HomeMy WebLinkAboutResolution - 2020-R0409 - Contract 15544 with Children's Hope Residential ServicesResolution No. 2020-RO409
Item No. 7.5
December 1, 2020
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute
for and on behalf of the City of Lubbock, Contract No. 15544 for substance use disorder
treatment services as per RFP 21-15544-MA, by and between the City of Lubbock and
Children's Hope Residential Services, Inc. dba Grace Manor, of Lubbock, Texas, and 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
December 1, 2020
DANIEL M. POPE, MAYOR
ATTEST:
Re ec Garza, City Secre
APPROVED AS TO CONTENT:
1-av)-r,� C, -
Bill Ho on, Deputy C' nager
APPROVED AS TO FORM:
Ryan firo e, Assistant City Attorney
ccdocs/RES.Contract 15544 - Substance use disorder treatment services
November 10, 2020
Resolution No. 2020-RO409
Contract 15544
City of Lubbock, TX
SUBSTANCE USE DISORDER TREATMENT SERVICES
Agreement
This Service Agreement (this "Agreement") is entered into as of the 1 st day of December 2020
("Effective Date") by and between Children's Hope Residential Services, Inc. dba Grace Manor (the
Contractor), and the City of Lubbock (the "City").
RECITALS
WHEREAS, the City has issued a Request for Proposals 21-15544-MA, SUBSTANCE USE
DISORDER TREATMENT SERVICES.
WHEREAS, the proposal submitted by the Contractor has been selected as the proposal which best
meets the needs of the City for this service; and
WHEREAS, Contractor desires to perform as an independent contractor to provide SUBSTANCE
USE DISORDER TREATMENT SERVICES, upon terms and conditions maintained in this Agreement;
and
NOW THEREFORE, for and in consideration of the mutual promises contained herein, the City and
Contractor agree as follows:
City and Contractor acknowledge the Agreement consists of the following exhibits which are
attached hereto and incorporated herein by reference, listed in their order of priority in the event of
inconsistent or contradictory provisions:
1. This Agreement
2. Exhibit A — General Requirements
3. Exhibit B — Service Types and Unit Rates
4. Exhibit C — Proposal Narratives
5. Exhibit D — Business Associate Agreement
6. Exhibit E - Insurance
Scope of Work
Contractor shall provide the services that are specified in Exhibit A. The Contractor shall comply with all
the applicable requirements set forth in Exhibit B, C, D and E attached hereto.
Article 1
1.1 The contract shall be for a term of one year, with the option of three, one-year extensions,
said date of term beginning upon formal approval. The City of Lubbock does not guarantee
any specific amount of compensation, volume, minimum, or maximum amount of services
under this bid and resulting contract. The Contractor must maintain the insurance coverage
required during the term of this contract including any extensions. It is the responsibility of
the Contractor to ensure that valid insurance is on file with the Purchasing and Contract
Management Department as required by contract or contract may be terminated for non-
compliance.
1.2 The Contractor shall not assign any interest in this Agreement and shall not transfer any
interest in the Agreement, whatsoever, without prior consent of the City.
1.3 All funds for payment by the City under this Agreement are subject to the availability of an
annual appropriation for this purpose by the City. In the event of non -appropriation of funds
by the City Council of the City of Lubbock for the goods or services provided under the
Agreement, the City will terminate the Agreement, without termination charge or other
liability, on the last day of the then -current fiscal year or when the appropriation made for
the then -current year for the goods or services covered by this Agreement is spent, whichever
event occurs first. If at any time funds are not appropriated for the continuance of this
Agreement, cancellation shall be accepted by the contractor on 30 days prior written notice,
but failure to give such notice shall be of no effect and the City shall not be obligated under
this Agreement beyond the date of termination.
1.4 This contract shall remain in effect until the first of the following occurs: (1) the expiration
date, (2) performance of services ordered, or (3) termination of by either party with a 30 day
written notice. The City of Lubbock reserves the right to award the canceled contract to the
next lowest and best bidder as it deems to be in the best interest of the city.
Article 2 Miscellaneous.
2.1 This Agreement is made in the State of Texas and shall for all purposes be construed in
accordance with the laws of said State, without reference to choice of law provisions.
2.2 This Agreement is perfonnable in, and venue of any action related or pertaining to this
Agreement shall lie in, Lubbock, Texas.
2.3 This Agreement and its Exhibits contains the entire agreement between the City and
Contractor and supersedes any and all previous agreements, written or oral, between the
parties relating to the subject matter hereof. No amendment or modification of the teens of
this Agreement shall be binding upon the parties unless reduced to writing and signed by
both parties.
2.4 This Agreement may be executed in counterparts, each of which shall be deemed an original.
2.5 In the event any provision of this Agreement is held illegal or invalid, the remaining
provisions of this Agreement shall not be affected thereby.
2.6 The waiver of a breach of any provision of this Agreement by any parties or the failure of
any parties otherwise to insist upon strict performance of any provision hereof shall not
constitute a waiver of any subsequent breach or of any subsequent failure to perform.
2.7 This Agreement shall be binding upon and inure to the benefit of the parties and their
respective heirs, representatives and successors and may be assigned by Contractor or the
City to any successor only on the written approval of the other party.
2.8 All claims, disputes, and other matters in question between the Parties arising out of or
relating to this Agreement or the breach thereof, shall be formally discussed and negotiated
between the Parties for resolution. In the event that the Parties are unable to resolve the
claims, disputes, or other matters in question within 30 days of written notification from the
aggrieved Party to the other Party, the aggrieved Party shall be free to pursue all remedies
available at law or in equity.
2.9 At any time during the term of the contract, or thereafter, the City, or a duly authorized audit
representative of the City or the State of Texas, at its expense and at reasonable times,
reserves the right to audit Contractor's records and books relevant to all services provided to
the City under this Contract. In the event such an audit by the City reveals any errors or
overpayments by the City, Contractor shall refund the City the full amount of such
overpayments within 30 days of such audit findings, or the City, at its option, reserves the
right to deduct such amounts owing the City from any payments due Contractor.
2.10 The City reserves the right to exercise any right or remedy 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 do.
2.11 The contractor shall not assign or sublet the contract, or any portion of the contract, without
written consent from the Director of Purchasing and Contract Management. Should consent
be given, the Contractor shall insure the Subcontractor or shall provide proof of insurance
from the Subcontractor that complies with all contract Insurance requirements document, this
provision shall control.
2.12 Contractor acknowledges by supplying any Goods or Services that the Contractor has read,
fully understands, and will be in full compliance with all terms and conditions and the
descriptive material contained herein and any additional associated documents and
Amendments. The City disclaims any tenns and conditions provided by the Contractor
unless agreed upon in writing by the parties. In the event of conflict between these terms
and conditions and any tenns and conditions provided by the Contractor, the terms and
conditions provided herein shall prevail. The terms and conditions provided herein are the
final tenns agreed upon by the parties, and any prior conflicting terms shall be of no force
or effect.
