of this transaction, continuing supervision by the City and State together with statutory and contractual requirements provide sufficient assurance that this public purpose will be accomplished and an audit provides sufficient protection of the handling of public money; and WHEREAS, the City Council had found that the Contractor has the special expertise, knowledge and experience necessary for the performance of the contract and that the City will receive adequate consideration in the form of substantial public benefit; and WHEREAS, the City desires to contract with the Contractor to make available operating assistance for the Utility Assistance and Household Crisis Program. NOW, THEREFORE, it is agreed between the parties hereto that: II. SCOPE OF SERVICE A. General Overview of Program: Contractor will use the Comprehensive Energy Assistance Program (CEAP) funds awarded to administer the Utility Assistance Component in the following manner: CEAP Utility Assistance $669,887 CEAP Household Crisis 100,000 CEAP Program Services Cost 120.300 $890,187 B. City Responsibilities: 1. City agrees to provide Contractor assistance from the CEAP in an amount not to exceed $890,187 in return for Contractor performing the activities set forth in this Contract as consideration for said fiends. 2. It is expressly understood and agreed by the parties hereto that City's responsibilities are contingent upon the actual receipt of adequate funds to meet City's liabilities under this contract. If adequate funds are not available to make payment under this contract, City shall notify Contractor in writing within a reasonable time after such fact is determined. City shall terminate this Contract and will not be liable for failure to make payments to Contractor under this Contract. The funds shall be disbursed in the amounts and at the time the funds are disbursed to the City by the State of Texas. The City is not responsible for any amounts not distributed by the State of Texas. CSBG funds shall be disbursed in the amount and at the time funds are disbursed to the City by the State of Texas. 3. City shall not be liable to Contractor for any costs incurred by Contractor, or any portions thereof, which have been paid to Contractor or which are subject to payment to Contractor, or which have been reimbursed to Contractor or which are subject to reimbursement to Contractor by any source other than City or Contractor. 4. City shall not be liable for any costs incurred by Contractor which are not allowable costs as set forth in the contract. 5. City shall not be liable to Contractor for any costs incurred by Contractor or for any performances rendered by Contractor which are not strictly in accordance with the terms of this Contract. 6. City shall not be liable to Contractor for any costs incurred by Contractor in the performance of this Contract which have not been billed to City by Contractor within sixty (60) days following termination of this Contract. 7. City shall not be liable for costs incurred or performances rendered by Contractor before commencement of this Contract or after termination of this Contract. 21 CEAP 2017 Funding Agreement LSSS Utility Assistance 8. City's financial assistance will be limited to the following: a. The assistance made available through this Contract shall be used by the Contractor solely for the purpose of the Utility Assistance Program and b. The assistance shall provide funding for expenses incurred within the operation and scope of the programs. c. The services provided by the Contractor shall benefit lower-income families that reside in the County of Lubbock and whose gross household income does not exceed 125% of the most recent Poverty Income Guidelines issued by the U.S. Department of Health and Human Services. C. Contractor's Responsibilities 1. Contractor agrees to use funds made available through this Contract solely for the purpose of the Utility Assistance Program at Neighborhood House, 1212 13`x' Street, Suite 102, Lubbock, Texas 79401. 2. Contractor agrees to comply with applicable uniform administrative requirements, as described in the Lutheran Social Services Policy Manual and generally accepted administrative requirements for the Texas State Government located at ITAC5.141 et seq. And the federal administrative requirements located at 45CFR Part 96. 3. Contractor agrees to carry out the activities under this Contract in compliance with all State and Local laws and regulations. 4. Contractor agrees NOT to include documentation from a medical professional such as a doctor's letter, but only include other forms of documentation of disability such as Social Security or a Supplemental Security Income statement, and will keep in client's file to validate eligibility. III. TIME OF PERFORMANCE This Contract shall commence January 1, 2017 and shall terminate December 31, 2017. The term of this Contract and the provisions herein may be extended on a year to year basis during the five year roll-over cycle ending December 2018, provided funds are received from TDHCA and providing the Contractor meets its contractual obligations during the current funding year, subject to board approval and Mayor's signature. 