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Home My WebLink AboutC2012-360 - 9/18/2012 - ApprovedDEPARTMENT OF STATE HEALTH SERVICES This contract, number 2013 - 041112 (Contract), is entered into by and between the Department of State Health Services (DSHS or the Department), an agency of the State of Texas, and CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) (Contractor), a Government Entity, (collectively, the Parties). 1. Purpose of the Contract. DSHS agrees to purchase, and Contractor agrees to provide, services or goods to the eligible populations as described in the Program Attachments. 2. Total Amount of the Contract and Payment Method(s). The total amount of this Contract is $775,666.00, and the payment method(s) shall be as specified in the Program Attachments. 3. Funding Obligation. This Contract is contingent upon the continued availability of funding. If funds become unavailable through lack of appropriations, budget cuts, transfer of funds between programs or health and human services agencies, amendment to the Appropriations Act, health and human services agency consolidation, or any other disruptions of current appropriated funding for this Contract, DSHS may restrict, reduce, or terminate funding under this Contract. 4. Term of the Contract. This Contract begins on 09/01/2012 and ends on 08/31/2013. DSHS has the option, in its sole discretion, to renew the Contract as provided in each Program Attachment. DSHS is not responsible for payment under this Contract before both parties have signed the Contract or before the start date of the Contract, whichever is later. 5. Authority. DSHS enters into this Contract under the authority of Health and Safety Code, Chapter 1001. 6. Documents Forming Contract. The Contract consists of the following: a. Core Contract (this document) b. Program Attachments: 2013 - 041112 -001 2013 - 041112 -002 Section/Laboratory Response 2013 - 041112 -003 2013 -041112 -004 2013- 041112 -005 Activities 2013 - 041112 -006 2012 -36007 9/18/12 Ord. 029628 Dept. of State Health Services Tuberculosis Prevention and Control - State Preparedness and Prevention Community Preparedness N CPS - LABORATORY RESPONSE NETWORK -PHEP Infectious Disease Control Unit/FLU -LAB Immunization Local Health Departments Coalition Collaboration RLSS/LOCAL PUBLIC HEALTH SYSTEM -PnP Tuberculosis Prevention and Control - Federal ( INDEXED c. General Provisions (Sub- recipient) d. Solicitation Document(s), and (NA) e. Contractor's response(s) to the Solicitation Document(s). (NA) f. Exhibits Any changes made to the Contract, whether by edit or attachment, do not form part of the Contract unless expressly agreed to in writing by DSHS and Contractor and incorporated herein. 7. Conflicting Terms. In the event of conflicting terms among the documents forming this Contract, the order of control is first the Core Contract, then the Program Attachment(s), then the General Provisions, then the Solicitation Document, if any, and then Contractor' s response to the Solicitation Document, if any. 8. Payee. The Parties agree that the following payee is entitled to receive payment for services rendered by Contractor or goods received under this Contract: Name: CITY OF CORPUS CHRISTI Address: PO BOX 9277 CORPUS CHRISTI, TX 78469 -9277 Vendor Identification Number: 17460005741027 9. Entire Agreement. The Parties acknowledge that this Contract is the entire agreement of the Parties and that there are no agreements or understandings, written or oral, between them with respect to the subject matter of this Contract, other than as set forth in this Contract. By signing below, the Parties acknowledge that they have read the Contract and agree to its terms, and that the persons whose signatures appear below have the requisite authority to execute this Contract on behalf of the named party. DEPARTMENT OF STATE HEALTH SERVICES CORPUS CHRISTI- NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) B y: Signature of Authorized Official Date Bob Bumette, C.P.M., CTPM B yam.._ .. Signature Date Print d ame and Title lank Leopard 5t. Director, lient Services Contracting Unit Coreas Gh�;�s},� tix'184o Address rt teuptcii...._.. 92648 -1 • 1100 WEST 49TH STREET AUSTIN, TEXAS 78756 City, State, Zip (512) 458 -7470 Bob.Burnette@dshs.state.tx.us 92648 -1 Telephone Number E -mail Address for Official Correspondence 1 Client Services Contracting Unit MC 1886 Department of State Health Services 1100 W 49* Street PO Box 149347 Austin TX 78714 -9347 Phone: (512) 458 -7470 Fax: (512) 458 -7351 YOUR DOCUMENTS PLEASE DO NOT RETURN THESE DOCUMENTS TO DSHS. THESE DOCUMENTS ARE TO BE RETAINED FOR YOUR RECORDS. Please retain this_ set of contract documents and any attached forms for your records. CONTRACT NO. 2013-041112 PROGRAM ATTACHMENT NO. 002 PURCHASE ORDER NO. 0000385246 CONTRACTOR: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS PROGRAM: Preparedness and Prevention Community Preparedness Section/Laboratory Response N TERM:09/01/2012 THRU: 08/31/2013 SECTION I. STATEMENT OF WORK: The Contractor shall assist The Department of State Health Service (DSHS) in the implementation of Office of the Assistant Secretary for Preparedness and Response (OASPR), Hospital Preparedness Program (HPP) - CFDA Number 93.889 - to enhance the ability of hospitals and health care systems to prepare for and respond to bioterrorism and other public health emergencies. Contractor shall conduct activities at the local level as stated in the Fiscal Year (FY) 2013 Hospital Preparedness Program Workplan for the Texas Laboratory Response Network (LRN), Exhibit A (Workplan). Contractor shall: • Maintain extensive collaboration with all hospitals located in the identified service area to plan for response activities for biothreats; • Present laboratory- oriented training to hospitals and reference laboratories in the identified service area on the LRN sentinel protocols to include packaging and shipping of both biological and chemical samples according to published Centers for Disease Control and Prevention (CDC) protocols; • Maintain a system for safe specimen transport from local laboratories; • Explore the capabilities and needs of sentinel laboratories; • Submit a quarterly report according to DSHS guidelines; and • Provide individual LRN surge capability plan. Contractor shall comply with all applicable federal and state laws, rules, and regulations including, but not limited to, the following: • Public Law 107 -188, Public Health Security and Bioterrorism Preparedness and Response Act of 2002; • Public Law 107 -188, Regulation of Certain Biological Agents and Toxins; • Public Law 109 -417, Pandemic and All - Hazards Preparedness Act of 2006; and • Chapter 81, Texas Health and Safety Code. ATTACHMENT — Page 1 Contractor shall comply with all applicable regulations, standards and guidelines in effect on the beginning date of this Program Attachment. The following documents are incorporated by reference and made a part of this Program Attachment: • FY 2013 Office of the Assistant Secretary for Preparedness and Response (OASPR) Hospital Preparedness Program - CFDA Number 93.889 - http: / /www.phe.gov/ preparedness /planning/hpp /pages /default.aspx • FY 2013 Hospital Preparedness Program Workplan for Laboratory Response Network (LRN) Laboratories; • Contractor's FY 2013 Applicant Information and Budget Detail; and • CDCs Local Emergency Preparedness and Response Inventory. Contractor shall notify DSHS in advance of Contractor's plans to participate in or conduct local exercises, in a format specified by DSHS. Contractor shall participate in statewide exercises planned by DSHS as needed to assess the capacity of Contractor to respond to bioterrorism, other outbreaks of infectious disease, and other public health threats and emergencies. Contractor shall prepare after - action reports, documenting and correcting any identified gaps or weaknesses in preparedness plans identified during exercises, in a format specified by DSHS. Contractor shall cooperate with DSHS to coordinate all planning, training and exercises performed under this Program Attachment with the Governor's Division of Emergency Management of the State of Texas, or other, points of contact at the discretion of the division, to ensure consistency and coordination of requirements at the local level and eliminate duplication of effort between the various domestic preparedness funding sources in the state. In the event of a public health emergency involving a portion of the state, Contractor shall mobilize and dispatch staff or equipment that were purchased with funds from this Program Attachment and that are not performing critical duties in the jurisdiction served to the affected area of the state upon receipt of a written request from DSHS. Contractor shall inform DSHS in writing if it shall not continue performance under this Program Attachment within thirty (30) days of receipt of an amended standard(s) or guideline(s). DSHS may terminate the Program Attachment immediately or within a reasonable period of time as determined by DSHS. Contractor shall develop, implement, and maintain a timekeeping system for accurately documenting staff time and salary expenditures for all staff funded through this Program Attachment, including partial Full Time Employees (FTEs) and temporary staff. DSHS reserves the right, where allowed by legal authority, to redirect funds in the event of financial shortfalls. DSHS will monitor Contractor's expenditures on a quarterly basis. ATTACHMENT -- Page 2 If expenditures are below that projected in Contractor's total Contract amount, Contractor's budget may be subject to a decrease for the remainder of the Contract term. Vacant positions existing after ninety (90) days may result in a decrease in funds. SECTION II. PERFORMANCE MEASURES: Contractor shall complete the PERFORMANCE MEASURES as stated in the attached Exhibit A (Workplan). Contractor shall provide reports as requested by DSHS to satisfy information - sharing requirements set forth in Texas Government Code, Sections 421 .071 and 421.072 (b) and (c). Contractor shall provide services in the following counties: Bee, Calhoun, Goliad, Jackson, Jim Wells, Kleberg, Live Oak, Nueces, Refugio, San Patricio, Victoria SECTION III. SOLICITATION DOCUMENT: Exempt — Governmental Entity SECTION IV. RENEWALS: Renewals are permitted on a one -year basis, at DSHS's discretion, and dependent upon funding availability, through FY 2013. SECTION V. PAYMENT METHOD: Cost Reimbursement Funding is further detailed in the attached Categorical Budget and, if applicable, Equipment List. SECTION VI. BILLING INSTRUCTIONS: Contractor shall request payment by submitting the State of Texas Purchase Voucher (Form B -13) on a monthly basis and acceptable supporting documentation for reimbursement of the required services /deliverables. Vouchers and supporting documentation should be mailed or submitted by fax or electronic mail to the addresses /number below: Claims Processing Unit, MC 1940 Texas Department of State Health Services 1100 West 49`h Street PO Box 149347 Austin, TX 78714 -9347 ATTACHMENT -- Page 3 The fax number for submitting State of Texas Purchase Voucher (Form B -13), and Financial Status Report to the Claims Processing Unit is (512) 458 -7442. The email address is invoices @dshs.state.tx.us. SECTION VII. BUDGET: SOURCE OF FUNDS: CFDA #93.889 DUNS Number 069457786 Funding is further detailed in the attached Categorical Budget and, if applicable, Equipment List. SECTION VIII. SPECIAL PROVISIONS: General Provisions, Article I Compliance and Reporting , Reporting Section 1.03 is revised to include: Reporting. Contractor shall submit reports in accordance with the reporting requirements established by the Department and shall provide any other information requested by the Department in the format required by DSHS. Failure to submit any required report or additional requested information by the due date specified in the Program Attachment(s) or upon request constitutes a breach of contract, may result in delayed payment and/or the imposition of sanctions and remedies, and, if appropriate, emergency action; and may adversely affect evaluation of Contractor's future contracting opportunities with the Department. Contractor shall submit quarterly progress reports to DSHS no later than thirty (30) days after the end of each quarter in a format specified by DSHS. Contractor shall provide DSHS other reports, including financial reports, and any other reports that DSHS determines necessary to accomplish the objectives of this contract and to monitor compliance. If Contractor is legally prohibited from providing such reports, it shall immediately notify DSHS. General Provisions, Article IV Payment Methods and Restrictions, Billing Submission Section 4.02, is amended to include the following: Billing Submission. Contractors shall bill the Department in accordance with the Program Attachment(s) in the form and format prescribed by DSHS. Unless otherwise specified in the Program Attachment(s) or permitted under the Third Party Payors section of this Article, Contractor shall submit requests for reimbursement or payment monthly by the last business day of the month following the end of the month covered by the bill. Contractor shall maintain all documentation that substantiates billing submissions and make the documentation available to DSHS upon request. Contractor shall submit requests for reimbursement or payment, or revisions to previous reimbursement request(s), no later than August 14, 2013 for costs incurred between the services dates of September 1, 2012 and June 30, 2013. General Provisions, Article IV Payment Methods and Restrictions, Financial Status Reports (FSRs) Section 4.05, is amended to include the following: ATTACHMENT — Page 4 26 Financial Status Reports (FSRs). Except as otherwise provided in these General Provisions or in the terms of the Program Attachment(s), for contracts with categorical budgets, Contractor shall submit quarterly FSRs to Accounts Payable by the last business day of the month following the end of each quarter of the Program Attachment term for Department review and financial assessment. Contractor shall submit the final FSR no later than sixty (60) calendar days following the end of the applicable term. Contractor shall submit FSRs to Accounts Payable by the last business day of the month following the end of each term reported. The FSR period will be reported as follows: Quarter One shall include September 1, 2012 through November 30, 2012. Quarter two shall include December 1, 2012 through February 28, 2013. Quarter three shall include March 1, 2013 through June 30, 2013. Quarter four shall include July 1, 2013 through August 31, 2013. Contractor shall submit the final FSR no later than sixty (60) calendar days following the end of the applicable term. General Provisions, Article V Terms and Conditions of Payment Article, is revised to include: Prompt Payment. Upon receipt of a timely, undisputed invoice pursuant to this Contract, Department will pay Contractor. Payments and reimbursements are contingent upon a signed Contract and will not exceed the total amount of authorized funds under this Contract. Contractor is entitled to payment or reimbursement only if the service, work, and/or product has been authorized by the Department and performed or provided pursuant to this Contract. If those conditions are met, Department will make payment in accordance with the Texas prompt payment law (Tex. Gov. Code Chapter 2251). Contractor shall comply with Tex. Gov. Code Chapter 2251 regarding its prompt payment obligations to subcontractors. Payment of invoices by the Department will not constitute acceptance or approval of Contractor's performance, and all invoices and Contractor's performance are subject to audit or review by the Department. Withholding Payments. Department may withhold all or part of any payments to Contractor to offset reimbursement for any ineligible expenditures, disallowed costs, or overpayments that Contractor has not refunded to Department, or if financial status report(s) required by the Department are not submitted by the date(s) due. Department may take repayment (recoup) from funds available under this Contract in amounts necessary to fulfill Contractor's repayment obligations. Condition Precedent to Requesting Payment. Contractor shall disburse program income, rebates, refunds, contract settlements, audit recoveries, and interest earned on such funds before requesting cash payments including any advance payments from Department. Acceptance as Payment in Full. Except as permitted in the Fees for Personal Health Services section of the Services Article of these General Provisions or under 25 Tex. Admin. Code § 444.413, Contractor shall accept reimbursement or payment from DSHS as payment in full for services or goods provided to clients or participants, and Contractor ATTACHMENT — Page 5 shall not seek additional reimbursement or payment for services or goods from clients or participants or charge a fee or make a profit with respect to the Contract. A fee or profit is considered to be an amount in excess of actual allowable costs that are incurred in conducting an assistance program. DSHS will monitor Contractor's billing activity and expenditure reporting on a quarterly basis. Based on these reviews, DSHS may reallocate funding between contracts to maximize use of available funding. General Provisions, Article VI Allowable Costs and Audit Requirements, Section 6.01 is amended to include the following: Allowable Costs. For services satisfactorily performed, and sufficiently documented, pursuant to this Contract, DSHS will reimburse Contractor for allowable costs. Contractor must have incurred a cost prior to claiming reimbursement and within the applicable term to be eligible for reimbursement under this Contract. DSHS will determine whether costs submitted by Contractor are allowable and eligible for reimbursement. If DSHS has paid funds to Contractor for unallowable or ineligible costs, DSHS will notify Contractor in writing, and Contractor shall return the funds to DSHS within thirty (30) calendar days of the date of this written notice. DSHS may withhold all or part of any payments to Contractor to offset reimbursement for any unallowable or ineligible expenditures that Contractor has not refunded to DSHS, or if financial status report(s) required under the Financial Status Reports section are not submitted by the due date(s). DSHS may take repayment (recoup) from funds available under this Contract in amounts necessary to fulfill Contractor's repayment obligations. Applicable cost principles, audit requirements, and administrative requirements include- Applicable Entity Applicable Cost Principles Audit Requirements Administrative Requirements State, Local and Tribal Governments OMB Circular A -87 (2 CFR, Part 225) OMB Circular A -133 and UGMS UGMS, OMB Circular A -102, and applicable Federal awarding agency common rule Educational Institutions OMB Circular A -21 (2 CFR, Part 220) OMB Circular A -133 OMB Circular A -110 (2 CFR, Part 215) and applicable Federal awarding agency common rule; and UGMS, as applicable Non - Profit Organizations OMB Circular A -122 (2 CFR, Part 230) OMB Circular A -133 and UGMS UGMS; OMB Circular A -110 (2 CFR, Part 215) and applicable Federal awarding agency common rule ATTACHMENT — Page 6 For - profit 48 CFR Part 31, OMB Circular A- UGMS and applicable Organization other Contract Cost 133 and UGMS Federal awarding than a hospital and an organization named in OMB Circular A -122 (2 CFR Part, 230) as not subject to that circular. Principles Procedures, or uniform cost accounting standards that comply with cost principles acceptable to the federal or state awarding agency agency common rule A chart of applicable Federal awarding agency common rules is located through a weblink on the DSHS website at http: / /www.dshs. state .tx.us /contracts /links.shtm. OMB Circulars will be applied with the modifications prescribed by UGMS with effect given to whichever provision imposes the more stringent requirement in the event of a conflict. For the purposes of this Program Attachment, funds may not be used for research, reimbursement of pre -award costs, purchase vehicles of any kind, new construction, or to purchase incentive items. General Provisions, Article XII General Business Operations of Contractor, Equipment Purchases, Section 12.20is revised as follows: Equipment (Including Controlled Assets). Equipment means an article, of nonexpendable, tangible personal property having a useful lifetime of more than one year and an acquisition cost of $5,000 or more, and "controlled assets." Controlled assets include firearms regardless of the acquisition cost, and the following assets with an acquisition cost of $500 or more, but less than $5,000: desktop and laptop computers (including notebooks, tablets and similar devices), non - portable printers and copiers, emergency management equipment, communication devices and systems, medical and laboratory equipment, and media equipment. Prior approval by DSHS of the purchase of controlled assets is not required. Contractors on a cost reimbursement payment method shall inventory all equipment, including controlled assets. Contractor shall initiate the purchase of all equipment approved in writing by DSHS, in the first quarter of the Contract or Program Attachment term, as applicable. Failure to timely initiate the purchase of equipment may result in the loss of availability of funds for the purchase of equipment. Requests to purchase previously approved equipment after the first quarter of the Program Attachment must be submitted to the contract manager assigned to the Program Attachment. Contractor is required to initiate the purchase of approved equipment and controlled assets no later than August 31, 2013 as documented by issue of a purchase order or written order confirmation from the vendor on or before August 31, 2013. In addition, all equipment and controlled assets must be received no later than 60 calendar days following the end of the Program Attachment term. ATTACHMENT — Page 7 General Provisions, Article XIH General Terms, Amendment Section 13.15, is amended to include the following: Amendment. The Parties agree that the Department may unilaterally reduce funds pursuant to the terms of this Contract without the written agreement of Contractor. All other amendments to this Contract must be in writing and agreed to by both Parties, except as otherwise specified in the Contractor's Notification of Change to Certain Contract Provisions section or the Contractor's Request for Revision to Certain Contract Provisions section of this Article. Contractor's request for certain budget revisions or other amendments must be submitted in writing, including a justification for the request, to the contract manager assigned to the Program Attachment; and if a budget revision or amendment is requested during the last quarter of the Contract or Program Attachment term, as applicable, Contractor's written justification must include a reason for the delay in making the request. Revision or other amendment requests may be granted at the discretion of DSHS. Except as otherwise provided in this Article, Contractor shall not perform or produce, and DSHS will not pay for the performance or production of, different or additional goods, services, work or products except pursuant to an amendment of this Contract that is executed in compliance with this section; and DSHS will not waive any term, covenant, or condition of this Contract unless by amendment or otherwise in compliance with this Article. Contractor shall submit all amendment and contract revision requests in writing to the Contract Manager at least 90 -days prior to the end of the term of this Program Attachment. Requests shall include all revised documents necessary to complete the amendment process (Le., revised budget(s) and /or revised supporting documentation.) Exceptions to the 90 -day rule must be pre - approved by DSHS. General Provisions, Article XIIf General Terms, Contractor's Request for Revision of Certain Contract Provisions Section 13.17 e), is amended to include the following: Contractor's Request for Revision of Certain Contract Provisions. A Contractor's Revision Request is an alternative method for amending certain specified provisions of this Contract that is initiated by Contractor, but must be approved by DSHS. The following amendments to this Contract may be made through a Contractor's Revision Request, rather than through the amendment process described in the Amendment section of this Article: a) cumulative budget transfers among direct cost categories, other than the equipment category, that exceed 25% of Program Attachments of $100,000 or more, provided that the total budget amount is unchanged (This subsection does not apply to contracts funded by funding sources that have different percentage requirements); b) budget transfer to other categories of funds for direct payment to trainees for training allowances; c) change in clinic hours or location; ATTACHMENT — Page 8 tq d) change in the equipment list substituting an item of equipment equivalent to an item of equipment on the approved budget; e) changes in the equipment category of a previously approved equipment budget; f) changes specified in applicable OMB Circular cost principles as requiring prior approval, regardless of dollar threshold (e.g., foreign travel expenses, overtime premiums, membership fees; and g) cumulative budget transfers into or out of the equipment category that do not exceed 10% of any Program Attachment, provided that the total budget amount is unchanged (cumulative transfers from or to the equipment category that equal or exceed 10% of any Program Attachment require an amendment to this Contract as described in the Amendment section of this Article). In order to request a revision of any of the enumerated provisions, Contractor shall obtain a Contract Revision Request form from the DSHS website available at http : /Iwww.dshs.state.tx.us /grants /forms.shtm, and complete the form as directed by the Department. Two copies of the completed form must be signed by Contractor's representative who is authorized to sign contracts on behalf of Contractor, and both original, signed forms must be submitted to the contract manager assigned to the Program Attachment. Any approved revision will not be effective unless signed by the DSHS Director of the Client Services Contracting Unit. A separate Contractor Revision Request is required for each Program Attachment to be revised. Circumstances of a requested contract revision may indicate the need for an amendment described in the Amendment section of this Article rather than a contract revision amendment under this section. Contractor is not required to submit a Contract Revision Request for a change in previously approved equipment when substituting an equivalent equipment item (For example, purchase of XYZ brand computer instead of approved ABC brand computer with essentially identical features as the XYZ computer). All requirements pertaining to Equipment, not otherwise amended in this Program Attachment, remain in effect. ATTACHMENT — Page 9 2013- 041112 -002 Categorical Budget: UPPL.. CONTRACTUAL THE TOTAL DIRECT CHARGES INDIRECT CHAR( TOTAL HS SHA CONTRACTOR SHARE ►THER MATC $0.00 2,700. $40,014.00 $40,014.00 $0.00 Total reimbursements will not exceed $40,014.00 Financial status reports are due: 12/31/2012, 03/29/2013, 07/30/2013, 10/30/2013 (-' 0.4 O qi oc U en a 1- o U 0 Li Q ce Q E co 0 Q 1- Z a 1 Ili 13" z et 0 co 2 Y a. O C7 Z w O 0 w Q U u) fe▪ Z o H u) 000 N m o Z �- c' _ M Lli w c W Z cc cn w 0 o' re 1— z a. ▪ ag U ▪ O M i- m cc t J O 0 O 2 a; E cu Z L 0 ✓ co c 0 0 Exhibit A — Page 1 DSHS Doc. #2013 - 041112 -002 Program ID: CPS/L Education and Preparedness Training Z — cC . 0 0 C W L c Eua� 0to (a 0c0 4-QN p CO • a) U a) c N 'O O as 0 roc .c O O N-4 0 0 E O. co 2 �'� ate. ''nn Z�.y O) O ca 2 0 3 -0 _0 .U) -0�U7 Qc..a a) cn O 7 o 2 a) y• alN -0 a o -6 0_ E -0 0_ -LH2 1 I O 'O N O o '4- C'4-- — -0 Ca▪ m" c C '_ U O • N a) a �C 0 --. �> U Li U ra a) o. o c ;c0' O • 0 .- N 2 - N E O • Q C o— C U O O L o o u) -0 Cl- 0O)U).. 0< (13.0 o c o c▪ • c • U ' � O O a. O ) L U C • E� • 7.5 .L Q) 0 Q U to L• ai 0 C • O as Q O (13 O) -C N -Q O 0 Q 72. O .s � ) 0 Q, C aZ O a cc 61) CL O- 0 0 a) co a) w 0 o 0 Z'j CC '5 o w (.7) c a)0' O O O o N Q.4 1 O res L c 0 O Q 0 4) c a) 0 - N — o c co 0 Exhibit A — Page 2 CONTRACT NO. 2013-041112 PROGRAM ATTACHMENT NO. 003 PURCHASE ORDER NO. 0000385688 CONTRACTOR: CORPUS CHRISTI- NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS PROGRAM: CPS - LABORATORY RESPONSE NETWORK -PHEP TERM: 09/01/2012 THRU: 08/31/2013 SECTION I. STATEMENT OF WORK: Contractor shall perform activities in support of the Centers for Disease Control and Prevention (CDC) Cooperative Agreement Work Plan for Public. Health Emergency Preparedness (Funding Opportunity CDC-RFA-TP12-1201). CDC's new five -year Public Health Emergency Preparedness Cooperative Agreement is designed to upgrade and integrate state and local public health jurisdictions' preparedness for and response to bioterrorism, outbreaks of infectious disease, and other public health threats and emergencies. The existence of any one of these conditions constitutes an "incident ". Contractor shall conduct activities at the local level as stated in the Fiscal Year (FY) 2013 Public Health Emergency Preparedness Workplan for Laboratory Response Network (LRN) Laboratories. Contractor shall: A) Maintain a confirmatory bioterrorism testing laboratory with a staff trained and proficient in CDCs LRN biothreat protocols; B) Test samples from identified service area for biothreat agents and toxins. Once biological agent is identified, Contractor shall be prepared to test for other infectious agents and for other public health threats and emergencies; C) Test food samples for select biological agents using conventional and advanced bacteriological techniques and CDC -LRN protocols; D) Maintain extensive collaboration with local law enforcement, hazardous material and other emergency responders. In addition, Contractor shall prepare Standard Operating Procedures and Standard Operating Guidelines (SOPs /SOGs) covering interaction with these agencies in the event of an emergency or incident; E) Upon request provide copies of all new or revised SOPs /SOGs related to preparedness to DSHS with quarterly report; F) Utilize DSHS's provided Public Health Laboratory Information Management System (PHLIMS) for reporting biothreat testing and results. This reporting shall include sample and laboratory data as well as the final report; G) Prepare current information during an incident; PROGRAM ATTACHMENT — Page 1 34 H) Submit a quarterly report according to DSHS guidelines; and I) Provide LRN surge capability plan. Contractor's laboratory microbiologist shall be responsible for training other Contractor laboratory staff in setting up and performing all diagnostic and reference testing for select biological agents; monitoring and evaluating biothreat incidents, outbreaks of infectious disease and other public health threats and emergencies; communicating with all other laboratories within the service area as defined by DSHS; and interacting with DSHS and CDC. Contractor shall comply with all applicable federal and state laws, rules, and regulations including, but not limited to, the following: • Public Law 107 -188, Public Health Security and Bioterrorism Preparedness and Response Act of 2002; • Public Law 109 -417, Pandemic and All- Hazards Preparedness Act of 2006; and • Chapter 81, Texas Health and Safety Code. Contractor shall comply with all applicable regulations, standards and guidelines in effect on the beginning date of this Program Attachment. The following documents are incorporated by reference and made a part of this Program Attachment: • Centers for Disease Control and Prevention (CDC) Guidance for Public Health Emergency Preparedness (http: / /www.cdc.gov /phpr /capabilities /index.htm); • FY 2013 Public Health Emergency Preparedness Workplan for Laboratory Response Network (LRN) Laboratories; • Contractor's FY 2013 Applicant Information and Budget Detail; and • CDCs Local Emergency Preparedness and Response Inventory. The CDC LRN -PREP Budget Period 1 (July 1, 2012 through June 30, 2013) funds awarded herewith must be matched by costs or third party contributions that are not paid by the Federal Government under another award, except where authorized by Federal statute to be used for cost sharing or matching. The non - federal contributions (match) may be provided directly or through donations from public or private entities and may be in cash or in -kind donations, fairly evaluated, including plant, equipment, or services. The costs that the contractor incurs in fulfilling its matching or cost - sharing requirement are subject to the same requirements, including the cost principles, that are applicable to the use of Federal funds, including prior approval requirements and other rules for allowable costs as described in 45 CFR 74.23 and 45 CFR 92.24. Contractor is required to provide matching funds for the CDC LRN -PHEP Budget Period 1 (July 1, 2012 through June 30, 2013) of the Funding Opportunity Number CDC -RFA- TP12 -1201 not less than 10% of total costs. Refer to the DSHS Contractor's Financial Procedures Manual, Chapter 9 (http: / /www.dshs.state.tx.us /contracts /cfpm.shtm) for additional guidance on match requirements, including descriptions of acceptable match resources. Documentation of match, including methods and sources, must be included in PROGRAM ATTACHMENT -- Page 2 35 the Contractor's contract budget and PHEP Contractor must follow procedures for generally accepted accounting practices and meet audit requirements. Contractor shall notify DSHS in advance of Contractor's plans to participate in or conduct local exercises, in a format specified by DSHS. Contractor shall participate in statewide exercises planned by DSHS as needed to assess the capacity of Contractor to respond to bioterrorism, other outbreaks of infectious disease, and other public health threats and emergencies. Contractor shall prepare after- action reports, documenting and correcting any identified gaps or weaknesses in preparedness plans identified during exercises, in a format specified by DSHS. Contractor shall cooperate with DSHS to coordinate all planning, training and exercises performed under this Program Attachment with the Texas Division of Emergency Management, or other points of contact at the discretion of the division, to ensure consistency and coordination of requirements at the local level and eliminate duplication of effort between the various domestic preparedness funding sources in the state. In the event of a public health emergency involving a portion of the state, Contractor shall mobilize and dispatch staff or equipment that were purchased with funds from this Program Attachment and that are not performing critical duties in the jurisdiction served to the affected area of the state upon receipt of a written request from DSHS. Contractor shall inform DSHS in writing if it shall not continue performance under this Program Attachment within thirty (30) days of receipt of an amended standard(s) or guideline(s). DSHS may terminate the Program Attachment immediately or within a reasonable period of time as determined by DSHS. Contractor shall develop, implement, and maintain a timekeeping system for accurately documenting staff time and salary expenditures for all staff funded through this Program Attachment, including partial FTEs and temporary staff. DSHS reserves the right, where allowed by legal authority, to redirect funds in the event of financial shortfalls. DSHS will monitor Contractor's expenditures on a quarterly basis. If expenditures are below that projected in Contractor's total Contract amount, Contractor's budget may be subject to a decrease for the remainder of the Contract term. Vacant positions existing after ninety (90) days may result in a decrease in funds. SECTION II. PERFORMANCE MEASURES: Contractor