HomeMy WebLinkAboutC2005-478 - 9/13/2005 - ApprovedDEPAii'FMi~ OF STATE I~KALTH SERVICES
llM WE~T 49Tti STREET
AL~TIN, TEXAS 787~-3199
I:}~[S ~..~ No. 74~9r~1741 21Xl6
EXECq..rl'F~ ~]' DUPL~ATE OR[O'INALq ON THE DATES S'~IOWN.
,k~bon,md Cooaceol ~ (tl~e -~.,ve if dl.tlmm
09/13/05
Res026439
D~HS
DETAILS OF ATTACHMENTS
DI~'
02 C.~s2030467 !
R~.~t.PH~
O3
End Som:c of Amount
l~nds*
0b~ t/05 12/3 I/~ 93.t16 109,.q26.00
04~1~5 ~ 93.99,8 89,782.00
09~1~5 OR/'2M~ 111,166.50
T~
o4 I co.ob0~t~ -"l
'DSES Docnun~ No.74~.,~z41 2006
Ch~n~ No. 04
0~0
0~0
0~0
O_nO [
$ 0._m_ [
Tom
111,166..q0
144,3.50.00!
BIlDCtET ~ O~' ~ z.t~O AMOUNT A'I'I'ACHMENT POR DETAn -q
2
D(~ NO. 74~41-21X~
A"FrA~ NO. 04
I:~CHASE ORDE~ NO. 0000~ 12"/
I-n~.ALTH DIST~cr (CITY)
RECE[VINO ACII~NCY PR(XIRAM: IMMUNIZATION BRANCH
TERM: ~ 01, 2005 THRU: Augnm 31, 2006
S~I'ION L 5COPE OF WORK
tmn~nitted in writing to PERFORM~O Aol:~CY.
the iu~ cov~'-L~- of chil&~u tw~ ye.m~ of sbu or youn~ 0e~s thsu 3~ mo~
of sbu). PER_H3RMINO AO~CY ~all im:~qmom~e trsditiou~l mud
sy,a~ma~c ,ppru~chm de.igued to eli,,',+,',,,,,, t~ ~ i ...... ,,.,i,,-,~ daliv,~y, ,md
PERFORMINO Ac,~CY ~ m~xt ~11 ~m~o~k c~{tos~ u ~ i~ 25 ~
Admini~ve Code ('FAC) Psrt I §§97.i - 9~.6 m~d 119'/.101 - ~7.102.
PERPOR_MINO AC~CY mh~il roport all vs~ue s~ ovuut with the Nstiona{ Childhood Vsix:ine Injury ,Act of 1986.
PERFORMINO A(]EN~ ~ulll iufoml mmd ~ th~ l:mblic ~ ~ ~
ATrACHMBNT - P%~- I
PERPORMING AGENCY shall ensm~ a health car~ wcn'lffot~0 that is knowledg~.hl~
immumzstion s~vk~.
PERFORMI]VG AGENCY shall comply with writ~n policies and pmceduma l~vid~l
by RECEIVING AOENCY Pmgr-m in nutnnging sme-mpp{ied vaccine, incimiin8
guidelines for pmix~ su~ng~ hud handling of vnccinea.
PERFO~O AOENCY shall not amy vncctnationa to ~ciplenm bec~na~ thery do not
rusk~ within PERPO~O An~CY'S jumdiction.
whe~ public secU~ (ft~ or Iow cost) iuummization mrvice~ a~ offumd in
PERPORMING AGENCY'S local atun.
PER_PORMINO AOENCY shah no~ ~ n f~ f~' vncctnes pmvid~ by ~O
A~CY P~gmm. All vaccium olmmiued ~ ~O AGi~h'C'Y ~ ~mll
t~ uaed ~oleiy for putpomus of thi,~ comnct AtXacimMmt nnd shah notbe nord to ag~g~
TAC §1.91, no ooe shall be dmtied immnni,~tion s~&gu in ~ clinics ~ of
~tmbility to p~y th~ administration fee~ Fee ~dui~s shall no~ be I~ml o~ v~n~ ~
rormulalioa, or d~ in series. A copy of PERFORMING AGENCY'S Fee sched~ shall
be st~nitmd to RECEIVING Ac',~ Program by April 1".
AJI eqUtl:U~ and vaccine used by I:'ERIW~RMING A~CY which am [mmvtdod by
RECEIVll~O AOENCY Pmgr, tm= ,,h,{{ be s:countu:l for -- public ~.