2.13 Section 2270.002, Government Code, (a) This section applies only to a contract that: (1)
Is between a governmental entity and a company with 10 or more full-time employees;
and (2) has a value of $100,000 or more that is to be paid wholly or partly from public
funds of the governmental entity. (b) A governmental entity may not enter into a contract
with a company for goods or services unless the contract contains a written verification
from the company that it: (1) does not boycott Israel; and (2) will not boycott Israel during
the term of the contract.
2.14 SB 252 prohibits the City from entering into a contract with a vendor that is identified by
The Comptroller as a company known to have contracts with or provide supplies or service
with Iran, Sudan or a foreign terrorist organization.
INTENTIONALLY LEFT BLANK-----
IN WITNESS WHEREOF, the parties hereto have caused this Contract to be executed the day and
year first above written. Executed in triplicate.
CITY OF LUBBOCK CONTRACT
BY:
Daniel M. Pope, Mayor thorized Representative
ATTEST:
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Reb a arza, City Sec to
AP V AS TO CONTENT:
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Katherine Wells, Director of Health
APPROVED AS TO FORM
Ryan o Assistant City Attorne
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GENERAL REQUIREMENTS
1 INTRODUCTION
Exhibit A
The City of Lubbock's Health Department invites proposals from qualified applicants to facilitate
substance use treatment for Substance Use Disorder Treatment Services, Co -Occurring Psychiatric
Substance Use Disorder (COPSD) services in the Lubbock area. This is to include residential, intensive
outpatient, and other services as needed. The services are grant funded.
2 CONTRACT TERM
The contract shall be for a term of one year, with the option of three, one-year extensions, said date of term
beginning upon formal approval. The City of Lubbock does not guarantee any specific amount of
compensation, volume, minimum, or maximum amount of services under this bid and resulting contract.
The Contractor must maintain the insurance coverage required during the term of this contract including
any extensions. It is the responsibility of the Contractor to ensure that valid insurance is on file with the
Purchasing and Contract Management Department as required by contract or contract may be terminated
for non-compliance.
3. LEVELS OF CARE / SERVICE TYPES
A. OUTPATIENT TREATMENT SERVICES (ASAM Level
1 Outpatient Services)
Contractor shall:
l . Adhere to Texas Administrative Code ( TAC) rules adopted by System Agency related to SUD UM
Guidelines for outpatient treatment programs / services.
2. Provide and document in Clinical Management of Behavioral Health Services (CMBHS) one (1)
3. Document in CMBHS a discharge follow-up sixty (60) calendar days after discharge from the
outpatient treatment services.
4. When the assessment indicates placement in System Agency funded Women and Children Intensive
or Supportive Residential services but there are no available beds, Contractor shall provide coordinated
interim care until a Women and Children Intensive or Supportive Residential bed becomes available.
A pregnant Client, if she chooses and is appropriate for this service type, shall be transferred to Women
and Children Intensive and Supportive Residential services no later than the eighth month of pregnancy
in order to provide sufficient time to adjust to the changes prior to delivery of her child.
5. As part of the education hours, Contractor will provide and document in CMBHS:
i. A minimum of one (1) hour per week (or one (1) hour per month for Clients who have been
transferred to outpatient after successfully completing a residential level of care) of evidence -based
parenting education and document these services; and
ii. A minimum of six (6) hours (or two (2) hours for Clients who have been transferred to outpatient
after successfully completing a residential level of care) of reproductive health education prior to
discharge and document these services.
6. Provide and document in CMBHS research -based education on the effects of ATOD
on the fetus.
GENERAL REQUIREMENTS
1 INTRODUCTION
Exhibit A
The City of Lubbock's Health Department invites proposals from qualified applicants to facilitate
substance use treatment for Substance Use Disorder Treatment Services, Co -Occurring Psychiatric
Substance Use Disorder (COPSD) services in the Lubbock area. This is to include residential, intensive
outpatient, and other services as needed. The services are grant funded.
2 CONTRACT TERM
The contract shall be for a term of one year, with the option of three, one-year extensions, said date of term
beginning upon formal approval. The City of Lubbock does not guarantee any specific amount of
compensation, volume, minimum, or maximum amount of services under this bid and resulting contract.
The Contractor must maintain the insurance coverage required during the term of this contract including
any extensions. It is the responsibility of the Contractor to ensure that valid insurance is on file with the
Purchasing and Contract Management Department as required by contract or contract may be terminated
for non-compliance.
3. LEVELS OF CARE / SERVICE TYPES
A. OUTPATIENT TREATMENT SERVICES (ASAM Level
1 Outpatient Services)
Contractor shall:
1. Adhere to Texas Administrative Code ( TAC) rules adopted by System Agency related to SUD UM
Guidelines for outpatient treatment programs / services.
2. Provide and document in Clinical Management of Behavioral Health Services (CMBHS) one (1)
3. Document in CMBHS a discharge follow-up sixty (60) calendar days after discharge from the
outpatient treatment services.
4. When the assessment indicates placement in System Agency funded Women and Children Intensive
or Supportive Residential services but there are no available beds, Contractor shall provide coordinated
interim care until a Women and Children Intensive or Supportive Residential bed becomes available.
A pregnant Client, if she chooses and is appropriate for this service type, shall be transferred to Women
and Children Intensive and Supportive Residential services no later than the eighth month of pregnancy
in order to provide sufficient time to adjust to the changes prior to delivery of her child.
5. As part of the education hours, Contractor will provide and document in CMBHS:
i. A minimum of one (1) hour per week (or one (1) hour per month for Clients who have been
transferred to outpatient after successfully completing a residential level of care) of evidence -based
parenting education and document these services; and
ii. A minimum of six (6) hours (or two (2) hours for Clients who have been transferred to outpatient
after successfully completing a residential level of care) of reproductive health education prior to
discharge and document these services.
6. Provide and document in CMBHS research -based education on the effects of ATOD
on the fetus.
