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Home My WebLink AboutC2006-038 - 1/31/2006 - Approved . DEP ARTMENT OF STATE HEALTH SERVICES 1100 WEST 49TH STREET AUSTIN, TEXAS 78756-3199 '-;T A rE OF TEXAS DSHS Document No, 74600057412006 COL\iTY OF TRA VIS Contract Change Notice No. 08 rhe Department of State Health Services, heremafter referred to as RECEIVING AGENCY, did heretofore enter into a contract in wnting with CORPUS CHRISTI-NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) hereinafter referred to as PERFORMING AGENCY. The parties thereto now desire to amend such contract attachment(s) as follows: SUMMARY OF TRANSACTION: .A, TT NO. 01A: RLSS-LOCAI PUBLIC HEALTH SYSTEM f-.--...---..- ._____._.__. AIi terms and conditions not hereby amended remain m full force and effect. ---- EXHTfTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN. CORPUS CHRISTI (CITY OF) Authonzed Contracting Entity (type above If different from PERFORMING AGENCY) for and in behalf of: PERFORMING AGENCY: RECEIVING AGENCY: CORPUS CHRISTI-NUECES COlJNTY PUBLIC HEAL TH DISTRICT (CITY) DEPARTMENT OF STATE HEALTH SERVICES , B). Signature (i pe~n) authorized t(:sign) By "'.o'.~.. ~:;>1:;,.;. ..... . '\.! - (Signature of person authorized to sign) .1' ~=~eo r '/-<--~. rJO'e i Name and Tille) ". '~ v:!:J i V \~~4(- Bob Burnette, Director Client Services Contracting Unit (Name and Title) Date Date: .:,)IILfI[)~ I REC '( )MMENDED i~ By _~A.iIt( k"'L(C~t\i" /tU/1 (PERFORMING AGENCY Direc r, If dIfferent from person authof!zed to sign contract ATTEST: ~~ r:. '/ SR".flETARV -- 2006-038 01/31/06 Res026625 r\ JC CSCU - Rev, 6/05 1<JjJ 1(;~~5..... AU I "Ui(l~ " tlkJ"':'l._~ m- .. ..._.--.....~ ~F:Ct'T..v ~~ Cover Page 1 DSHS DETAILS OF ATTACHMENTS \tU DSHS Program IDI Term Financial Assistance Direct Total Amount Amd DSHS Purchase ! Assistance (DSHS Share) \io Order Number Begin End Source of ! Amount ! Funds* i ~-,_.-+-,-~~-" - -- f--- - ---- -- 01 rBIPC () \/0 1/0 ') 12/31/05 93 116 109,526.00 0.00 109,526.00 0000302370 l-_.__ , "-- f---- - e-.' 02 DIAB/CDSP 04/0 1/05 03/29/06 93988 89,782.00 0.00 89,782.00 0000304678 I -- f-- --- f-.--.-- t-- RLSS/LPHS 03A _0000310453 09/01/05 08/3 1/06 State 93.991 156,509.00 0.00 156,509.00 _._- I -- -- IMM/LOCALS I 04 0000309 ] 27 09/01/0) 08/3 1/06 State 93.268 144,350.00 0.00 144,350.00 -------- ---- , -,-_.- 1--- 05 TBIPC 09/01/0) 08/3 1/06 State ]42,307.00 0.00 ]42,307.00 .0000309464 i -.-.-. - f---- ---- ~- 06 CPS/BIO-LAB 09/01/05 08/3 1/06 93283 200,000.00 0.00 200,000.00 00003 10 ] 78 j - ! 07 NSS/WIC-CARD 10/0 1/0) 09/30/06 10557 0.00 0.00 0.00 i 0000311568 .- DSHS Document No 746000574] 200h Totals ! $842,474.00 $ 0.00 $842,474.00 Change No. 08 ! *Federal funds are indicated by a number from the Catalog of Federal Domestic Assistance (CFDA), if applicable. REFER TO BUDCiFT SECTION OF ANY ZERO AMOUNT A.TTACHMENT FOR DETAILS. Cover Page 2 DOCUMENT NO. 7460005741-2006 A TT ACHMENT NO. 03A PURCHASE ORDER NO. 0000310453 PERFORMING AGENCY CORPUS CHRISTI-NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) RECEIVING AGENCY PROGRAM: REGIONAL AND LOCAL SERVICES SECTION TERM: September 01 2005 THR U: August 3 I, 2006 It is mutually agreed by and between the contracting parties to amend the conditions of Document No. 7460005741 2006 -03as written below. All other conditions not hereby amended are to remain in full force and effect. SECTION 1. SCOPE OF WORK is revised to include the following: PERFORMING AGENCY shall comply with applicable RECEIVING AGENCY programmatic guidelines in accordance with activities