shall complete the PERFORMANCE MEASURES as stated in the attached Exhibit A. Contractor shall provide reports as requested by DSHS to satisfy information - sharing requirements set forth in Texas Government Code, Sections 421 .071 and 421.072 (b) and (c). PROGRAM ATTACHMENT -- Page 3 Contractor shall provide services in the following counties: Aransas, Bee, Calhoun, Goliad, Jackson, Jim Wells, Kleberg, Live Oak, Nueces, Refugio, San Patricio, Victoria SECTION III. SOLICITATION DOCUMENT: Exempt -- Governmental Entity SECTION IV. RENEWALS: DSHS may renew the Program Attachment for up to three (3) additional one -year terms at DSHS's sole discretion. SECTION-V. PAYMENT METHOD: Cost Reimbursement Funding is further detailed in the attached Categorical Budget and, if applicable, Equipment List. SECTION VI. BILLING INSTRUCTIONS: Contractor shall request payment by submitting the State of Texas Purchase Voucher (Form B -13) on a monthly basis and acceptable supporting documentation for reimbursement of the required services /deliverables. Additionally, the Contractor shall submit the Match/Reimbursement Certification (Form B -13A) and the Financial Status Report (FSR -269A) on a quarterly basis. Vouchers and supporting documentation shall be mailed or submitted by fax or electronic mail to the addresses /number below. Claims Processing Unit, MC 1940 Texas Department of State Health Services 1100 West 49th Street PO Box 149347 Austin, TX 78714 -9347 The fax number for submitting State of Texas Purchase Voucher (Form B -13), Match/Reimbursement Certification Form (B -13A), and Financial Status Report to the Claims Processing Unit is (512) 458 -7442. The email address is invoices@dshs.state.tx.us. SECTION VII. BUDGET: SOURCE OF FUNDS: CFDA #93.069 DUNS NUMBER: 069457786 SECTION VIII. SPECIAL PROVISIONS: PROGRAM ATTACHMENT — Page 4 General Provisions, Article I, Compliance and Reporting , Section 1.03 is amended to include: Reporting. Contractor shall submit programmatic reports in accordance with the reporting requirements established by the Department and shall provide any other information requested by the Department in the format required by DSHS. Contractor shall provide DSHS other reports, including financial report, and any other reports that DSHS determines necessary to accomplish the objectives of this contract and to monitor compliance. If Contractor is legally prohibited from providing such reports, Contractor shall immediately notify DSHS in writing. Failure to submit any required report or additional requested information by the due date specified in the Program Attachment(s) or upon request constitutes a breach of contract, may result in delayed payment and/or the imposition of sanctions and remedies, and, if appropriate, emergency action; and may adversely affect evaluation of Contractor's future contracting opportunities with the Department. Contractor shall provide reports as requested by DSHS to satisfy information - sharing requirements set forth in Texas Government Code, Sections 421.071 and 421.072 (b) and (c). General Provisions, Article IV, Payment Methods and Restrictions, Billing Submission Section 4.02, is amended to include the following: Billing Submission. Contractors shall bill the Department in accordance with the Program Attachment(s) in the form and format prescribed by DSHS. Unless otherwise specified in the Program Attachment(s) or permitted under the Third Party Payors section of this Article, Contractor shall submit requests for reimbursement or payment monthly by the last business day of the month following the end of the month covered by the bill. Contractor shall maintain all documentation that substantiates billing submissions and make the documentation available to DSHS upon request. Contractor shall submit requests for reimbursement or payment, or revisions to previous reimbursement request(s), no later than July 30, 2013 for costs incurred between the services dates of September 1, 2012 and June 30, 2013. General Provisions, Article IV, Payment Methods and Restrictions, Financial Status Reports (FSRs) Section 4.05, is amended to include the following; Financial Status Reports (FSRs). Except as otherwise provided in these General Provisions or in the terms of the Program Attachment(s), for contracts with categorical budgets, Contractor shall submit quarterly FSRs to Accounts Payable by the last business day of the month following the end of each term reported. The FSR period will be reported as follows: Quarter One shall include September 1, 2012 through November 30, 2012. Quarter two shall include December 1, 2012 through February 28, 2013. Quarter three shall include March 1, 2013 through June 30, 2013. Quarter four shall include July 1, 2013 through August 31, 2013. PROGRAM ATTACHMENT — Page 5 Contractor shall submit the final FSR no later than sixty (60) calendar days following the end of the applicable term. General Provisions, Article VII, General Business Operations of Contractor, Section 12.20 Equipment (Including Controlled Assets)., is revised as follows: Equipment means an article of nonexpendable, tangible personal property having a useful lifetime of more than one year and an acquisition cost of $5,000 or more, and "controlled assets." Controlled assets include firearms regardless of the acquisition cost, and the following assets with an acquisition cost of $500 or more, but less than $5,000: desktop and laptop computers (including notebooks, tablets and similar devices), non - portable printers and copiers, emergency management equipment, communication devices and systems, medical and laboratory equipment, and media equipment. Prior approval by DSHS of the purchase of controlled assets is not required. Contractor is required to initiate the purchase of approved equipment and controlled assets no later than August 31, 2013 as documented by issue of a purchase order or written order confirmation from the vendor on or before August 31, 2013. In addition, all equipment and controlled assets must be received no later than 60 calendar days following the end of the Program Attachment term. General Provisions, Article V, Terms and Conditions of Payment, Section 5.01„ is revised to include: Prompt Payment. Upon receipt of a timely, undisputed invoice pursuant to this Contract, Department will pay Contractor. Payments and reimbursements are contingent upon a signed Contract and will not exceed the total amount of authorized funds under this Contract. Contractor is entitled to payment or reimbursement only if the service, work, and/or product has been authorized by the Department and performed or provided pursuant to this Contract. If those conditions are met, Department will make payment in accordance with the Texas prompt payment law (Tex. Gov. Code Chapter 2251). DSHS will monitor Contractor's billing activity and expenditure reporting on a quarterly basis. Based on these reviews, DSHS may reallocate funding between contracts to maximize use of available funding. Contractor shall comply with Tex. Gov. Code Chapter 2251 regarding its prompt payment obligations to subcontractors. Payment of invoices by the Department will not constitute acceptance or approval of Contractor's performance, and all invoices and Contractor's performance are subject to audit or review by the General Provisions, Article VI, Allowable Costs and Audit Requirements, Section 6.01, is amended to include the following: Allowable Costs. For services satisfactorily performed, and sufficiently documented, pursuant to this Contract, DSHS will reimburse Contractor for allowable costs. Contractor must have incurred a cost prior to claiming reimbursement and within the applicable term to be eligible for reimbursement under this Contract. DSHS will determine whether costs submitted by Contractor are allowable and eligible for reimbursement. For the purposes of this Program PROGRAM ATTACHMENT — Page 6 39 Attachment, funds may not be used for research, reimbursement of pre -award costs, purchase vehicles of any kind, new construction, or to purchase incentive items. If DSHS has paid funds to Contractor for unallowable or ineligible costs, DSHS will notify Contractor in writing, and Contractor shall return the funds to DSHS within thirty (30) calendar days of the date of this written notice. DSHS may withhold all or part of any payments to Contractor to offset reimbursement for any unallowable or ineligible expenditures that Contractor has not refunded to DSHS, or if financial status report(s) required under the Financial Status Reports section are not submitted by the due date(s). DSHS may take repayment (recoup) from funds available under this Contract in amounts necessary to fulfill Contractor's repayment obligations. Applicable cost principles, audit requirements, and administrative requirements include- Applicable Entity Applicable Cost Principles Audit Requirements Administrative Requirements State, Local and Tribal Governments OMB Circular A -87 (2 CFR, Part 225) OMB Circular A -133 and UGMS UGMS, OMB Circular A -102, and applicable Federal awarding agency common rule Educational Institutions OMB Circular A -21 (2 CFR, Part 220)[; UGMS, OMB Circular A -133 0M13 Circular A -110 (2 CFR, Part 215) and applicable Federal awarding agency common rule; and UGMS, as applicable and applicable] Non - Profit Organizations OMB Circular A -122 (2 CFR, Part 230) OMB Circular A -133 and UGMS UGMS; OMB Circular A -110 (2 CFR, Part 215) and applicable Federal awarding agency common rule For -profit Organization other than a hospital and an organization named in OMB Circular A -122 (2 CFR Part, 230) as not subject to that circular. 48 CFR Part 31, Contract Cost Principles Procedures, or uniform cost accounting standards that comply with cost principles acceptable to the federal or state awarding agency OMB Circular A- 133 and UGMS UGMS and applicable Federal awarding agency common rule PROGRAM ATTACHMENT — Page 7 A chart of applicable Federal awarding agency common rules is located through a weblink on the DSHS website at http: / /www.dshs.state.tx.us /contracts /links.shtm. OMB Circulars will be applied with the modifications prescribed by UGMS with effect given to whichever provision imposes the more stringent requirement in the event of a conflict. General Provisions, Article XIII, General Terms, Section 13.15, is amended to include the following: Amendment. The Parties agree that the Department may unilaterally reduce funds pursuant to the terms of this Contract without the written agreement of Contractor. All other amendments to this Contract must be in writing and agreed to by both Parties, except as otherwise specified in the Contractor's Notification of Change to Certain Contract Provisions section or the Contractor's Request for Revision to Certain Contract Provisions section of this Article. Contractor's request for certain budget revisions or other amendments must be submitted in writing, including a justification for the request, to the contract manager assigned to the Program Attachment; and if a budget revision or amendment is requested during the last quarter of the Contract or Program Attachment term, as applicable, Contractor's written justification must include a reason for the delay in making the request. Revision or other amendment requests may be granted at the discretion of DSHS. Except as otherwise provided in this Article, Contractor shall not perform or produce, and DSHS will not pay for the performance or production of, different or additional goods, services, work or products except pursuant to an amendment of this Contract that is executed in compliance with this section; and DSHS will not waive any term, covenant, or condition of this Contract unless by amendment or otherwise in compliance with this Article. Contractor must submit all amendment and revision requests in writing to the Division Contract Management Unit at least 90 days prior to the end of the term of this Program Attachment General Provisions, Article XIII, General Terms, Contractor's Request for Revision of Certain Contract Provisions Section 13.17, is amended to include the following: Contractor's Request for Revision of Certain Contract Provisions. A Contractor's Revision Request is an alternative method for amending certain specified provisions of this Contract that is initiated by Contractor, but must be approved by DSHS. The following amendments to this Contract may be made through a Contractor's Revision Request, rather than through the amendment process described in the Amendment section of this Article: a) cumulative budget transfers among direct cost categories, other than the equipment category, that exceed 25% of Program Attachments of $100,000 or more, provided that the total budget amount is unchanged b) budget transfer to other categories of funds for direct payment to trainees for training allowances; c) change in clinic hours or location; d) change in the equipment list substituting an item of equipment equivalent to an item of equipment on the approved budget; e) changes in the equipment category of a previously approved equipment budget; PROGRAM ATTACHMENT — Page 8 111 f) changes specified in applicable OMB Circular cost principles as requiring prior approval, regardless of dollar threshold (e.g., foreign travel expenses, overtime premiums, membership fees; and g) cumulative budget transfers into or out of the equipment category that do not exceed 10% of any Program Attachment, provided that the total budget amount is unchanged (cumulative transfers from or to the equipment category that equal or exceed 10% of any Program Attachment require an amendment to this Contract as described in the Amendment section of this Article). In order to request a revision of any of the enumerated provisions, Contractor shall obtain a Contract Revision Request form from the DSHS website available at http:l /www.dslis.state.tx.us /grants /forms.shtm, and complete the form as directed by the Department. Two copies of the completed form must be signed by Contractor's representative who is authorized to sign contracts on behalf of Contractor, and both original, signed forms must be submitted to the contract manager assigned to the Program Attachment. Any approved revision will not be effective unless signed by the DSHS Director of the Client Services Contracting Unit. A separate Contractor Revision Request is required for each Program Attachment to be revised. Circumstances of a requested contract revision may indicate the need for an amendment described in the Amendment section of this Article rather than a contract revision amendment under this section. Contractor is not required to submit a Contract Revision Request for a change in previously approved equipment when substituting an equivalent equipment item (for example, purchase of XYZ brand computer instead of approved ABC brand computer with essentially identical features as the XYZ computer). All requirements pertaining to Equipment, not otherwise amended in this Program Attachment, remain in effect. PROGRAM ATTACHMENT -- Page 9 ,2013 - 0{41.112 -003 Categorical Budget: FRINGE BENEFITS $23;138.00 EQUIPMENT CONTRACTUAL TOTAL DIRECT CHARGES TOTAL- $0.00 $177,136.00 $194,849.00 $17,713.00 Total reimbursements will not exceed $177,136.00 Financial status reports are due: 12/31/2012, 03/29/2013, 07/30/2013, 10/30/2013 The budgeted indirect cost amount is based an indirect cost rate agreement approved by a Federal cognizant agency or a state single audit - coordinating agency. A copy of the current approved rate agreement is on file at DSHS. DSHS Doc. 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N O u3 Z o .c ix N HCCI >� c O N N c u) (_ C c O O-7 a X ,r 0) W c L •Q c ca .c a)z� o N O E _ -ON3 a [r Q co ENVIRONMENTAL HEALTH RESPONDER - Included in the definition for Public Health Responder 0') U - a, (0 c a) 04 0 ..c a) 0 as c U_ •o c N 7 o as E N Q 0 +c- u) ) O a) o .- c�i E _N a) •1 >, a) a) c aw u) O c Z N N co co -U L) O c o c N a) ar a) 'vi ; ''u) c a u) c 2 a) Q O O X W O iii a) a) a) N Q) °' -C O V U c a�ili _ o = _ +. ,�2 O N •- 0_ C �. c Q) = t) L. o o �, O_0c 0 -oa 0 as � N o c _c; O_ as a) - Q. �oo .o N 0) o 13 a—� is omo oas a) 403 V) U O) 5 = E.c ?1 c I o •- ca E2V ` 0 a-+ W Z o o ❑ 0 o .c 2 _c Z:5 1- 1- a E H 2 a 0 W U W W o o re o 2 I-- a) H H co W U' ..... _°' a ZEc LLaa)) g Goa) PUBLIC HEALTH - Public health is the effort to protect, promote, maintain and restore a population's health. c co a) — N 'i 0 C0 0 N u) 03 N O g. a) O a) . c O ''-' 3 MI ' O (6 N 03 0 U 2 O C J. a V C N • O 03 O a . 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L° EXHIBIT A — Page 5 of 10 L!$ N c 05 CO c c A J N O� E NU)o c E L (a 0 'L7 .5 N 0 0 — 0 (s .c O O N 9+ p 'c c ]+ p U O 1 N Q N coo co Y � i �, N 0 p N cn 0 v- > cO o O Q 'O O C p 0 N • +' co 0 0 N (4 W N c C uj N 0 O a) O N i C a) N 10 0 O 0 ' C CD O E c (I) u) a) O O O E N (o ^ +' co3 u'c ir) 00aa)) o v)'ctia. Q. Zvi COE CON U) NEB N o o L U c 0 u> ai cn c CO CO CO '° d; U) o co -a0a op o cE 0 � ascta o L O .c O O (a al .,' p LEE 0.0 o_0 o p 0 O O ° U L C a) cll .c 7• 0 C C r-+ C N N w C� Z - O. U) 'F In ) O 0 0 C_ �CD O u) C ) n I—� W cu) d cn ccoo < > W 0Q- Maintain current Select Agent and APHIS permits. Obtain and maintain security clearances. O � L N O L L. 8 o -0 0 -c -E, o .s o0 --p 5.O u) • 'cot o a Z g y= o C E 1 J O o at= = 2 12 2.2 E(} v p • c ❑ p a O 1 L > L vp- 61•••• O ' Q) O W 0 ,C_ O _ 47. E CL Cr) 2 0E ❑ v ❑ E U (1) .1 cA 0 EXHIBIT A — Page 6 of I0 0 X a) - 0 a> C ":O c� 7 0 U QC _f V. 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O O O c a;_, 8_ >, O N N O N ' U -N V) C c LL O ca O a) ❑ N O ,� O a) C O i A .� U❑ N O +O-' ` �+ 7 "D ! a3 U N O` p) O' O Y c E - - a0+ E:" )a cca �m -°a�O'aa as•� c m¢_� C a) F2) mew c�-c; a�i �c �y o0� 20 'OE InE mU o• -2NZ c�° 2 a�E o� : W O_� 5c u,c�mt -CO c Zvi �Qm E E ins a) a) a) 0) `" c6 J O_ L- '''e. 2 N U O c ) a) a O "� J N RS U U C a) (a N c �' c� O i E O CL co C O (n U a) O - U a) cr a) O N❑ U U O N >, O N ❑ O = O .CO C O C fl. • O O O> O C Q <. "°:�.a tea) a_ as EcC EXHIBIT A— Page 8 of 10 O x z o m c c y o Q „ ce 03 0 N ^` .Q (6 0 N = X n O LL Li_ .�1 c E E c� C Q Cif a3 .E -c o .) N .c as O Q :. U_ E w co, •L Q) o N a) c U) 0. (� U >, o E O 0) c - c 0 If5 Q -j1 � c U) , E C`. o c, Ts E O o > E �.- C5 N Eo: ) V co co ..cD C.0) N -C (f) O - cn N �. . -0 C. C N L L W (3 O a) • q) CV c Rs � � �1"'. a . w co oCr_ 1 C C O U -c C 0_ CO a) a) CIS C C N 1 C) CIS c - O :7) cts C U C N 0) 0.,— 1 0 C w 0)O 0) v c (a• —L Lei J 4.4 > a • N N E Si O w .c >43 co Q N 0 a) Ca C Ca 0 L 'c 0 2 I-0 (' O {,c3 o N N 0 •C as -2 O C N 000cc Participate in Epi-X by having at feast one staff member registered. 1a3 0 a) N N m 0 X • oa) O o C.) t5 ❑ c L L c O- a) N co Q U 0 a) (.M N U co Ca U E C O Q O a) 4- a L u3 o Cif O N o a) c E a) cB o o - U o c- C Ca o (a N o 0-� E N +-� O O O o ❑ c +r ca c•�0 �o ,� � C o c4 O • C .O Q) o- o o 0 E E ona al a) W E U ro ca O Ca c 4_ 0Q a) O O C 0 p Q c Q 0 a) co ai 0 • If. E Ec� c.o o co c o tea)::. It; o V) m-V) a O a) p 0 a) o as c 4) C +. o E0 ccnca C o o 0 O 4 ,O C U ❑ O O E ❑ U � aa '- cc!0a) =m_ C 1(5 0 U G la EU a)oa) co a) c .- o E4) a) +� N c 2 E R: c U ca O cCa C 4w.. O }, O O O 0 o (4 ca c . (1) cc❑c -o❑0a) = ) a5 'as O aj a= E ` EC E m O- .O 0 :5.1a). N 0 co 02 fl:. 0 'j ❑ U O• -E (.o a) W(A•a)CU`*- ,alw�I�c.�c I— a) EXHIBIT A — Page 9 of 10 c� a� 0 L z o a) 3 c N 0 co c- w tn w N L c� a12 cp m a ro a) N -Q L 0. LL O0 C. ` (0 CO . 0 0;.:`: 0. 0 O : -� N 0 N ca: (o o0 Ca C O • (!) E • 0 O c U) C6 t (A 0 • U 1 0 = 0" CIS Q C (] E'° 2 3 9- N as ( aN U 2 a) QC = c .a ca aa)) -.-- 4' L= 0) L 0 2 d- a) 0 - a) - L (N U (� a) O c) a) � 2 i > E U) "in m u ) .1) O' U to a) 2 a) a) C a) i N a) C O Zr) O 4 '7 E E •= y CO _U C r) O C a ) ++ ct O O U _ (0 0 M L E O O N� U C`~ a) -0 E c.9 a) U 8- co a) c c4 L. O O a) o) a) ca 0 = u� N uS c E V 7 Q N= ` +- a3 N 8 •L a) 0 c a) O O • (� • Nom, +� �. a) -0 (L O N N 0� p U 03 .0 ▪ E Q) . a) Z U a c E a) ❑ 0 N a-, O- 0- Q U. O O co a) 'a a) O en , a) a) O `p 1— O C _i LB ±.' a) U i- "r O O V O_ cn . a) •1 _c a) 1- D a) M E °c O Q) �' 7 -O C 3 C 4 0O C") 0) 0 O < ° •c CO 2 Maintain CDC digital certificate for access to LRN Messenger C _a `"'. U O = O ▪ �, , 0 Q c 0. �O O U) O O a) O c O 0 ca _c a) 0 2c -0 .c a) 00 CO-. n 4 U N C • 0 OCL a_�. _0 _a w =W-0 O:1- al ca= c7)2 .: t ate) as U CL 40 ou O c�v—,❑ op 0 ` c O U -2 O Z' `- ('3 0 u) wCE_0.E 0�.-. =ol— 1"oc8_5 L O C 0 F:S - O_ ° _c u)'�nv)E0,�E a) 1 (6 1 0•in..c'u) 1—_2 EXHIBIT A— Page 10 of 10 CONTRACT NO. 2013-0411 12 PROGRAM ATTACHMENT NO. 004 PURCHASE ORDER N00000386017 CONTRACTOR: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS PROGRAM: Infectious Disease Control Unit/FLU -LAB TERM: 09/01/2012 THRU: 08/31/2013 SECTION I. STATEMENT OF WORK: Contractor shall identify and recruit submitters of clinical specimens through discussions and a mutual agreement with local health departments in the Contractor's service area. Contractor may contact Vanessa.Telles a dshs.state.tx.us, and flutexas @dshs.state.tx.us for guidance on appropriate submitters. Contractor shall: • receive clinical specimens Monday through Friday from designated submitters within the Contractor's service area; • test up to two hundred (200) clinical specimens meeting Clinical Laboratory Improvement Act (CLIA'88) specifications; • perform on each specimen, the Centers for Disease Control and Prevention (CDC) Real Time (RT) Polymerase Chain Reaction Method (PCR) for typing of influenza viruses; • retain positive influenza specimens through the end of May 20I3; • when directed by the Influenza Coordinator within the Emerging and Acute Infectious Diseases Branch, appropriately submit the requested number of positive specimens to the Laboratory Services Section, Texas Department of State Health Services, Austin, Texas or to another specified contract laboratory; • comply with Department of State Health Services (DSHS) Infectious Disease Control Unit (IDCU) Program established flu surveillance protocol; and • comply with Health and Safety Code Chapter §81.046 located at http: / /www. statutes.legis. state.tx.us /Docs /H S/htm/H S . 81.htm# 81.046. DSHS IDCU Program shall: • ensure Contractor receives a copy of the protocol, no later than the week ending October 6, 2012 (Mortality and Morbidity Weekly Report (MMWR) week 40). PROGRAM ATTACHMENT — Page 1 5L DSHS reserves the right, where allowed by legal authority, to redirect funds in the event of unanticipated financial shortfalls. DSHS Program will monitor Contractor's expenditures on a quarterly basis. If expenditures are below that projected in Contractor's Program Attachment amount, Contractor's budget may be subject to a decrease for the remainder of the Renewal Program Attachment term. Vacant positions existing after ninety (90) days may result in a decrease in funds. SECTION II. PERFORMANCE MEASURES: The following performance measure will be used to assess in part Contractor's effectiveness in providing the services described in this Contract without waiving the enforceability of any of the other terms of the Contract. Contractor shall: 1. Perform testing weekly unless no samples were received that week; 2. When requested, send samples of all specimens testing positive for influenza to the Laboratory Services Section, Department of State Health Services (DSHS), Austin, Texas or other designated laboratory within ten (10) business days of request; and 3. Provide and submit written weekly reports on the RT -PCR influenza testing results, in the format provided by DSHS, each Monday, or if a holiday the next business day, beginning October 8, 2012 by electronic mail to Vanessa.Telles @dshs.state.tx.us, Mitra.kookrna @dshs.state.tx.us, and flutexas @dshs.state.tx.us. SECTION III. SOLICITATION DOCUMENT: Exempt - Governmental Entity SECTION IV. RENEWALS: DSHS may renew this Program Attachment for up to one (1) additional one -year term at the sole discretion of DSHS. SECTION V. PAYMENT METHOD: Cost Reimbursement Funding is further detailed in the attached Categorical Budget and, if applicable, Equipment List. PROGRAM ATTACHMENT — Page 2 SECTION VI. BILLING INSTRUCTIONS: Contractor shall request payment using the State of Texas Purchase Voucher (Form B -13) on a monthly basis and acceptable supporting documentation for reimbursement of the required services /deliverables. Additionally, the Contractor shall submit the Financial Status Report (FSR- 269A) on a quarterly basis. Vouchers and supporting documentation should be mailed or submitted by fax or electronic mail to the addresses /number below. Claims Processing Unit, MC 1940 Department of State Health Services 1100 West 49th Street PO Box 149347 Austin, Texas 78714 -9347 The fax number for submitting State of Texas Purchase Voucher (Form B -13) and Financial Status Report to the Claims Processing Unit is (512) 458 -7442. The email address is invo ices @dshs . state. tx. us. SECTION VII. BUDGET: Source of Funds: State DUNS #: 069457786 SECTION VIII. SPECIAL PROVISIONS: General Provisions, Article XIII. General Terms, Section 13.15 Amendment, is amended to include the following: Contractor must submit all amendment and revision requests in writing to the Division Contract Management Unit at least ninety (90) days prior to the end of the term of this Program Attachment. PROGRAM ATTACHMENT — Page 3 :2013- 041112 -004 Categorical Budget: PERSONN FRINGE BENEFITS EQUIPMENT PPLIE CONTRACTUAL $0.00 TOTAL DIRECT CHARGES DIRECT CHAR TOTAL $0.00 $5,000.00 $5,000.00 CONTRACTOR SHARE Total reimbursements will not exceed $5,000.00 Financial status reports are due: 12/31/2012, 03/29/2013, 06/28/2013, 10/30/2013 CONTRACT NO. 2013 - 041112 PROGRAM ATTACHMENT NO. 005 PURCHASE ORDER NO. 0000385634 CONTRACTOR: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS PROGRAM: Immunization Local Health Departments Coalition Collaboration Activities TERM: 09/01/2012 THRU: 08/31/2013 SECTION I. STATEMENT OF WORK: Contractor shall implement and operate an immunization program for children, adolescents, and adults, with special emphasis on accelerating interventions to improve the immunization coverage of children two (2) years of age or younger (0 to 35 months of age). Contractor shall incorporate traditional and non - traditional systematic approaches designed to eliminate barriers, expand immunization capacity, and establish uniform operating policies, as described herein. Contractor shall be enrolled as a provider in the Texas Vaccines for Children Program (TVFC) by the effective date of this Renewal Program Attachment, and must adhere to the TVFC Operations Manual and associated TVFC policy guidelines provided by DSHS (located at http: / /www.dshs.state.tx.us /immunize /tvfc /tvfc manuaI.shtm). Contractor shall comply with written policies and procedures provided by DSHS in managing vaccines supplied through the TVFC program, including guidelines for proper storage and handling of vaccines and for safeguarding vaccine in the event of natural disaster. Contractor shall comply with all requirements laid out in the final, approved Exhibit A. • Contractor will continue to use the current vaccine management system as described in the TVFC Operations Manual until directed by DSHS to transition to a new "provider choice" system. Contractor shall, as directed by DSHS, implement provider choice in contractor's clinic(s) by the schedule provided by DSHS. • Contractor shall notify providers of changes to vaccine managements reporting, and present updates and training to providers, as requested by DSHS. This would include any transition to a "provider choice" system. • Contractor shall plan and implement community -based activities to accomplish the required tasks as specified in the final, approved (Exhibit A). Contractor shall report all reportable conditions as specified in 25 Texas Administrative Code (TAC) Part 1 § §97.1 -97.6 and § §97.101 - 97.102, and as otherwise required by law. Contractor shall report all vaccine adverse event occurrences in accordance with the 1986 National Childhood Vaccine Injury Act (NCVIA) 42 U.S.C. § 300aa -25 (located at http : /lvaers.hhs.gov /default.htm). PROGRAM ATTACHMENT — Page 1 Contractor shall inform and educate the public about vaccines and vaccine - preventable diseases, as described in the DSHS Immunization Contractors Guide for Local Health Departments. Contractor shall work to promote a health care workforce within the Local Health Department's service area (including Contractor's staff) that is knowledgeable about vaccines, vaccine safety, vaccine - preventable diseases, and delivery of immunization services. Contractor shall not deny vaccinations to recipients because they do not reside within Contractor's jurisdiction or because of an inability to pay an administration fee. Contractor shall comply with all applicable federal and state regulations and statutes, including but not limited to: • Human Resources Code §42.043, VTCA; • Education Code § §38.001 - 38.002, VTCA; • Health and Safety Code §§12.032, 81.023 and 161.001- 16L009, VTCA; • 25 TAC Chapter 97; • 25 TAC, Chapter 96; • 25 TAC, Chapter 100; • 42 USC § §247b and 300 as -25; and • Omnibus Budget Reconciliation Act of 1993, 26 USC §4980B. Contractor shall comply with current applicable state and federal standards, policies and guidelines, including but not limited to DSHS's Standards for Public Health Clinic Services, revised August 31, 2004 (located at http : / /www.dshs. state. tx.us /qmb /default.shtm#public). Contractor shall be responsible for conducting outreach regarding vaccinations for children (19 through 35 months of age in the Contractor's jurisdiction) included on the list distributed to Contractor by DSHS. Lists are distributed at the start of each tri- annual reporting period (September 1, 2012, January 1, 2013, and May 1, 2013). Contractor must receive written approval from DSHS before varying from applicable policies, procedures, protocols, and /or work plans, and must update and disseminate its implementation documentation to its staff involved in activities under this contract within forty -eight (48) hours of making approved changes. DSHS reserves the right, where allowed by legal authority, to redirect funds in the event of financial shortfalls. DSHS will monitor Contractor's expenditures on a quarterly basis. If expenditures are below what is projected in Contractor's total Renewal Program Attachment amount, Contractor's budget may be subject to a decrease for the remainder of the Contract term. Vacant positions existing after ninety (90) days may result in a decrease in funds. In the 2008 -2012 Centers for Disease Control and Prevention (CDC) Immunization Program Operations Manual (http: / /www.cdc.gov /vaccinesl vac -ben /policies /iponiidefault.htm), the CDC PROGRAM ATTACHMENT — Page 2 has identified the establishment of community stakeholder groups as one important aspect of the larger effort to increase immunization levels. The increasing number of recommended vaccines requires ongoing education for the public and medical providers, as emphasized in DSHS's Inter - Local Application Work Plan (http: / /www.dshs. state. tx. us /immunize /docs /ContractorlWork Plan.pdf) for local health departments. The CDC "encourages the use or development of coalitions, partnerships, and other unique relationships to maximize efforts" to involve the community in the evolving education regarding recommended immunizations. For this contract: Contractor shall engage community groups /stakeholders in a collaboration to increase community vaccination coverage levels throughout Texas, as described herein. Using Model Strategies for Successful Meetings (Exhibit B) and Partner Identification tool (Exhibit C) • The Contractor shall develop, lead, direct, and host no less than two (2) community planning group /coalition meetings in its local jurisdiction. • Contractor shall develop a planning group with the goal of establishing a sustainable mechanism on a local level that can be replicated utilizing best practices as identified by the CDC, http: / /www.cdc.gov /vaccines /partners.htm. • Best practices for increasing vaccination coverage levels include: o Working with other community associations and/or affiliations; o establishing "medical homes" for clients; utilizing effective reminder /recall systems; o Consistent use of an immunization ImmTrac registry; and o Provider education on vaccines; and public and parent education on the importance of vaccination completeness and timeliness. • Contractor will appoint a coalition coordinator and a facilitator; • Attend at least one TISWG meeting prior to December 31,2012; • DSHS shall coordinate all technical assistance to include specialized training and support provided by a DSHS designee; • At least one on -site technical assistance visit will occur during this contract period. Contractor shall comply with all applicable federal and state regulations and statutes, including but not limited to: • DSHS regulations at 25 TAC §97.101 & §97.221; and • Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) guidelines located at http: / /www.cdc.gov/ vaccines /recs /acip /default.htm. SECTION II. PERFORMANCE MEASURES: The following performance measure(s) will be used, in part, to assess Contractor's effectiveness in providing the services described in this Renewal Program Attachment, without waiving the enforceability of any of the terms of the Contract: • LHDs shall investigate and document, in accordance with DSHS Texas Vaccine- Preventable Disease Surveillance Guidelines (located at PROGRAM ATTACHMENT -- Page 3 ran http: / /www.dshs. state. tx. us /idcu /health/vaccine_ preventable _diseases /resources /vpd_guide.p df) and NBS Data Entry Guidelines, at least 90% of suspected reportable vaccine - preventable disease cases within thirty (30) days of notification. • LHDs shall complete 100% of the follow -up activities, designated by DSHS, for TVFC provider quality assurance site visits assigned by DSHS. • LHDs shall contact and provide case management to 100% of the number of hepatitis B surface antigen - positive pregnant women identified. • LHDs shall contact 1 00% or 400 per FTE (whichever is fewer) families of children who are not up -to -date on their immunizations according to the IrnmTrac- generated list provided to the LHD by DSHS at the beginning of each reporting period. • LHDs shall review 100% of monthly biological reports, vaccine order forms (when applicable), and temperature logs for accuracy to ensure the vaccine supply is within established maximum stock levels. • LHDs shall complete 100% of child -care facility and Head Start center assessments, in accordance with the Immunization Population Assessment Manual, as assigned by DSHS. • LHDs shall complete 100% of public and private school assessments, retrospective surveys, and validation surveys, in accordance with the Immunization Population Assessment Manual, as assigned by DSHS. • LHDs shall implement provider choice as directed by DSHS according to the schedule provided by DSHS. Contractor shall utilize the AFIX (Assessment, Feedback, Incentives, and eXchange) methodology, found in the Immunization Quality Assurance Tool Resource Manual, (located at http: / /www.dshs.state.tx.us /immunize /dots /QA site visit.pdf) to conduct quality assurance site - visits for all sub - contracted entities and non -local health department Women, Infant and Children (WIC) clinics. Assessment shall be done using the DSHS Immunization Quality Assurance Site Visit tool provided by DSHS and the Comprehensive Clinic Assessment Software Application (Co- CASA), as specified by the DSHS Program. Contractor shall submit assessment results to the designated DSHS Regional Immunization Program manager within two (2) weeks after completion. Contractor is required to complete and submit tri- annual reports, utilizing a format provided by the DSHS Program: Report Type Reporting Period Report Due Date Programmatic 9/1/2012 — 12/31/2012 1/30/2013 Programmatic 1/1/2013 — 4/30/2013 5/30/2013 Programmatic 5/1/2013 — 8/31/2013 09/30/2013 PROGRAM ATTACHMENT — Page 4 I� f Progress Reports for Collaboration/Coalition Activities Report Type Reporting Period Report Due Date Progress Report 