31 CEAP 2017 Funding Agreement LSSS — Utility Assistance ILYA V. VI. VII. BUDGET PAYMENT City will pay up to $890,187 to Contractor based upon the receipt of request for funds and project expense summary for the above-described project. Contractor shall submit to City invoices for items purchased. City shall determine the reasonableness of each purchase and shall not make disbursement of any such payment until City has reviewed and approved each purchase. If need is shown to exist, City staff can release up to 10% of the funds to be used as start-up funding. Contractor will then bill City monthly for expenses occurred during the month. By December 31, 2017, Contractor will have provided City with proper documentation to show how all funds were expended, including the start-up costs. NOTICES Communication and details concerning this Contract shall be directed to the following Contract representatives: Piata Bryant City of Lubbock P. O. Box 2000 Lubbock, TX 79457 SPECIAL CONDITIONS Joy Loper Lutheran Social Services 1212 13`x' Street, Suite 102 Lubbock, TX 79401 A. Contractor will maintain adequate case management files on each client assisted; whether the case management is funded through this grant or not, and whether the case management is provided by the Contractor or not. B. Contractor will keep adequate documentation of the design of the program, the implementation of the program, and evaluation of program design. C. Contractor will keep documentation of their efforts to leverage CEAP funds with other programs to enhance the services provided to clients. 41 CEAP 2017 Funding Agreement LSSS Utility Assistance CEAP/CSBG Funds Program: Utility Assistance (UA) $ 669,887 Household Crisis UA 100,000 Administrative & Program Services costs 120,300 TOTAL $ 890,187 PAYMENT City will pay up to $890,187 to Contractor based upon the receipt of request for funds and project expense summary for the above-described project. Contractor shall submit to City invoices for items purchased. City shall determine the reasonableness of each purchase and shall not make disbursement of any such payment until City has reviewed and approved each purchase. If need is shown to exist, City staff can release up to 10% of the funds to be used as start-up funding. Contractor will then bill City monthly for expenses occurred during the month. By December 31, 2017, Contractor will have provided City with proper documentation to show how all funds were expended, including the start-up costs. NOTICES Communication and details concerning this Contract shall be directed to the following Contract representatives: Piata Bryant City of Lubbock P. O. Box 2000 Lubbock, TX 79457 SPECIAL CONDITIONS Joy Loper Lutheran Social Services 1212 13`x' Street, Suite 102 Lubbock, TX 79401 A. Contractor will maintain adequate case management files on each client assisted; whether the case management is funded through this grant or not, and whether the case management is provided by the Contractor or not. B. Contractor will keep adequate documentation of the design of the program, the implementation of the program, and evaluation of program design. C. Contractor will keep documentation of their efforts to leverage CEAP funds with other programs to enhance the services provided to clients. 41 CEAP 2017 Funding Agreement LSSS Utility Assistance D. Contractor will keep documentation of their efforts to cooperate and collaborate with other service providers. VIII. GENERAL CONDITIONS A. General Compliance Contractor agrees to comply with all applicable federal, state and local laws and regulations governing the funds provided under this Contract which were made available under City's Comprehensive Energy Assistance Program and Community Services Block Grant. Contractor shall administer the Comprehensive Energy Assistance Program (the "CEAP Program") to eligible clients in accordance with Texas Department of Housing and Community Affairs ("TDHCA") CEAP regulations and as out lined in Texas Administrative Code (TAC 10) regulations and the Low -Income Home Energy Assistance Act of 1981, as amended, 42 U.S.C. Sec. 8621 et seq. (the "LIHEAP Act" Public Law 97-35), and the LIHEAP State Plan; and sections 103 & 107 of the Contract Work Hours and Safety Standards Act (40 USC 327-330) as supplemented by Agency of labor regulations (29 CFR, Part 5). B. Labor Standards The Contractor agrees to comply with the requirements of the Secretary of Labor in accordance with the Copeland "Anti -Kickback" Act (40 U.S.0 276a -276a-5; 40 USC 327 and 40 USC 26c) and all other applicable Federal, state and local laws and regulations pertaining to the labor standards insofar as those acts apply to the performance of this contract. C. Right to Exercise The City reserves the right to exercise any right or remedy available to it by law, contract, equity, or otherwise, including without limitation, the right to seek any and all forms of relief in a court of competent jurisdiction. Further, the City shall not be subject to any arbitration process prior to exercising its unrestricted right to seek judicial remedy. The remedies set forth herein are cumulative and not exclusive, and may be exercised concurrently. To the extent of any conflict between this provision and another provision in, or related to, this document, the former shall control. 