outlined in the final accepted FY06 Service Delivery Plan. PERFORMANCE MEASURES PERFORMING AGENCY shall complete the PERFORMANCE MEASURES as stated in the FY 06 LPHS Service Delivery Plan, and as agreed upon by RECEIVING AGENCY, and hereby attached as Exhibit B. SECTION 1. SCOPE OF WORK, fourth paragraph, is revised to add the following bulleted items. . PERFORMING AGENCY'S FY 06 LPHS Service Delivery Plan; . FY 05 Texas Application for Preventive Health and Health Services Block Grant Funds: and . Government Code section 403.1055, "Permanent Fund for Children and Public Health" SECTION II. SPECIAL PROVISIONS, second paragraph, IS revised to add the followmg: PERFORMING AGENCY shall submit an Annual Budget and Expenditures Report in a format specified by and to RECEIVING AGENCY by December 15, 2006. ATTACHMENT - Page I DEPARTMENT OF STATE HEALTH SERVICES RECEIVING AGENCY PROGRAM: REGIONAL AND LOCAL SERVICES SECTION PERFORMING AGENCY: CORPUS CHRISTI-NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) CONTRACT TERM 09/0l/05 THRU: 08/3l/06 BUDGET PERIOD: 09/0l/05 THRU 08/3l/06 DSHS DOC. NO 7460005741 200603A CHG 08 REVISED CONTRACT BUDGET FINANCIAL ASSISTANCE OBJECT CLASS CATEGORIES C1JRRENT APPROVED CHANGE NEW OR REVISED BUDGET (A) REQUESTED (B) BUDGET (C) Personnel $68,335.00 $88,174.00 $156,509.00 Fringe Beneftts 0.00 0.00 0.00 Tra\e ~ 0.00 0.00 0.00 I I EqUipment r- 0.00 0.00 0.00 I SUppill." r- 000 0.00 0.00 I ( 'onrLL tual ;- 0.00 0.00 0.00 Other ~._-- 0.00 0.00 0.00 · i I or otal DIrect Charge' ~ $68,335.00 $88,174.00 $156,509.00 I ! ndireCl Charge, l' 0.00 0.00 0.00 rc l'J \1 f- $68,335.00 $88,174.00 $156,509.00 L PERH lRMING A.( ,ENCY SHARI I Program Income t- 0.00 0.00 0.00 ! Other Match r-----.-.- 0.00 0.00 0.00 I i- I REeF IVING AGENCY SHARE I" $68,335.00 $88,174.00 $156,509.00 r PERFORMING AGENCY SHARE $0.00 $0.00 $0.00 Deta!! on Indirect Cost Rate Type: Rate o.on Base $0.00 Total $0.00 Budget Justification Increase IS to budget additional funds for extended term of contract from 02/2812006 to 08/3112006. Revlsed Number to be Served/Units of Service: .~.966 Form No. GC-9 ECPS - Rev. 10/04 Financial status reports are due the 30th .,f December. 30th of March. 30th of June, and the 30th of November. = - .- .c .- ..= ~ ~ L .-1" c:o \1'.. M " r; -= ::: -? J'J -0 :: ::l ;.... - - -' Q,j Q. .- s.. Eo- ~ - ~ - [I.l 51 :: ~ ..c :: ~ .! S ~..a ~- s..lI'l ~8 ._ N - ~- Q I. ~j ~ .- e > ~ s.._ ~ Q., r:J'J~ J'J Q,j ';.; .- ~ s.. QJ ."Jj ..= ..... 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OJ) .... c: ,~ -0 C'::l - c: ..c: 0 ('j u 0.. c: ... 0 -' 0 ,- .... 3 "0 ('j E u 0 0 0 .... 0 4- OJ ... 5 -0 0.. f--- rJ) (I) ::E e;:; 4:"0 ;(; g- ~I-o 'r'll:: g C'::l c:: . 0"', VJ ~I (I) ,:s OJ) :,5~!~ u u 1 i____ CERTIFICA TIONREGARDING LOBBYING CERTIFICA TION FOR CONTRACTS. GRANTS. LOANS AND COOPERATIVE AGREEMENTS fhe undersigned certifies, to the best of his or her knowledge and belief that: 11) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or an employee of any agency, a member of Congress in cO,nnection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-111, "Disclosure Form to Report Lobbying," in accordance with it's instructions. ( J) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction impos~d by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. . I Si~ture \ '- l' ! -j ) G I .) ) Date Print Name of Authorized Individual '460005741 2006-03 Application or Contract Number CORPUS CHRISTI-NUECES CCUNTY PUBLIC HEALTH DISTRICT (CITY) Organization Name and Address 1702 HORNE ROAD ::ORPUS CHRISTI, TX 2?469_-000J