9/1/2012- 10/31/2012 11/30/2012 Progress Report 11/112012- 12/31/2012 01/30/2013 Final Summary Report 05/01/2012- 12/3112012 02/28/2013 Tri- annual and Collaboration /Coalition Progress reports should be submitted electronically to dshsimrnunizationcontracts @dshs.state.tx.us according to the time frames stated above. In addition, Contractor shall: • Identify participants showing a commitment to collaborate with one or more community entities; • Provide signed letters of agreement or other- documentation of commitment by August 31, 2012; • Receive technical assistance to include specialized training and support provided by DSHS; • One (1) on -site technical assistance visit will be scheduled during this contract period; • Submit a final report Exhibit E by February 28, 2013. • Reports should be submitted electronically to: DSHSImmunizationcontracts@dshs.state.tx.us SECTION III. SOLICITATION DOCUMENT: Exempt — Governmental Entity SECTION IV. RENEWALS: DSHS may renew the Renewal Program Attachment for up to one (1) twelve -month term at DSHS's sole discretion. SECTION V. PAYMENT METHOD: Cost Reimbursement Funding is further detailed in the attached Categorical Budget and, if applicable, Equipment List. SECTION VI. BILLING INSTRUCTIONS: Contractor shall request payment using the State of Texas Purchase Voucher (Form B -13) and acceptable supporting documentation for reimbursement of the required services /deliverables. The Form B -13 can be found at the following link http://www.dshs.state.tx.us/grants/forms/b13form.doc. Vouchers and supporting documentation should be mailed or submitted by fax or electronic mail to the addresses /number below. PROGRAM ATTACHMENT — Page 5 Department of State Health Services Claims Processing Unit MC 1940 1100 West 49th Street P. O. Box 149347 Austin, Texas 78714 -9347 The fax number for submitting State of Texas Purchase Voucher (Form B -13) to the Claims Processing Unit is (512) 458-7442. The email address is invoices @dshs.state.tx.us. SECTION VII. BUDGET: SOURCE OF FUNDS: CFDA #93.268 and STATE DUNS NUMBER: 069457786 SECTION VIII. SPECIAL PROVISIONS: General Provision, Funding Article, Use of Funds Section, is revised to include: • Funds shall not be used for purchase of vaccines, inpatient care, construction of facilities, or debt retirement. • Travel expenses shall be reimbursed according to Contractor's written travel policy, as submitted and approved with Contractor's FY2011 Application for Immunization Funds. If no written travel policy was submitted, or if the submitted policy is not approved by DSHS, travel expenses shall be reimbursed according to current state travel regulations located at http:l /www. window. state .tx.uslcomptrolltexastra.html. For immunization activities performed under this Renewal Program Attachment, General Provisions, General Business Operations of Contractor Article, Overtime Compensation Section, is replaced with the following paragraphs: • Contractor is authorized to pay employees who are not exempt under the Fair Labor Standards Act (FLSA), 29 USC, Chapter 8, §201 et seq., for overtime or compensatory time at the rate of time and one -half per FLSA. • Contractor is authorized to pay employees who are exempt under FLSA on a straight time basis for work performed on a holiday or for regular compensatory time hours when the taking of regular compensatory time off would be disruptive to normal business operations. • Authorization for payment under this provision is limited to work directly related to immunization activities and shall be in accordance with the amount budgeted in this contract Attachment. Contractor shall document proper authorization or approval for any work performed by exempt or non - exempt employees in excess of forty (40) hours per work week. PROGRAM ATTACHMENT — Page 6 • All revenues directly generated by this Renewal Program Attachment or earned as a result of this Renewal Program Attachment during the term of this Renewal Program Attachment are considered program income; including income generated through Medicaid billings for immunization related clinic services. The Contractor shall use this program income to further the scope of work detailed in this Renewal Program Attachment, and must keep documentation to demonstrate such to DSHS's satisfaction. This program income may not be used to take the place of existing local, state, or federal program funds. General Provision, General Business Operations of Contractor Article, Property Inventory and Protection of Assets Section, is revised to include: All equipment used by Contractor which is provided by DSHS shall be accounted for as public property. The DSHS Program will investigate equipment loss, destruction, or other waste and may require (at its discretion) Contractor to replace or reimburse the DSHS Program. This provision does not waive any other remedies legally available to DSHS regarding contract breaches. PROGRAM ATTACHMENT — Page 7 61.1 2013- 041112 -005 Categorical Budget: PERSONNEL FRINGE BENEFITS T EQUIPMENT PPLIE CONTRACTUAL $185,703.00 $45,906.00 0,205 00 $0.00 NTH TOTAL DIRECT CHARGES INDIREGTCHARGES TOTAL 3,648. $254,137.00 CONTRACTOR SHARE TH ER MATE $254,137.00 254 137 $140,183.00 Total reimbursements will not exceed $254,137.00 Financial status reports are due: 12/31/2012, 03/29/2013, 06/28/2013, 10/30/2013 IMMILHD CCA DSHS Contract Number: 2013-041112 CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) EXHIBIT A Contractors are required to perform all activities of the annual Work Plan in compliance with all documents referenced in this Work Plan. 1. PROGRAM PLANNING AND EVALUATION General Requirement 1A: Implement a comprehensive immunization program. Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments. Activities 1A: • Adhere to Standards for Child and Adolescent Immunization Practices and Standards for Adult Immunization Practices found at: http: / /www.cdc.gov /vaccines /pubs /pinkbook/ downloads /appendiceslH/standards- pediatric.pdf and http : / /www.cdc.gov /vaccines/ pubs /pinkbook/ downloads /appendices /H/standards- adult.pdf. • Maintain current policies in compliance with the DSHS Immunization Contractors Guide for Local Health Departments and have them available to Contractor's staff. • Maintain staffing levels to meet required activities of the contract. • Lapse no more than 5% of total funded amount of the contract. • Submit required tri - annual reports by January 30, May 30, and September 30 of each contract term. 2. VACCINE MANAGEMENT (http: // www. dshs .state.tx.us /immunize /tvfc /tvfc manual.shtm) General Requirement 2A: Ensure that expired, wasted, and unaccounted -for vaccines do not exceed 5% in Contractor's clinics. Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments and TVFC Operations Manual. Activity 2A: • Maintain storage and handling polices and procedures according to the TVFC Operations Manual. • Ensure that appropriate Vaccine Management plan is in place at each clinic location and that it includes an updated Emergency Contingency Plan. General Requirement 2B: Assist all other TVFC providers in local jurisdiction with maintaining appropriate vaccine stock levels. Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments and TVFC Operations Manual. Activities 2B: • Evaluate maximum vaccine stock levels twice a year in all TVFC provider clinics under Contractor's jurisdiction and assess providers' inventories when visiting clinics. This activity will become part of the Electronic Vaccine Inventory (EVI) system and local health departments will be advised if any assistance on this activity is needed. • Review 100% of all vaccine orders, monthly biological reports, and monthly temperature logs for accuracy and to ensure that the vaccine supply requested is within established guidelines. Review may be done from a paper report or on the EVI system. • If vaccine is available locally, conduct transfers and/or deliveries to support the TVFC providers requesting assistance. • Educate and assist all TVFC providers with TVFC Provider Choice, as directed by DSHS o To avoid the appearance of impropriety, the LHD must not involve pharmaceutical manufacturer representative in provider choice trainings; or, the LHD must not take any other actions which appear to have a connection between activities sponsored under this contract and any other activities the LHD wishes to conduct on its own which would involve pharmaceutical manufacturer representatives giving presentations to providers. • Offer provider updates, training and information as changes to vaccine management occurs. 3. REGISTRIES (http: / /www.dshs. state .tx.us /immunize /providers.shtm and http: / /dshs. state. tx. us /immunize /immtrac /default.shtm) General Requirement 3A: Effectively utilize ImmTrac (the DSHS on -line immunization registry) in Contractor's clinics. Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments. Activities 3A: • Search for the client's immunization history at every client encounter. • Review the client's record for vaccines due and overdue according to the CDC Recommended Schedules at http: / /www.cdc.gov/ vaccines /recs /schedules /default.htm. • Report to ImmTrac all immunizations administered to children (younger than 18 years) and consented adults in Contractor's clinics, either directly into ImmTrac online or through TWICES. • Update demographic information as needed. • Follow recommended guidelines for obtaining and submitting ImmTrac consent forms according to the instructions found at http: / /www.dshs. state. tx. us / immunize /does /consent guidelines.pdf. • Implement changes to the consent process as directed by DSHS. • Offer updated Immunization History Report to the client or client's parent or guardian at every client encounter. • At every client encounter, compare all immunization histories (ImmTrac, TWICES, validated patient -held records, clinic medical record) and enter into ImmTrac or TWICES any historical immunizations not in ImmTrac. General Requirement 3B: Work in good faith, and as described herein, to increase the number of children less than six years of age who participate in ImmTrac. Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments. Activity 3B: • Verbally, and with DSHS produced literature, inform parents presenting at Contractor's clinics about ImmTrac and the benefits of inclusion in ImmTrac. General Requirement 3C: Work in good faith, and as specified herein, to ensure ImmTrac- registered private providers use ImmTrac effectively as defined in the DSHS Immunization Contractors Guide for Local Health Departments. Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments. Activities 3C: • Provide orientation to all ImmTrac providers at least once a year and maintain documentation of all technical assistance provided (e.g. telephone logs). • Explain and demonstrate the effective use of ImmTrac according to the instructions located in the DSHS Immunization Contractors Guide for Local Health Departments. • Explain guidelines for obtaining and submitting ImmTrac consent forms according to the instructions found at http:// www .dshs.state.tx.us /immunize /dots /consent auidelines.pdf. • Conduct follow -up with registered ImmTrac providers who are inactive or not using ImmTrac effectively. General Requirement 3D: Ensure that ImmTrac data, entered by Contractor's staff, is complete, current, and accurate. Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments. Activities 3D: • Train Contractor's staff on ImmTrac data entry and quality standards. • Update all demographic information, including address and telephone number, at every client encounter. 4. PROVIDER QUALITY ASSURANCE (http: // www. dshs .state.tx.us /immunize /tuft /tvfc manual.shtm) General Requirement 4: Complete site visit follow -up assigned by DSHS Austin or Health Service Region staff within prescribed timeframes outlined in the TVFC Operations Manual.. Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments. Activities 4: • Conduct site visit follow -up and submit results following the process described and within deadlines established in the TVFC Operations Manual. • Conduct site visits in 100% of subcontracted entities as listed in the Inter -Local Application and non -Local Health Department WIC immunization clinics, if applicable. 5. PERINATAL HEPATITIS B PREVENTION ( http : / /www•.dshs.state.tx.us /idcir /disease /hepatitis /hepatitis b /perinatal /manual /) General Requirement 5A: Ensure all pregnant women are screened for hepatitis B surface antigen (HBsAg) and that all HBsAg - positive pregnant women are reported to DSHS. Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments and Perinatal Hepatitis B Prevention Manual. Activity 5A: • Develop a surveillance system that includes prenatal care providers, obstetrical care providers, family practitioners, and labor and delivery facilities to assure all HBsAg - positive pregnant women are reported to DSHS within one week of diagnosis. • Educate prenatal care providers routinely to screen pregnant women for HBsAg status during each pregnancy, implement procedures for documenting HBsAg screening results in prenatal care records and forward original laboratory results to the delivery facility. • Educate delivery hospitals to verify prenatal HBsAg test results of pregnant women on admission for delivery and test for HBsAg at delivery. General Requirement 5B: Ensure that all infants born to HBsAg - positive women and women whose HBsAg status is unknown will receive the first dose of the hepatitis B vaccine and hepatitis B immune globulin (HBIG) within 12 hours of birth. Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments and Perinatal Hepatitis B Prevention Manual. Activity 5B: • Assure all labor and delivery facilities develop standing orders and policies to administer the first dose of the hepatitis B vaccine and HBIG to at risk infants within 12 hours of birth • Identify labor and delivery facilities that do not have standing orders and/or policies and educate providers to establish standing orders and policies to administer to at -risk infants the first dose of the hepatitis B vaccine and HBIG within 12 hours of birth • Determine the number of newborns that do not receive the first dose of the hepatitis B vaccine and/or the hepatitis B immune globulin and work with those facilities to ensure all at -risk infants receive the hepatitis B vaccine series and hepatitis B immune globulin within 12 hours of birth • Report to DSHS all infants born to HBsAg (+) women within fifteen (15) calendar days of the event. General Requirement 5C: Ensure that I00% of the number of identified infants born to HBsAg - positive women will complete the hepatitis B vaccine series and post - vaccination serology (PVS) testing or staff will document appropriately if lost to follow -up. Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments and Perinatal Hepatitis B Prevention Manual. Activity 5C: • Administer or obtain from the provider or IMMTRAC the complete hepatitis B vaccine series. Infants shall complete the hepatitis B vaccine series by 6 -- 8 months of age if the infant receives a single antigen or Pediarix vaccine and by 15 months of age if the infant receives the Comvax series. • Perform PVS testing or obtain from the provider or IMMTRAC PVS testing results to determine immunity against hepatitis B. Post vaccine serology testing shall be done by 9 — 15 months of age if the infant received a single antigen or Pediarix vaccine and by 18 months of age if the infant received the Comvax vaccine series. General Requirement 5D: All reported HBsAg ( +) mothers shall be interviewed and names and locating information of household contacts and sexual partners elicited for serologic testing. Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments and Perinatal Hepatitis B Prevention Manual. Activity 5D: • Household contacts and sexual partners shall be identified for each reported HBsAg(+) mother • Each identified contact and sexual partner shall be serologically tested to determine susceptibility status General Requirement 5E: 80% of all susceptible household and sexual contacts to HBsAg- positive women will complete the hepatitis B vaccine series and post vaccine serology testing or staff will document appropriately if lost to follow -up. Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments and Perinatal Hepatitis B Prevention Manual. Activity 5E: • Administer the hepatitis B vaccine series according to the Recommended Adult Immunization Schedule to susceptible household contacts and sexual partner or obtains vaccination data from the provider. • Administer post vaccine serology testing 1 2 months after the last dose of the vaccine series to determine status or obtain PVS results from the provider. 6. EDUCATION, INFORMATION, TRAINING, AND COLLABORATIONS (http:llwww.dshs. state. tx.us /immunize /providers.shtm) General Requirement 6A: Conduct educational, promotional, and outreach activities for the general public to enhance immunization awareness, including distribution of DSHS - provided materials. Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments. Activities 6A: • Contractor will provide vaccine and immunization education to target audiences and to the general public on the benefits of vaccination, the risk of vaccine - preventable diseases, staying on the ACIP Recommended Immunization Schedule(s) and the importance of not missing any vaccines. • Inform and educate parents of infants, children, adolescents, adults (men and women), grandparents, seniors, and healthcare providers and the general public about vaccines for all age groups and vaccine - preventable diseases. Information should include the importance and benefits of being fully vaccinated, vaccine recommendations, and the location(s) of community vaccination clinics. • Conduct at least one monthly immunization education activity targeting one of the target groups. • Document the activity with the number & type of participants, and evaluate activity by obtaining feedback from participants. • Use national immunization observances as opportunities to conduct specific education and promotional activities to give emphasis to the importance and benefits of vaccines: National Infant Immunization Week (NIIW), National Immunization Month (NIM), National Adult Immunization Week (NAIW), and National Influenza Week (N1W). • Develop and implement a written communications and customer service plan to assure customers receive consistent, correct immunization information and services in a courteous and friendly manner on a timely basis. • Participate in special initiatives as directed by DSHS, such as the Dairy Queen Coupon project, the Hallmark Card Governor's Program, and others. • Participate in statewide media campaigns by distributing DSHS- developed and produced public service announcements and materials to local television and radio stations, newspapers, parent publications, university newspapers, high school newspapers, and neighborhood newspapers. • Promote www.ImmunizeTexas.com, the Immunization Branch's website, The Upshot, electronic newsletter, and the Vaccine Advisory, vaccine newsletter to providers in the Contractor's jurisdiction. • Promote and distribute immunization literature for the public to TVFC providers and Contractor's clinics. • Provide information to clients, families, and the general public on the purpose of ImmTrac, the benefits of ImmTrac participation, and the importance of maintaining a complete immunization history in ImmTrac. • Inform the general public about the Texas Vaccines for Children (TVFC) program and the qualifications to participate in it. • Distribute TVFC information and educational materials at venues where parents of TVFC - eligible children might frequent. • Inform and highly recommend to the medical community and local providers within the Contractor's' jurisdiction on the annual CDC Epidemiology and Prevention of Vaccine - Preventable Disease (EN-VAC) training. General Requirement 6B: Educate, inform, and train the medical community and local providers within Contractor's jurisdiction on Immunization activities listed below: Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments. Activities 6B: • Provide training on TVFC requirements and updates (as described in the TVFC .71 Operations Manual) to TVFC providers annually at a minimum. • Ensure that the TVFC providers have the most up -to -date, DSHS- produced immunization information in their offices. • Provide training, information, and technical assistance to promote the effective use of ImmTrac by private providers (which includes education regarding the benefits of ImmTrac participation). • Educate private providers about the ImmTrac enrollment process and the statutory requirement to report immunizations. • As directed by DSHS identify first responders and their immediate family in the community and inform them of the opportunity to be included in ImmTrac. • Conduct educational-training for hospital and health care providers within the Contractor's jurisdiction, to increase mandatory screening and reporting of HBsAg- positive women. • Provide training on the prevention of Perinatal Hepatitis B to providers within the Contractor's jurisdiction. • Educate physicians, laboratories, hospitals, schools, child -care staff, and other health providers on VPD reporting requirements. • Educate and update providers on the most current Advisory Committee on Immunization Practices (ACIP) recommendations for all age groups, as well as on applicable regulatory vaccination requirements. • Provide training relating to Standards for Child and Adolescent Immunization Practices, and Standards for Adult Immunization Practices (http://www.cdc.gov/ vaccines /pubs /pinkbook/downloads /appendices /H/standards- pediatric.pdf and http: / /www.cdc.gov /vaccines /pubs /pinkbook/ downloads /appendices /Hlstandards- adult.pdf) to all immunization providers within Contractor's jurisdiction. • Inform all private providers on the federal requirement that the most current Vaccine Information Statements (VIS) must be distributed to patients (http: / /www.cdc.gov/ vaccines /pubs /vis /default.htm). • Promote a health care workforce that is knowledgeable about vaccines, vaccine recommendations, vaccine safety, vaccine - preventable diseases, and the delivery of immunization services. • Educate healthcare workers on the need to get themselves vaccinated. • Provide information to community health care employers (hospitals, clinics, doctor's offices, long -term care facilities) about the importance of vaccination of health care workers. • Educate private providers to send NIS surveys to the Contractor for research prior to returning the survey to CDC, if applicable. • Coordinate educational and other activities with local WIC programs to assure that children participating in WIC are screened and referred to their "medical home" for vaccination using a documented immunization history in accordance with the Standards for Child and Adolescent Immunization Practices (http: / /www.cdc.gov /vaccines /pubs /pinkbook/ downloads /appendices /H /standards- pediatric.pdf). • Offer educational opportunities to all WIC programs in the service area, including information about on -line and satellite- broadcast continuing education opportunities from the Centers for Disease Control and Prevention (CDC) Continuing Education web site (http: / /www.cdc.gov /vaccines /ed /default.htm). General Requirement 6C: Conduct outreach to targeted groups for the promotion of best practices and special activities related to immunizations. Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments. Activities 6C: • Conduct outreach (including, but not limited to, the specific outreach described in the DSHS Immunization Contractors Guide for Local Health Departments) to families of children 19 to 35 months of age who are not up to date on their immunizations according to ImmTrac; locate additional immunization histories; and enter history data into ImmTrac. • Collaborate with prenatal health care providers, birth registrars, hospital staff, pediatricians, and other entities to educate parents, expectant parents, and providers about ImmTrac and the benefits of participation. Includes the dissemination of DSHS educational materials as appropriate. • Identify and contact families of children for whom ImmTrac consent has been granted but who do not have complete immunization records in ImmTrac. General Requirement 6D: Conduct recruitment to increase the number of ImmTrac providers, TVFC providers, and Perinatal Hepatitis B providers. Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments. Activities 611 • Conduct recruitment activities as defined in the TVFC Operations Manual with providers on the DSHS - supplied provider recruitment list. • Target adolescent health care providers for recruitment and emphasize adolescent vaccine requirements and recommendations. • Recruit new private provider sites for ImmTrac. • Participate with DSHS regional staff in recruitment of hospitals and providers conducting surveillance and reporting of Perinatal Hepatitis B. General Requirement 6E: Establish collaborative efforts with appropriate community entities regarding promoting immunizations and the reduction of vaccine - preventable diseases. Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments. Activities 6E: • Identify providers, hospitals, schools, child care facilities, social service agencies, and community groups involved in promoting immunizations and reducing vaccine - preventable diseases. • List and maintain contact information of group members and collaborations and identify the best practices they are promoting. • Maintain written agreements and updates of group members and collaborations. Document communications, group meetings and planning of activities that promote the Best Practices identified in contract agreement. Documents are to be accessible during site visits. • Report new group members on the tri -annual report. 7. EPIDEMIOLOGY AND SURVEILLANCE (http: / /tivww. dshs. state.tr.uslidcu /health/vaccine preventable diseases /resources /vpd ,raiide.p di) General Requirement 7: Investigate and document at least 90% of reportable suspected vaccine - preventable disease cases within thirty (30) days of notification in accordance with DSHS Texas Vaccine- Preventable Disease Surveillance Guidelines (http: /hvww.dshs. state .tx.us /idcu /health/vaccine preventable diseases /resources /vpd Ruide.p c) and National Electronic Disease Surveillance System (NEDSS)). Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments. Activities 7: • Adhere to the DSHS Vaccine - Preventable Disease (VPD) Surveillance Guidelines, NEDSS Data Entry Guidelines, and Epi Case Criteria Guide ( https : / /trnedss.dshs.state.tr.us: 8009/ PHINDo_ r/ UserResources /EpiCaseGuicle.pdf) in conducting this General Requirement and the associated activities. • Complete all data entry into NEDSS Base System (NBS) following the NBS Data Entry Guidelines. (https: / /txnedss.czshs. state. tx.us:8009 /PHINDoxlUserResources /Data Entry Guidelin es 2007. pd f ). • Verify and enter complete vaccination history in NBS on all VPD investigations with case status of confirmed or probable. Complete vaccination history should be assessed through ImmTrac, provider offices, school records, or patient records. • Routinely review and follow up on all VPD laboratory reports received, including electronic lab reports (ELRs) sent from DSHS through NBS and Health Alert Network (HAN). • Report on steps taken by Contractor to ensure the completeness of VPD reporting within Contractor's jurisdiction on triannual reports. • All new VPD surveillance staff will attend Introduction to NBS training and complete the certification process in order to gain access to the NBS system. 8. POPULATION ASSESSMENT (Immunization Population Assessment Manual available on line at http: / /www.dshs. state .tx.us /immunize /docs /school /2010- 201 1 PopulationAssessmentManual.odf (Reference Stock No. 11- 12550, Revised 09/10) General Requirement/Activity SA: When assigned by DSHS, complete 100% of child- care facility and Head Start center assessments and child care audits. Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments and Population Assessment Manual. General RequiremeritUActivity 8B: When assigned by DSHS, complete I00% of public and private school assessments, retrospective surveys, and validation surveys. Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments and Population Assessment Manual. 9. SERVICE DELIVERY General Requirement 9: Provide immunization services and ACIP - recommended vaccines in Contractor's clinics to children, adolescents and adults to maximize vaccine coverage levels within Contractor's jurisdiction. Activities under this requirement shall be conducted in accordance with the DSHS Immunization Contractors Guide for Local Health Departments. Activities 9: • Ensure that all ACIP - recommended vaccines are routinely available to eligible TVFC patients and that Adult Safety Net vaccines are available to eligible adult patients. • Recommend the simultaneous administration of all needed vaccines for the patient. • Follow only medically supportable contraindications to vaccination. • Verbally educate patients and parents /guardians about the benefits and risks of vaccination, and distribute DSHS educational materials as applicable as part of this conversation. • Discuss, and attempt to schedule, the next immunization visit at each client encounter. • Explain the benefits of a "medical home" and assist the parent/guardian in obtaining or identifying the child's medical home. • Use a Reminder /Recall system (manual, TWICES, ImmTrac, or other system). • Establish "standing orders" for vaccination in Contractor's clinics, consistent with legal requirements for standing order (including, but not limited to, those found in the Texas Medical Practice Act). • Implement an employee immunization policy according to CDC recommendations in Contractor's clinics. 74 IMM/LDH CCA DSHS Contract Number: 2013- 041112 CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) Exhibit B Model Strategies for Successful Meetings • Have facilitated meetings led by facilitator with expertise in leading diverse professionals in discussion. • Have realistic goals and purpose for the collaboration and refer back to the goals and purpose when needed. • Provide feedback to the group validating their input and suggestions. • Recognize organizations and individuals for their contributions. • Encourage group interactive. • Schedule meetings consistently in professional and courteous environments. • Invite diverse partners using the Use the Partner Identification Tool (Exhibit B) to select those who are locally available to you. • Determine equipment needs prior to meeting. • Give participants adequate notice of meetings. • Develop a distribution system to send attendees the following: o Meeting announcements o Minutes from previous meetings o Call to action events o Other information as applicable • Have and maintain attendance rosters. • Agenda's shall include but not limited to: o Welcome o Introductions of attendees o Cover key points of meeting o Announcements 711, o Cover meetings of previous meeting as applicable o Introduction of guest speakers as applicable 1- 0 V CC (1) F cn a "E c7 c[ S CC . -g E U .5:to. as O Q E cz a) .cn Ri 0 Cd N 0 c c O O :.. cq N O O 0 E eL a3 — to D as c Q1 47 O O O c, cc u ic, -0 .O C N Q O O a} ca c 0. ca.° cq O = CO N c 0 O O N ate-' C y •U U N — . 7 N C O0 O N CU) U 5 O> U A 0 < = N Cat d« O a.,...8 c O_•� 7 C.V L- cu ' -U E al . 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Do you have documentation or letters of agreement, if yes list collaborators information. (must be available upon request) rS 2. Goals and Activities a. Is your collaboration targeting single or multiple populations? List the population groups. b. Is your collaboration focusing on multiple "best practices: known to raise vaccination coverage levels? List best practices. c. How many meetings have you had this quarter? Attach minutes and sign in sheet. 1 d. How many "Best Practice" activities where planned this quarter? List 0 U 0 0 U by O • ccS• Cs. a) (24 azs .,y O O • bA • • U N R. En En "C3 on b 0 O E1 N ri G4 y 0 U 0 O Sy 0 0 b c7 cd •_• cn Q) U o � G a) 0 v) 0 • 0 0 c•• >, cr 0 a) G aJ .G 0 ..O 0 ,n • ceo bAm Lop U U a) 0 H U its 0 cts O 0 Cr • . w N - c . • ' 0 0 0 G 0 G a) .�". 0 s. 'c $.4 G C cC O 0 k" i0-� 4 O n - 4 O 0 M 3 `1-' G by ,--i d N G4 y 4-- 0 a.) 'd U a U G 1-4 0 d 0 0.0 0u r a J w 0 U •2 z - 1. 