51 CEAP 2017 Funding Agreement LSSS Utility Assistance D. Independent Contractor Nothing contained in this Contract is intended to, or shall be construed in any manner, as creating or establishing the relationship of employer/employee between the parties. Contractor shall at all times remain an independent contractor with respect to the services to be performed under this Contract. City shall be exempt from payment of all Unemployment Compensation, FICA, retirement, life and/or medical insurance and Worker's Compensation insurance as the Contractor is an independent Contractor. E. Indemnity and Release Grantee shall indemnify and hold harmless, to the fullest extent permitted by law, the City, and City's respective officers, employees, elected officials and agents, from and against any and all losses, damages, claims or liabilities, of any kind or nature, which arise directly or indirectly, or are related to, in any way, manner or form, the activities contemplated hereunder, including, but not limited to, losses, damages, claims or liabilities arising from or related to, in any way, manner or form, the act or omission of third parties and/or the negligence or fault of City, its respective officers, employees, elected officials and /or agents. Grantee further covenants and agrees to defend any suits or administrative proceedings brought against the City and/or the City's respective officers, employees, elected officials and/or agents on account of any such claim, and to pay or discharge the full amount or obligation of any such claim incurred by, accruing to, or imposed on the City, or the City's respective officers, employees, elected officials and/or agents, as applicable, resulting from such suits, claims and/or administrative proceedings or any matter resulting from the settlement or resolution of said suits, claims and/or administrative proceedings, in addition, Grantee shall pay to the City, applicable, all attorney's fees incurred by such parties in enforcing Grantee's indemnity in this section. The City, and its respective officers, employees, elected officials and agents shall not be liable and Grantee hereby releases the City, and its respective officers, employees, elected officials and agents, for, from and/or against any losses, damages, claims or liabilities to Grantee, on any theory of legal liability, including, but not limited to the negligence, of any type of degree or fault, of the City, arising from or related to, in any way, manner of form, the unenforceability or voidance, for any reason, of all or part of this agreement. The indemnity and release provided herein shall survive the termination or voidance of this agreement. F. Worker's Compensation Contractor shall provide Worker's Compensation insurance coverage or other approved coverage for all employees involved in the performance of this Contract. 61 CEAP 2017 Funding Agreement LSSS — Utility Assistance G. Insurance and Bonding Throughout the term of this Contract, the Contractor will maintain liability insurance in the following minimum amounts: Type of Insurance Minimum Liability Commercial General Liability $1,000,000 Limit Property Damage Liability $100,000 Each Occurrence H. City Recognition Contractor shall insure recognition of the role of City's COMPREHENSIVE ENERGY ASSISTANCE PROGRAM in providing funding through this Contract. All activities, facilities and items utilized pursuant to this Contract shall be prominently labeled as to funding source. In addition, Contractor will include a reference to the support provided herein in all publications made possible with funds made available under this Contract. I. Amendments City or Contractor may amend this Contract at any time, provided that such amendments make specific reference to this Contract, and are executed in writing, signed by a duly - authorized representative of both organizations and approved by City Council if required by law. Such amendments shall not invalidate this Contract, nor relieve nor release City or Contractor from its obligations under this Contract. City may, in its discretion, amend this Contract to conform with federal, state or local governmental guidelines, policies and available funding amounts, or for other reasons. If such amendments result in a change in the funding, the scope of services, or the activities to be undertaken as part of this Contract, such modifications will be incorporated only by written amendment signed by both City and Contractor. J. Suspension or Termination Either party may terminate this