HomeMy WebLinkAboutC2005-329 - 6/14/2005 - ApprovedDEPARTMENT OF STATE HEALTH SERVICES
1100 WEST 49TH STRF. FT
AUSTIN~ TRx~,S 78756-3199
STATE ()F'I'EXA~
('O~ 'N'FY OI. TRAV'IS
DSHS Dormant No. 74~f3~'741Ag~f~
~ O~n~ NcO:~ No. 06
The Depm'tn~nt of Sm~ Ho~th S~'v~_e,~_ _ he~inm'~r refer~d m ~ ~NG A~, ~ ~ ~ i~ a ~ ~
~~O A~. ~ ~ ~ ~w ~ w ~ ~ ~h'~ ~s) u ~
S~Y OF ~~:
~NO.~B: ~S-~XX
AIl t~-n~ ~od conctiliom not I~ amop,4~l r~min in full tk~ and effect.
EXECI :TEl) IN DLrPLICATE ORIGINAL.~ ON THE DATES SHOWN.
CORPUS CI-~ ~.~1'I ¢crl'Y oF}
Am. hon-,'~ Cona'~--~_ Er~ty (type above
~ PI:.R.-~ }RMINO AOF=NCY) for ~ in
PERFOIOdlNG AGENCY:
RECEIVING AGI~ICY:
CORPUS CHRI~'~-~I~ COUNTY PUBLIC
I-W-~LLT~I DIs"rRICT (CITY)
DEPARTMENT OF STATE HEALTH ~I~VICB8
By:. (S~
Bob Bm"nell~ D~nc~a'
(Name ~nd Title)
DSHS
2005-329
06/14/05
Ord026297
DETAILS OF ATTACHMENTS
Fimn~iml A~i~
~,500.~0 0.00 2~.00
162,30~.00 0.00 162,305.00
.~6j274.00 0.00 306,274.00
38.756.00 0.00 3B,756.00
*Feb-mi tunds m~ ind~t,-a by n number from the Catalog of r--~t,-~l l)om~s~c Aasis~nce (CFDA), if ~.,I.,licah~ REFER TO
BI fEI(lET SFA"TION OF ANY ZF_.RO AMOUNT A'V'I'ACI-.IMEI~IT FOR DL~rAILS.
DOCUMENT NO. 7460005741A-2005
A'I~ACHMENT NO. 04B
PERFORMING AGENCY: CORPUS CHRISTI-NUF_L'~-q COUNTY PUBLIC HFJkLTH
DISTRICT (CITY)
RECF2VING AGENCY PROGRAM: COMMUNITY HgALTH SERVI_c~-q SECTION
TERM: September 01.2~04 THRU: Auguat 31. 2005
I! ~s m,,,nlly ~ by and between the contracting pm'tiea to amend the condi~mm of
I~cument No. 7460005741A2005 -04A aa written below. All other conditiona m~t het~
amended ar~ to remain in full fo, c~ and effect.
SFX'~TION I. SCOPE OF WORK. fifth para~m-aph with heading PERFORMANCE MEASURF_3,
ih replaced with the following:
The following performance meaaurea will be used to ~ in pert the PERFORMING
AGENCY'S effectiveness in providing the ~-rvice~ dmcribed in this contract Attachment,
without waiving the enforceability of any of the outer terrn~ of the conuact.
PERFORMING AGENCY ahall prowde medical servicea to 2e/7 u~d,?tic.~_,'d clienta who live
or receive aervicea in the following county(iea)/m'~a: Nuecea. The servicea ~ be provided to
th~ chents in th~ following population categoriea and in the following nt~mhera:
Numb~ of Cli~nt~
Women 19 and Under
61
Wcrm~ 20 to 34 191
W~m'~en 35 and Over
Mak-~ 3
Total Medical Clienta
277
SECTION Iff_ BUDGET is repla~d with th~ following:
SECTION m_ BUDGET:
PERFORMING AGENCY ahall ~ to the current schedule of allowable aervicea and ratm aa
referenced in SEC~ON II. SPECIAL PROVISIONS. aa amended and approved by the
R F~P2IVING AGENCY.
lotal payrr~-m~ will not exceed $38,756.00.
AI'TA~NT - Pa~ I