0 > 0 ca 48 �Qxo 4 p4 '0 cJ as �1 IMMILDH CCA DSHS Contract Number: 2013 - 041112 CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) Exhibit E Final Report SOW Final Report should be on your letterhead and include the following: o Project Title o Project Coordinator o Period Covered o Brief Background of Project o Summary to include the following o Project Expectations o Project Outcomes o Project Barriers o Number of meetings held o Describe focus of events held o Describe if objectives were met o Will you continue with this project? Why or why not? o Signature and date Client Services Contracting Unit MC 1886 Department of State Health Services 1100 W 49th Street PO Box 149347 Austin TX 78714-9347 Phone: (512) 458 -7470 Fax: (512) 458 -7351 YOUR DOCUMENTS PLEASE DO NOT RETURN THESE DOCUMENTS TO DSHS. THESE DOCUMENTS ARE TO BE RETAINED FOR YOUR RECORDS. Please retain this set of contract documents and any attached forms for your records. DOCUMENT NO. 2013- 041112- ATTACHMENT NO. 006 PURCHASE ORDER NO. 0000385670 CONTRACTOR: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS PROGRAM: RLSS /LOCAL PUBLIC HEALTH SYSTEM -PnP TERM: 09/01/2012 THRU: 08/31/2013 SECTION I. SCOPE OF WORK: CONTRACTOR shall improve or strengthen local public health infrastructure within the State of Texas by: • Developing objective(s) to address a public health issue; • Utilizing resources provided through this contract Attachment to conduct activities and services that provide or support the delivery of essential public health services; • Assessing, monitoring, and evaluating the essential public health activities and services provided through this Program Attachment; and • Developing strategies to improve the delivery of essential public health service(s) to identified service area. These tasks shall be performed in accordance with Department of State Health Services (DSHS) Division for Regional and Local Health Services Interlocal Application. The assessment and/or evaluation activities must include measurable standards. Acceptable standards include the National Public Health Performance Standards approved by the Centers for Disease Control and Prevention, Performance Standards developed by the Texas Association of Local Health Officials, Healthy People 2010, and any federal, state or local law or regulation governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this Program Attachment must be pre - approved by DSHS. CONTRACTOR shall comply with all applicable federal and state laws, rules, regulations and standards including, but not limited to, the following: • Chapter 23 -11 of the Healthy People 2010; • Section 121.002, Texas Health & Safety Code, definition of ten essential public health services; • Government Code, Section 403.1055, "Permanent Fund for Children and Public Health ". CONTRACTOR shall not use funds from the Permanent Fund for Children and Public Health for lobbying expenses under the Government Code, Section 403.1067. ATTACHMENT — Page 1 CONTRACTOR shall comply with all applicable regulations, standards, and guidelines in effect on the beginning date of this Program Attachment. DSHS shall inform CONTRACTOR in writing of any changes to applicable federal and state laws, rules, regulations, standards and guidelines. CONTRACTOR shall comply with the amended law, rule, regulation, standard or guideline except that CONTRACTOR shall inform DSHS Program in writing if it shall not continue performance under this contract Attachment within thirty (30) days of receipt of an amended standard(s) or guideline(s). DSHS may terminate the Program Attachment immediately or within a reasonable period of time as determined by DSHS. SECTION II. PERFORMANCE MEASURES CONTRACTOR shall complete the PERFORMANCE MEASURES as stated in the CONTRACTOR'S FY11 Local Public Health Service (LPHS) Service Delivery Plan, and as agreed upon by DSHS, hereby attached as Exhibit A. CONTRACTOR shall provide activities and services as submitted by CONTRACTOR in the following county(ies) /area: Nueces SECTION HL SOLICITATION DOCUMENT: Exempt — Governmental Entity SECTION IV. RENEWALS: N/A SECTION V. PAYMENT METHOD: Cost Reimbursement SECTION VI. BILLING INSTRUCTIONS: Contractor shall request payment using the State of Texas Purchase Voucher (Form B -13) and include acceptable supporting documentation of the required services /deliverables if indicated in the attached Exhibit A. One of the following methods Iisted below should be selected and used consistently throughout the term of the contract for submitting vouchers and supporting documentation. • Send as an email attachment to invoices@dshs.state.tx.us (preferred method) • Fax to Claims Processing Unit at (512)776 -7442 • Submit to the following address: Department of State Health Services Fiscal Claims Processing Unit P.O. Box 149347, MC 1940 Austin, Texas 78714 -9147 SECTION VIL BUDGET: ATTACHMENT — Page 2 i3� SOURCE OF FUNDS: State DUNS Number: 069457786 SECTION VIII. SPECIAL PROVISIONS: General Provisions, Section 1.03 Reporting Article, are revised to include the following paragraph: Contractor shall submit quarterly and final performance reports that describe progress toward achieving the objectives contained in approved Contractor's Service Delivery Plan and any written revisions. Contractor shall submit the performance reports by the end of the month following the end of each quarter, in a format to be provided by DSHS. Failure to submit a required report of additional requested information by the due date specified in the Program Attachment (s) or upon request constitutes breach of contract, may result in delay payment, and may adversely affect evaluation of Contractor's future contracting opportunities with the department. Reports should be sent electronically to: LocalPHTeam @dshs.state.tx.us or by facsimile to 512- 458 -7154. A copy of the report should be sent to the respective DSHS Health Service Region, Attention: Deputy Regional Director. The report signature page should be sent via mail to: DSHS Regional and Local Health Services Attn: Local Services Team 1100 West 49th Street P.O. BOX 149347 MC 1908 Austin, Texas, 78714 -9347. General Provisions, Section 12.01 Responsibilities and Restrictions Concerning Governing Board, Officers and Employees, is not applicable to this program Attachment. General Provisions, Section 12.20 Equipment (Including Controlled Assets) Purchases, is revised to include the following: For the purpose of this Program Attachment, equipment is not approved as part of the base budget for LPHS. The funds are for direct services. Although, at mid -year of the contract term, if fiends are identified as not being used, the funds may be used to purchase equipment in the 3`d quarter of the contract or program attachment term. Contractor must submit proposal to redirect funds with justification as to how the equipment helps achieve the goals, objectives, and deliverables outlined in Exhibit A (Project Service Delivery Plan). The proposal must be submitted to the contract manager assigned to the program attachment. ATTACHMENT — Page 3 2013- 041112 -006 Categorical Budget: RSON FRINGE BENEFITS $35,842.00 EQUIPMENT 'LI CONTRACTUAL HE TOTAL DIRECT CHARGES DIRECT CfARG $0.00 $164,368.00 TOTAL CONTRACTOR SHARE $164,368.00 Total reimbursements will not exceed $164,368.00 $0.00 Financial status reports are due: 12/31/2012, 03/29/2013, 06/28/2013, 10/30/2013 NMI OF) 03 Tio 0 rj cL) .. r Texas Department of State Health Services V fi� a 11 ql O O C coy 4. oil y y y b C � O N b` CD O C) CI) ..- C b yi4 >1 chbli ll) o � .- Z �.y•�. O U J a E U m RS O ▪ �OOcc O y l V O 0 0 .c am r :a a CO -(3 1'3 o Ts (1) � - Croa�U r 3 o 3 © 4 � q) s_. ... � � N �zNottty4-- Z '-- 0 4S U O ca • V z ..... H -0 aQ•92.o 4)� YI 0) 0 cu C .V Q y O� `F.. - Vi U 0 41a a7 m 2 4. .s ,� cr 4 � .y G � 4�.0 Oro • ❑ L O y V C ti 13 . 2 CL . T S a'c11 O O 2 O�. • y C -0 y Q U .. ` ro m .3 3 0W '-4 C 4 a .` t v p .-Ca V. CD 0 —63" CO C:15 0 z y� .. la E cl: o '��oro aa ..• m o = wb.�? o % 3`m MIN • • U 0 O O y V C .0 m a� j N +� Q} y g Or -d t j q-8 •U dy O Za V m ° •- ai�a)a.0c c c a y (.1) m j m Performance Measure: List the performance measure that will be used to determine if the objective has been met. List a performance measure for each objective listed above. 1. All reportable disease identified in Nueces County will be investigated, will receive appropriate public health intervention, and will be accurately recorded in the Health District database. 2. All policies and protocols related to disease surveillance, investigation, reporting, and outbreak response will be current, complete, and in compliance with DSHS and CDC standards. Deliverable Describe the tangible evidence that the activity was completed. 3 v to sz 6" cri y � c, o o ° o 0. °° q 0 ag •—, ate.% o 0 v o v co) o 3 aE (N1 >, Cin Y CU V .� "O 0 LG �' ' 3 o 04 a4-I L. 1 O d O 5 n U o . ti b R 5 o _ ' 3 °' °) .0 t., . , o a) .� g3 = t 0 ° 0 v o 6 c) "0 7•-• _ :ii ilul "0 1 Y. a3S c.)43oL o. Ny n ..t 4. Y Evaluation and Improvement Plan List the standard and describe how it is used to evaluate the activities conducted. This can be a local, state or federal guideline. as CI 1:5 V a) O a C"-) 0 ,+ L .5 o Gl .8 "c' g °A vi • 75 C Gtr • I) qb to . 0 U �.-. a a) p z N a b a) • g g V Q 4r V v .. .� U o �r o b w o a Lr •L'i a) zor M `T. .r a •� b y GL CI �, 3 AA 4r 4r" a o 4 L a) y zz cn -CI O 2 co: v 2 al O 3 `1) o o m g .(•. H� , 4. TS v., 4?-2 Gtr rq0 C O ,.. z N 4. Activities List the activities conducted to meet the proposed objective. Use numbering system to designate match between issues /programs and objectives. U 0 4 , = a) c a) 3 • cn 'O C"' xi co) 0 00 c3 o A c.4 a) a 4. .1-.) cu 4�J v W a v s. w N o a) ) o = , A V 5 `da) _ 'O O M � q ^Cr c cd 0 y ti. ~Orcn a O vi v s O n d• O MI w 0 .0 ` 3 va = 3 E' a.% 1. • 3 0. z 4 b '"' cn CS u P 70 a) o 3 c 0 70 or -6.1 va -0 _, 0 O r2, rte- 8 O y7 i, 1.9 el O cl crs D d CONTRACT NO. 2013 - 041112 PROGRAM ATTACHMENT NO. 007 PURCHASE ORDER NO. 0000385352 CONTRACTOR: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS PROGRAM: Tuberculosis Prevention and Control - Federal TERM: 09/01/2012 THRU: 08/31/2013 SECTION I. STATEMENT OF WORK: Throughout the Contractor's defined service area of Nueces, the Contractor shall develop and provide: (1) basic services and associated activities for tuberculosis (TB) prevention and control; and (2) expanded outreach services to individuals of identified special populations who have TB and/or who are at high risk of developing TB. Contractor shall provide the services outlined above in compliance with the following: • DSHS Standards of Performance for the Prevention and Control of Tuberculosis, available at http: / /www.dshs. state. tx. us /IDCU/ disease /tb /publications /SOP -2008- finai.doc; • DSHS Standards for Public Health Clinic Services, available at http: / /www.dshs. state. tx.us/ qmb /dshsstndrds4clinicservs.pdf; • DSHS TB Policy and Procedures Manual, available at http: / /www.dshs. state. tx. us /idcu /disease /tb /publications /; • American Thoracic Society (ATS) and Centers for Disease Control and Prevention (CDC) joint statements on diagnosis, treatment and control of TB available at http : / /www.cdc. aov /mtnwr /preview /mmwrhtml /rr5211 a l .htm; • Diagnostic Standards and Classification of Tuberculosis in Adults and Children, (American Journal of Respiratory and Critical Care Medicine, Vol. 161, pp. 1376 -1395, 2000) http : / /ajrccm.atsjournals.org /cgi /reprint /161 /4/ 1376; • Treatment of Tuberculosis, (ATS /CDC /IDSA), 2003 available at http: / /www.cdc.gov /tb /pubs /mrnwr /Maj guide /default.htm; • Targeted Tuberculin Testing and Treatment of Latent TB Infection (LTBI), Morbidity and Mortality Weekly Report, Vol. 49, No. RR -6, 2000, available at http:// www. cdc .gov /mm.wr /PDF /rr /r.r4906.pdf; • Updated: Adverse Event Data and Revised American Thoracic Society /CDC Recommendations Against the Use of Rifampin and Pyrazinamide for Treatment of Latent Tuberculosis Infection — United States, 2003, MMWR 52 (No. 31) http: / /www.cdc.go v /mrnwr /preview /mmwrhtml /mm5231 a4.htin; PROGRAM ATTACHMENT — Page 1 • Controlling Tuberculosis in the United States, MMWR, Vol. 54, No. RR -12, 2005 http://www.cdc.gov/mmwr/preview/mmwrhtml/a5412al.htm; • Guidelines for the Prevention and Treatment of Opportunistic Infections Among HIV- Exposed and HIV- Infected Children at http: // www. cdc .gov /mmwr /pdf /rr /rr58e0826.pdf; • Guidelines for Prevention and Treatment of Opportunistic Infections in HIV - Infected Adults and Adolescents at http:/ /www. cdc .gov /mmwr /pdf /rr /rr58e324.pdf; and • Updated Guidelines on Managing Drug Interactions in the Treatment of HIV- Related Tuberculosis at http:/ /www. cdc.gov /tb /publications /guidelines /TB HIV Drugs /default.htm. Contractor shall comply with all applicable federal and state regulations and statutes, including, but not limited to, the following: • Texas Tuberculosis Code, Health and Safety Code, Chapter 13, Subchapter B; • Communicable Disease Prevention and Control Act, Texas Health and Safety Code, Chapter 81; • Screening and Treatment for Tuberculosis in Jails and Other Correctional Facilities, Health and Safety Code, Chapter 89; • Texas Administrative Code TAC, Title 25, Part 1, Chapter 97, Subchapter A, Control of Communicable Diseases; and • Texas Administrative Code TAC, Title 25, Part 1, Chapter 97, Subchapter H, Tuberculosis Screening for Jails and Other Correctional Facilities. Contractor shall perform all activities under this Renewal Program Attachment in accordance with Contractor's final, approved work plan (attached as Exhibit A), and detailed budget as approved by DSHS. Contractor must receive written approval from DSHS before varying from applicable policies, procedures, protocols, and the final approved work plan, and must update its implementation documentation within forty -eight (48) hours of making approved changes so that staff working on activities under this contract knows of the change(s). DSHS reserves the right, where allowed by legal authority, to redirect funds in the event of financial shortfalls. DSHS will monitor Contractor's expenditures on a quarterly basis. If expenditures are below what is projected in Contractor's total Renewal Program Attachment amount, Contractor's budget may be subject to a decrease for the remainder of the Contract term. Vacant positions existing after ninety (90) days may result in a decrease in funds. Because of the inherent time to complete treatment for tuberculosis disease and latent tuberculosis infection in relation to the period of this Renewal Program Attachment, required reporting under this Renewal Program Attachment will show results for work performed under previous Renewal Program Attachments. Contractor shall provide a complete and accurate annual narrative report, in the format provided by DSHS, demonstrating compliance with the requirements of this Renewal Program Attachment. That report shall include, but is not limited to, a detailed analysis of performance related to the performance measures listed below. A progress report of activities in January through May 2013 shall also be submitted in a format provided by DSHS. These reports shall be PROGRAM ATTACHMENT — Page 2 qI sent to the Department of State Health Services, Tuberculosis Services Branch, Mail Code 1873, PO Box 149347, Austin, Texas 78714 -9347 via regular mail, or by fax to (512) 371 -4675, and sent by e -mail to TBContractReporting @dshs.state.tx.us. Contractor shall maintain the documentation used to calculate performance measures as required by the General Provisions Article VIII "Records Retention" and by the Texas Administrative Code Title 22, Part 9 Chapter 165, § 165.1 regarding the retention of medical records. Report periods and due dates are as follows: PERIOD COVERED DUE DATE January 2012 — December 2012 February 15, 2013 January 2013 — May 2013 July 15, 2013 Contractor shall send all initial reports of confirmed and suspected TB cases to DSHS within seven (7) working days of identification or notification. Any updates to initial DSHS Report of Cases and Patient Services Forms (TB -400) (e.g., diagnosis, medication changes, x -rays, and bacteriology) and case closures shall be sent within thirty (30) days of when a change in information in a required reporting field occurs to DSHS at PO Box 149347, Mail Code 1873, Austin, Texas 78714 -9347. Contractor shall send an initial report to DSHS of contacts on all Class 3 TB cases and smear - positive Class 5 TB suspects within thirty (30) days of identification using DSHS' Report of Contacts Form (TB -340 and TB -341). Any new follow -up information (not included in the initial report) related to the evaluation and treatment of contacts shall be sent to DSHS on the TB-340 and T13-341 at intervals of ninety (90) days, 120 days, and two (2) years after the day the Contractor became aware of the TB case. Electronic reporting to DSHS for Class 3 TB cases, smear positive Class 5 TB suspects, and their contacts may become available during the term of this Renewal Program Attachment. Once notified of this option by DSHS, Contractor may avail itself of this option if it adheres to all the electronic reporting requirements (including system requirements) provided at that time. Contractor will determine and report annually the number of persons which receive at least one (1) TB service, including but not limited to: tuberculin skin tests, chest radiographs, health care worker services, or treatment with one or more anti - tuberculosis medications. Contractor shall monitor and manage its usage of anti - tuberculosis medications and testing supplies furnished by DSHS in accordance with first - expiring -first -out (FEFO) principles of inventory control to minimize waste for those products with expiration dates. On a monthly basis, the Contractor shall perform a count of its inventory of anti- tuberculosis medications and tuberculosis testing supplies furnished by DSHS and reconcile the quantities by product and lot number found by the direct count with the quantities by product and lot number listed in the electronic inventory management system furnished by DSHS. All these tasks shall be performed by the Contractor using the designated database and the designated procedures. PROGRAM ATTACHMENT — Page 3 Contractor shall evaluate and monitor Class B immigrants and when needed place them on appropriate prophylaxis for successful completion of treatment. Immigrant notifications shall be obtained through the Electronic Disease Notification (EDN) system. The TB Follow -up Worksheet in EDN shall be completed for all immigrants whose notification was obtained through EDN. Contractor shall evaluate refugees and other at -risk clients referred by the Refugee Health Program for further clinical evaluation and when needed place those refugees on appropriate prophylaxis and monitor them for successful completion of treatment. The TB Worksheet in EDN shall be completed on refugees and other at -risk clients who are reported through EDN. SECTION 11. PERFORMANCE MEASURES: The following performance measures will be used to assess, in part, Contractor's effectiveness in providing the services described in this Renewal Program Attachment, without waiving the enforceability of any of the other terms of the contract or any other method of determining compliance: 1. Cases, and suspected cases, of TB under treatment by Contractor shall be placed on timely and appropriate Direct Observed Therapy (DOT). If data indicates a compliance rate for this Performance Measure of less than 90 %, then DSHS may (at its sole discretion) require additional measures be taken by Contractor to improve that percentage, on a timeline set by DSHS; 2. Newly diagnosed TB cases that are eligible* to complete treatment within 12 months shall complete therapy within 365 days or less; *Exclude TB cases 1) diagnosed at death, 2) who die during therapy, 3) who are resistant to Rifampin, 4) who have meningeal disease, and/or 5) who are younger than 15 years with either miliary disease or a positive blood culture for TB. If data indicates a compliance rate for this Performance Measure of less than 85 %, then DSHS may (at its sole discretion) require additional measures be taken by Contractor to improve that percentage, on a timeline set by DSHS; 3. TB cases with initial cultures positive for Mycobacterium tuberculosis complex shall be tested for drug susceptibility and have those results documented in their medical record. If data indicates a compliance rate for this Performance Measure of less than 97.4 %, then DSHS may (at its sole discretion) require additional measures be taken by Contractor to irnprove that percentage, on a timeline set by DSHS; 4. Newly- reported cases of TB with Acid -fast Bacillis (AFB) positive sputum culture results will have documented conversion to sputum culture- negative within 60 days of initiation of treatment. If data indicates a compliance rate for this Performance Measure of less than 45% then DSHS may (at its sole discretion) require additional measures be taken by contractor to improve the percentage, on a timeline set by DSHS; PROGRAM ATTACHMENT — Page 4 93 5. Newly - reported TB cases shall have an HIV test performed (unless they are known HIV - positive, or if the patient refuses) and shall have positive or negative HIV test results reported to DSHS according to the schedule provided herein. If fewer than 80% of newly reported TB cases have a result of an HIV test reported, then DSHS may (at its sole discretion) require additional measures be taken by Contractor to improve that percentage, on a timeline set by DSHS; 6. Newly - reported suspected cases of TB disease shall be started in timely manner on the recommended initial 4 -drug regimen. If fewer than 93.2% of newly- reported TB cases are started on an initial 4 -drug regimen in accordance with this requirement, then DSHS may (at its sole discretion) require additional measures be taken by Contractor to improve that percentage, on a timeline set by DSHS; 7. Newly- reported TB patients with a positive AFB sputum -smear result shall have at least three contacts identified as part of the contact investigation that must be pursued for each case. If data indicates a compliance rate for this Performance Measure of less than 90 %, then DSHS may (at its sole discretion) require additional measures be taken by Contractor to improve that percentage, on a timeline set by DSHS; 8. Newly- identified contacts, identified through the contact investigation, that are associated with a sputum AFB smear - positive TB case shall be evaluated for TB infection and disease. If data indicates a compliance rate for this Performance Measure of less than 81.5%, then DSHS may (at its sole discretion) require additional measures be taken by Contractor to improve that percentage, on a timeline set by DSHS; 9. Contacts, identified through the contact investigation, that are associated with a sputum AFB smear- positive case and that are newly diagnosed with latent TB infection (LTBI) shall be started on timely and appropriate treatment. If data indicates a compliance rate for this Performance Measure of less than 65 %, then DSHS may (at its sole discretion) require additional measures be taken by Contractor to improve that percentage, on a timeline set by DSHS; 10. Contacts, identified through the contact investigation, that are associated with a sputum AFB smear - positive case that are newly diagnosed with LTBI and that were started on treatment shall complete treatment for LTBI as described in Targeted Tuberculin Testing and Treatment of Latent TB Infection ( LTBI), Morbidity and Mortality Weekly Report, Vol. 49, No. RR -6, 2000, and according to the timelines given therein. If data indicates a compliance rate for this Performance Measure of less than 45 %, then DSHS may (at its sole discretion) require additional measures be taken by Contractor to improve that percentage, on a timeline set by DSHS; 11. Newly - reported TB patients that are older than 12- years -old and that have a pleural or respiratory site of disease shall have sputum AFB - culture results reported to DSHS according to the timelines for reporting initial and updated results given herein. If data PROGRAM ATTACHMENT — Page 5 indicates a compliance rate for this Performance Measure of less than 89.5 %, then DSHS may (at its sole discretion) require additional measures be taken by Contractor to improve that percentage, on a timeline set by DSHS; and 12. All reporting to DSHS shall be completed as described herein under Section I above and submitted by the deadlines given. If the Contractor fails to meet any of the performance measures, the Contractor shall furnish in the narrative report, due February 15, 2013, a written explanation including a plan (with schedule) to meet those measures. This requirement does not excuse any violation of this Contract, nor does it limit DSHS as to any options available under the contract regarding breach. SECTION III. SOLICITATION DOCUMENT: Exempt - Governmental Entity SECTION IV. RENEWALS: DSHS may renew the Program Attachment for up to one (1) additional one -year term, at DSHS's sole discretion. SECTION V. PAYMENT METHOD: Cost Reimbursement Funding is further detailed in the attached Categorical Budget and if applicable, Equipment List. SECTION VI. BILLING INSTRUCTIONS: Contractor shall request payment using the State of Texas Purchase Voucher (Form B -13) and acceptable supporting documentation for reimbursement of the required services /deliverables. Vouchers and supporting documentation should be mailed or submitted by fax or electronic mail to the addresses /number below. Claims Processing Unit, MC1940 Department of State Health Services 1100 West 49th Street PO Box 149347 Austin, TX 78714 -9347 The fax number for submitting State of Texas Purchase Voucher (Form B -13) to the Claims Processing Unit is (512) 776 -7442. The email address is invoices @dshs.state.tx.us. PROGRAM ATTACHMENT — Page 6 45 SECTION VII. BUDGET SOURCE OF FUNDS: CFDA Funding #93.116 DUNS #069457786 SECTION VIII. SPECIAL PROVISIONS: General Provisions, Article III. FUNDING, Section 3.06, Nonsupplanting, is revised to include the following: Funding from this Renewal Program Attachment shall not be used to supplant (i.e., used in place of funds dedicated, appropriated or expended for activities funded through this Renewal Program Attachment) state or local funds, but Contractor shall use such funds to increase state or local funds currently available for a particular activity. Contractor shall maintain local funding at a sufficient rate to support the local program. If the total cost of the project is greater than DSHS' set funding, Contractor shall supply funds for the remaining costs in order to accomplish the objectives set forth in this Program Attachment. All revenues directly generated by this Renewal Program Attachment or earned as a result of this Renewal Program Attachment during the term of this Renewal Program Attachment are considered program income, including income generated through Medicaid billings for TB related clinic services. Contractor shall use this program income to further the scope of work detailed in this Renewal Program Attachment, and must keep documentation to demonstrate such to DSHS' s satisfaction. This program income may not be used to take the place of existing local, state, or federal program funds. General Provisions, ARTICLE IV. PAYMENT METHODS AND RESTRICTIONS, Section 4.02 Billing Submission, is amended to include the following: Contractor shall submit requests for reimbursement or payment, or revisions to previous reimbursement request(s), no later than January 30, 2013 for costs incurred between the services dates of September 1, 2012 and December 31, 2012 General Provisions, ARTICLE IV. PAYMENT METHODS AND RESTRICTIONS, Section 4.05 Financial Status Reports, is amended to include the following: Contactor shall submit FSRs to Accounts Payable by the last business day of the month following the end of each term reported. The FSR period will be reported as follows: Quarter One shall include September 1, 2012 through December 31, 2012. Quarter two shall include January 1, 2013 through March 31, 2013. Quarter three shall include April 1, 2013 through June 30, 2013. Quarter four shall include July 1, 2013 through August 31, 2013. Contractor shall submit the final FSR no later than sixty (60) calendar days following the end PROGRAM ATTACHMENT — Page 7 of the applicable term. General Provisions, Article XIII. General Terms, Section 13.15 Amendment, is amended to include the following: Contractor must submit all amendment and revision requests in writing to the Division Contract Management Unit at least ninety (90) days prior to the end of the term of this Program Attachment. PROGRAM ATTACHMENT — Page 8 2013- 041112 -007 Categorical Budget: EQUIPMENT PPLIE! CONTRACTUAL TOTAL DIRECT CHARGES N DIREi $13,352.00 7° $61,735.00 CONTRACTOR SHARE Total reimbursements will not exceed $61,735.00 Financial status reports are due: 01/31/2013, 04/30/2013, 07/31/2013, 10/30/2013 DSHS CONTRACT: 2013-041112-007 CORPUS CHRISTI NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) TB /PC -FED EXHIBIT A WORK PLAN 1. Summarize the proposed services, service area, population to be served, location (counties to be served), etc. List subcontractors you will work with in your area. Also, address if and how you will serve individuals from counties outside your stated service area. The service area for Corpus Christi - Nueces County Tuberculosis Elimination Program covers approximately 838 miles of land. The Gulf of Mexico is to the east, San Patricio County to the north, Jim Wells County to the west, Kleberg County to the south and approximately 150 miles from the Mexican border. The total population in Nueces County is 340,223 with an ethnicity divided into 60.6% Hispanic, 32.8% Anglo, 3.6% Black and 3% categorized as "other". This information was obtained from The County Information Project, Texas Association of Counties. The Corpus Christi - Nueces County Tuberculosis Elimination Program (CCNCTBEP) provides basis services for tuberculosis control and prevention in Corpus Christi and Nueces County. Services are provided in compliance with the Corpus Christi - Nueces County Tuberculosis Elimination Clinic's Protocols, Texas Department of State Health Services Tuberculosis Surveillance Division Standards of Performance, American Thoracic Society and Center for Disease Control (ATS /CDC) Joint Statements. The Corpus Christi - Nueces County Tuberculosis Elimination Program identified 14 countable cases for 2011, this is a case rate of 4 cases per 100,000 of the population. Clinical and outreach services target identification of TB cases /suspects, contacts, evaluation of those individuals seeking to immigrate to this country with alien waivers. Outreach services target those individuals in correctional facilities, homeless shelters, alcohol /drug treatment centers, identification of the homeless living on streets with active tuberculosis and those individuals with latent TB infection (LTBI) and /or HIV /Aids at high risk of developing active tuberculosis. CCNCTBEP works closely with the neighboring counties, hospital, local physicians, and local, county and federal jails /prisons and the State TB nurse to do DOT /DOPT, contact investigation, x -ray services, medications, monitoring and transportation to or from Texas Center for Infectious Diseases for Corpus Christi, Nueces County and surrounding counties when requested. 2. Describe delivery systems, workforce (attach organizational chart), policies, support systems (Le., training, research, technical assistance, information, financial and administrative systems) and other infrastructure available to achieve service delivery and policy- making activities. What resources do you have to perform the project, who will deliver services and how will they be delivered? The main objective for CCNCTBEP is 100% DOT resulting in prevention and cure of Tuberculosis, and all policies and activities are based on this objective. The City of Corpus Christi provides the office space, utilities, administrative support and computer maintenance for the Internet based programs, TWICES and PICS, utilized by CCNCTBEP. Both the state and federal grants have been decreasing yearly. The financial management is now assigned to an accountant at City Hall to oversee the expenditures and send in the FRS to the state for payment. CCNCTBEP initiated a program in 2003 to earn money by selling ppd's to the general public for a cash fee. The ppd and supplies are purchased with program income. This has kept our clinic viable as the amount of the grants decrease. CCNCTBEP has been fortunate to be able to retain the core staff of one (1) RN for 15 years (Barbara Cavazos, RN) paid by Nueces County and works clinic, DOT and contact investigation; one (1) outreach worker for 17 years (Gabriel Duran, CSA) in the Federal Grant that does DOT /DOPT, contact investigation, outreach ppd's for the eleven (11) homeless shelters, locates missing clients and helps locate individuals on alien waivers for evaluation; one (1) receptionist for 17 years (Brenda Hinojosa) in the State Grant, who manages the LTBI records, sends missed appointment letters and is responsible for program income bank deposits; and one (1) medical records tech for 15 years (Veronica Karen Rodriguez) who is responsible for the case registry, data entry of TB suspects /cases, monthly sputum collection, DOT /DOPT, works with all staff to help initiate contact investigations, prepares monthly clinic data reports, takes over the duties of the outreach worker and /or receptionist if they are out and a new TB Program Manager, Laura Oberts, RN, BSN, paid by the City of Corpus Christi. All staff work in the office and field as needed to do contact investigations, DOT /DOPT and tracking of patients, those patients missing DOT /DOPT doses are located by the outreach worker and a female employee will be utilized when needed, i.e., to bring in a female client for evaluation or work -up. AN staff members are licensed and /or certified to drive the outreach van for DOT /DOPT or to transport a client to the Texas Center for Infectious Disease in San Antonio for admission. CCNDTBEP is very fortunate to have a vehicle at their disposal 100% of the time for TB outreach. We are also very fortunate that the City of Corpus Christi provides the use of a city vehicle when our van is to be serviced. 3. Determine the number of persons who received from the CONTRACTOR in 2012 at least one TB service including but not limited to tuberculin skin tests, chest radiographs, health care worker services, or treatment with one or more anti - tuberculosis medications. The CCTBC counts, on a monthly basis, the number of ppd's placed for paying and non- paying clients, the number of homeless, number of alcohol /drug treatment clients tested and/or x- rayed, the number of preventive medication refills, the number of doses of DOT /DOPT administered and the number of missed doses is recorded. Daily sign - in logs are kept of all clients utilizing these services provided by the TB clinic and the number of services provided is pulled from this sign -in log. 4. Describe how data is collected and tabulated, who will be responsible for data collection and reporting, and how often data collection activities will occur. Describe how you will conduct community surveillance, to identify unreported cases of TB and individuals suspected of having TB infection. Describe how you will maintain a record of outbreaks, in your area, with a description of the outbreak and how it was managed. Monthly counts are recorded on all services provided by the CCNCTBEP, such as TB skin tests and readings, nurse consultations /evaluations, positive reactors, referrals, chest x -rays, preventive medication, DOT /DOPT. All clients are required to sign in when they arrive at the TB clinic and they specify on the sign -in sheet the service needed. Identify and examine all household, social, occupational and other close contacts to the suspected infectious TB suspect/case within seven (7) days of notification utilizing the concentric circle and send the preliminary TB -340 to Austin TB Elimination. All close household contacts to a smear positive TB suspect/case will have a chest x -ray regardless of their TB skin test result. A follow -up TB -340 is to be forward to Austin within 90 days and again at 120 days with the final report being sent when all positive reactors have completed their INH regimen of 9 months preventive therapy. All children with a negative chest x -ray that live in the house with a smear positive TB suspect/case are placed on directly observe preventive therapy. At the 3 -month follow - up those with a positive ppd are continued for nine (9) months on INH and those that have a negative ppd at follow -up may discontinue INH if the ppd is negative and the TB suspect/case is no longer smear positive or no longer in the home. All household contacts five (5) years and younger are placed on DOPT, older household contacts are placed on DOPT as resources allow. All patients on DOT /DOPT are assessed for drug toxicity prior to each dose of medication and must come into the clinic once a month for a workup that includes a drug toxicity check, visual acuity and age appropriate lab. All positive reactors referred to CCTBC by private physician are questioned as to who infected them. They are provided with a chest x -ray or given a referral for a chest x -ray privately. The x -rays are read by Dr. William W. Burgin, Jr. and preventive medication is ordered if the chest x -ray is normal. Positive reactors picking up medication monthly must have a drug toxicity check, visual acuity and age appropriate lab with their monthly workup. Treatment for latent TB infection (LTBI) is provided without cost to the patient. 5. Describe how the accuracy, timeliness and completeness of data collected will be assessed and verified. If not already in place, describe how you will develop a written plan to assess the quality of data collected. Data is gathered monthly from the daily sign -in log (date /time included), log book for monthly lab, HIV, syphilis, referrals, chest x -ray log, alcohol /drug treatment facility log, jail reports, homeless shelter log, monthly count of DOT /DOPT doses, monthly count of paid and non -paid ppd's. 6. Describe coordination with the other health and human services providers in the service area(s) and delineate how duplication of services is to be avoided List other community programs you will be working with in your jurisdiction (community based organizations, private providers, hospitals, and service organizations). CCNCTBEP manages all reported TB suspects /cases in Corpus Christi - Nueces County and works closely with all community based organizations often assisting TB programs in other counties with the management of the TB suspects /cases. The TB clinic staff coordinates monthly with the homeless shelters, drug /alcohol abuse programs, county jail and federal detention center the testing and /or evaluation of those clients that utilize their facilities. This data is gathered monthly and indicates the number of clients tested and /or evaluated for TB disease and /or infection. 7. Describe ability to provide services to culturally diverse populations (e.g., use of interpreter services, language translation, compliance with ADA requirements, location, hours of service delivery, and other means to ensure accessibility for the defined population). CCNCTBEP has two bilingual full -time employees, Brenda Hinojosa and Gabriel Duran. They speak English and Spanish fluently, Mr. Duran is able to translate clinic forms and client instructions when needed. Also at our disposal is the Language Line Services at www.languageline.com or at 1 -800- 752 -6096. 