Contract at any time by giving written notice to the other party of such termination and specifying the effective date thereof at least thirty (30) days before the effective date of such termination. Partial termination of the Scope of Service in Paragraph "II.B" above may only be undertaken with the prior approval of City. In the event of any termination for convenience, all finished or unfinished documents, data, studies, surveys, maps, models, photographs, reports, or other materials prepared by Contractor under this Contract shall at the option of City, become the property of City, and Contractor shall be entitled to receive just and equitable compensation for any satisfactory work completed on such documents or materials prior to the termination. City may also suspend or terminate this Contract, in whole or in part, if Contractor materially fails to comply with any term of this Contract, or with any of the rules, 71 CEAP 2017 Funding Agreement LSSS Utility Assistance regulations, or provisions referred to herein; and the City may declare the Contractor ineligible for any further participation in City contracts, in addition to other remedies as provided by law. In the event there is probable cause to believe Contractor is in noncompliance with any applicable rules or regulations, City may withhold up to fifteen percent (15%) of said contract funds until such time as Contractor is found to be in compliance by City or is otherwise adjudicated to be in compliance. The City may also terminate this agreement in the event of an emergency or disaster, whether an act of God, natural or manmade, by giving twenty-four (24) hour notice. The City may give said notice verbally to Grantee. Any expenditure incurred prior to receiving notice will be reimbursed; however, in no event shall the City pay any expenses incurred after notice of termination is received by Grantee. K. Prevention of Waste, Fraud, and Abuse Contractor shall establish, maintain, and utilize systems and procedures to prevent, detect, and correct waste, fraud, and abuse in activities funded under this contract. The systems and procedures shall address possible waste, fraud, and abuse by Contractor, its employees, recipients, vendors, and administrating agencies. Contractor's internal control systems and all transactions and other significant events are to be clearly documented, and the documentation is to be readily available for monitoring by City. Contractor shall give Department complete access to all of its records, employees, and agents for the purposes of any investigation of the funded programs. Contractor shall immediately notify City of any discovery of waste, fraud or abuse. Contractor shall fully cooperate with City's efforts to detect, investigate, and prevent waste, fraud and abuse in the funded program. Contractor may not discriminate against any employee or other person who reports a violation of the terms of this contract or of any law or regulation to the City or to any appropriate law enforcement authority, if the report is made in good faith. L. Legal Remedies In instances where the Contractors violate or breach this Contract, the City may apply administrative, contractual, or legal remedies. The City may suspend all activities temporarily pending either corrective action by the Contractor or a decision by the City to terminate this contract. M. Legal Authority Contractor represents that it possesses the practical ability and legal authority to enter in to this contract, receive and manage funds authorized by this contract, and to perform the services Contractor has obligated itself to perform under this contract. gl CEAP 2017 Funding Agreement LSSS Utility Assistance The person signing this contract on behalf of Contractor herby warrants that he/she has been authorized by Contractor to execute this contract on behalf of Contractor and to bind Contractor to all terms herein set forth. IX. ADMINISTRATIVE REQUIREMENTS A. Financial Management 1. Accounting Standards Contractor agrees to comply with Attachment F of 2 CFR Part 200 and agrees to adhere to the accounting principles and procedures required therein, utilize adequate internal controls, and maintain necessary source documentation for all costs incurred. 2. Cost Principles Contractor shall administer its program in conformance with 2 CFR Part 200, "Cost Principles for Non -Profit Organizations", or 2 CFR Part 200 Cost Principles for Educational Institutions", as applicable, for all costs incurred whether charged on a direct or indirect basis. B. Documentation and Record-Keepiniz Record Keeping Requirements Contractor shall maintain fiscal and programmatic records and supporting documentation for all expenditures made under this Contract in accordance with the UGMS and Section III, Common rule: State Uniform Administrative Requirements for Grants and Cooperative Agreements, Subpart C — Post Award Requirements, 18.42. For purposes of compliance, all associated documentation must be readily available, whether stored