RECEIVING AOENC'Y Pucr~-,,, will investiila{~ a;lUi.pug, ut or va:cin~ loaa, dustmction,
~ or o~er wasU: and may ~ PER_-~ORMINO Acn~cY to mp~ace or
r~imbtn~e ~0 AGENCY Program.
~ emh l~imt wit~ a fo~n that i~ nplxuved by RECEIVtNO AGENCY ~ in
compliancu with 25 TAC, Chaptn' 100 tu ~ pmmicipation in the statc-wia-
~mmuuization registry 0mmTrac).
PERI~R_MING AOENCY shall pmvi~ to RECEIVING AOENCY Program puriodk:
d~a umm~m of all vnccir~ ~lrnirdstered in a fornm that is ~co,~nnr{ble f~- inc. Ju~ion in
~ st,m~vide irnn'nmi~,ntlon l~ifo'y, lmmTrnc, ~x{ in iiccofdmx~ with th~ ~
prowded by RF.,CEIVUVO AGENCY.
ATTA~ - 1~ 2
^tmchrr~nt unless nmended. The following doctnaents n~ tmmrpom~d by nffemmce nad
mad~ a ptrt of this contract Attnchrnm~.
· Hgalthm~rl~fetyCod~l§81.023and 161.001-161.009, V'IXT~
· 2.5 TAC C'IuqWe~ 9"/;
· 25 TAC, Ch~pu~ 96;
· 2~ TAC, Chq:m~ 100;
· ~O A~a~ICY'S Sumdsrds for Publi~ H~alth CIh~ ~ ~
Augu~ 31, 2004;
· 1~O ACJ~3'~CY'S Vm:x~~lo D,~ Snrv'ed. lhm~ gnidolln~
· R.EC~O AOl~ ~y ~;
lznmuui.-,,~on ~ (ACIP) guickl~ iuduc~$ tho ,,.,,.,~_,r.
· S'tmmd~d~ fo~ Child ~ Ado~ {mrmmt~'-~on 1~ tioo~. ~ 8, 2002,
ro,::onmmmutod by time National V~:~ Advisory C~,.,,{,h~_. ~ by tho
LTrdted S~u~i,~ Public I-~ S~.__. mind m~kmm~l by {:lmm ~ ~ of
Within t~d.rty (30) days of re~:'~pt of nn smem:lod standing(s) or gutdolino(s),
PERIWIG AOENCY shall inform RECEIVINO AOENCY Progr~n. in writing, ff
it will no~ continue peffonnan~ under this Att~hmm~ in eom~ with tl~ stumbled
standa~l(s) or ~tdeline(n). RECEIVING AICf93VCy may tmmin~n t{~ c~mlrnct
Attnchmm~ imm~dialeJy o~ within a reasonable period of ~ ns d,.~.~ by
RECEIVING AGENCY.
Ali activities shall be porfon~ed in ncco~lance with PERI~RMXNO ACtEN~$ Aroma]
Plan and deuced budil~ as approved by RECEIVING AOENCY Program bmod on tho
2004 Interlocal Applic~on for Immtmi~,ntion Serv'k:~ UA ]i}4 0003.1, datmi Jun~ 16,
2003 md my ~XlU~t ma~w~l appacatiom. T'ne following ~ minim(s)
wiU be used, in pm't, to sssess FERFORMING ACIENCY~ effectivunma in [m~lding tim
A~FACHMENT - Pa~ 3
FER={=~O AOENCY ~hnll su~t to ~C] AC]{~ICY Ptugrnm lt~
monthly t~-lX, ttn of doses nclministe~d and the monthly bio{ogicnl m'd~ fcnmn in a
fu~nai lu~vid~ by ~O AOENCY and in ace~dance with tho sc{mednk~
and may consist of umil
Asaemnent. Feedlx,ck, l,~-'~tives, and eXchangu (AFiX) m~hodology as aMtan,~l
by RECEIVXNO AOENCY. PER=I:~R_MINO AOEb{'CY shah sub-~ ~- -- t
m~m{t~ to RBCBIVINO AOENCY Piugmm within two (2) wo~ks ~ compklion.