8. Describe your strategy for the management of TB cases and suspects, with emphasis on provision of directly observed therapy (DOT); and use of incentives and enablers. All TB suspects /cases are placed on 4 -drug therapy given by DOT per the American Thoracic Society (ATS), Center for Disease Control (CDC) and Infectious Diseases Society of America (IDSA) guidelines. Private physicians are provided current information related to TB management to ensure the correct medication and DOT is ordered. If a private physician does not place a patient on 4-drug therapy or DOT, a consultation is requested for that physician with Dr. William W. Burgin, Jr., Dr. Barbara Seaworth, Dr. David Griffith or Dr. Jeffrey Starke. TB suspects /cases determined to be infectious by smear are placed on home isolation until they are no longer able to transmit disease. Control orders are utilized at the start of care to establish parameters and prevent the need for quarantine. Control orders are given in the patient's language or an interpreter or guardian may read the letter to the patient. Court ordered management would be initiated for those that are non - compliant. Education is provided for TB suspects /cases and their families that cover TB disease vs. infection, INH side effects, importance of following all the instructions given, the schedule for follow -up chest x -rays, having blood drawn, monthly work -ups, sputum collection and the phone number of the case manager. All TB suspects /cases are informed that if they need to talk to the TB Clinic medical consultant they can schedule an appointment to speak to the consultant. Drug susceptibility is done on all initial specimens identified as M.TB and treatment is adjusted if drug resistance is identified. Sputum is collected on three (3) consecutive days every two weeks while smear positive. When the patient converts to being smear negative sputum is then collected on three (3) consecutive days monthly until the end of treatment. If the patient remains smear and culture positive on adequate doses of medication then new susceptibilities are requested. Drug levels are done on an as needed basis for those patients that continue to be smear and culture positive longer than the guidelines address. Those patients identified as drug resistant or with low drug levels, require a consultation with a state paid consultant. A licensed physician certified in pulmonary diseases monitors TB suspects/cases. HIV and syphilis counseling as well as testing, are part of the admission lab. Toxicity assessment is done prior to each dose of medication. Liver profiles are drawn per DSHS Tuberculosis Elimination Division protocols throughout treatment. Visual acuity is done monthly while color vision and hearing screening is done based on the drugs the patient is prescribed. All this is recorded in the patient's record. TB suspects /cases are treated without consideration to the patient's ability to pay. 9. Describe your process for review of cases under management. TB suspects /cases have physician review. Patients are started on a 4 -drug therapy: 14- day regimen of daily medication, then changed to twice weekly for two months on four drugs. At the end of two months, the drug regimen is again changed and the patient continues therapy on two drugs until nine (9) months have been completed. All doses of medication are given by directly observed therapy. Sputum is collected every two weeks while the patient is smear positive. Sputum collection continues monthly after converting to smear negative and susceptibilities are reviewed. Drug levels are utilized for those patients who have not converted to smear and culture negative in a timely manner. Current chest x -rays are evaluated every three months and monthly workups are done by clinic nurse. 10.Describe your strategy for the implementation of cohort analysis of cases at !east quarterly. The CCNCTBEP has implemented the cohort review process with the first analysis of cases in July 2011. In attendance to these will be all TB clinic staff and medical director. This clinic also utilizes the DSHS audit forms for chart and program review on a quarterly basis, forms are then recorded in the patient's chart. 11. Describe your strategy for the management of contacts and positive reactors, with emphasis on directly observed preventive therapy (DOPT). Identify and evaluate all household, social, occupational and other close contacts to the suspected infectious TB suspects /cases within 7 days of notification utilizing the concentric circle and send the preliminaryTB -340 to Austin TB Surveillance. All close household contacts to a smear positive TB suspect or case will have a chest x -ray regardless of their TB skin test result. A follow -up TB -340 is to be forwarded to Austin within 90 days and again at 120 days with the final report being sent when all positive reactors have completed their INH regimen of 9 months preventive therapy. Children with a negative chest x -ray that live in the house with a smear positive TB suspect/case are placed on directly observed preventive therapy on INH. Those with a positive ppd at follow -up are continued for 9 months on INH and those that have a negative ppd at follow -up may discontinue INH if the TB suspect/case is no longer smear positive or no longer in the home. Household contacts five (5) years and younger are placed on DOPT as resources allow. All patients on DOT /DOPT are assessed for drug toxicity prior to each dose of medication and must come into the clinic once a month for a workup that includes a drug toxicity check, visual acuity and age appropriate lab. All positive reactors referred to CCTBC by private physicians are questioned as to who infected them. They are provided a chest x -ray or given a referral for a chest x -ray privately. The x -rays are read by Dr. William W. Burgin, Jr. and INH is ordered if the chest x -ray is normal. Positive reactors picking up medication monthly must have a drug toxicity check and age appropriate lab with their monthly workup. Treatment for latent TB infection (LTBI) is provided without cost to the patient. 12. Describe your process for the review of ongoing contact investigations and your strategy to assess reasons for identification of fewer than three contacts for each case; for delays in interviewing cases or evaluating contacts, and low completion of preventive therapy for infected contacts. Staff meetings are held to identify when follow -up evaluations are due, problematic areas with DOT /DOPT, suspects /cases, and /or contacts. When problems are identified, additional assessment is done and solutions are presented. If necessary, additional consultation with the client and staff is scheduled. The client has the option to attend or not attend, a date is set to readdress the problem and update staff on progress. Contacts are educated on the importance of starting and completing preventive therapy if their skin test is positive. CCTBEP has staff to educate both in English and Spanish. 13. Describe your infection control procedures. All CCNCTBEP staff receive education related to personal respirators, when to wear the respirators and how to maintain them. Each staff member has been fit tested. CCNCTBEP has three (3) portable hepa filter units as needed. A mask is placed on anyone in the office that is coughing and the patient is immediately taken to an exam room with a hepa filter and UV Tight. Sputum is collected in a negative pressure chamber. CCNCTBEP has seven (7) UV lights installed in the clinic areas, the x -ray room, lobby and hallway over the clinic exit sign. Skin testing for TB staff is done every three months. To date, the five employees working in this program remain skin test negative and four have worked in the TB clinic more than ten years. 14. Describe plans to conduct targeted TB screening programs for high -risk populations. The CCNCTBEP staff has excellent working relationships with the homeless shelters, drug /alcohol treatment centers, jail and other adult and juvenile correctional facilities. We work closely with the indigent health clinic at Christus Spohn Memorial Hospital, high -risk maternity clinics, the Valley Aids Clinic and Coastal Bend Aids Foundation. The primary DOT provider speaks and writes fluent Spanish. Information is provided to Austin TB Surveillance through CCNCTBEP related to these targeted populations. 15.Describe your strategy to provide professional education and training programs for new and current TB staff. Professional education consists of the education and training of new employees and the continuing education of TB staff. Training is provided to all new employees within 60 days. Each new employee must receive 40 hours of TB education within the first 60 days of employment and 16 hours of training each year thereafter. This includes all staff involved in TB activities including physicians, nurses, investigators, outreach workers, data entry clerks, receptionists and . other support staff. The TB education will be utilized when possible to provide workshops with continuing hours of education being documented. CDC's "Self Study Modules on Tuberculosis" are used in the initial training and the test given at the completion of the modules. initial and follow -up training will include the suggested reading materials identified in the DSHS contract. A written plan will be developed for each new employee and addressed with the new staff member by the TB program manager, on the first day the employee spends in the TB clinic after City orientation. A time frame will be established for completing the initial education phase and a time frame will be established for acquiring the 16 hours of TB education needed yearly. The assessment of need will be done by the employee and program manager and the plan will be written yearly before the annual employee evaluation and reviewed quarterly with the employee by the program manager and a copy will be placed in their personal record and they will retain a copy for themselves. Staff will be instructed where the staff education notebook is kept and that they are responsible for recording each educational event and notifying the program manager if a workshop is cancelled and rescheduling is needed. A copy of DSHS Performance Standards for professional education will be given to each new employee at time of hire and to all other staff, and a copy will be placed in the TB Education Notebook for reference. 16. Describe your strategy to document the evaluation of immigrants and refugees with the following notifications: Class A; Class B1 — Pulmonary; Class B1 -- Extrapulmonary; Class B2; Class B3. Class A applicants are first located and a home assessment is done. If small children are in the home, other living arrangements must be made. If needed, the client is transported to the TB clinic, sputum is collected, a record is opened, arrangements are made for a chest x -ray, explanations are given in the patient's language or in English and medications will be started per physician orders as what to expect, a personal and medical history is taken. The state TB elimination program is notified, client information and current status is given with the name of the airlines, the flight number, number of stops made by the plane where individuals either got on or off the plane and if the client changed planes. If unable to locate the client at the given address, if individuals are there, information will be requested as to where the individual has gone and a referral will be made to the local health department in that area to locate this individual for a comprehensive evaluation for tuberculosis. Class B1 pulmonary applicants must be located and provided a complete evaluation and education as above to determine if they have developed active disease. The same information as above needs to be collected to ensure if this person has or has not developed active disease so that all the people they travelled with can be notified and evaluated in a timely manner. Class B1 completed treatment applicants must be located, provided a chest x -ray, three consecutive sputum collected and travel information obtained if necessary, to inform the authorities and the airlines to locate contacts to the individual travelling on the planes. If the evaluation is negative, no additional testing is necessary at this time. Educate the client about TB and have them follow -up as needed. Educate on the signs and symptoms of TB. Class B1 extra - pulmonary and Class B2 LTBI applicants must be located and provided a complete work -up. Collect the necessary information, i.e., the airlines, in the event the client is active. Identify and obtain addresses of individuals the client was around prior to immigrating that might have had TB or could have been exposed. Educate the client to recognize signs and symptoms of Tuberculosis; treat with DOT if physician elects to treat. Class B3 contact applicants are given a TB skin test, if necessary, to complete the immigration process. If the TB skin test is positive a chest x -ray must be done to rule out tuberculosis. If the x -ray is negative, the applicant is given education in TB disease vs. infection, i.e., the advantages and possible side effects of the medication, length of treatment and that there is no guarantee that by taking the medication one will not get TB, as the TB skin test will always show positive even if the medication is taken. Fiscal Year 2013 Department of State Health Services Contract General Provisions (Core /Subrecipient) ARTICLE I Section 1.01 Section 1.02 Section 1.03 Section 1.04 Section 1.05 Section 1.06 Section 1.07 Section 1.08 Section 1.09 Section 1.10 Section 1.11 ARTICLE II Section 2.01 Section 2.02 Section 2.03 Section 2.04 Section 2.05 Section 2.06 Section 2.07 ARTICLE III Section 3.01 Section 3.02 Section 3.03 Section 3.04 Section 3.05 Section 3.06 ARTICLE IV Section 4.01 Section 4.02 Section 4.03 Section 4.04 Section 4.05 Section 4.06 ARTICLE V Section 5.01 Section 5.02 Section 5.03 Section 5.04 ARTICLE VI Section 6.01 Section 6.02 Section 6.03 ARTICLE VII Section 7.01 Section 7.02 COMPLIANCE AND REPORTING 5 Compliance with Statutes and Rules. 5 Compliance with Requirements of Solicitation Document. 5 Reporting. 5 Client Financial Eligibility. 5 Applicable Contracts Law and Venue for Disputes. 5 Applicable Laws and Regulations Regarding Funding Sources. 5 Statutes and Standards of General Applicability. 6 Applicability of General Provisions to Interagency and Interlocal Contracts. 7 Civil Rights Policies and Complaints. 8 Licenses, Certifications, Permits, Registrations and Approvals. 8 Funding Obligation. 9 SERVICES 9 Education to Persons in Residential Facilities. 9 Disaster Services. 9 Consent to Medical Care of a Minor. 9 Telemedicine Medical Services. 9 Fees for Personal Health Services 10 Cost Effective Purchasing of Medications. 10 Services and Information for Persons with Limited English Proficiency 10 FUNDING 10 Debt to State and Corporate Status. 10 Application of Payment Due. 10 Use of Funds. 10 Use for Match Prohibited. 11 Program Income. 11 Nonsupplanting. 11 PAYMENT METHODS AND RESTRICTIONS 11 Payment Methods. 11 Billing Submission. 11 Final Billing Submission. 11 Working Capital Advance. 12 Financial Status Reports (FSRs). 12 Third Party Payors. 12 TERMS AND CONDITIONS OF PAYMENT 12 Prompt Payment. 12 Withholding Payments. 12 Condition Precedent to Requesting Payment. 13 Acceptance as Payment in Full. 13 ALLOWABLE COSTS AND AUDIT REQUIREMENTS 13 Allowable Costs. 13 Independent Single or Program- Specific Audit. 14 Submission of Audit. 14 CONFIDENTIALITY 15 Maintenance of Confidentiality. 15 Department Access to PHI and Other Confidential Information 15 General Provisions (Core Subrecipient) 2013 Rev. 7/12 1 Fiscal Year 2013 Department of State Health Services Contract General Provisions (Core /Subrecipient) Section 7.03 Exchange of Client - Identifying Information. 15 Section 7.04 Security of Patient or Client Records. 15 Section 7.05 HIV /AIDS Model Workplace Guidelines. 15 ARTICLE VIII RECORDS RETENTION 15 Section 8.01 Retention. 15 ARTICLE IX ACCESS AND INSPECTION 16 Section 9.01 Access. 16 Section 9.02 State Auditor's Office. 16 Section 9.03 Responding to Deficiencies. 16 ARTICLE X NOTICE REQUIREMENTS 17 Section 10.01 Child Abuse Reporting Requirement. 17 Section 10.02 Significant Incidents. 17 Section 10.03 Litigation. 17 Section 10.04 Action Against the Contractor. 17 Section 10.05 Insolvency. 17 Section 10.06 Misuse of Funds and Performance Malfeasance. 18 Section 10.07 Criminal Activity and Disciplinary Action. 18 Section 10.08 Retaliation Prohibited. 18 Section 10.09 Documentation. 18 ARTICLE XI ASSURANCES AND CERTIFICATIONS 18 Section 11.01 Certification. 18 Section 11.02 Child Support Delinquencies. 19 Section 11.03 Authorization. 19 Section 11.04 Gifts and Benefits Prohibited. in connection with this Contract. 19 Section 11.05 Ineligibility to Receive the Contract. 20 Section 11.06 Antitrust. 20 Section 11.07 Initiation and Completion of Work. 20 ARTICLE XH GENERAL BUSINESS OPERATIONS OF CONTRACTOR 20 Section 12.01 Responsibilities and Restrictions Concerning Governing Body, Officers and Employees. 20 Section 12.02 Management and Control Systems. 21 Section 12.03 Insurance. 21 Section 12.04 Fidelity Bond. 21 Section 12.05 Liability Coverage. 21 Section 12.06 Overtime Compensation. 22 Section 12.07 Program Site. 22 Section 12.08 Cost Allocation Plan. 22 Section 12.09 No Endorsement. 22 Section 12.10 Historically Underutilized Businesses (HUBs). 22 Section 12.11 Buy Texas. 23 Section 12.12 Contracts with Subrecipient and Vendor Subcontractors. 23 Section 12.13 Status of Subcontractors. 23 Section 12.14 Incorporation of Terms in Subrecipient Subcontracts. 23 Section 12.15 Independent Contractor. 24 Section 12.16 Authority to Bind. 24 Section 12.17 Tax Liability. 24 Section 12.18 Notice of Organizational Change. 24 Section 12.19 Quality Management. 24 Section 12.20 Equipment (Including Controlled Assets). 24 Section 12.21 Supplies. 24 General Provisions (Core Subrecipient) 2013 Rev. 7/12 2 Fiscal Year 2013 Department of State Health Services Contract General Provisions (Core /Snbrecipient) Section 12.22 Changes to Equipment List. 25 Section 12.23 Property Inventory and Protection of Assets. 25 Section 12.24 Bankruptcy. 25 Section 12.25 Title to Property. 25 Section 12.26 Property Acquisitions. 25 Section 12.27 Disposition of Property. 25 Section 12.28 Closeout of Equipment. 26 Section 12.29 Assets as Collateral Prohibited. 26 ARTICLE XIII GENERAL TERMS 26 Section 13.01 Assignment. 26 Section 13.02 Lobbying. 26 Section 13.03 Conflict of Interest. 26 Section 13.04 Transactions Between Related Parties. 27 Section 13.05 Intellectual Property. 27 Section 13.06 Other Intangible Property. 28 Section 13.07 Severability and Ambiguity. 28 Section 13.08 Legal Notice. 28 Section 13.09 Successors. 28 Section 13.10 Headings. 28 Section 13.11 Parties. 28 Section 13.12 Survivability of Terms. 28 Section 13.13 Direct Operation. 29 Section 13.14 Customer Service Information. 29 Section 13.15 Amendment. 29 Section 13.16 Contractor's Notification of Change to Certain Contract Provisions. 29 Section 13.17 Contractor's Request for Revision of Certain Contract Provisions. 29 Section 13.18 Immunity Not Waived. 30 Section 13.19 Hold Harmless and Indemnification. 30 Section 13.20 Waiver. 30 Section 13.21 Electronic and Information Resources Accessibility and Security Standards. 30 Section 13.22 Force Majeure. 31 Section 13.23 Interim Contracts. 31 Section 13.24 Cooperation and Communication. 31 ARTICLE XIV BREACH OF CONTRACT AND REMEDIES FOR NON - COMPLIANCE 31 Section 14.01 Actions Constituting Breach of Contract. 31 Section 14.02 General Remedies and Sanctions. 32 Section 14.03 Notice of Remedies or Sanctions. 33 Section 14.04 Emergency Action. 34 ARTICLE XV CLAIMS AGAINST THE DEPARTMENT 34 Section 15.01 Breach of Contract Claim. 34 Section 15.02 Notice. . 34 Section 15.03 Sole Remedy.. 34 Section 15.04 Condition Precedent to Suit. 34 Section 15.05 Performance Not Suspended. 34 ARTICLE XVI TERMINATION AND TEMPORARY SUSPENSION 35 Section 16.01 Expiration of Contract or Program Attachment(s). 35 Section 16.02 Effect of Termination. Contract. 35 Section 16.03 Acts Not Constituting Termination. 35 Section 16.04 Termination or Temporary Suspension Without Cause. 35 Section 16.05 Termination For Cause. 36 General Provisions (Core Subrecipient) 2013 Rev. 7/12 3 Fiscal Year 2013 Department of State Health Services Contract General Provisions (Core /Subrecipient) Section 16.06 ARTICLE XVII Section 17.01 Section 17.02 Section 17.03 ARTICLE XVIII Section 18.01 Section 18.02 Section 18.03 Section 18.04 Section 18.05 Notice of Termination. 37 VOID, SUSPENDED, AND TERMINATED CONTRACTS 37 Void Contracts. 37 Effect of Void, Suspended, or Involuntarily Terminated Contract. 37 Appeals Rights. 37 CLOSEOUT 37 Cessation of Services At Closeout. 37 Administrative Offset. 37 Deadline for Closeout. 37 Payment of Refunds. 38 Disallowances and Adjustments. 38 General Provisions (Core Subrecipient) 2013 Rev. 7/12 4 ARTICLE I[ COMPLIANCE AND REPORTING Section 1.01 Compliance with Statutes and Rules. Contractor shall comply, and shall require its subcontractor(s) to comply, with the requirements of the Department's rules of general applicability and other applicable state and federal statutes, regulations, rules, and executive orders, as such statutes, regulations, rules, and executive orders currently exist and as they may be lawfully amended. The Department rules are located in the Texas Administrative Code, Title 25 (Rules). To the extent this Contract imposes a higher standard, or additional requirements beyond those required by applicable statutes, regulations, rules or executive orders, the terms of this Contract will control. Contractor further agrees that, upon notification from DSHS, Contractor shall comply with the terms of any contract provisions DSHS is required to include in its contracts under legislation effective at the time of the effective date of this Contract or during the term of this Contract. Section 1.02 Compliance with Requirements of Solicitation Document. Except as specified in these General Provisions or the Program Attachment(s), Contractor shall comply with the requirements, eligibility conditions, assurances, certifications and program requirements of the Solicitation Document, if any, (including any revised or additional terms agreed to in writing by Contractor and DSHS prior to execution of this Contract) for the duration of this Contract or any subsequent renewals. The Parties agree that the Department has relied upon Contractor's response to the Solicitation Document. The Parties agree that any misrepresentation contained in Contractor's response to the Solicitation Document constitutes a breach of this Contract. Section 1.03 Reporting. Contractor shall submit reports in accordance with the reporting requirements established by the Department and shall provide any other information requested by the Department in the format required by DSHS. Failure to submit any required report or additional requested information by the due date specified in the Program Attachment(s) or upon request constitutes a breach of contract, may result in delayed payment and/or the imposition of sanctions and remedies, and, if appropriate, emergency action; and may adversely affect evaluation of Contractor's future contracting opportunities with the Department. Section 1.04 Client Financial Eligibility. Where applicable, Contractor shall use financial eligibility criteria, financial assessment procedures and standards developed by the Department to determine client eligibility. Section 1.05 Applicable Contracts Law and Venue for Disputes. Regarding all issues related to contract formation, performance, interpretation, and any issues that may arise in any dispute between the Parties, this Contract will be governed by, and construed in accordance with, the laws of the State of Texas. In the event of a dispute between the Parties, venue for any suit will be Travis County, Texas. Section 1.06 Applicable Laws and Regulations Regarding Funding Sources. Where applicable, federal statutes and regulations, including federal grant requirements applicable to funding sources, will apply to this Contract. Contractor agrees to comply with applicable laws, executive orders, regulations and policies, as well as Office of Management and Budget (OMB) Circulars (as codified in Title 2 of the Code of Federal Regulations), the Uniform Grant and Contract Management Act of 1981 (UGMA), Tex. Gov. Code Chapter 783, and Uniform Grant Management Standards (UGMS), as revised by federal circulars and incorporated in UGMS by the Comptroller of Public Accounts, Texas Procurement and Support Services Division. UGMA and UGMS can be located through web links on the DSHS website at http: / /www.dshs. state .tx.us /contracts/links.shtm. Contractor also shall comply with all applicable federal and state assurances contained in UGMS, Part III, State Uniform Administrative Requirements for Grants and Cooperative Agreements § .14. If applicable, Contractor shall comply with the Federal awarding agency's Common Rule, and the U.S. Health and Human Services Grants Policy Statement, both of which may be General Provisions (Core Subrecipient) 2013 Rev. 7/12 5 located through web links on the DSHS website at http:I /www.dshs. state .tx.us /contracts/links.shtm. For contracts funded by block grants, Contractor shall comply with Tex. Gov. Code Chapter 2105. Section 1.07 Statutes and Standards of General Applicability. Contractor is responsible for reviewing and complying with all applicable statutes, rules, regulations, executive orders and policies. To the extent applicable to Contractor, Contractor shall comply with the following: a) the following statutes, rules, regulations, and DSHS policy (and any of their subsequent amendments) that collectively prohibit discrimination, exclusion from or limitation of participation in programs, benefits or activities or denial of any aid, care, service or other benefit on the basis of race, color, national origin, limited English proficiency, sex, sexual orientation (where applicable), disabilities, age, substance abuse, political belief or religion: 1) Title VI of the Civil Rights Act of 1964, 42 USC §§0 2000d et seq.; 2) Title IX of the Education Amendments of 1972, 20 USC § ❑ ❑ § 1681 -1683, and 1685 -1686; 3) Section 504 of the Rehabilitation Act of 1973, 29 USC § 794(a); 4) the Americans with Disabilities Act of 1990, 42 USC §§ ❑ 12101 et seq.; 5) Age Discrimination Act of 1975, 42 USC § ❑ ❑ § 6101 -6107; 6) Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970, 42 USC § ❑ 290dd (b)(1); 7) 45 CFR Parts 80, 84, 86 and 91; 8) U.S. Department of Labor, Equal Employment Opportunity E.O. 11246; 9) Tex. Lab. Code Chapter 21; 10) Food Stamp Act of 1977 (7 USC § 200 et seq.; 11) Executive Order 13279, 45 CFR Part 87 or 7 CFR Part 16 regarding equal treatment and opportunity for religious organizations; 12) Drug Abuse Office and Treatment Act of 1972, 21 USC §§ 1101 et seq., relating to drug abuse; 13) Public Health Service Act of 1912, §§ ❑ 523 and 527, 42 USC § ❑ 290dd -2, and 42 CFR Part 2, relating to confidentiality of alcohol and drug abuse patient records; 14) Title VIII of the Civil Rights Act of 1968, 42 USC §§ 3601 et seq., relating to nondiscrimination in housing; and 15) DSHS Policy AA -5018, Non - discrimination Policy for DSHS Programs; b) Immigration Reform and Control Act of 1986, 8 USC § 1324a, and Immigration Act of 1990, 8 USC 1101 et seq., regarding employment verification; and Illegal Immigration Reform and Immigrant Responsibility Act of 1996; c) Pro - Children Act of 1994, 20 USC §§ 6081 -6084, and the Pro - Children Act of 2001, 20 USC § 7183, regarding the non -use of all tobacco products; d) National Research Service Award Act of 1971, 42 USC §§ ❑ 289a -1 et seq., and 6601 (PL 93 -348 and PL 103 -43), regarding human subjects involved in research; e) Hatch Political Activity Act, 5 USC §§ ❑ ❑ 1501 -1508 and 7324 -28, which limits the political activity of employees whose employment is funded with federal funds; f) Fair Labor Standards Act, 29 USC §§ 201 et seq., and the Intergovernmental Personnel Act of 1970, 42 USC §§ 4701 et seq., as applicable, concerning minimum wage and maximum hours; g) Tex. Gov. Code Chapter 469, pertaining to eliminating architectural barriers for persons with disabilities; h) Texas Workers' Compensation Act, Tex. Lab. Code Chapters 401 -406 and 28 Tex. Admin. Code Part 2, regarding compensation for employees' injuries; i) The Clinical Laboratory Improvement Amendments of 1988, 42 USC § 263a, regarding the regulation and certification of clinical laboratories; j) The Occupational Safety and Health Administration Regulations on Blood Borne Pathogens, 29 CFR § 1910.1030, or Title 25 Tex. Adman. Code Chapter 96 regarding safety standards for handling blood borne pathogens; k) Laboratory Animal Welfare Act of 1966, 7 USC §§ 2131 et seq., pertaining to the treatment of laboratory animals; 1) environmental standards pursuant to the following: 1) Institution of environmental quality control measures under the National Environmental Policy Act of 1969, 42 USC §§ 4321 -4347 and Executive Order 11514 (35 Fed. Reg. 4247), "Protection and Enhancement of Environmental Quality;" 2) General Provisions (Core Subrecipient) 2013 Rev. 7/12 6 Notification of violating facilities pursuant to Executive Order 11738 (40 CFR Part 32), "Providing for Administration of the Clean Air Act and the Federal Water Pollution Control Act with respect to Federal Contracts, Grants, or Loans;" 3) Protection of wetlands pursuant to Executive Order 11990, 42 Fed. Reg. 26961; 4) Evaluation of flood hazards in floodplains in accordance with Executive Order 11988, 42 Fed. Reg. 26951 and, if applicable, flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (PL 93 -234); 5) Assurance of project consistency with the approved State Management program developed under the Coastal Zone Management Act of 1972, 16 USC §§ 1451 et seq.; 6) Federal Water Pollution Control Act, 33 USC §1251 et seq.; 7) Protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, 42 USC §§ 300f -300j; 8) Protection of endangered species under the Endangered Species Act of 1973, 16 USC §§ 1531 et seq.; 9) Conformity of federal actions to state clean air implementation plans under the Clean Air Act of 1955, 42 USC § §7401 et seq.; 10) Wild and Scenic Rivers Act of 1968 (16 USC §§ 1271 et seq.) related to protecting certain rivers system; and 11) Lead -Based Paint Poisoning Prevention Act (42 USC §§ 4801 et seq.) prohibiting the use of lead -based paint in residential construction or rehabilitation; m) Intergovernmental Personnel Act of 1970 (42 USC § §4278 -4763) regarding personnel merit systems for programs specified in Appendix A of the federal Office of Program Management's Standards for a Merit System of Personnel Administration (5 CFR Part 900, Subpart F); n) Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (PL 91 -646), relating to fair treatment of persons displaced or whose property is acquired as a result of Federal or federally- assisted programs; o) Davis -Bacon Act (40 USC §§ 276a to 276a -7), the Copeland Act (40 U.S.C. § 276c and 18 USC § 874), and the Contract Work Hours and Safety Standards Act (40 USC §§ 327 -333), regarding labor standards for federally- assisted construction subagreements; p) National Historic Preservation Act of 1966, §106 (16 USC § 470), Executive Order 11593, and the Archaeological and Historic Preservation Act of 1974 (16 USC §§ 469a -1 et seq.) regarding historic property to the extent necessary to assist DSHS in complying with the Acts; q) financial and compliance audits in accordance with Single Audit Act Amendments of 1996 and OMB Circular No. A -133, "Audits of States, Local Governments, and Non -Profit Organizations;" r) Trafficking Victims Protection Act of 2000, Section 106(g) (22 USC § 7104); s) Executive Order, Federal Leadership on Reducing Text Messaging While Driving, October 1, 2009, if required by a federal funding source of the Contract; and t) requirements of any other applicable state and federal statutes, executive orders, regulations, rules and policies. If this Contract is funded by a federal grant or cooperative agreement, additional state or federal requirements found in the Notice of Grant Award are imposed on Contractor and incorporated herein by reference. Contractor may obtain a copy of any applicable Notice of Grant Award from the contract manager assigned to the Program Attachment. Section 1.08 Applicability of General Provisions to Interagency and Interlocal Contracts. Certain sections or portions of sections of these General Provisions will not apply to Contractors that are State agencies or units of local government; and certain additional provisions will apply to such Contractors. a) The following sections or portions of sections of these General Provisions will not apply to interagency or interlocal contracts: 1) Hold Harmless and Indemnification, Section 13.19; 2) Independent Contractor, Section 12.15 (delete the third sentence in its entirety; delete the word "employees" in the fourth sentence; the remainder of the section applies); 3) Insurance, Section 12.03; 4) Liability Coverage, Section 12.05; 5) Fidelity Bond, Section 12.04; General Provisions (Core Subrecipient) 2013 Rev. 7/12 7 6) Historically Underutilized Businesses, Section 12.10 (Contractor, however, shall comply with HUB requirements of other statutes and rules specifically applicable to that entity); 7) Debt to State and Corporate Status, Section 3.01; 8) Application of Payment Due, Section 3.02; and 9) Article XV Claims against the Department (This Article is inapplicable to interagency contracts only). b) The following additional provisions will apply to interagency contracts: 1) This Contract is entered into pursuant to the authority granted and in compliance with the provisions of the Interagency Cooperation Act, Tex. Gov. Code Chapter 771; 2) The Parties hereby certify that (1) the services specified are necessary and essential for the activities that are properly within the statutory functions and programs of the affected agencies of State government; (2) the proposed arrangements serve the interest of efficient and economical administration of the State government; and (3) the services, supplies or materials contracted for are not required by Section 21 of Article 16 of the Constitution of the State of Texas to be supplied under contract given to the lowest responsible bidder; and 3) DSHS certifies that it has the authority to enter into this Contract granted in Tex. Health & Safety Code Chapter 1001, and Contractor certifies that it has specific statutory authority to enter into and perform this Contract. c) The following additional provisions will apply to interlocal contracts: 1) This Contract is entered into pursuant to the authority granted and in compliance with the provisions of the Interlocal Cooperation Act, Tex. Gov. Code Chapter 791; 2) Payments made by DSHS to Contractor will be from current revenues available to DSHS; and 3) Each Party represents that it has been authorized to enter into this Contract. d) Contractor agrees that Contract Revision Requests (pursuant to the Contractor's Request for Revision to Certain Contract Provisions section), when signed by a duly authorized representative of Contractor, will be effective as of the effective date specified by the Department, whether that date is prior to or after the date of any ratification by Contractor's governing body. Section 1.09 Civil Rights Policies and Complaints. Upon request, Contactor shall provide the Health and Human Services Commission (MSC) Civil Rights Office with copies of all Contractor's civil rights policies and procedures. Contractor shall notify HHSC's Office of Civil Rights of any civil rights complaints received relating to performance under this Contract no more than ten (10) calendar days after Contractor's receipt of