Exhibit B
SERVICE TYPE AND UNIT RATES
TREATMENT FOR ADULT (TRA)
Service Type
Unit
Rate
Adult Outpatient -Individual
Outpatient -Group Counseling
$18.84
Outpatient -Group Education
$17.79
Outpatient -Individual Counseling
$60.69
Adult Intensive Residential
$113.02
Adult - Supportive Residential
$42.90
Adult - Ambulatory Detoxification
$88.95
Adult — Residential Detoxification
$234.41
Adult — HIV Residential
$180.00
Adult HIV Residential Wraparound Services (Medicaid Adult — 21 and Over)
$35.58
TREATMENT FOR WOMEN
Service Type
Unit
Rate
Adult Specialized Female Residential Intensive
$113.02
Adult Specialized Female Residential Supportive
$82.67
Adult Specialized Female Residential Detox
$234.41
Adult Specialized Female Ambulatory Detox
$88.95
Adult Specialized Female W/C Residential Intensive
$217.67
Adult Spec Fern W/C Residential Wraparound Services — LESS THAN 21
$54.41
Adult Spec Fern W/C Residential Wraparound Services — 21 and OVER
$107.78
Adult Specialized Female W/C Residential Supportive
$185.22
Adult Spec Female Outpatient Services
Adult Spec Female Outpatient Group Counseling
$29.30
Adult Spec Female Outpatient Group Education
$17.79
Adult Spec Female Outpatient Individual
$80.57
CO-OCCURRING PSYCHIATRIC & SUBSTANCE ABUSE DISORDERS (COPSD)
Service Type
Unit
Rate
Co-occurring Psychiatric & Substance Abuse Disorders (COPSD) — Adult
$66.98
Co-occurring Psychiatric & Substance Abuse Disorders (COPSD) — Youth
$66.98
Exhibit C
SUBSTANCE USE DISORDER TREATMENT SERVICES
PROPOSAL NARRATIVE
TRA
Treatment of Adults
Response to Questions
a. What services do you provide and how long have you provided services? How do you
address the needs of the priority populations in the scope of work?
Grace Manor considers Region 1 and the City of Lubbock to be our primary referral source. Our
goal is to work with the economically challenged, uninsured or underinsured, etc. and offer 100
percent of our services, if needed, to the Region and the City. We will serve other groups and
communities to be good neighbors to our sister agencies and organizations throughout Texas.
Grace Manor provides the following services: 1) inpatient treatment; 2) outpatient treatment; 3)
screening assessments; 4) life skills; 5) family and community outreach; 6) educational and
chemical dependency programs; 7) relapse education and prevention; 8) family support services;
and 9) trauma -focused services.
Grace Manor has provided adult substance abuse treatment services since July, 2020. Grace
Manor is a division of Children's Hope, a youth behavioral treatment facility that opened in 2002
and is accredited by the Joint Commission. Combined with our behavioral and co-occurring
treatment for all ages, Grace Manor and Children's Hope has provided substance abuse
treatment, as part of wraparound services, to both youth and adults for the past 20 years.
Per the TRA Scope of Work, Grace Manor can provide inpatient treatment services for both
women and men. We are licened by Texas Health and Human Services to provide 40 inpatient
beds for inpatient treatment and 120 slots for outpatient treatment per day. Under the TRA grant,
our agency can provide up to six inpatient beds for adult women and 16 beds for adult men.
Admission priority will be given to: 1) women who are pregnant; 2) adults with children who are
involved with Child Protective Services; 3) IV drug users. The number of clients who will
receive outpatient treatment under this grant will vary but not exceed 120 at any time (see Grace
Manor's TRF application for a description of the number of inpatient beds we will offer female
clients).
Client needs will be addressed upon referral to Grace Manor from two broad primary sources: 1)
individual referral; and 2) referral from area hospitals, health care providers, homeless shelters,
medication assisted treatment facilities (MATS), law enforcement agencies, courts, Women's
Protective Services, Child Protective Services, and HHSC's Region 1 Outreach, Screening,
Assessment, and Referral (OSAR). Upon completion of the CMBHS Screening Assessment tool
and the client meets DSM-IV criteria for a substance abuse disorder, the client will be referred to
either inpatient or outpatient services at a level appropriate to their needs as determined by the
screening assessment. The client's financial eligibility will be determined during their CMBHS
screening. The client's continuum of care will be tailored to their specific needs throughout their
treatment episode.
Grace Manor will use to primary texts in the treatment of substance abuse. Our substance abuse
treatment program is based upon working with clients who have a criminal history and/or
criminal mindset. The 22-year-old, evidence -based treatment curriculum used at Grace Manor
was developed by Dr. Kenneth W. Wanberg and Dr. Harvey B. Milkman. Their books, Criminal
Conduct and Substance Abuse Treatment: Strategies for Self -Improvement and Change:
Pathways to Responsible Living and its companion workbook serves as the primary treatment
program used to treat Grace Manor's clients. Wanberg's and Milkman's text is used at most
state -funded substance abuse treatment and correctional programs. Grace Manor will use
Seeking Safety: A Treatment Manual for PTSD and Substance Abuse as an empirically -based
treatment program to address trauma. Our organization also utilizes volunteers from local 12-
step recovery programs. Grace Manor's licensed counselors and therapists work with clients to
provide recovery support services to assist the client in the initiation and maintenance of their
substance abuse recovery. Combined with the Wanberg and Milkman's texts and other curricula,
the in-, out-, and aftercare services provided by Grace Manor are supported through
Memorandums of Understanding (MOU) with the following internal and external groups: 1)
Grace Manor's recovery coach program that is provided by trained employees; 2) members of
12-step groups; 3) United Supermarkets; 4) half -way house programs; 5) local hospitals and
health care providers; and 6) Mullins ISD. Grace Manor is the only substance abuse treatment
facility in the Lubbock area that offers wraparound educational services onsite through Mullins
ISD. We provide free GED testing and courses that can lead to any and all clients earning their
high school diploma or GED. We are currently seeking MOUs with local homeless shelters,
WPS, CPS, and various law enforcement and judicial agencies. Since Grace Manor has recently
moved into providing substance abuse treatment programs for adults, our agency is finalizing our
MOU negotiations.
b. How many individuals do you serve daily and annually? What is your rate of
completion? What is the procedure for follow up after patient discharge?
Grace Manor has the capacity to provide 40 inpatient beds and 120 outpatient slots per day. Our
agency employees adequate staff to ensure services for maximum capacity, especially in light of
the COVID-19 pandemic, in our inpatient and outpatient programs. Therefore, we have 40
residential treatment beds and 120 outpatient slots available per day for clients in need of grant
support. We anticipate filling 40 percent of our potential inpatient vacancies with clients who
will be funded under the TRA program. Therefore, at a maximum, Grace Manor anticipates 16
male beds, six female beds, and 48 outpatient slots which could be filled with clients on a daily
basis who will receive TRA funding. Our maximum annual capacity is 8,030 inpatient client
slots (16 male beds X 356 days = 5,840 slots for inpatient male treatment; 6 female beds X 365
days = 2,190 for inpatient female treatment; 5,840 inpatient male treatment slots + 2,190
inpatient female slots = 8,030 total slots; 48 outpatient slots X 365 days = 17,520 outpatient
slots). However, Grace Manor has established a financial review process for clients. Using
Federal Poverty Rate Guidelines, clients will be required to pay, based on a sliding fee scale,
their portion of treatment expenses. Therefore, Grace Manor will not bill the TRA account for
services to clients who can afford to pay for services, a portion of the services, or have private
insurance.