electronically or hard copy to justify compliance with program rules and regulations. Open Records: Contractor acknowledges that all information collected, assembled, or maintained by Contractor pertaining to this Contract is subject to the Texas Public Information Act, Chapter 552 of Texas Government Code and must provide citizens, public agencies, and other interested parties with reasonable access to all records pertaining to the Contract subject to and in accordance with the Texas Public Information Act. Contractor shall give the HHS, the U.S. General Accounting Office, the Texas Comptroller, the State Auditor's Office, and Department, or any of their duly authorized representatives, access to and the right to examine and copy, on or off the premises of Contractor, all records pertaining to this Contract. Such right to access shall continue as long as the records are retained by Contractor. Contractor agrees to maintain such records in an accessible location for the greater of. (1) four (4) years; (2) if notified by the City in writing , the date that the final audit is accepted with all audit issues resolved to the City's satisfaction, (3) if any litigation claim, negotiation, inspection, or other action has started before the expiration of 91 CEAP 2017 Funding Agreement LSSS Utility Assistance the required retention period records must be retained until completion of the action and resolution of all issues which arise under it; (4) a date consistent with any other period required by federal or state law or regulation. Contractor agrees to cooperate with any examination conducted pursuant to this Subsection. Upon termination of this Contract, all records are property of the City. 2. Retention Contractor shall retain all record pertinent to expenditures incurred under this Contractor for a period of five (5) years after the termination of all activities funded under this Contract, or after the resolution of all State audit findings, whichever occurs later. 3. Client Data Contractor shall maintain client data demonstrating client eligibility for services provided. Such data shall include, but not be limited to: total number of information and referral calls received and broken down into subject categories for every call; specific information obtained through random screening of calls such as income level, gender, race, age, education -level, and household size. Such information shall be made available to City monitors or their designees for review by the 10'x' day of every month. 4. Audits and Inspections All Contractor records with respect to any matters covered by this Contract shall be made available to City, their designees or the State Government, at any time during normal business hours, as often as City or State deems necessary, to audit, examine, and make excerpts or transcripts of all relevant data, both financial and programmatic. Any deficiencies noted in audit reports must be fully cleared by Contractor within thirty (30) days after receipt by the Contractor. Failure to comply with the above audit requirements will constitute a violation of this Contract and may result in the withholding of future payments. C. Operation and Financial Reports 1. Financial Record Reports Contractor agrees to submit to the City invoices for the services and approved costs of this program by the 10`' day of each month; and 2. Operation Reports Contractor agrees to submit to the City a monthly activity report in accordance with instructions provided by the State. 101 CEAP 2017 Funding Agreement LSSS Utility Assistance VIII. PERSONNEL AND PARTICIPANT CONDITIONS A. Civil Rights Contractor agrees to comply and to require all subcontractors to comply with Title VI of the Civil Rights Act of 1964 as amended, Title VIII of the Civil Rights Act of 1968 as amended, Section 109 of Title I of the Housing and Community Development Act of 1974, Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, the Age Discrimination Act of 1975, Executive Order 11063, and with Executive Order 11246 and the regulations issued under the order at 41 CFR chapter 60. No person shall on the ground of race, color, religion, sex, national origin, age, disability, political affiliation or belief be excluded from participation in, be denied the benefits of, be subjected to discrimination under, or be denied employment in the administration of or in connection with any program or activity funded in whole or in part with funds made available under this contract. B. Conduct 1. Prohibit Political Activity and Lobbying The Grantee hereby certifies that: a. No Federal appropriated fiends have been paid or will be paid, by or on behalf of it, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement; b. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, it will complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions; c. It will 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; d. None of the funds provided under this contract shall be used for influencing the outcome of any election, or the passage or defeat of any legislative measure. This prohibition shall not be construed to prevent any official or employee of Contractor from furnishing to any member of its governing body upon request, or to any other local or official not considered 111 CEAP 2017 Funding Agreement LSSS Utility Assistance under law to be confidential information. Any action taken against an employee or official for supplying such information shall subject the person initiating the action to immediate dismissal from employment; e. No fiends provided under this Contract may be used directly or indirectly to hire employees or in any other way fund or support candidates for the legislative, executive, or judicial branches of government of Contractor, the State of Texas, or the government of the United States; and f. None of the funds provided under this contract shall be paid to any official or employee who violates any of the provisions of this section. 2. Conflict of Interest and Nepotism Contractor covenants that neither it nor any member of its governing body presently has any interest or shall acquire any interest, direct or indirect, which would conflict in any manner or degree with the performance of this contract. Contractor further covenants that in the performance of this contract no person having such interest shall be employed or appointed by contactor. No person (1) Who is an employee, agent, consultant, officer, or official of the contractor and who exercises or has exercised any functions or responsibilities with respect to assisted contract activities; or (2) Who is in a position to participate in a decision making process or gains inside information with regard to such activities, may obtain a personal or financial interest or benefit, direct or indirect, in any contract, subcontract, or agreement with respect thereto, or the proceeds there under, either for themselves or those with whom they have familiar or business ties, during their tenure. Contractor's employees, officers, and/or agents shall neither solicit nor accept gratuities, favors, or anything of monetary value from subcontractors, or potential subcontractors. C. Air & Water The Grantee agrees to comply with the following requirements insofar as they apply to the performance of this contract: Clean Air Act, 42 U.S.C., 7401, et seq., Federal Water Pollution Control Act, as amended, 33 U.S.C. 1251, et seq., as amended, 1318 relating to inspection, monitoring, entry, reports, and information, as well as other requirements specified in said Section 114 and Section 308, and all regulations and guidelines issued thereunder. 121 CEAP 2017 Funding Agreement LSSS Utility Assistance IN WITNESS WHEREOF, the Parties have executed this contract as of the date first written above. CITY OF LUBBOCK J�' DANIEL M. POOE MAYOR ATTEST: tG) At(�e— Rebeca Garza, City Secret APPROVED AS TO CONTENT: Karen Murfee, CD Director E-11 9 ' ;Cel 7571 JustiP tt, Assiskant City Attorney 131Pa e CEAP 2017 Funding Agreement LSSS - Utility Assistance LUTHERAN SOCIAL SERVICES OF THE SOUTH, INC. AUTHORIZED REPRESENTATIVE FED. I.D.# q 7 4ql Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277 CERTIFICATE OF INTERESTED PARTIES FORM 1295 10f1 Complete Nos. 1- 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number: 2017-159285 Date Filed: 01/27/2017 Date Acknowledged: 01/31/2017 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Lutheran Social Services of the South, Inc. Austin, TX United States 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. City of Lubbock 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 13247 Services to low-income individuals and admin CEAP. 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I Intermediary 5 Check only if there is NO Interested Party. X 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. Signature of authorized agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said this the day of 20 to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277 Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1 of 1 Complete Nos.1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2017-159285 Lutheran Social Services of the South, Inc. Austin, TX United States Date Filed: 01/27/2017 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. City of Lubbock Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 13247 Services to low-income individuals and admin CEAP. 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I Intermediary 5 Check only if there is NO Interested Party. ❑ X 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. Z. DANA LYNN HEINJ Notary Public, State of Comm. Expires 02-06.Signature of authorized agent of contracting business entity Notary ID 484031 Sworn to and subscribed before me, by the said �� t �Ln S ��j L this the 3 u day of 20. to certify which, witness my hand and seal of office. Signature of office a ministering oath Printed name of officer admirlistering oath Title of officer administer' oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277