the claim. Notice must be directed to — HHSC Civil Rights Office 701 W. 51st St., Mail Code W206 Austin, Texas 78751 Toll -free phone (888) 388 -6332 Phone (512) 438 -4313 TTY Toll -free (877) 432 -7232 Fax (512) 438 -5885 Section 1.10 Licenses, Certifications, Permits, Registrations and Approvals. Contractor shall obtain and maintain all applicable licenses, certifications, permits, registrations and approvals to conduct its business and to perform the services under this Contract. Failure to obtain or any revocation, surrender, expiration, non - renewal, inactivation or suspension of any such license, certification, permit, registration or approval constitutes grounds for termination of this Contract or other remedies the Department deems appropriate. Contractor shall ensure that all its employees, staff and volunteers obtain and maintain in active status all licenses, certifications, permits, registrations and approvals required to perform their duties under this Contract General Provisions (Core Subrecipient) 2013 Rev. 7/12 8 and shall prohibit any person who does not hold a current, active required license, certification, permit, registration or approval from performing services under this Contract. Section 1.11 Funding Obligation. This Contract is contingent upon the availability of funding. If funds become unavailable through lack of appropriations, budget cuts, transfer of funds between programs or health and human services agencies, amendment of the Appropriations Act, health and human services agency consolidation, or any other disruptions of current appropriated funding for this Contract, DSHS may restrict, reduce or terminate funding under this Contract. Notice of any restriction or reduction will include instructions and detailed information on how DSHS will fund the services and/or goods to be procured with the restricted or reduced funds. ARTICLE II SERVICES Section 2.01 Education to Persons in Residential Facilities. If applicable, Contractor shall ensure that all persons, who are housed in Department - licensed and/or - funded residential facilities and who are twenty -two (22) years of age or younger, have access to educational services as required by Tex. Educ. Code § 29.012. Contractor shall notify the local education agency or local early intervention program as prescribed by Tex. Educ. Code § 29.012 not later than the third calendar day after the date a person who is twenty -two (22) years of age or younger is placed in Contractor's residential facility. Section 2.02 Disaster Services. In the event of a local, state, or federal emergency, including natural, man- made, criminal, terrorist, and/or bioterrorism events, declared as a state disaster by the Governor, or as a federal disaster by the appropriate federal official, Contractor may be called upon to assist DSHS in providing services, as appropriate, in the following areas: community evacuation; health and medical assistance; assessment of health and medical needs; health surveillance; medical care personnel; health and medical equipment and supplies; patient evacuation; in- hospital care and hospital facility status; food, drug, and medical device safety; worker health and safety; mental health and substance abuse; public health information; vector control and veterinary services; and victim identification and mortuary services. Contractor shall carry out disaster services in the manner most responsive to the needs of the emergency, be cost - effective, and be least intrusive on Contractor's primary services. Section 2.03 Consent to Medical Care of a Minor. If Contractor provides medical, dental, psychological or surgical treatment to a minor under this Contract, either directly or through contracts with subcontractors, Contractor shall not provide treatment of a minor unless informed consent to treatment is obtained pursuant to Tex. Fam. Code Chapter 32, relating to consent to treatment of a child by a non - parent or child or pursuant to other state law. If requirements of federal law relating to consent directly conflict with Tex. Fam. Code Chapter 32, federal law supersedes state law. Section 2.04 Telemedicine Medical Services. Contractor shall ensure that if Contractor or its subcontractor uses telemedicine /telepsychiatry that the services are implemented in accordance with written procedures and using a protocol approved by Contractor's medical director and using equipment that complies with the equipment standards as required by the Department. Procedures for providing telemedicine service must include the following requirements: a) clinical oversight by Contractor's medical director or designated physician responsible for medical leadership; b) contraindication considerations for telemedicine use; c) qualified staff members to ensure the safety of the individual being served by telemedicine at the remote site; d) safeguards to ensure confidentiality and privacy in accordance with state and federal laws; e) use by credentialed licensed providers providing clinical care within the scope of their licenses; General Provisions (Core Subrecipient) 2013 Rev. 7/12 9 f) demonstrated competency in the operations of the system by all staff members who are involved in the operation of the system and provision of the services prior to initiating the protocol; g) priority in scheduling the system for clinical care of individuals; h) quality oversight and monitoring of satisfaction of the individuals served; and i) management of information and documentation for telemedicine services that ensures timely access to accurate information between the two sites. Telemedicine Medical Services does not include chemical dependency treatment services provided by electronic means under Rule § 448.911. Section 2.05 Fees for Personal Health Services. Contractor may develop a system and schedule of fees for personal health services in accordance with the provisions of Tex. Health & Safety Code § 12.032, DSHS Rule § 1.91 covering Fees for Personal Health Services, and other applicable laws or grant requirements. The amount of a fee must not exceed the actual cost of providing the services. No client may be denied a service due to inability to pay. Section 2.06 Cost Effective Purchasing of Medications. If medications are funded under this Contract, Contractor shall make needed medications available to clients at the lowest possible prices and use the most cost effective medications purchasing arrangement possible. Section 2.07 Services and Information for Persons with Limited English Proficiency. Contractor shall take reasonable steps to provide services and information, both orally and in writing, in appropriate languages other than English, to ensure that persons with limited English proficiency are effectively informed and can have meaningful access to programs, benefits, and activities. Contractor shall identify and document on the client records the primary language /dialect of a client who has limited English proficiency and the need for translation or interpretation services and shall not require a client to provide or pay for the services of a translator or interpreter. Contractor shall make every effort to avoid use of any persons under the age of eighteen (18) or any family member or friend of the client as an interpreter for essential communications with a client with limited English proficiency, unless the client has requested that person and using the person would not compromise the effectiveness of services or violate the client's confidentiality and the client is advised that a free interpreter is available. ARTICLE III FUNDING Section 3.01 Debt to State and Corporate Status. Pursuant to Tex. Gov. Code § 403.055, the Department will not approve and the State Comptroller will not issue payment to Contractor if Contractor is indebted to the State for any reason, including a tax delinquency. Contractor, if a corporation, certifies by execution of this Contract that it is current and will remain current in its payment of franchise taxes to the State of Texas or that it is exempt from payment of franchise taxes under Texas law (Tex. Tax Code §§ 171.001 et seq.). Contractor, if a corporation, further certifies that it is and will remain in good standing with the Secretary of State's office. A false statement regarding franchise tax or corporate status is a material breach of this Contract. If franchise tax payments become delinquent during the Contract term, all or part of the payments under this Contract may be withheld until Contractor's delinquent franchise tax is paid in full. Section 3.02 Application of Payment Due. Contractor agrees that any payments due under this Contract will be applied towards any debt of Contractor, including but not limited to delinquent taxes and child support that is owed to the State of Texas. Section 3.03 Use of Funds. Contractor shall expend Department funds only for the provision of approved services and for reasonable and allowable expenses directly related to those services. General Provisions (Core Subrecipient) 2013 Rev. 7/12 10 Section 3.04 Use for Match Prohibited. Contractor shall not use funds provided through this Contract for matching purposes in securing other funding unless directed or approved by the Department in writing. Section 3.05 Program Income. Gross income directly generated from Department funds through a project or activity performed under a Program Attachment and/or earned only as a result of a Program Attachment during the term of the Program Attachment are considered program income. Unless otherwise required under the terms of the grant funding this Contract, Contractor shall use the addition alternative, as provided in UGMS § _.25(g)(2), for the use of program income to further the program objectives of the state or federal statute under which the Program Attachment was made, and Contractor shall spend the program income on the same Program Attachment project in which it was generated. Contractor shall identify and report this income in accordance with the Compliance and Reporting Article of these General Provisions, the Contractor's Financial Procedures Manual located at http: / /www.dshs.state.tx.us /contracts /cfpm.shtm and the provisions of the Program Attachment(s). Contractor shall expend program income during the Program Attachment term and may not carry forward to any succeeding term. Contractor shall refund program income not expended in the term in which it is earned to DSHS. DSHS may base future funding levels, in part, upon Contractor's proficiency in identifying, billing, collecting, and reporting program income, and in using it for the purposes and under the conditions specified in this Contract. Section 3.06 Nonsupplanting. Contractor shall not supplant (i.e., use funds from this Contract to replace or substitute existing funding from other sources that also supports the activities that are the subject of this Contract) but rather shall use funds from this Contract to supplement existing state or local funds currently available for a particular activity. Contractor shall make a good faith effort to maintain its current level of support. Contractor may be required to submit documentation substantiating that a reduction in state or local funding, if any, resulted for reasons other than receipt or expected receipt of funding under this Contract. ARTICLE IV PAYMENT METHODS AND RESTRICTIONS Section 4.01 Payment Methods. Except as otherwise provided by the provisions of the Program Attachment(s), the payment method for each Program Attachment will be one of the following methods: a) cost reimbursement. This payment method is based on an approved budget in the Program Attachment(s) and acceptable submission of a request for reimbursement; or b) unit rate /fee- for - service. This payment method is based on a fixed price or a specified rate(s) or fee(s) for delivery of a specified unit(s) of service, as stated in the Program Attachment(s) and acceptable submission of all required documentation, forms and/or reports. Section 4.02 Billing Submission. Contractors shall bill the Department in accordance with the Program Attachment(s) in the form and format prescribed by DSHS. Unless otherwise specified in the Program Attachment(s) or permitted under the Third Party Payors section of this Article, Contractor shall submit requests for reimbursement or payment monthly by the last business day of the month following the end of the month covered by the bill. Contractor shall maintain all documentation that substantiates billing submissions and make the documentation available to DSHS upon request. Section 4.03 Final Billing Submission. Unless otherwise provided by the Department, Contractor shall submit a reimbursement or payment request as a final close -out bill not later than sixty (60) calendar days following the end of the term of the Program Attachment for goods received and services rendered during the term. If necessary to meet this deadline, Contractor may submit reimbursement or payment requests by facsimile transmission. Reimbursement or payment requests received in DSHS's offices more than sixty (60) calendar days following the end of the applicable term will not be paid. Consideration of requests for an exception will be made on a case -by -case basis, subject to the availability of funding, and only for an extenuating circumstance, such as a catastrophic event, natural disaster, or criminal activity that substantially General Provisions (Core Subrecipient) 2013 Rev. 7/12 11 interferes with normal business operations or causes damage or destruction of a place of business and/or records. A written statement describing the extenuating circumstance and the last request for reimbursement must be submitted for review and approval to the DSHS Accounting Section. Section 4.04 Working Capital Advance. If allowed under this Contract, a single one -time working capital advance per term of the Program Attachment may be granted at the Department's discretion. Contractor must submit documentation to the contract manager assigned to the Program Attachment to justify the need for a working capital advance. Contractor shall liquidate the working capital advance as directed by the Department. The requirements for the documentation justifying the need for an advance and the directions for liquidating the advance are found in the Contractor's Financial Procedures Manual located at http: / /www.dshs. state .tx.us /contracts /cfpm.shtm. Section 4.05 Financial Status Reports (FSRs). Except as otherwise provided in these General Provisions or in the terms of the Program Attachment(s), for contracts with categorical budgets, Contractor shall submit quarterly FSRs to Accounts Payable by the last business day of the month following the end of each quarter of the Program Attachment term for Department review and financial assessment. Contractor shall submit the final FSR no later than sixty (60) calendar days following the end of the applicable term. Section 4.06 Third Party Payors. A third party payor is any person or entity who has the legal responsibility for paying for all or part of the services provided. Third party payors include, but are not limited to, commercial health or liability insurance carriers, Medicaid, or other federal, state, local, and private funding sources. Except as provided in this Contract, Contractor shall screen all clients and shall not bill the Department for services eligible for reimbursement from third party payors. Contractor shall (a) enroll as a provider in Children's Health Insurance Program and Medicaid if providing approved services authorized under this Contract that may be covered by those programs, and bill those programs for the covered services; (b) provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs; (c) allow clients who are otherwise eligible for Department services, but cannot pay a deductible required by a third party payor, to receive services up to the amount of the deductible and to bill the Department for the deductible; (d) not bill the Department for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted, in which case the thirty (30) -day requirement in the Billing Submission section will be extended until all such appeals have been exhausted; (e) maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement; (f) bill all third party payors for services provided under this Contract before submitting any request for reimbursement to Department; and (g) provide third party billing functions at no cost to the client. ARTICLE V TERMS AND CONDITIONS OF PAYMENT Section 5.01 Prompt Payment. Upon receipt of a timely, undisputed invoice pursuant to this Contract, Department will pay Contractor. Payments and reimbursements are contingent upon a signed Contract and will not exceed the total amount of authorized funds under this Contract. Contractor is entitled to payment or reimbursement only if the service, work, and/or product has been authorized by the Department and performed or provided pursuant to this Contract. If those conditions are met, Department will make payment in accordance with the Texas prompt payment law (Tex. Gov. Code Chapter 2251). Contractor shall comply with Tex. Gov. Code Chapter 2251 regarding its prompt payment obligations to subcontractors. Payment of invoices by the Department will not constitute acceptance or approval of Contractor's performance, and all invoices and Contractor's performance are subject to audit or review by the Department. Section 5.02 Withholding Payments. Department may withhold all or part of any payments to Contractor to offset reimbursement for any ineligible expenditures, disallowed costs, or overpayments that Contractor has not refunded to Department, or if financial status report(s) required by the Department are not submitted by the General Provisions (Core Subrecipient) 2013 Rev. 7/12 12 date(s) due. Department may take repayment (recoup) from funds available under this Contract in amounts necessary to fulfill Contractor's repayment obligations. Section 5.03 Condition Precedent to Requesting Payment. Contractor shall disburse program income, rebates, refunds, contract settlements, audit recoveries, and interest eamed on such funds before requesting cash payments including any advance payments from Department. Section 5.04 Acceptance as Payment in Full. Except as permitted in the Fees for Personal Health Services section of the Services Article of these General Provisions or under 25 Tex. Admin. Code § 444.413, Contractor shall accept reimbursement or payment from DSHS as payment in full for services or goods provided to clients or participants, and Contractor shall not seek additional reimbursement or payment for services or goods from clients or participants or charge a fee or make a profit with respect to the Contract. A fee or profit is considered to be an amount in excess of actual allowable costs that are incurred in conducting an assistance program. ARTICLE VI ALLOWABLE COSTS AND AUDIT REQUIREMENTS Section 6.01 Allowable Costs. For services satisfactorily performed, and sufficiently documented, pursuant to this Contract, DSHS will reimburse Contractor for allowable costs. Contractor must have incurred a cost prior to claiming reimbursement and within the applicable term to be eligible for reimbursement under this Contract. DSHS will determine whether costs submitted by Contractor are allowable and eligible for reimbursement. If DSHS has paid funds to Contractor for unallowable or ineligible costs, DSHS will notify Contractor in writing, and Contractor shall return the funds to DSHS within thirty (30) calendar days of the date of this written notice. DSHS may withhold all or part of any payments to Contractor to offset reimbursement for any unallowable or ineligible expenditures that Contractor has not refunded to DSHS, or if financial status report(s) required under the Financial Status Reports section are not submitted by the due date(s). DSHS may take repayment (recoup) from funds available under this Contract in amounts necessary to fulfill Contractor's repayment obligations. Applicable cost principles, audit requirements, and administrative requirements include- Applicable Entity Applicable Cost Principles Audit Requirements 1 Administrative Requirements UGMS, OMB Circular A -102, and applicable Federal awarding agency common rule State, Local and Tribal Governments OMB Circular A -87 (2 CFR, Part 225) 0M13 Circular A -133 and UGMS Educational Institutions OMB Circular A -21 (2 CFR, Part 220) OMB Circular A -133 OMB Circular A -110 (2 CFR, Part 215) and applicable Federal awarding agency common rule; and UGMS, as applicable Non -Profit Organizations OMB Circular A -122 (2 CFR, Part 230) OMB Circular A -133 and UGMS UGMS; OMB Circular A -110 (2 CFR, Part 215) and applicable Federal awarding agency common rule For -profit Organization other than a hospital and 48 CFR Part 31, Contract Cost Principles OMB Circular A- 133 and UGMS UGMS and applicable Federal awarding agency common rule an organization named General Provisions (Core Subrecipient) 2013 Rev. 7/12 13 in OMB Circular A -122 Procedures, or (2 CFR Part, 230) as not uniform cost subject to that circular. accounting standards that comply with cost principles acceptable to the federal or state awarding agency A chart of applicable Federal awarding agency common rules is located through a weblink on the DSHS website at htlp: / /www.dshs.state.tx.us /contracts /links.shtm. OMB Circulars will be applied with the modifications prescribed by UGMS with effect given to whichever provision imposes the more stringent requirement in the event of a conflict. Section 6.02 Independent Single or Program - Specific Audit. If Contractor within Contractor's fiscal year expends a total amount of at least $500,000 in federal funds awarded, Contractor shall have a single audit or program - specific audit in accordance with the Office of Management and Budget (OMB) Circ. No. A -133, the Single Audit Act of 1984, P L 98 -502, 98 Stat. 2327, and the Single Audit Act Amendments of 1996, P L 104 -156, 110 Stat. 1396. The $500,000 federal threshold amount includes federal funds passed through by way of state agency awards. If Contractor within Contractor's fiscal year expends a total amount of at least $500,000 in state funds awarded, Contractor must have a single audit or program - specific audit in accordance with UGMS, State of Texas Single Audit Circular. For -profit Contractors whose expenditures meet or exceed the federal and/or state expenditure thresholds stated above shall follow the guidelines in OMB Circular A -133 or UGMS, as applicable, for their program - specific audits. The HHSC Office of Inspector General (OIG) will notify Contractor to complete the Single Audit Status Registration Form. If Contractor fails to complete the Single Audit Status Form within thirty (30) calendar days after notification by OIG to do so, Contractor shall be subject to DSHS sanctions and remedies for non - compliance with this Contract. The audit must be conducted by an independent certified public accountant and in accordance with applicable OMB Circulars, Government Auditing Standards, and UGMS, which is accessible through a web link on the DSHS website at http: / /www.dshs. state .tx.us /contracts/links.shtm. Contractor shall procure audit services in compliance with this section, state procurement procedures, as well as with the provisions of UGMS. Contractor, unless Contractor is a state governmental entity, shall competitively re- procure independent single audit services at least every five (5) years. Section 6.03 Submission of Audit. Within thirty (30) calendar days of receipt of the audit reports required by the Independent Single or Program - Specific Audit section, Contractor shall submit one copy to the Department's Contract Oversight and Support Section, and one copy to the OIG, at the following addresses: Department of State Health Services Contract Oversight and Support, Mail Code 1326 F.O. Box 149347 Austin, Texas 78714 -9347 Health and Human Services Commission Office of Inspector General Compliance /Audit, Mail Code 1326 P.O. Box 85200 Austin, Texas 78708 -5200 If Contractor fails to submit the audit report as required by the Independent Single or Program - Specific Audit section within thirty (30) calendar days of receipt by Contractor of an audit report, Contractor shall be subject to DSHS sanctions and remedies for non - compliance with this Contract. General Provisions (Core Subrecipient) 2013 Rev. 7/12 14 ARTICLE VII CONFIDENTIALITY Section 7.01 Maintenance of Confidentiality. Contractor must maintain the privacy and confidentiality of information and records received during or related to the performance of this Contract, including patient and client records that contain protected health information (PHI), and any other information that discloses confidential personal information or identifies any client served by DSHS, in accordance with applicable federal and state laws, rules and regulations, including but not limited to 7 CFR Part 246; 42 CFR Part 2; 45 CFR Parts 160 and 164 (Health Insurance Portability and Accountability Act [HIPAA]); Tex. Health & Safety Code Chapters 12, 47, 81, 82, 85, 88, 92, 161, 181, 241, 245, 251, 534, 576, 577, 596, 611, and 773; and Tex. Occ. Code Chapters 56 and 159 and all applicable rules and regulations. Section 7.02 Department Access to PHI and Other Confidential Information. Contractor shall cooperate with Department to allow Department to request, collect and receive PHI and other confidential information under this Contract, without the consent of the individual to whom the PHI relates, for funding, payment and administration of the grant program, and for purposes permitted under applicable state and federal confidentiality and privacy laws. Section 7.03 Exchange of Client - Identifying Information. Except as prohibited by other law, Contractor and DSHS shall exchange PHI without the consent of clients in accordance with 45 CFR § 164.504(e)(3)(i)(B), Tex. Health & Safety Code § 533.009 and Rule Chapter 414, Subchapter A or other applicable laws or rules. Contractor shall disclose information described in Tex. Health & Safety Code § 614.017(a)(2) relating to special needs offenders, to an agency described in Tex. Health & Safety Code § 614.017(c) upon request of that agency, unless Contractor documents that the information is not allowed to be disclosed under 45 CFR Part 164 or other applicable law. Section 7.04 Security of Patient or Client Records. Contractor shall maintain patient and client records in compliance with state and federal law relating to security and retention of medical or mental health and substance abuse patient and client records. Department may require Contractor to transfer original or copies of patient and client records to Department, without the consent or authorization of the patient or client, upon termination of this Contract or a Program Attachment to this Contract, as applicable, or if the care and treatment of the individual patient or client is transferred to another entity. Prior to providing services funded under this Contract to a patient or client, Contractor shall attempt to obtain consent from the patient or client to transfer copies of patient or client records to another entity funded by DSHS upon termination of this Contract or a Program Attachment to this Contract, as applicable, or if care or treatment is transferred to another DSHS- funded contractor. Section 7.05 HIV /AIDS Model Workplace Guidelines. If providing direct client care, services, or programs, Contractor shall implement Department's policies based on the HIV /AIDS (human immunodeficiency virus /acquired immunodeficiency syndrome) Model Workplace Guidelines for Businesses, State Agencies, and State Contractors, Policy No. 090.021, and Contractor shall educate employees and clients concerning HIV and its related conditions, including AIDS, in accordance with the Tex. Health & Safety Code § f1 ❑ 85.112 -114. A link to the Model Workplace Guidelines can be found at http: / /www.dshs. state. tx. us /hivstd/policy /policies. shim. ARTICLE VIII RECORDS RETENTION Section 8.01 Retention. Contractor shall retain records in accordance with applicable state and federal statutes, rules and regulations. At a minimum, Contractor shall retain and preserve all other records, including financial records that are generated or collected by Contractor under the provisions of this Contract, for a period of four (4) years after the termination of this Contract. If services are funded through Medicaid, the General Provisions (Core Subrecipient) 2013 Rev. 7/12 15 federal retention period, if more than four (4) years, will apply. Contractor shall retain all records pertaining to this Contract that are the subject of litigation or an audit until the litigation has ended or all questions pertaining to the audit are resolved. Legal requirements for Contractor may extend beyond the retention schedules established in this section. Contractor shall retain medical records in accordance with Tex. Admin. Code Title 22, Part 9, § 165.1(b) and (c) or other applicable statutes, rules and regulations governing medical information. Contractor shall include this provision concerning records retention in any subcontract it awards. If Contractor ceases business operations, it shall ensure that records relating to this Contract are securely stored and are accessible by the Department upon Department's request for at least four (4) years from the date Contractor ceases business or from the date this Contract terminates, whichever is sooner. Contractor shall provide, and update as necessary, the name and address of the party responsible for storage of records to the contract manager assigned to the Program Attachment. ARTICLE IX ACCESS AND INSPECTION Section 9.01 Access. In addition to any right of access arising by operation of law, Contractor, and any of Contractor's affiliate or subsidiary organizations or subcontractors shall permit the Department or any of its duly authorized representatives, as well as duly authorized federal, state or local authorities, including the Comptroller General of the United States, OIG, and the State Auditor's Office (SAO), unrestricted access to and the right to examine any site where business is conducted or client services are performed, and all records (including financial records, client and patient records, if any, and Contractor's personnel records and governing body personnel records), books, papers or documents related to this Contract; and the right to interview members of Contractor's governing body, staff, volunteers, participants and clients concerning the Contract, Contractor's business and client services. If deemed necessary by the Department or the OIG, for the purpose of investigation or hearing, Contractor shall produce original documents related to this Contract. The Department and HIISC will have the right to audit billings both before and after payment, and all documentation that substantiates the billings. Payments will not foreclose the right of Department and HHSC to recover excessive or illegal payments. Contractor shall make available to the Department information collected, assembled or maintained by Contractor relative to this Contract for the Department to respond to requests that it receives under the Public Information Act. Contractor shall include this provision concerning the right of access to, and examination of, sites and information related to this Contract in any subcontract it awards. Section 9.02 State Auditor's Office. Contractor shall, upon request, make all records, books, papers, documents, or recordings related to this Contract available for inspection, audit, or reproduction during normal business hours to any authorized representative of the SAO. Contractor understands that the acceptance of funds under this Contract acts as acceptance of the authority of the SAO, or any successor agency, to conduct an audit or investigation in connection with those funds. Contractor shall cooperate fully with the SAO or its successor in the conduct of the audit or investigation, including providing all records requested, and providing access to any information the SAO considers relevant to the investigation or audit. The SAO's authority to audit funds will apply to Contract funds disbursed by Contractor to its subcontractors, and Contractor shall include this provision concerning the SAO's authority to audit and the requirement to cooperate, in any subcontract Contractor awards. Section 9.03 Responding to Deficiencies. Any deficiencies identified by DSHS or HHSC upon examination of Contractor's records or during an inspection of Contractor's site(s) will be conveyed in writing to Contractor. Contractor shall submit, by the date prescribed by DSHS, a resolution to the deficiency identified in a site inspection, program review or management or financial audit to the satisfaction of DSHS or, if directed by DSHS, a corrective action plan to resolve the deficiency. A DSHS or HHSC determination of General Provisions (Core Subrecipient) 2013 Rev. 7/12 16 either an inadequate or inappropriate resolution of the findings may result in contract remedies or sanctions under the Breach of Contract and Remedies for Non - Compliance Article of these General Provisions. ARTICLE X NOTICE REQUIREMENTS Section 10.01 Child Abuse Reporting Requirement. This section applies to mental health and substance abuse contractors and contractors for the following public health programs: Human Immunodeficiency Virus /Sexually Transmitted Diseases (HIV /STD); Family Planning (Titles V, X and XX); Primary Health Care; Maternal and Child Health; and Women, Infants and Children (WIC) Nutrition Services. Contractor shall make a good faith effort to comply with child abuse reporting guidelines and requirements in Tex. Fam. Code Chapter 261 relating to investigations of reports of child abuse and neglect. Contractor shall develop, implement and enforce a written policy that includes at a minimum the Department's Child Abuse Screening, Documenting, and Reporting Policy for Contractors/Providers and train all staff on reporting requirements. Contractor shall use the DSHS Child Abuse Reporting Form as required by the Department located at www.dshs. state .tx.us /childabusereporting. Contractor shall retain reporting documentation on site and make it available for inspection by DSHS. Section 10.02 Significant Incidents. In addition to notifying the appropriate authorities, Contractor shall report to the contract manager assigned to the Program Attachment significant incidents involving substantial disruption of Contractor's program operation, or affecting or potentially affecting the health, safety or welfare of Department - funded clients or participants within seventy -two (72) hours of discovery. Section 10.03 Litigation. Contractor shall notify the contract manager assigned to the Program Attachment of litigation related to or affecting this Contract and to which Contractor is a party within seven (7) calendar days of becoming aware of such a proceeding. This includes, but is not limited to an action, suit or proceeding before any court or governmental body, including environmental and civil rights matters, professional liability, and employee litigation. Notification must include the names of the parties, nature of the litigation and remedy sought, including amount of damages, if any. Section 10.04 Action Against the Contractor. Contractor shall notify the contract manager assigned to the Program Attachment if Contractor has had a contract suspended or terminated for cause by any local, state or federal department or agency or nonprofit entity within three (3) working days of the suspension or termination. Such notification must include the reason for such action; the name and contact information of the local, state or federal department or agency or entity; the date of the contract; and the contract or case reference number. If Contractor, as an organization, has surrendered its license or has had its license suspended or revoked by any local, state or federal department or agency or non - profit entity, it shall disclose this information within three (3) working