Service Type
Maximum
Capacity for
Enrolled at One
12 Months
Time
Adult Outpatient
48 slots
17,520 slots
Outpatient — Group
48 slots
17,520 slots
Counseling
Outpatient — Group
48 slots
17,520
Education
slots
Outpatient — Individual
48 slots
17.520 slots
Counseling
Adult Intensive Residential
22 slots
8,030 slots
Adult — Supportive
0
0
Residential
Adult — Ambulatory
0
0
Detoxication
0
Adult — Residential
0
Detoxification
Adult — HIV Residential
0
0
Total Dollars Requested
Grace Manor anticipates our completion rate to exceed the national average, 20 percent of all
clients, admitted to a substance abuse treatment facility. We anticipate a higher completion rate
because of the wraparound services we will provide and are consistent with those implemented
by other treatment centers and state programs in the United States.
As stated in an article published on May 19, 2020 by the American Addiction Centers, "Rehab
Success Rates and Statistics — Research -Based Treatment and Practice -Based Evidence," a
solution to a low success rate is to marry research -based treatment of Cognitive Behavioral
Therapy with "practice -based evidence" using the experience of long-time counselors with
scientific backing of more accepted and established programs. Substance abuse programs, like
those provided at Grace Manor, that include a cognitive -behavioral treatment program, taught by
experienced counselors, and individualized wraparound services yield a higher success rate.
Delaware's Division of Substance Abuse and Mental Health Department implemented similar
strategies in 2001 when completion and success rates were less than 50 percent. Five years later,
their state -run facilities were running at a minimum capacity of 95 percent with 70 percent of
clients attending treatment and completing all services. Grace Manor's curriculum, experienced
employees, and establishing MOUs with agencies to provide wraparound services should
increase our success rate beyond the national average.
Grace Manor has worked with local businesses, health care providers, individual members of 12-
step programs, and through the establishment of family support services, aftercare, GED
programs to provide wraparound services for clients during treatment and post -discharge. We
anticipate these combined, individualized wraparound services will increase our overall client
success rate.
c. What curriculum and strategies do you currently implement? Do these meet the grant
requirements listed in the scope of work? If not, what changes to programming need to
be made?
As stated in Question (a), Grace Manor uses Dr. Kenneth W. Wanberg and Dr. Harvey B.
Milkman text, Criminal Conduct and Substance Abuse Treatment: Strategies for Self -
Improvement and Change: Pathways to Responsible Living and its companion workbook as the
basis for our treatment program. We also use Seeking Safety by Lisa Najavits to address trauma.
Individual needs will be provided to clients as necessary. Divided into three phases, our
treatment program addresses the requirements expressed in Exhibit O, Section III, Part 19:
Recovery Oriented Values and Principles of RFP 21-15544-MA: Substance Use Disorder
Treatment Services: A) Choice and Self -Determination; B) Community Integration; C) Peer
Culture; D) Family Inclusion; E) Continuity of Care; F) Partnership -Consultant Relationships;
and G) Culturally and Linguistically Competent.
Wanberg's and Milkman's curriculum provides individual and group counseling that will meet
the menu of support and services that will correspond to a client's interests and recovery goals
while expecting them to reflect on their evolving expressed interests and needs.
If a client is enrolled in the inpatient treatment program, s/he will complete Phase 1 which
includes: 1) establishing the core strategies and conceptual framework for treatment; 2)
developing a therapeutic relationship and enhancing motivation; 3) facilitating a client's
learning, growth, and change; 4) using cognitive -behavioral therapies that will address any
unethical or illegal activities that contributed to one's addiction and encouraging change; and 5)
development of a relapse and recidivism prevention program specifically designed for the client.
Seeking Safety's curriculum allows the counselor, in both group and individual sessions, to
address issues surrounding trauma and substance abuse. Upon completion of inpatient treatment,
the client will transition to our outpatient program where s/he will complete Phases 2 and 3.
Phase 2 requires clients to develop relationships with other clients enrolled in their outpatient
group and further develop pro -social activities and life skills such as parenting, budgeting,
accessing and using social services, employment or educational opportunities, reconnecting with
family members, attending 12-step programs, etc. Phase 3 focuses upon the client fully
transitioning back into mainstream society as a clean and sober member of it. If a client is
enrolled in our outpatient program, s/he will complete all three phases while enrolled in the
program. Interpreters will be provided to clients who are not English proficient, have intellectual
disabilities, are reading deficient, or are hearing impaired.
d. How many people do you propose serving through this funding program?
As described in Question B, Grace Manor anticipates a maximum number of 22 inpatient clients
and 48 outpatient clients will be enrolled under the TRA program at one time throughout the
fiscal year.
TRF
Treatment of Adults
Response to Questions
a. What services do you provide and how long have you provided services? How do you
address the needs of the priority populations in the scope of work?
Grace Manor considers Region 1 and the City of Lubbock to be primary referral source. Our
goal is to work with the economically challenged, uninsured or underinsured, etc. and offer 100
percent, if needed, to Region and the City first. We will serve other groups and communities to
be good neighbors to our sister agencies and organizations throughout Texas.
Grace Manor provides the following services: 1) inpatient treatment; 2) outpatient treatment; 3)
screening assessments; 4) life skills; 5) family and community outreach; 6) educational and
chemical dependency programs; 7) relapse education and prevention; 8) family support services;
and 9) trauma -focused services.
Grace Manor has provided adult substance abuse treatment services since July, 2020. Grace
Manor is a division of Children's Hope, a youth behavioral treatment facility opened in 2002 and
is accredited by the Joint Commission. Combined with our behavioral and co-occurring
treatment for all ages, Grace Manor and Children's Hope has provided substance abuse
treatment, as part of wraparound services, to both youth and adults for 20 years.
Per the TRF Scope of Work, Grace Manor can provide inpatient treatment services for both
women. Our agency can provide up to 18 inpatient beds for adult women under the TRF grant.
Admission priority will be given to: 1) women who are pregnant; 2) women with children who
are involved with Child Protective Services and/or; and 3) women who are IV drug users.