PI~J~R.W,~qG At'~=~iCY s~tll n~u, uit nnd e~mmll pmvicksra {nt~ tt~ Tox~
fo~ Chilcl~'n ~
1. lmpknz~tt a plan t~ i .~'uve vnccinnIiun covem~ ~
2. Work with the local WIC ai~n~e~ for ruf~'ml of uti:kn'-v - ',,,.~d WIC
~ Hen]th Depm'tme~ clinic~;
lmmTmc;
in h'm~Tmc;
8. ~ tho numb=r of educatimud oplxxUmitie~ on vacci~-~
with em!,h~s ou pocketm of ~
11. Inc'r~aa~ the reporting of vmtceila case~;
12. Coa~pl~u 90~ of vnccine-l:,~venmble dise~s~ invoatigntioua within ~ (30)
13. Identify all iufants ~ to hep~ B suffice ~ti~ (HBaAO)-pontti~
~ ,#omen. PERPOR.MINO AGENCY shah investtlln~ 100~, of
ueaununi 8nd follow-up ,,, clize~od by l:~dth mud Safety Code 181.090 snd
A'I~A~- Pn8~ 4
RECEIVING A~CY'S Vnccin~-Prc-vemtnb~ ~ ~~
Guidelines;
i4. Enaum all reported infnnta born to I-IBsAg p~itive women m~five hetmti~ B
vaccine and l-l~patitis B lmmtme Globulin (I-IBIO) within seven Or) days of
birth;
15. Coh,plgte 100% of assigned chttdca~ facility ,,--,~s-rrmnta or stn'vey~; and,
16, Complete 100% of assigned public or l~ivnt~ school n,--~-m~'~t~ or surveryt
A~.~dvitim may be subsequently nmended as ~ by tim ~ fer ~
Comml a~d Pmventicm nad ~O AOENCY Pmsl~m. RIK2BIVIN~
ACiBIqCY Program must st~rove, in wrifin~ ~y mvi~on~ t~ ~O
A(3i~'$ Anmmi Plato
SECTION H. SPECIAL PROVISIONS
PERlaORMING AOBNCY shnll comply with Texas l:i~lh nnd Snf~ty Cede, Oaal~'s 81
and 161.
/~ ~rvic¢.~. ,~..~.~,4 Stme 16, 2003 sad nny su~equ~tt renewal
Travel expenses ahnll be mimburned ~$ to curm~t stn~ travel mgulali~m nnd nlml]
the reimlmt~x~ for milen~ allowed undm' th~ A~ A~
Monthly billin~ mint be sutn~tt~I on · StYe ~f Te~ns Vo~mlmr R~lumt form no inmr
than the ¢lo~e of tim following month.
PERFO~G A~ is ~ to com~L,~ and submit the fotlowing mpmU
~lizing a forn~ p,,~vided by RECEIV]~O AOENCY Pmgnn~
For ]rnmtmi~,nvion activities perfommd ttnd~ tiffs contxact A"-~hm~t; Oemnl
Pmvtsiom, Overflm~ Co--2' 'l~m A.rticl~ is not applicat~. In addition,
PER_.t~RMING AGENCY shall comply with th~ following paragmt~:
~O AOENCY is aulhorized m l~y employ,~___ who m not t~pt
under the Fab' Labor Standarc~ Act (FLSA), 29 USC, Omt~sr 8, [201 et ~Cl., for
A~I'ACHbq~NT _ P~ $
FERPORMINO AGENCY is ~.~'ized to pay em?loyem who m'e exempt und~
FLSA o~ s sa'ai~ht time bnais for work p.~f~.,ed on a holiday o~ for ~
CmnlXn'~atm'y ~rne hoots when the tn]ting of regular co~IX~'"~ ~ off wonbt
Aulhortz~on for I~nyment under this lXOVi~ ii lin,riled to weft dilectly teJAod
to imm[mi~,,~ioo activities and dllH be in ICcofdaAce with the al~ottflt Ix]d~ed tn
this con~a~ Attw..hmem. PE1U~ORMING AGENCY shah do~m~..~ ~
A]"I'AC}-IlV~:~VT - PmS~ 6
~iECTION III. BUDGET:
$115~27.00
2S.S23~O
0~0
0~0
0.00
0.00
0.00
Sl~,3.~o.oo
$o. oo
$144,35o.oo
Total reim~ will nc~ exceed $144,350.00.
of November.
(1) Nofedernl -,tKOp. htL.4 fambhavebem pdd orwlii belmld, bym-~mbebalfaftim
(2)
meemy, · nmnMm' d C, ongrmmm, mn mfficmm- ur . .k:d d ~ o~an
·.im, Ttt d · nmnbm' d ~ h, ..-.,,-.mkm wlthtM, fmdmrml,. , k [rant,
Form-Ill, "l:)bclesure Form to RfNJort Lobbylnl." tn re:em'dinah with tt's
(3)
Print Nnn~ ofA~tbrni.~d individ~M
746ooo57u 2oo6-o~
App~ -'b oF C_,mdzuet Number
1702
78469-0000