days of the surrender, suspension or revocation to the contract manager assigned to the Program Attachment by submitting a one -page description that includes the reason(s) for such action; the name and contact information of the local, state or federal department or agency or entity; the date of the license action; and a license or case reference number. Section 10.05 Insolvency. Contractor shall notify in writing the contract manager assigned to the Program Attachment of Contractor's insolvency, incapacity, or outstanding unpaid obligations to the Internal Revenue Service (IRS) or Texas Workforce Commission (TWC) within three (3) working days of the date of determination that Contractor is insolvent or incapacitated, or the date Contractor discovered an unpaid obligation to the IRS or TWC. Contractor shall notify in writing the contract manager assigned to the Program General Provisions (Core Subrecipient) 2013 Rev. 7/12 17 Attachment of its plan to seek bankruptcy protection within three (3) working days of such action by Contractor's governing body. Section 10.06 Misuse of Funds and Performance Malfeasance. Contractor shall report to the contract manager assigned to the Program Attachment, any knowledge of debarment, suspected fraud, program abuse, possible illegal expenditures, unlawful activity, or violation of financial laws, rules, policies, and procedures related to performance under this Contract. Contractor shall make such report no later than three (3) working days from the date that Contractor has knowledge or reason to believe such activity has taken place. Additionally, if this Contract is federally funded by the Department of Health and Huxnan Services (MIS), Contractor shall report any credible evidence that a principal, employee, subcontractor or agent of Contractor, or any other person, has submitted a false claim under the False Claims Act or has committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving those funds. Contractor shall make this report to the SAO at hltp: /lsao.fraud.state.tx.us, and to the HHS Office of Inspector General at http:/ /www.oig.hhs.gov /fraud/hotline/ no later than three (3) working days from the date that Contractor has knowledge or reason to believe such activity has taken place. Section 10.07 Criminal Activity and Disciplinary Action. Contractor affirms that no person who has an ownership or controlling interest in the organization or who is an agent or managing employee of the organization has been placed on community supervision, received deferred adjudication, is presently indicted for or has been convicted of a criminal offense related to any financial matter, federal or state program or felony sex crime. Contractor shall notify in writing the contract manager assigned to the Program Attachment if it has reason to believe Contractor, or a person with ownership or controlling interest in the organization or who is an agent or managing employee of the organization, an employee or volunteer of Contractor, or a subcontractor providing services under this Contract has engaged in any activity that would constitute a criminal offense equal to or greater than a Class A misdemeanor or if such activity would reasonably constitute grounds for disciplinary action by a state or federal regulatory authority, or has been placed on community supervision, received deferred adjudication, or been indicted for or convicted of a criminal offense relating to involvement in any financial matter, federal or state program or felony sex crime. Contractor shall make the reports required by this section no later than three (3) working days from the date that Contractor has knowledge or reason to believe such activity has taken place. Contractor shall not permit any person who engaged, or was alleged to have engaged, in an activity subject to reporting under this section to perform direct client services or have direct contact with clients, unless otherwise directed by DSHS. Section 10.08 Retaliation Prohibited. Contractor shall not retaliate against any person who reports a violation of, or cooperates with an investigation regarding, any applicable law, rule, regulation or standard to the Department, another state agency, or any federal, state or local law enforcement official. Section 10.09 Documentation. Contractor shall maintain appropriate documentation of all notices required under these General Provisions. ARTICLE XI ASSURANCES AND CERTIFICATIONS Section 11.01 Certification. Contractor certifies by execution of this Contract to the following: a) it is not disqualified under 2 CFR §376.935 or ineligible for participation in federal or state assistance programs; b) neither it, nor its principals, are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal or state department or agency in accordance with 2 CFR Parts 376 and 180 (parts A -I), 45 CFR Part 76 (or comparable federal regulations); c) it has not knowingly failed to pay a single substantial debt or a number of outstanding debts to a, federal or state agency; General Provisions (Core Subrecipient) 2013 Rev. 7/12 18 d) it is not subject to an outstanding judgment in a suit against Contractor for collection of the balance of a debt; e) it is in good standing with all state and/or federal agencies that have a contracting or regulatory relationship with Contractor; f) that no person who has an ownership or controlling interest in Contractor or who is an agent or managing employee of Contractor has been convicted of a criminal offense related to involvement in any program established under Medicare, Medicaid, or a federal block grant; g) neither it, nor its principals have within the three(3) -year period preceding this Contract, has been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a private or public (federal, state or local) transaction or contract under a private or public transaction, violation of federal or state antitrust statutes (including those proscribing price - fixing between competitors, allocation of customers between competitors and bid - rigging), or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements or false claims, tax evasion, obstruction of justice, receiving stolen property or any other offense indicating a lack of business integrity or business honesty that seriously and directly affects the present responsibility of Contactor or its principals; h) neither it, nor its principals is presently indicted or otherwise criminally or civilly charged by a governmental entity (federal, state or local) with the commission of any of the offenses enumerated in subsection g) of this section; and i) neither it, nor its principals within a three(3) -year period preceding this Contract has had one or more public transaction (federal, state or local) terminated for cause or default. Contractor shall include the certifications in this Article, without modification (except as required to make applicable to the subcontractor), in all subcontracts and solicitations for subcontracts. Where Contractor is unable to certify to any of the statements in this Article, Contractor shall submit an explanation to the contract manager assigned to the Program Attachment. If Contractor's status with respect to the items certified in this Article changes during the term of this Contract, Contractor shall immediately notify the contract manager assigned to the Program Attachment. Section 11.02 Child Support Delinquencies. As required by Tex. Fam. Code § 231.006, a child support obligor who is more than thirty (30) calendar days delinquent in paying child support and a business entity in which the obligor is a sole proprietor, partner, shareholder, or owner with an ownership interest of at least twenty -five percent (25 %) is not eligible to receive payments from state funds under a contract to provide property, materials, or services or receive a state - funded grant or loan. If applicable, Contractor shall maintain its eligibility to receive payments under this Contract, certifies that it is not ineligible to receive the payments specified in this Contract, and acknowledges that this Contract may be terminated and payment may be withheld if this certification is inaccurate. Section 11.03 Authorization. Contractor certifies that it possesses legal authority to contract for the services described in this Contract and that a resolution, motion or similar action has been duly adopted or passed as an official act of Contractor's governing body, authorizing the binding of the organization under this Contract including all understandings and assurances contained in this Contract, and directing and authorizing the person identified as the authorized representative of Contractor to act in connection with this Contract and to provide such additional information as may be required. Section 11.04 Gifts and Benefits Prohibited. Contractor certifies that it has not given, offered to give, nor intends to give at any time hereafter, any economic opportunity, present or future employment, gift, loan, General Provisions (Core Subrecipient) 2013 Rev. 7/12 19 gratuity, special discount, trip, favor, service or anything of monetary value to a DSHS or HHSC official or employee in connection with this Contract. Section 11.05 Ineligibility to Receive the Contract. (a) Pursuant to Tex. Gov. Code § 2155.004 and federal law, Contractor is ineligible to receive this Contract if this Contract includes financial participation by a person who received compensation from DSHS to participate in developing, drafting or preparing the specifications, requirements, statement(s) of work or Solicitation Document on which this Contract is based. Contractor certifies that neither Contractor, nor its employees, nor anyone acting for Contractor has received compensation from DSHS for participation in the development, drafting or preparation of specifications, requirements or statement(s) of work for this Contract or in the Solicitation Document on which this Contract is based; (b) pursuant to Tex. Gov. Code §§ 2155.006 and 2261.053, Contractor is ineligible to receive this Contract, if Contractor or any person who would have fmancial participation in this Contract has been convicted of violating federal law, or been assessed a federal civil or administrative penalty, in connection with a contract awarded by the federal government for relief, recovery or reconstruction efforts as a result of Hurricanes Rita or Katrina or any other disaster occurring after September 24, 2005; (c) Contractor certifies that the individual or business entity named in this Contract is not ineligible to receive the specified Contract under Tex. Gov. Code §§ 2155.004, 2155.006 or 2261.053, and acknowledges that this Contract may be terminated and payment withheld if these certifications are inaccurate. Section 11.06 Antitrust. Pursuant to 15 USC § 1, et seq. and Tex. Bus. & Comm Code § 15.01, et seq. Contractor certifies that neither Contractor, nor anyone acting for Contractor has violated the antitrust laws of this state or federal antitrust laws, nor communicated directly or indirectly regarding a bid with any competitor or any other person engaged in Contractor's line of business for the purpose of substantially lessening competition in such line of business. Section 11.07 Initiation and Completion of Work. Contractor certifier: that it shall initiate and complete the work under this Contract within the applicable time frame prescribed in this Contract. ARTICLE XII GENERAL BUSINESS OPERATIONS OF CONTRACTOR Section 12.01 Responsibilities and Restrictions Concerning Governing Body, Officers and Employees. Contractor and its governing body shall bear full responsibility for the integrity of the fiscal and programmatic management of the organization. This provision applies to all organizations, including Section 501(c)(3) organizations as defined in the Internal Revenue Service Code as not -for -profit organizations. Each member of Contractor's governing body shall be accountable for all funds and materials received from Department. The responsibility. of Contractor's governing body shall also include accountability for compliance with Department Rules, policies, procedures, and applicable federal and state laws and regulations; and correction of fiscal and program deficiencies identified through self-evaluation and Department's monitoring processes. Further, Contractor's governing body shall ensure separation of powers, duties, and functions of governing body members and staff. Staff members, including the executive director, shall not serve as voting members of Contractor's governing body. No member of Contractor's governing body, or officer or employee of Contractor shall vote for, confirm or act to influence the employment, compensation or change in status of any person related within the second degree of affinity or the third degree of consanguinity (as defined in Tex. Gov. Code Chapter 573) to the member of the governing body or the officer or any employee authorized to employ or supervise such person. This prohibition does not prohibit the continued employment of a person who has been continuously employed for a period of two (2) years prior to the election, appointment or employment of the officer, employee, or governing body member related to such person in the prohibited degree. These restrictions also apply to the governing body, officers and employees of Contractor's General Provisions (Core Subrecipient) 2013 Rev. 7/12 20 subcontractors. Ignorance of any Contract provisions or other requirements contained or referred to in this Contract will not constitute a defense or basis for waiving or appealing such provisions or requirements. Section 12.02 Management and Control Systems. Contractor shall comply with all the requirements of the Department's Contractor's Financial Procedures Manual, and any of its subsequent amendments, which is available at the Department's web site: http: / /www.dshs. state .tx.us /contracts /cfpm.shtm. Contractor shall maintain an appropriate contract administration system to ensure that all terms, conditions, and specifications are met. Contractor shall develop, implement, and maintain financial management and control systems that meet or exceed the requirements of UGMS and adhere to procedures detailed in Department's Contractor's Financial Procedures Manual. Those requirements and procedures include, at a minimum, the following: a) financial planning, including the development of budgets that adequately reflect all functions and resources necessary to carry out authorized activities and the adequate determination of costs; b) financial management systems that include accurate accounting records that are accessible and identify the source and application of funds provided under each Program Attachment of this Contract, and original source documentation substantiating that costs are specifically and solely allocable to the Program Attachment and are traceable from the transaction to the general ledger; and c) effective internal and budgetary controls; comparison of actual costs to budget; determination of reasonableness, allowableness, and allocability of costs; timely and appropriate audits and resolution of any findings; billing and collection policies; and a mechanism capable of billing and making reasonable efforts to collect from clients and third parties. Section 12.03 Insurance. Contractor shall maintain insurance or other means of repairing or replacing assets purchased with Department funds. Contractor shall repair or replace with comparable equipment any such equipment not covered by insurance that is lost, stolen, damaged or destroyed. If any insured equipment purchased with DSHS funds is lost, stolen, damaged or destroyed, Contractor shall notify the contract manager assigned to the Program Attachment to obtain instructions whether to submit and pursue an insurance claim. Contractor shall use any insurance proceeds to repair the equipment or replace the equipment with comparable equipment or remit the insurance proceeds to DSHS. Section 12.04 Fidelity Bond. For the benefit of DSHS, Contractor is required to carry a fidelity bond or insurance coverage equal to the amount of funding provided under this Contract up to $100,000 that covers each employee of Contractor handling funds under this Contract, including person(s) authorizing payment of such funds. The fidelity bond or insurance must provide for indemnification of losses occasioned by (1) any fraudulent or dishonest act or acts committed by any of Contractor's employees, either individually or in concert with others, and/or (2) failure of Contractor or any of its employees to perform faithfully his/her duties or to account properly for all monies and property received by virtue of his/her position or employment. The bond or insurance acquired under this section must include coverage for third party property. Contractor shall notify, and obtain prior approval from, the DSHS Contract Oversight and Support Section before settling a claim on the fidelity bond or insurance. Section 12.05 Liability Coverage. For the benefit of DSHS, Contractor shall at all times maintain liability insurance coverage, referred to in Tex. Gov. Code § 2261.102, as "director and officer liability coverage" or similar coverage for all persons in management or governing positions within Contractor's organization or with management or governing authority over Contractor's organization (collectively "responsible persons "). Contractor shall maintain copies of liability policies on site for inspection by DSHS and shall submit copies of policies to DSHS upon request. This section applies to entities that are organized as non -profit corporations under the Texas Non -Profit Corporation Act; for -profit corporations organized under the Texas Business Corporations Act; and any other legal entity. Contractor shall maintain liability insurance coverage in an amount not less than the total value of this Contract and that is sufficient to protect the interests of Department General Provisions (Core Subrecipient) 2013 Rev. 7/12 21 in the event an actionable act or omission by a responsible person damages Department's interests. Contractor shall notify, and obtain prior approval from, the DSHS Contract Oversight and Support Section before settling a claim on the insurance. Section 12.06 Overtime Compensation. Except as provided in this section, Contractor shall not use any of the fiords provided by this Contract to pay the premium portion of overtime. Contractor shall be responsible for any obligations of premium overtime pay due employees. Premium overtime pay is defined as any compensation paid to an individual in addition to the employee's normal rate of pay for hours worked in excess of normal working hours. Funds provided under this Contract may be used to pay the premium portion of overtime only under the following conditions: 1) with the prior written approval of DSHS; 2) temporarily, in the case of an emergency or an occasional operational bottleneck; 3) when employees are performing indirect functions, such as administration, maintenance, or accounting; 4) in performance of tests, laboratory procedures, or similar operations that are continuous in nature and cannot reasonably be interrupted or otherwise completed; or 5) when lower overall cost to DSHS will result. Section 12.07 Program Site. Contractor shall provide services only in locations that are in compliance with all applicable local, state and federal zoning, building, health, fire, and safety standards. Section 12.08 Cost Allocation Plan. Contractor shall submit a Cost Allocation Plan in the format provided in the Department's Contractor's Financial Procedures Manual to the Department's Contract Oversight and Support Section, at Mail Code 1326, P.O. Box 149347, Austin, Texas 78714 -9347, or by email to mailto:coscap@dshs.state.tx.us no later than the 60`5 calendar day after the effective date of the Contract, except when a Contractor has a current Cost Allocation Plan on file with the Department. Contractor shall implement and follow the applicable Cost Allocation Plan. If Contractor's plan is the same as the plan previously submitted to DSHS, by signing this Contract, Contractor certifies that its current Cost Allocation Plan for the current year is the same as the plan previously submitted. If the Cost Allocation Plan changes during the Contract term, Contractor shall submit a new Cost Allocation Plan to the Contract Oversight and Support Section within thirty (30) calendar days after the effective date of the change. Cost Allocation Plans must comply with the guidelines provided in the Department's Contractor's Financial Procedures Manual located at http: / /www.dshs. state .tx.us /contracts /cfpm.shtm. Section 12.09 No Endorsement. Other than stating the fact that Contractor has a contract with DSHS, Contractor and its subcontractors are prohibited from publicizing the contractual relationship between Contractor and DSHS, and from using the Department's name, logo or website link in any manner that is intended, or that could be perceived, as an endorsement or sponsorship by DSHS or the State of Texas of Contractor's organization, program, services or product, without the express written consent of DSHS. Section 12.10 Historically Underutilized Businesses (HUBs). If Contractor was not required to submit a HUB subcontracting plan and if subcontracting is permitted under this Program Attachment, Contractor is encouraged to make a good faith effort to consider subcontracting with HUBS in accordance with Tex. Gov. Code Chapter 2161 and 34 Tex. Admin. Code § 20.10 et seq. Contractors may obtain a list of HUBs at http: / /www.window. state .tx.us /procurement/prog/hub. If Contractor has filed a HUB subcontracting plan, the plan is incorporated by reference in this Contract. If Contractor desires to make a change in the plan, Contractor must obtain prior approval from the Department's HUB Coordinator of the revised plan before proposed changes will be effective under this Contract. Contractor shall make a good faith effort to subcontract with HUBS during the performance of this Contract and shall report HUB subcontract activity to the Department's HUB Coordinator by the 15th day of each month for the prior month's activity, if there was any such activity, in accordance with 34 Tex. Admin. Code § 20.16(b). General Provisions (Core Subrecipient) 2013 Rev. 7/12 22 Section 12.11 Buy Texas. Contractor shall purchase products and materials produced in Texas when the products and materials are available at a price and time comparable to products and materials produced outside of Texas as required by Tex. Gov. Code § 2155.4441. Section 12.12 Contracts with Subrecipient and Vendor Subcontractors. Contractor may enter into contracts with subrecipient subcontractors unless restricted or otherwise prohibited in a specific Program Attachment(s). Prior to entering into a subrecipient agreement equaling or exceeding $100,000, Contractor shall obtain written approval from DSHS. Contractor shall establish written policies and procedures for competitive procurement and monitoring of subcontracts and shall produce a subcontracting monitoring plan. Contractor shall monitor subrecipient subcontractors for both financial and programmatic performance and shall maintain pertinent records that must be available for inspection by DSHS. Contractor shall ensure that subcontractors are fully aware of the requirements placed upon them by state /federal statutes, rules, and regulations and by the provisions of this Contract. Contracts with all subcontractors, whether vendor or subrecipient, must be in writing and include the following: a) name and address of all parties and the subcontractor's Vendor Identification Number (VIN) or Employee Identification Number (EIN); b) a detailed description of the services to be provided; c) measurable method and rate of payment and total not -to- exceed amount of the contract; d) clearly defined and executable termination clause; and e) beginning and ending dates that coincide with the dates of the applicable Program Attachment(s) or that cover a term within the beginning and ending dates of the applicable Program Attachment(s). Contractor is responsible to DSHS for the performance of any subcontractor. Contractor shall not contract with a subcontractor, at any tier, that is debarred, suspended, or excluded from or ineligible for participation in federal assistance programs; or if the subcontractor would be ineligible under the following sections of these General Provisions: Ineligibility to Receive the Contract section (Assurances and Certifications Article); or the Conflict of Interest or Transactions Between Related Parties sections (General Terms Article). Section 12.13 Status of Subcontractors. Contractor shall require all subcontractors to certify that they are not delinquent on any repayment agreements; have not had a required license or certification revoked; and have not had a contract terminated by the Department. Contractors shall further require that subcontractors certify that they have not voluntarily surrendered within the past three (3) years any license issued by the Department. Section 12.14 Incorporation of Terms in Subrecipient Subcontracts. Contractor shall include in all its contracts with subrecipient subcontractors and solicitations for subrecipient subcontracts, without modification (except as required to make applicable to the subcontractor), (1) the certifications stated in the Assurances and Certifications Article; (2) the requirements in the Conflicts of Interest section and the Transaction Between Related Parties section of the General Terms Article; and (3) a provision granting to DSHS, SAO, .OIG, and the Comptroller General of the United States, and any of their representatives, the right of access to inspect the work and the premises on which any work is performed, and the right to audit the subcontractor in accordance with the Access and Inspection Article in these General Provisions. Each subrecipient subcontract contract must also include a copy of these General Provisions and a copy of the Statement of Work and any other provisions in the Program Attachment(s) applicable to the subcontract. Contractor shall ensure that all written agreements with subrecipient subcontractors incorporate the terms of this Contract so that all terms, conditions, provisions, requirements, duties and liabilities under this Contract applicable to the services provided or activities conducted by a subcontractor are passed down to that subcontractor. No provision of this Contract creates privity of contract between DSHS and any subcontractor of Contractor. If a subcontractor is unable to certify to any of the statements in Section 12.13 or any of the certifications stated in the Assurances General Provisions (Core Subrecipient) 2013 Rev. 7/12 23 and Certifications Article, Contractor shall submit an explanation to the contract manager assigned to the Program Attachment. If the subcontractor's status with respect to the items certified in Section 12.13 or the assurances stated in the Assurances and Certifications Article changes during the term of this Contract, Contractor shall immediately notify the contract manager assigned to the Program Attachment. Section 12.15. Independent Contractor. Contractor is an independent contractor. Contractor shall direct and be responsible for the performance of its employees, subcontractors, joint venture participants or agents. Contractor is not an agent or employee of the Department or the State of Texas for any purpose whatsoever. For purposes of this Contract, Contractor acknowledges that its employees, subcontractors, joint venture participants or agents will not be eligible for unemployment compensation from the Department or the State of Texas. Section 12.16 Authority to Bind. The person or persons signing this Contract on behalf of Contractor, or representing themselves as signing this Contract on behalf of Contractor, warrant and guarantee that they have been duly authorized by Contractor to execute this Contract for Contractor and to validly and legally bind Contractor to all of its terms. Section 12.17 Tax Liability. Contractor shall comply with all state and federal tax laws and is solely responsible for filing all required state and federal tax forms and making all tax payments. If the Department discovers that Contractor has failed to remain current on a liability to the IRS, this Contract will be subject to remedies and sanctions under this Contract, including immediate termination at the Department's discretion. If the Contract is terminated under this section, the Department will not enter into a contract with Contractor for three (3) years from the date of termination. Section 12.18 Notice of Organizational Change. Contractor shall submit written notice to the contract manager assigned to the Program Attachment within ten (10) business days of any change to the Contractor's name; contact information; key personnel, officer, director or partner; organizational structure, such as merger, acquisition or change in form of business; legal standing; or authority to do business in Texas. A change in Contractor's name and certain changes in organizational structure require an amendment to this Contract in accordance with the Amendments section of these General Provisions. Section 12.19 Quality Management. Contractor shall comply with quality management requirements as directed by the Department. Section 12.20 Equipment (Including Controlled Assets). Equipment means an article of nonexpendable, tangible personal property having a useful lifetime of more than one year and an acquisition cost of $5,000 or more, and "controlled assets." Controlled assets include firearms regardless of the acquisition cost, and the following assets with an acquisition cost of $500 or more, but less than $5,000: desktop and laptop computers (including notebooks, tablets and similar devices), non - portable printers and copiers, emergency management equipment, communication devices and systems, medical and laboratory equipment, and media equipment. Prior approval by DSHS of the purchase of controlled assets is not required. Contractors on a cost reimbursement payment method shall inventory all equipment, including controlled assets. Contractor shall initiate the purchase of all equipment approved in writing by DSHS, in the first quarter of the Contract or Program Attachment term, as applicable. Failure to timely initiate the purchase of equipment may result in the loss of availability of funds for the purchase of equipment. Requests to purchase previously approved equipment after the first quarter of the Program Attachment must be submitted to the contract manager assigned to the Program Attachment. Section 12.21 Supplies. Supplies are defined as consumable items necessary to carry out the services under this Contract including medical supplies, drugs, janitorial supplies, office supplies, patient educational supplies, software, and any items of tangible personal property other than those defined as equipment above. General Provisions (Core Subrecipient) 2013 Rev. 7/12 24 Section 12.22 Changes to Equipment List. All items of equipment, other than controlled assets, to be purchased with funds under this Contract must be itemized in Contractor's equipment list as finally approved by the Department in the executed Contract. Any changes to the approved equipment list in the executed Contract must be approved in writing by Department prior to the purchase of equipment. Contractor shall submit to the contract manager assigned to the Program Attachment, a written description including complete product specifications and need justification prior to purchasing any item of unapproved equipment. If approved, Department will acknowledge its approval by means of a written amendment or by written acceptance of Contractor's Contract Revision Request, as appropriate; or, in the case of minor changes to Contractor's approved equipment list, by email in accordance with the Contractor's Financial Procedures Manual. Section 12.23 Property Inventory and Protection of Assets. Contractor shall maintain an inventory of equipment, including controlled assets, and property described in the Other Intangible Property section of Article XIII and submit an annual cumulative report of the equipment and other property on Form GC -11 (Contractor's Property Inventory Report) to the Department's Contract Oversight and Support Section, Mail Code 1326, P.O. Box 149347, Austin, Texas 78714 -9347, no later than October l5th of each year. The report is located on the DSHS website at http: / /www.dshs. state .tx.us /contracts /forms.shtm. Contractor shall maintain, repair, and protect assets under this Contract to assure their full availability and usefulness. If Contractor is indemnified, reimbursed, or otherwise compensated for any loss of, destruction of, or damage to the assets provided or obtained under this Contract, Contractor shall use the proceeds to repair or replace those assets. Section 12.24 Bankruptcy. In the event of bankruptcy, Contractor shall sever Department property, equipment, and supplies in possession of Contractor from the bankruptcy, and title must revert to Department. If directed by DSHS, Contractor shall return all such property, equipment and supplies to DSHS. Contractor shall ensure that its subcontracts, if any, contain a specific provision requiring that in the event the subcontractor's bankruptcy, the subcontractor must sever Department property, equipment, and supplies in possession of the subcontractor from the bankruptcy, and title must revert to Department, who may require that the property, equipment and supplies be returned to DSHS. Section 12.25 Title to Property. At the conclusion of the contractual relationship between the Department and Contractor, for any reason, title to any remaining equipment and supplies purchased with funds under this Contract reverts to Department. Title may be transferred to any other party designated by Department. The Department may, at its option and to the extent allowed by law, transfer the reversionary interest to such property to Contractor. Section 12.26 Property Acquisitions. Department funds must not be used to purchase buildings or real property. Any costs related to the initial acquisition of the buildings or real property are not allowable. Section 12.27 Disposition of Property. Contractor shall follow the procedures in the American Hospital Association's (AHA's) "Estimated Useful Lives of Depreciable Hospital Assets" in disposing, at any time during or after the Contract term, of equipment purchased with the Department funds, except when federal or state statutory requirements supersede or when the equipment requires licensure or registration by the state, or when the acquisition price of the equipment is equal to or greater than $5,000. All other equipment not listed in the AHA reference (other than equipment that requires licensure or registration or that has an acquisition cost equal to or greater than $5,000) will be controlled by the requirements of UGMS. If, prior to the end of the useful life, any item of equipment is no longer needed to perform services under this Contract, or becomes inoperable, or if the equipment requires licensure or registration or had an acquisition price equal to or greater than $5,000, Contractor shall request disposition approval and instructions in writing from the contract manager assigned to the Program Attachment. After an item reaches the end of its useful life, Contractor shall General Provisions (Core Subrecipient) 2013 Rev. 7/12 25 ensure that disposition of any equipment is in accordance with Generally Accepted Accounting Principles, and any applicable federal guidance. Section 12.28 Closeout of Equipment. At the end of the term of a Program Attachment that has no additional renewals or that will not be renewed (Closeout) or when a Program Attachment is otherwise terminated, Contractor shall submit to the contract manager assigned to the Program Attachment, an inventory of equipment purchased with Department funds and request disposition instructions for such equipment. All equipment