Client needs will be addressed upon referral to Grace Manor from two broad primary sources: 1)
individual referral; and 2) referral from area hospitals, health care providers, homeless shelters,
medication assisted treatment facilities (MATS), law enforcement agencies, courts, Women's
Protective Services, Child Protective Services, and HHSC's Region 1 Outreach, Screening,
Assessment, and Referral (OSAR). Upon completion of the CMBHS Screening Assessment tool
and the client meets DSM-IV criteria for a substance abuse disorder, the client will be referred to
either inpatient or outpatient services at a level appropriate to their needs as determined by the
screening assessment. The client's financial eligibility will be determined during their CMBHS
screening. The client's continuum of care will be tailored to their specific needs throughout their
treatment episode.
Grace Manor will use two primary texts as a primary basis for its treatment program. Our
substance abuse treatment program is based upon working with clients who have a criminal
history and/or criminal mindset. The 22-year-old, evidence -based treatment curriculum used at
Grace Manor was developed by Dr. Kenneth W. Wanberg and Dr. Harvey B. Milkman. Their
books, Criminal Conduct and Substance Abuse Treatment: Strategies for Self -Improvement and
Change: Pathways to Responsible Living and its companion workbook serves as the primary
treatment program for Grace Manor's clients. Wanberg's and Milkman's text is used at most
state -funded substance abuse treatment and correctional programs. Grace Manor will use
Seeking Safety: A Treatment Manual for PTSD and Substance Abuse is an empirically -based
treatment program to address trauma. Our organization also utilizes volunteers from local 12-
step recovery programs. Grace Manor's licensed counselors and therapists work with clients to
provide recovery support services to assist the client in the initiation and maintenance of their
substance abuse recovery. Combined with the Wanberg and Milkman's texts and other curricula,
the in-, out-, and aftercare services provided by Grace Manor are supported through
Memorandums of Understanding (MOU) with the following internal and external groups: 1)
Grace Manor's recovery coach program that is provided by trained employees; 2) members of
12-step groups; 3) United Supermarkets; 4) half -way house programs; 5) local hospitals and
health care providers; and Mullins ISD. Grace Manor is the only substance abuse treatment
facility in the Lubbock area that offers wraparound educational services onsite through Mullins
ISD. We provide free GED testing and courses that can lead to any and all clients earning their
high school diploma or GED. We are currently seeking MOUs with local homeless shelters,
WPS, CPS, and various law enforcement and judicial agencies. Since Grace Manor has recently
moved into providing substance abuse treatment programs, our agency is finalizing our MOU
negotiations.
b. How many individuals do you serve daily and annually? What is your rate of
completion? What is the procedure for follow up after patient discharge?
Under the TRF grant, Grace Manor has the capacity to provide up to 24 female beds and 72
outpatient slots for female clients. Our agency employs adequate staff to ensure services for
maximum capacity, especially in light of the COVID-19 pandemic, in our inpatient and
outpatient programs. We anticipate filling 60 percent of our potential vacancies with clients who
will be funded under the TRF program. Our maximum annual capacity is 6,570 inpatient client
slots and 26,280 outpatient slots (72 outpatient slots X 365 = 26,280; 18 inpatient beds X 365
days = 6,570 slots annually). However, Grace Manor has established a financial review process
for clients. Using Federal Poverty Rate Guidelines, clients will be required to pay, based on a
sliding fee scale, their portion of treatment expenses. Therefore, Grace Manor will not bill the
TRF account for services to clients who can afford to pay for services, a portion of the services,
or have private insurance.
Service Type
Maximum
Capacity for
Enrolled at One
12 Months
Time
Adult Outpatient
72 slots
26,280 slots
Outpatient — Group
72 slots
26,280 slots
Counseling
Outpatient — Group
72 slots
26,280 slots
Education
Outpatient — Individual
72 slots
26,280 slots
Counseling
Adult Specialized Female
18 slots
6,570 slots
Residential Intensive
Adult Specialized Female
0
0
Residential Supportive
Adult Specialized Female
0
0
Residential Detox
Adult Specialized Female
0
0
Ambulatory Supportive
Adult Specialized Female
0
0
W/C Residential Intensive
Total Dollars Requested
Grace Manor anticipates our completion rate to exceed the national average, 20 percent of all
clients, admitted to a substance abuse treatment facility.
As stated in an article published on May 19, 2020 by the American Addiction Centers, "Rehab
Success Rates and Statistics — Research -Based Treatment and Practice -Based Evidence," a
solution to a low success rate is to marry research -based treatment of Cognitive Behavioral
Therapy with "practice -based evidence" using the experience of long-time counselors with
scientific backing of more accepted and established programs. Substance abuse programs, like
those provided at Grace Manor, that include a cognitive -behavioral treatment program, taught by
experienced counselors, and individualized wraparound services yield a higher success rate.
Delaware's Division of Substance Abuse and Mental Health Department implemented similar
strategies in 2001 when completion and success rates were less than 50 percent. Five years later,
their state -run facilities were running at a minimum capacity of 95 percent with 70 percent of
clients attending treatment and completing all services. Grace Manor's curriculum, experienced
employees, and establishing MOUs with agencies to provide wraparound services should
increase our success rate beyond the national average.
Grace Manor has worked with local businesses, health care providers, individual members of 12-
step programs, and through the establishment of family support services, aftercare, GED
programs and wraparound services for clients during and post -discharge. These will be provided
on an individual basis. We anticipate these combined, individualized wraparound services will
increase our overall client success rate.
c. What curriculum and strategies do you currently implement? Do these meet the grant
requirements listed in the scope of work? If not, what changes to programming need to
be made?
As stated in Question (a), Grace Manor uses Dr. Kenneth W. Wanberg and Dr. Harvey B.
Milkman text, Criminal Conduct and Substance Abuse Treatment: Strategies for Self -
Improvement and Change: Pathways to Responsible Living and its companion workbook as the
basis for our treatment program. We also use Seeking Safety by Lisa Najavits to address trauma.
Individual needs will be provided to clients as necessary. Divided into three phases, our
treatment program addresses the requirements expressed in Exhibit O, Section III, Part 19:
Recovery Oriented Values and Principles of RFP 21-15544-MA: Substance Use Disorder
Treatment Services: A) Choice and Self -Determination; B) Community Integration; C) Peer
Culture; D) Family Inclusion; E) Continuity of Care; F) Partnership -Consultant Relationships;
and G) Culturally and Linguistically Competent.
Wanberg's and Milkman's curriculum provides individual and group counseling that will meet
the menu of support and services that will correspond to a client's interests and recovery goals
while expecting them to reflect on their evolving personal interests and recovery goals.
If a client is enrolled in the inpatient treatment program, s/he will complete Phase 1 which
includes: 1) establishing the core strategies and conceptual framework for treatment; 2)
developing a therapeutic relationship and enhancing motivation; 3) facilitating a client's
learning, growth, and change; 4) addressing cognitive -behavioral therapies that will address any
unethical or illegal activities that contributed to one's addiction and encouraging change; and 5)
development of a relapse and recidivism prevention program specifically designed for the client.
Seeking Safety's curriculum allows the counselor, in both group and individual sessions, to
address issues surrounding trauma and substance abuse. Upon completion of inpatient treatment,
the client will transition to our outpatient program where s/he will complete Phases 2 and 3.
Phase 2 requires clients to develop relationships with other clients enrolled in their outpatient
group and further develop pro -social activities and life skills such as parenting, budgeting,
accessing and using social services, employment or educational opportunities, reconnecting with
family members, attending 12-step programs, etc. Phase 3 focuses upon the client fully
transitioning back into mainstream society as a clean and sober member of it. If a client is
enrolled in outpatient, s/he will complete all three phases while enrolled in the program.
Interpreters will be provided to clients who are not English proficient, have intellectual
disabilities, are reading deficient, or are hearing impaired.
d. How many people do you propose serving through this funding program?
Grace Manor anticipates a maximum number of 18 inpatient clients and 72 clients will be
enrolled under the TRF program at one time throughout the fiscal year.
COPSD
Treatment of Adults
Response to Questions
a. What services do you provide and how long have you provided services? How do you
address the needs of the priority populations in the scope of work?
Grace Manor considers Region 1 and the City of Lubbock to be primary referral source. Our
goal is to work with the economically challenged, uninsured or underinsured, etc. and offer 100
percent, if needed, to Region and the City first. We will serve other groups and communities to
be good neighbors to our sister agencies and organizations throughout Texas.
Grace Manor provides the following services: 1) inpatient treatment; 2) outpatient treatment; 3)
screening assessments; 4) life skills; 5) family and community outreach; 6) educational and
chemical dependency programs; 7) relapse education and prevention; 8) family support services;
and 9) trauma -focused services.
Chemical dependency education, relapse education, prevention, family support services, and
trauma -informed group counseling, group counseling, individual counseling, focus on trauma —
Strategies for Self -Improvement and Change/Seeking Safety.
Grace Manor has provided adult substance abuse treatment services since July, 2020. Grace
Manor is a division of Children's Hope, a youth behavioral treatment facility opened in 2002 and
is approved by the Joint Commission. Combined with our behavioral and co-occurring treatment
for all ages, Grace Manor and Children's Hope has provided substance abuse treatment, as part
of wraparound services, to both youth and adults for 20 years.
Per the COPSD Scope of Work, Grace Manor can provide inpatient treatment services for both
women and men. Underthe COPSD grant, our agency can provide up to 30 slots. Admission
priority will be given to: 1) women who are pregnant; 2) adults with children who are involved
with Child Protective Services; 3) are IV drug users: and 4) clients who present co-occurring
psychiatric and substance abuse disorders.
Client needs will be addressed upon referral to Grace Manor from two broad primary sources: 1)
individual referral; and 2) referral from area hospitals, health care providers, homeless shelters,
medication assisted treatment facilities (MATS), law enforcement agencies, courts, Women's
Protective Services, Child Protective Services, and HHSC's Region 1 Outreach, Screening,
Assessment, and Referral (OSAR). Upon completion of the CMBHS Screening Assessment tool
and the client meets DSM-IV criteria fora substance abuse and dual diagnosis disorder, the
client will be referred to either inpatient or outpatient services at a level appropriate to their
needs as determined by the screening assessment. The client will be referred to COPSD list for
additional counseling to treat his/her co-occurring mental health issues. The client's financial
eligibility will be determined during their CMBHS screening. The client's continuum of care
will be tailored to their specific needs throughout their treatment episode.
Our substance abuse treatment program is based upon working with clients who have a criminal
history and/or criminal mindset. The 22-year-old, evidence -based treatment curriculum used at
Grace Manor was developed by Dr. Kenneth W. Wanberg and Dr. Harvey B. Milkman. Their
books, Criminal Conduct and Substance Abuse Treatment. Strategies for Self -Improvement and
Change: Pathways to Responsible Living and its companion workbook serves as the primary
treatment program for Grace Manor's clients. Wanberg's and Milkman's text is used at most
state -funded substance abuse treatment and correctional programs. Grace Manor will use
Seeking Safety: A Treatment Manual for PTSD and Substance Abuse is an empirically -based
treatment program to address trauma. Treatment protocols for COPSD clients will be
individualized based upon their co-occurring mental health diagnoses. Since many clients' co-
occurring disorders will not be evident until substance abuse treatment begins, clients will not be
added to the list until additional mental health issues manifest. Grace Manor employs Licensed
Professional Counselors (LPC) and Licensed Professional Counselor interns (LPC-I) who can
provide the individualized co-occurring treatment for dual -diagnosed clients who qualify for
COPSD services.
Our organization also utilizes volunteers from local 12-step recovery programs. Grace Manor's
licensed counselors and therapists work with clients to provide recovery support services to
assist the client in the initiation and maintenance of their substance abuse recovery. Combined
with the Wanberg and Milkman's texts and other curricula, the in-, out-, and aftercare services
provided by Grace Manor are supported through Memorandums of Understanding (MOU) with
the following internal and external groups: 1) Grace Manor's recovery coach program that is
provided by trained employees; 2) members of 12-step groups; 3) United Supermarkets; 4) half-
way house programs; 5) local hospitals and health care providers; and Mullins ISD. Grace
Manor is the only substance abuse treatment facility in the Lubbock area that offers wraparound
educational services onsite through Mullins ISD. We provide free GED testing and courses that
can lead to any and all clients earning their high school diploma or GED. We are currently
seeking MOUs with local homeless shelters, WPS, CPS, and various law enforcement and
judicial agencies. Since Grace Manor has recently moved into providing substance abuse
treatment programs, our agency is finalizing our MOU negotiations.
b. How many individuals do you serve daily and annually? What is your rate of
completion? What is the procedure for follow up after patient discharge?
Grace Manor has the capacity to provide 40 inpatient beds and 120 outpatient slots. Our agency
anticipates a maximum of 100 percent capacity, especially in light of the COVID-19 pandemic,
in our inpatient and outpatient programs. Therefore, we have 30 slots available per day for
clients in need of grant support. Clients will receive a total of 20 one -hour sessions and will
spend an expected 2.5 months in COPSD counseling that will occur while enrolled in in- or
outpatient treatment and post -discharge. However, Grace Manor has established a financial
review process for clients. Using Federal Poverty Rate Guidelines, clients will be required to
pay, based on a sliding fee scale, their portion of treatment expenses. Therefore, Grace Manor
will not bill the TRA account for services to clients who can afford to pay for services, a portion
of the services, or have private insurance.
Service Type
Maximum
Capacity for
Enrolled at One
12 Months
Time (per week
completing a
four -week
span)
Co-occurring Psychiatric &
30
72
Substance Abuse Disorders
COPSD)
Total Dollars Requested
Grace Manor anticipates our completion rate to exceed the national average, 20 percent of all
clients, admitted to a substance abuse treatment facility.
As stated in an article published on May 19, 2020 by the American Addiction Centers, "Rehab
Success Rates and Statistics - Research -Based Treatment and Practice -Based Evidence," a
solution to a low success rate is to marry research -based treatment of Cognitive Behavioral
Therapy with "practice -based evidence" using the experience of long-time counselors with
scientific backing of more accepted and established programs. Substance abuse programs, like
those provided at Grace Manor, that include a cognitive -behavioral treatment program, taught by
experienced counselors, and individualized wraparound services yield a higher success rate.
Delaware's Division of Substance Abuse and Mental Health Department implemented similar
strategies in 2001 when completion and success rates were less than 50 percent. Five years later,
their state -run facilities were running at a minimum capacity of 95 percent with 70 percent of
clients attending treatment and completing all services. Grace Manor's curriculum, experienced
employees, and establishing MOUs with agencies to provide wraparound services should
increase our success rate beyond the national average. However, dual -diagnosed clients are less
likely to succeed if both their addiction and mental health issues are not simultaneously
addressed during and post -treatment release.
Grace Manor has worked with local businesses, health care providers, individual members of 12-
step programs, and through the establishment of family support services, aftercare, GED
programs and wraparound services for clients during and post -discharge. These will be provided
on an individual basis. We anticipate these combined, individualized wraparound services will
increase our overall client success rate who are enrolled in the COPSD program and substance
abuse treatment.
c. What curriculum and strategies do you currently implement? Do these meet the grant
requirements listed in the scope of work? If not, what changes to programming need to
be made?
As stated in Question (a), Grace Manor uses Dr. Kenneth W. Wanberg and Dr. Harvey B.
Milkman text, Criminal Conduct and Substance Abuse Treatment: Strategies for Self -
Improvement and Change: Pathways to Responsible Living and its companion workbook as the
basis for our treatment program. We also use Seeking Safety by Lisa Najavits to address trauma.
Individual needs will be provided to clients as necessary. Divided into three phases, our
treatment program addresses the requirements expressed in Exhibit O, Section III, Part 19:
Recovery Oriented Values and Principles of RFP 21-15544-MA: Substance Use Disorder
Treatment Services: A) Choice and Self -Determination; B) Community Integration; C) Peer
Culture; D) Family Inclusion; E) Continuity of Care; F) Partnership -Consultant Relationships;
and G) Culturally and Linguistically Competent.
Wanberg's and Milkman's curriculum provides individual and group counseling that will meet
the menu of support and services that will correspond to a client's interests and recovery goals
while expecting them to reflect on their evolving personal interests and recovery goals.
If a client is enrolled in the inpatient treatment program, s/he will complete Phase I which
includes: 1) establishing the core strategies and conceptual framework for treatment; 2)
developing a therapeutic relationship and enhancing motivation; 3) facilitating a client's
learning, growth, and change; 4) addressing cognitive -behavioral therapies that will address any
unethical or illegal activities that contributed to one's addiction and encouraging change; and 5)
development of a relapse and recidivism prevention program specifically designed for the client.
Seeking Safety's curriculum allows the counselor, in both group and individual sessions, to
address issues surrounding trauma and substance abuse. Upon completion of inpatient treatment,
the client will transition to our outpatient program where s/he will complete Phases 2 and 3.
Phase 2 requires clients to develop relationships with other clients enrolled in their outpatient
group and further develop pro -social activities and life skills such as parenting, budgeting,
accessing and using social services, employment or educational opportunities, reconnecting with
family members, attending 12-step programs, etc. Phase 3 focuses upon the client fully
transitioning back into mainstream society as a clean and sober member of it. If a client is
enrolled in outpatient, s/he will complete all three phases while enrolled in the program.
Interpreters will be provided to clients who are not English proficient, have intellectual
disabilities, are reading deficient, or are hearing impaired.
Combined with COPSD, dual -diagnosed clients will receive the counseling support that will
allow them to succeed post -release and ongoing recovery.
d. How many people do you propose serving through this funding program?
Grace Manor anticipates a maximum number of 30 clients will be enrolled under the COPSD
program at one time throughout the fiscal year. We anticipate clients will cycle through every
2.5 months with an estimated 72 clients entering and completing the program annually.
Exhibit D
BUSINESS ASSOCIATE AGREEMENT
BUSINESS ASSOCIATE AGREEMENT
This Business Associate Agreement (the "Agreement"), effective
is entered into by and between the City of Lubbock ("City" or
"Covered Entity") Children's Hope Residential Services, Inc. dba Grace Manor (the
"Business Associate"), (each a "Party" and collectively the "Parties").
Business Associate is a provider of City clients for Substance Use Disorder Treatment
Services. (the "Services"), and the Covered Entity is a political subdivision of the State of
Texas. The Parties have an agreement (the "Master Agreement") under which the Business
Associate regularly uses and/or discloses Protected Health Information in its performance of the
Services described. Both Parties are committed to complying with the Standards for Privacy of
Individually Identifiable Health Information under the Health Insurance Portability and
Accountability Act of 1996 ("HIPAA"). This Agreement sets forth the terms and conditions,
pursuant to which the Protected Health Information, that is provided, created, or received by the
Business Associate, from or on behalf of the Covered Entity, will be handled between the
Business Associate and the Covered Entity, and further with third parties during the term of the
Master Agreement and after its termination. The Parties agree as follows:
Covered Entity will make available to Business Associate certain information (e.g.,
medical records, patient information that is confidential and must be afforded special treatment
and protection) in connection with Services provided by Business Associate to Covered Entity
pursuant to the Master Agreement.
Business Associate will have access to and/or receive from Covered Entity certain
Information that can be used or disclosed only in accordance with this Agreement, the Master
Agreement and the Department of Health and Human Service Privacy Regulations.
Covered Entity and Business Associate agree as follows:
1. Business Associate shall not use or disclose Protected Health Information except
as provided in this Agreement, the Master Agreement or required by law.
A) The City of Lubbock agrees to provide Business Associate with a list of
employees who are authorized to request retrieval of government documents.
The City of Lubbock will be responsible for ensuring the fax machine is in a
secured area for the receipt of confidential information.
B) The City of Lubbock will fax to Business Associate a written, signed, and
dated release of information request to Business Associate at: (806) 687-
2772. Business Associate will verify the name of the requestor and the
incoming fax number prior to retrieving the requested document(s). Business
Associate will verbally contact the original requestor prior to faxing or
physically returning the documents and confirm request, verify documents,
fax number and/or ship to address.
C) Business Associate will return requested documents per City of Lubbock
instructions. Fax requested returns will be to the authorized requestor's
Business Associate Agreement — City of Lubbock Page 1 of 3
attention at (806)775-2164. Physical return of documents will be to the
authorized requestor's attention at: The City of Lubbock, Citizens Tower,
1314 Avenue K, 9th Floor, Lubbock, TX 79401
D) Business Associate will document method of return and original written
authorization of release. Business Associate will maintain all release
information for a period of six (6) years.
2. Business Associate shall implement and maintain appropriate safeguards to
prevent the use or disclosure of Protected Health Information other than as
provided herein.
3. Business Associate shall report to Covered Entity any use or disclosure of
Protected Health Information in violation of this Agreement or the Master
Agreement in which Business Associate becomes aware.
4. Business Associate agrees that anytime information is provided to or made
available to any subcontractors or agents, Business Associate shall enter into a
subcontract with the subcontractor or agent that contains the same terms,
conditions and restrictions on the use and disclosure of information as contained
in this Contract.
5. Business Associate shall make Protected Health Information available through
and upon written request of the Covered Entity, to the individual subjects of such
information.
6. Business Associate shall incorporate into this Agreement any amendments or
corrections to Protected Health Information when notified by Covered Entity.
7. Business Associate shall provide for an accounting of uses and disclosures of
Protected Health Information as requested by Covered Entity.
8. Business Associate shall make its internal practices, books and records relating to
the use and disclosure of Protected Health Information available to the Secretary
of the Department of Health and Human Services (HHS) as necessary for
purposes of determining Covered Entity's compliance with the HIPAA Privacy
Rule.
9. At termination of this Agreement Business Associate agrees to return or destroy
all information received from, or created or received by Business Associate on
behalf of Covered Entity. Business Associate agrees not to retain any copies of
the information after termination of this contract. If return or destruction of the
information is not feasible, Business Associate agrees to extend the protections of
this Agreement for as long as necessary to protect the information after the
termination of this Contract.
10. Covered Entity may terminate this agreement if it determines that Business
Associate has violated a material term of this agreement after first providing
written notice of such breach to Business Associate. Business Associate will then
Business Associate Agreement— atyof Lubbock Page 2 of 3
have seventy-two (72) hours to rectify said breach and notify Covered Entity of
the resolution.
11. If termination of the contract is not feasible, then Covered Entity must report this
violation to the Secretary of HHS.
12. The information shall be and remain the property of Covered Entity. Business
Associate agrees that it acquires no title or rights to the information, including any
de -identified information, as a result of this Contract.
In witness whereof, Business Associate and City have caused this Contract to be signed
and delivered by their duly authorized representatives, as of the date set forth above.
The City of Lubbock
:N
PrintName:
Title: N, .(kk-
Contractor
By:
Print Name:
Title: ' f U
Business Assodate Agreement— Otyof Lubbock Page 3 of 3
Exhibit E
City of Lubbock, TX
Purchasing & Contract Management
INSURANCE COVERAGE REQUIRED
TYPE OF INSURANCE
GENERAL LIABILITY
0 Commercial General Liability
❑ Claims Made ❑ Other
❑ W/Hea%y Equipment N Occurrence
❑ XCU
❑ To Include Products of Complete Operation Endorsements
❑ PROFESSIONAL LIABILITY ❑ Occurrence
❑ or Technical Errors and Omissions
❑ CYBER LIABILITY
❑
Occurrence
OTHER:
O Medical Malpractice
❑�
Occurrence
AUTOMOTIVE LIABILITY
0 Any Auto
❑
All O%%ned Autos
❑ Scheduled Autos
❑
Hired Autos
❑ Non -Owned Autos
EXCESS LIABILITY
COMBINED SINGLE LIMIT
General Aggregate
Products-Comp/Op AGG
Personal & Ad%. Injur%
Contractual Liability
Fire Damase (Any one Fire
Med Exp (Any one Person)
General Aggregate
General Aggregate
Combined Single Limit
General Aggregate
Per Occurrence
Aggregate
II❑ Umbrella Form Each Occurrence
(GARAGE LIABILITY
❑ Any Auto
EJ
romm
x
x
x
x
Aggregate
Auto Only - Fach Accident _
Other than Auto Only : Each Accident _
Aggregate
❑ BUILDER'S RISK ❑ 1000oofthe Total Contract Price
❑ INSTALLATION FLOATER ❑ 1000o of the Total Material Costs
❑ POLLUTION
❑ CARGO
❑■ WORKERS COMPENSATION or OCCUPATONAL MEDICAL AND DISABILITY 500.000
0 EMPLOYERS' LIABILITY �=
OTHER: COPIES OF ENDOSENIENTS ARE REQUIRED
❑■ City of Lubbock named as additional insured on Auto'General Liability on a primary and non-contributory basis.
To include Products and Completed Operations Endorsements
❑■ Waiver of subrogation in favor of the City of Lubbock on all coverages
❑ No insurance required.
IAdditional Comments:
CERTIFICATE OF INTERESTED PARTIES FORM 1295
loft
Complete Nos. 1- 4 and 6 if there are Interested parties. OFFICE USE ONLY
Complete Nos.1, 2, 3, 5, and 6 If there are no Interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form, and the city, state and country of the business entity's place Certificate Number
of business. 2020-689499
Children's Hope Residential Services, Inc. DBA Grace Manor
Lubbock, TX United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form Is 11/13/2020
being filed.
City of Lubbock, TX 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.
21-15544-MA
Substance Use Disorder Treatment Services
4 Nature of Interest --
Name of Interested Party City, State, Country (place of business) (check applicable)
Controlling Intermediary
Aldrich, James Lubbock, TX United States X
5 Check only if there is NO Interested Party. ❑
6 UNSWORN DECLARATION
My name is laftgs AlAdrAn and my date of birth is
My address Is
(street) (City) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing Is true and correct.
Executed in L 400+�� County, State of _ _ _ , on the day of dhgNj&., 20.70
(month) (year)
Signature of authorized agent of contracting business entity
(Decierant)
Forms provided by Texas Ethics Commission ,ethics.state.tx.us Version V1.1.3aGaaf7d
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:
2020-689499
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Children's Hope Residential Services, Inc. DBA Grace Manor
Lubbock, TX United States
Date Filed:
11/13/2020
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, TX
Date Acknowledged:
11/16/2020
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.
21-15544-MA
Substance Use Disorder Treatment Services
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
Aldrich, James
Lubbock, TX United States
X
5 Check only if there is NO Interested Party.
6 UNSWORN DECLARATION
My name is and my date of birth is
My address is
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in County, State of on the day of , 20
(month) (year)
Signature of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.3a6aaf74