purchased with Department funds must be secured by Contractor at the time of Closeout or termination of the Program Attachment and must be disposed of according to the Department's disposition instructions, which may include return of the equipment to DSHS or transfer of possession to another DSHS contractor, at Contractor's expense. Section 12.29 Assets as Collateral Prohibited. Contractors on a cost reimbursement payment method shall not encumber equipment purchased with Department funds without prior written approval from the Department. ARTICLE XIII GENERAL TERMS Section 13.01 Assignment. Contractor shall not transfer, assign, or sell its interest, in whole or in part, in this Contract, or in any equipment purchased with funds from this Contract, without the prior written consent of the Department_ Section 13.02 Lobbying. Contractor shall comply with Tex. Gov. Code § 556.0055, which prohibits contractors who receive state funds from using those funds to pay lobbying expenses. Further, Contractor shall not use funds paid under this Contract, either directly or indirectly, to support the enactment, repeal, modification, or adoption of any law, regulation or policy at any level of government, or to pay the salary or expenses of any person related to any activity designed to influence legislation, regulation, policy or appropriations pending before Congress or the state legislature, or for influencing or attempting to influence an officer or employee of any federal or state 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 contract or the extension, continuation, renewal, amendment, or modification of any contract (31 USC § 1352 and UGMS). If at any time this Contract exceeds $100,000 of federal funds, Contractor shall file with the contract manager assigned to the Program Attachment a declaration containing the name of any registrant under the Lobbying Disclosure Act of 1995 who has made lobbying contacts on behalf of Contractor in connection with this Contract, a certification that none of the funds provided by Department have been or will be used for payment to lobbyists, and disclosure of the names of any and all registered lobbyists with whom Contractor has an agreement. Contractor shall file the declaration, certification, and disclosure at the time of application for this Contract; upon execution of this Contract unless Contractor previously filed a declaration, certification, or disclosure form in connection with the award; and at the end of each calendar quarter in which any event occurs that materially affects the accuracy of the information contained in any declaration, certification, or disclosure previously filed. Contractor shall require any person who requests or receives a subcontract to file the same declaration, certification, and disclosure with the contract manager assigned to the Program Attachment. Contractor shall also comply, as applicable, with the lobbying restrictions and requirements in 2 CFR Part 230 (OMB Circulars A -122), Appendix B paragraph 25; 2 CFR Part 225 (A -87) Appendix B section 24; 2 CFR §215.27 (A -110) and 2 CFR Part 220 (A -21) Appendix A, subsection J.17 and J.28. Contractor shall include this provision in any subcontracts. Section 13.03 Conflict of Interest. Contractor represents to the Department that it and its - subcontractors, if any, do not have nor shall Contractor or its subcontractors knowingly acquire or retain, any financial or other General Provisions (Core Subrecipient) 2013 Rev. 7/12 26 interest that would conflict in any manner with the performance of their obligations under this Contract. Potential conflicts of interest include, but are not limited to, an existing or potential business or personal relationship between Contractor (or subcontractor), its principal (or a member of the principal's immediate family), or any affiliate or subcontractor and the Department or HHSC, their commissioners or employees, or any other entity or person involved in any way in any project that is the subject of this Contract. Contractor shall establish safeguards to prohibit employees and subcontractors and their employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest or personal gain. If, at any time during the term of this Contract, Contractor or any of its subcontractors has a conffict of interest or potential conflict of interest, Contractor shall disclose the actual or potential conflict of interest to the contract manager assigned to the Program Attachment within ten (10) days of when Contractor becomes aware of the existence of the actual or potential conflict of interest. Contractor shall require each of its subcontractors to report to Contractor any conflict of interest or potential conflict of interest the subcontractor has or may have within ten (10) days of when the subcontractor becomes aware of the actual or potential conffict of interest. Section 13.04 Transactions Between Related Parties. Contractor shall identify and report to DSHS any transactions between Contractor and a related party that is part of the work that the Department is purchasing under this Contract before entering into the transaction or immediately upon discovery. Contractor shall submit to the contract manager assigned to the Program Attachment the name, address and telephone number of the related party, how the party is related to Contractor and the work the related party will perform under this Contract. A related party is a person or entity related to Contractor by blood or marriage, common ownership or any association that permits either to significantly influence or direct the actions or policies of the other. Contractor, for purposes of reporting transactions between related parties, includes the entity contracting with the Department under this Contract as well as the chief executive officer, chief financial officer and program director of Contractor. Contractor shall comply with Tex. Gov. Code Chapter 573. Contractor shall maintain records and supply any additional information requested by the Department, regarding a transaction between related parties, needed to enable the Department to determine the appropriateness of the transaction pursuant to applicable state or federal law, regulations or circulars, which may include 45 CFR part 74, OMB Circ. No. A -110, 2 CFR § 215.42, and UGMS. Section 13.05 Intellectual Property. Tex. Health & Safety Code § 12.020 authorizes DSHS to protect intellectual property developed as a result of this Contract. a) "Intellectual property" means created property that may be protected under copyright, patent, or trademark/service mark law. b) For purposes of this Contract intellectual property prepared for DSHS use, or a work specially ordered or commissioned through a contract for DSHS use is "work made for hire." DSHS owns works made for hire unless it agrees otherwise by contract. To the extent that title and interest to any such work may not, by operation of law, vest in DSHS, or such work may not be considered a work made for hire, Contractor irrevocably assigns the rights, title and interest therein to DSHS. DSHS has the right to obtain and hold in its name any and all patents, copyrights, registrations or other such protections as may be appropriate to the subject matter, and any extensions and renewals thereof. Contractor shall give DSHS and the State of Texas, as well as any person designated by DSHS and the State of Texas, all assistance required to perfect the rights defined herein without charge or expense beyond those amounts payable to Contractor for goods provided or services rendered under this Contract. c) If federal funds are used to finance activities supported by this Contract that result in the production of intellectual property, the federal awarding agency reserves a royalty -free, nonexclusive, and irrevocable license to reproduce, publish, or otherwise use, and to authorize others to use, for federal government purposes (1) the copyright in any intellectual property developed under this Contract, including any subcontract; and (2) any rights of copyright to which a Contractor purchases ownership with contract funds. Contractor shall place an acknowledgment of federal awarding agency grant General Provisions (Core Subrecipient) 2013 Rev. 7/12 27 support and a disclaimer, as appropriate, on any publication written or published with such support and, if feasible, on any publication reporting the results of or describing a grant - supported activity. An acknowledgment must be to the effect that "This publication was made possible by grant number from (federal awarding agency)" or "The project described was supported by grant number from (federal awarding agency)" and "Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the (federal awarding agency)." d) If the terms of a federal grant award the copyright to Contractor, DSHS reserves a royalty -free, nonexclusive, worldwide and irrevocable license to reproduce, publish or otherwise use, and to authorize others to use, for DSHS, public health, and state governmental noncommercial purposes (1) the copyright, trademark, service mark, and/or patent on an invention, discovery, or improvement to any process, machine, manufacture, or composition of matter; products; technology; scientific information; trade secrets; and computer software, in any work developed under a grant, subgrant, or contract under a grant or subgrant; and (2) any rights of copyright, service or trade marks or patents to which a grantee, subgrantee or a Contractor purchases ownership with contract funds. e) If the results of the contract performance are subject to copyright law, Contractor cannot publish those results without prior review and approval of DSHS. Contractor shall submit requests for review and approval to the contract manager assigned to the Program Attachment. Section 13.06 Other Intangible Property. At the conclusion of the contractual relationship between Department and Contractor, for any reason, Department shall have the sole ownership rights and interest in all non- copyrightable intangible property that was developed, produced or obtained by Contractor as a specific requirement under this Contract or under any grant that funds this Contract, such as domain names, URLs, software licenses with a value of $500 or more, etc. Contractor shall inventory all such non - copyrightable intangible property. Contractor shall cooperate with Department and perform all actions necessary to transfer ownership of such property to the Department or its designee, or otherwise affirm Department's ownership rights and interest in such property. This provision will survive the tecinination or expiration of this Contract. Section 13.07 Severability and Ambiguity. If any provision of this Contract is construed to be illegal or invalid, the illegal or invalid provision will be deemed stricken and deleted to the same extent and effect as if never incorporated, but all other provisions will continue. The Parties represent and agree that the language contained in this Contract is to be construed as jointly drafted, proposed and accepted. Section 13.08 Legal Notice. Any notice required or permitted to be given by the provisions of this Contract will be deemed to have been received by a Party on the third business day after the date on which it was mailed to the Party at the address specified by the Party to the other Party in writing or, if sent by certified mail, on the date of receipt. Section 13.09 Successors. This Contract will be binding upon the Parties and their successors and . assignees, except as expressly provided in this Contract. Section 13.10 Readings. The articles and section headings used in this Contract are for convenience of reference only and will not be construed in any way to define, limit or describe the scope or intent of any provisions. Section 13.11 Parties. The Parties represent to each other that they are entities fully familiar with transactions of the kind reflected by the contract documents, and are capable of understanding the terminology and meaning of their terms and conditions and of obtaining independent legal advice pertaining to this Contract. Section 13.12 Survivability of Terms. Termination or expiration of this Contract or a Program Attachment for any reason will not release either Party from any liabilities or obligations in this Contract that (a) the General Provisions (Core Subrecipient) 2013 Rev. 7/12 28 Parties have expressly agreed will survive any such termination or expiration, or (b) remain to be performed or (c) by their nature would be intended to be applicable following any such termination or expiration. Section 13.13 Direct Operation. At the Department's discretion, the Department may temporarily assume operations of a Contractor's program or programs funded under this Contract when the continued operation of the program by Contractor puts at risk the health or safety of clients and/or participants served by Contractor. Section 13.14 Customer Service Information. If requested, Contractor shall supply such information as required by the Department to comply with the provisions of Tex. Gov. Code Chapter 2114 regarding Customer Service surveys. Section 13.15 Amendment. The Parties agree that the Department may unilaterally reduce funds pursuant to the terms of this Contract without the written agreement of Contractor. All other amendments to this Contract must be in writing and agreed to by both Parties, except as otherwise specified in the Contractor's Notification of Change to Certain Contract Provisions section or the Contractor's Request for Revision to Certain Contract Provisions section of this Article. Contractor's request for certain budget revisions or other amendments must be submitted in writing, including a justification for the request, to the contract manager assigned to the Program Attachment; and if a budget revision or amendment is requested during the last quarter of the Contract or Program Attachment term, as applicable, Contractor's written justification must include a reason for the delay in making the request. Revision or other amendment requests may be granted at the discretion of DSHS. Except as otherwise provided in this Article, Contractor shall not perform or produce, and DSHS will not pay for the performance or production of, different or additional goods, services, work or products except pursuant to an amendment of this Contract that is executed in compliance with this section; and DSHS will not waive any term, covenant, or condition of this Contract unless by amendment or otherwise in compliance with this Article. Section 13.16 Contractor's Notification of Change to Certain Contract Provisions. The following changes may be made to this Contract without a written amendment or the Department's prior approval: a) contractor's contact person and contact information; b) contact information for key personnel, as stated in Contractor's response to the Solicitation Document, if any; c) cumulative budget transfers that exceed 25% among direct cost categories, other than the equipment category, of cost reimbursement contract Program Attachments of less than $100,000, provided that the total budget amount is unchanged (This subsection does not apply to contracts funded by funding sources that have different percentage requirements); d) minor corrections or clarifications to the Contract language that in no way alter the scope of work, objectives or performance measures; and e) a change in Contractor's share of the budget concerning non -DSHS funding other than program income and match, regardless of the amount of the change, provided that in changing the budget, Contractor is not supplanting DSHS funds. Contractor within ten (10) calendar days shall notify in writing the contract manager assigned to the Program Attachment of any change enumerated in this section. The notification may be by letter, fax or email. Except for contracts funded by funding sources that have different percentage requirements, cumulative budget line item transfers of 25% or less among direct cost categories, other than equipment, of cost reimbursement contracts of any amount do not require written amendment or prior approval or notification. Section 13.17 Contractor's Request for Revision of Certain Contract Provisions. A Contractor's Revision Request is an alternative method for amending certain specified provisions of this Contract that is initiated by Contractor, but must be approved by DSHS. The following amendments to this Contract may be General Provisions (Core Subrecipient) 2013 Rev. 7/12 29 made through a Contractor's Revision Request, rather than through the amendment process described in the Amendment section of this Article: a) cumulative budget transfers among direct cost categories, other than the equipment category, that exceed 25% of Program Attachments of $100,000 or more, provided that the total budget amount is unchanged (This subsection does not apply to contracts funded by funding sources that have different percentage requirements); b) budget transfer to other categories of funds for direct payment to trainees for training allowances; c) change in clinic hours or location; d) change in the equipment list substituting an item of equipment equivalent to an item of equipment on the approved budget; e) changes in the equipment category of a previously approved equipment budget; f) changes specified in applicable OMB Circular cost principles as requiring prior approval, regardless of dollar threshold (e.g., foreign travel expenses, overtime premiums, membership fees; and g) cumulative budget transfers into or out of the equipment category that do not exceed 10% of any Program Attachment, provided that the total budget amount is unchanged (cumulative transfers from or to the equipment category that equal or exceed 10% of any Program Attachment require an amendment to this Contract as described in the Amendment section of this Article). In order to request a revision of any of the enumerated provisions, Contractor shall obtain a Contract Revision Request form from the DSHS website available at http:// www. dshs .state.tx.us/grants /forms.shtm, and complete the form as directed by the Department. Two copies of the completed form must be signed by Contractor's representative who is authorized to sign contracts on behalf of Contractor, and both original, signed forms must be submitted to the contract manager assigned to the Program Attachment. Any approved revision will not be effective unless signed by the DSHS Director of the Client Services Contracting Unit. A separate Contractor Revision Request is required for each Program Attachment to be revised. Circumstances of a requested contract revision may indicate the need for an amendment described in the Amendment section of this Article rather than a contract revision amendment under this section. Section 13.18 Immunity Not Waived. THE PARTIES EXPRESSLY AGREE THAT NO PROVISION OF THIS CONTRACT IS IN ANY WAY INTENDED TO CONSTITUI'E A WAIVER BY DEPARTMENT OR THE STATE OF TEXAS OF ANY IMMUNITIES FROM SUIT OR FROM LIABILITY THAT DEPARTMENT OR THE STATE OF TEXAS MAY HAVE BY OPERATION OF LAW. Section. 13.19 Hold Harmless and Indemnification. Contractor, as an independent contractor, agrees to hold Department, the State of Texas, individual state employees and officers, and the federal government harmless and to indemnify them from any and all liability, suits, claims, losses, damages and judgments; and to pay all costs, fees, and damages to the extent that such costs, fees, and damages arise from performance or nonperformance of Contractor, its employees, subcontractors, joint venture participants or agents under this Contract. Section 13.20 Waiver. Acceptance by either Party of partial performance or failure to complain of any action, non - action or default under this Contract will not constitute a waiver of either Party's rights under this Contract. Section 13.21 Electronic and Information Resources Accessibility and Security Standards. As required by 1 Tex. Admin. Code Chapters 213 and 206, as a state agency, DSHS must procure products that comply with the State of Texas Accessibility requirements for Electronic and Information Resources specified in 1 Tex. Admin. Code Chapter 213 and Website Accessibility Standards /Specifications specified in 1 Tex. Admin. Code Chapter 206 (collectively EIR Standards) when such products are available in the commercial marketplace or when such products are developed in response to a procurement solicitation. If performance General Provisions (Core Subrecipient) 2013 Rev. 7/12 30 under this Contract includes the development, modification or maintenance of a website or other electronic and information resources for DSHS or for the public on behalf of DSHS, Contractor certifies that the website or other electronic and information resources comply with the EIR Standards. Contractor further certifies that any network hardware or software purchased or provided under this Contract has undergone independent certification testing for known and relevant vulnerabilities, in accordance with rules adopted by Department of Information Resources. Section 13.22 Force Majeure. Neither Party will be liable for any failure or delay in performing all or some of its obligations, as applicable, under this Contract if such failure or delay is due to any cause beyond the reasonable control of such Party, including, but not limited to, extraordinarily severe weather, strikes, natural disasters, fire, civil disturbance, epidemic, war, court order, or acts of God. The existence of any such cause of delay or failure will extend the period of performance in the exercise of reasonable diligence until after the cause of the delay or failure no longer exists and, if applicable, for any reasonable period of time thereafter required to resume performance. A Party, within a period of time reasonable under the circumstances, must inform the other by any reasonable method (phone, email, etc.) and, as soon as practicable, must submit written notice with proof of receipt, of the existence of a force majeure event or otherwise waive the right as a defense to non - performance. Section 13.23 Interim Contracts. The Parties agree that the Contract and/or any of its Program Attachments will automatically continue as an "Interim Contract" beyond the expiration date of the term of the Contract or Program Attachment(s), as applicable, under the following circumstances: (1) on or shortly prior to the expiration date of the Contract or Program Attachment, there is a state of disaster declared by the Governor that affects the ability or resources of the DSHS contract or program staff managing the Contract to complete in a timely manner the extension, renewal, or other standard contract process for the Contract or Program Attachment; and (2) DSHS makes the determination in its sole discretion that an Interim Contract is appropriate under the circumstances. DSHS will notify Contractor promptly in writing if such a determination is made. The notice will specify whether DSHS is extending the Contract or Program Attachment for additional time for Contractor to perform or complete the previously contracted goods and services (with no new or additional funding) or is purchasing additional goods and services as described in the Program Attachment for the term of the Interim Contract, or both. The notice will include billing instructions and detailed information on how DSHS will fund the goods or services to be procured during the Interim Contract term. The Interim Contract will terminate thirty (30) days after the disaster declaration is terminated unless the Parties agree to a shorter period of time. Section 13.24 Cooperation and Communication. Contractor shall cooperate with Department staff and, as applicable, other DSHS contractors, and shall promptly comply with requests from DSHS for information or responses to DSHS inquiries concerning Contractor's duties or responsibilities under this Contract. ARTICLE XIV BREACH OF CONTRACT AND REMEDIES FOR NONCOMPLIANCE Section 14.01 Actions Constituting Breach of Contract. Actions or inactions that constitute breach of contract include, but are not limited to, the following: a) failure to properly provide the services and/or goods purchased under this Contract; b) failure to comply with any provision of this Contract, including failure to comply with all applicable statutes, rules or regulations; c) failure to pay refunds or penalties owed to the Department; d) failure to comply with a repayment agreement with the DSHS or agreed order issued by DSHS; e) failure by Contractor to provide a full accounting of funds expended under this Contract; f) discovery of a material misrepresentation in any aspect of Contractor's application or response to the Solicitation Document; General Provisions (Core Subrecipient) 2013 Rev. 7/12 31 g) any misrepresentation in the assurances and certifications in Contractor's application or response to the Solicitation Document or in this Contract; or h) Contractor is on or is added to the Excluded Parties List System (EPLS). Section 14.02 General Remedies and Sanctions. The Department will monitor Contractor for both programnnatic and financial compliance. The remedies and sanctions in this section are available to the Department against Contractor and any entity that subcontracts with Contractor for provision of services or goods. HHSC OIG may investigate, audit and impose or recommend imposition of remedies or sanctions to Department for any breach of this Contract and may monitor Contractor for financial compliance. The Department may impose one or more remedies or sanctions for each item of noncompliance and will determine remedies or sanctions on a case - by-case basis. Contractor is responsible for complying with all of the terms of this Contract. The listing of or use of one or more of the remedies or sanctions in this section does not relieve Contractor of any obligations under this Contract. A state or federal statute, rule or regulation, or federal guideline will prevail over the provisions of this Article unless the statute, rule, regulation, or guideline can be read together with the provision(s) of this Article to give effect to both. If Contractor breaches this Contract by failing to comply with one or more of the terms of this Contract, including but not limited to compliance with applicable statutes, rules or regulations, the Department may take one or more of the following actions: a) terminate this Contract or a Program Attachment of this Contract as it relates to a specific program type. In the case of termination, the Department will inform Contractor of the termination no less than thirty(30) calendar days before the effective date of the termination in a notice of termination, except for circumstances that require immediate termination as described in the Emergency Action section of this Article. The notice of termination will state the effective date of the termination, the reasons for the termination, and, if applicable, alert Contractor of the opportunity to request a hearing on the termination pursuant to Tex. Gov. Code Chapter 2105 regarding administration of Block Grants. Contractor shall not make any claim for payment or reimbursement for services provided from the effective date of termination; b) suspend all or part of this Contract. Suspension is an action taken by the Department in which the Contractor is notified to temporarily (1) discontinue performance of all or part of the Contract, and/or (2) discontinue incurring expenses otherwise allowable under the Contract as of the effective date of the suspension, pending DSHS's determination to terminate or amend the Contract or permit the Contractor to resume performance and/or incur allowable expenses. Contractor shall not bill DSHS for services performed during suspension, and Contractor's costs resulting from obligations incurred by Contractor during a suspension are not allowable unless expressly authorized by the notice of suspension; c) deny additional or future contracts with Contractor; d) reduce the funding amount for failure to 1) provide goods and services as described in this Contract or consistent with Contract performance expectations, 2) achieve or maintain the proposed level of service, 3) expend funds appropriately and at a rate that will make full use of the award, or 4) achieve local match, if required; e) disallow costs and credit for matching funds, if any, for all or part of the activities or action not in compliance; f) temporarily withhold cash payments. Temporarily withholding cash payments means the temporary withholding of a working capital advance, if applicable, or reimbursements or payments to Contractor for proper charges or obligations incurred, pending resolution of issues of noncompliance with conditions of this Contract or indebtedness to the United States or to the State of Texas; g) permanently withhold cash payments. Permanent withholding of cash payment means that Department retains funds billed by Contractor for (1) unallowable, undocumented, disputed, inaccurate, improper, or erroneous billings; (2) material failure to comply with Contract provisions; or General Provisions (Core Subrecipient) 2013 Rev. 7/12 32 (3) indebtedness to the United States or to the State of Texas; h) declare this Contract void upon the Department's determination that this Contract was obtained fraudulently or upon the Department's determination that this Contract was illegal or invalid from this Contract's inception and demand repayment of any funds paid under this Contract; i) request that Contractor be removed from the Centralized Master Bidders List (CMBL) or any other state bid list, and barred from participating in future contracting opportunities with the State of Texas; j) delay execution of a new contract or contract renewal with Contractor while other imposed or proposed sanctions are pending resolution; k) place Contractor on probation. Probation means that Contractor will be placed on accelerated monitoring for a period not to exceed six (6) months at which time items of noncompliance must be resolved or substantial improvement shown by Contractor. Accelerated monitoring means more frequent or more extensive monitoring will be performed by Department than would routinely be conducted; 1) require Contractor to obtain technical or managerial assistance; m) establish additional prior approvals for expenditure of funds by Contractor; n) require additional or more detailed, financial and/or programmatic reports to be submitted by Contractor; o) demand repayment from Contractor when it is verified that Contractor has been overpaid, e.g., because of disallowed costs, payments not supported by proper documentation, improper billing or accounting practices, or failure to comply with Contract terms; p) pursue a claim for damages as a result of breach of contract; q) require Contractor to prohibit any employee or volunteer of Contractor from performing under this Contract or having direct contact with DSHS-funded clients or participants, or require removal of any employee, volunteer, officer or governing body member, if the employee, volunteer, officer or member of the governing body has been indicted or convicted of the misuse of state or federal funds, fraud or illegal acts that are in contraindication to continued obligations under this Contract, as reasonably determined by DSHS; r) withhold any payments to Contractor to satisfy any recoupment, liquidated damages, match insufficiency, or any penalty (if the penalty is permitted by statute) imposed by DSHS, and take repayment from funds available under this Contract in amounts necessary to fulfill Contractor's payment or repayment obligations; s) reduce the Contract term; t) recoup improper payments when it is verified that Contractor has been overpaid, e.g., because of disallowed costs, payments not supported by proper documentation, improper billing or accounting practices or failure to comply with. Contract terms; u) assess liquidated damages; v) demand repayment of an amount equal to the amount of any match Contractor failed to provide, as determined by DSHS; w) impose other remedies, sanctions or penalties permitted by statute. Section 14.03 Notice of Remedies or Sanctions. Department will formally notify Contractor in writing when a remedy or sanction is imposed (with the exception of accelerated monitoring, which may be unannounced), stating the nature of the remedies and sanction(s), the reasons for imposing them, the corrective actions, if any, that must be taken before the actions will be removed and the time allowed for completing the corrective actions, and the method, if any, of requesting reconsideration of the remedies and sanctions imposed. Other than in the case of repayment or recoupment, Contractor is required to file, within fifteen (15) calendar days of receipt of notice, a written response to Department acknowledging receipt of such notice. If requested by the Department, the written response must state how Contractor shall correct the noncompliance (corrective action plan) or demonstrate in writing that the findings on which the remedies or sanction(s) are based are either invalid or do not warrant the remedies or sanction(s). If Department determines that a remedy General Provisions (Core Subrecipient) 2013 Rev. 7/12 33 or sanction is warranted, unless the remedy or sanction is subject to review under a federal or state statute, regulation, rule, or guideline, Department's decision is final. Department will provide written notice to Contractor of Department's decision. If required by the Department, Contractor shall submit a corrective action plan for DSHS approval and take corrective action as stated in the approved corrective action plan. If DSHS determines that repayment is warranted, DSHS will issue a demand letter to Contractor for repayment. If full repayment is not received within the time limit stated in the demand letter, and if recoupment is available, DSHS will recoup the amount due to DSHS from funds otherwise due to Contractor under this Contract. Section 14.04 Emergency Action. In an emergency, Department may immediately terminate or suspend all or part of this Contract, temporarily or permanently withhold cash payments, deny future contract awards, or delay contract execution by delivering written notice to Contractor, by any verifiable method, stating the reason for the emergency action. An "emergency" is defined as the following: a), Contractor is noncompliant and the noncompliance has a direct adverse effect on the public or client health, welfare or safety. The direct adverse effect may be programmatic or financial and may include failing to provide services, providing inadequate services, providing unnecessary services, or using resources so that the public or clients do not receive the benefits contemplated by the scope of work or performance measures; or b) Contractor is expending funds inappropriately. Whether Contractor's conduct or noncompliance is an emergency will be determined by Department on a case -by -case basis and will be based upon the nature of the noncompliance or conduct. ARTICLE XV CLAIMS AGAINST THE DEPARTMENT Section 15.01 Breach of Contract Claim. The process for a breach of contract claim against the Department provided for in Tex. Gov. Code Chapter 2260 and implemented in Department Rules §§ 4.11- 4.24 will be used by DSHS and Contractor to attempt to resolve any breach of contract claim against DSHS. Section 15.02 Notice. Contractor's claims for breach of this Contract that the Parties cannot resolve in the ordinary course of business must be submitted to the negotiation process provided in Tex. Gov Code Chapter 2260, subchapter B. To initiate the process, Contractor shall submit written notice, as required by subchapter B, to DSHS's Office of General Counsel. The notice must specifically state that the provisions of Chapter 2260, subchapter B, are being invoked. A copy of the notice must also be given to all other representatives of DSHS and Contractor. Subchapter B is a condition precedent to the filing of a contested case proceeding under Tex. Gov. Code Chapter 2260, subchapter C. Section 15.03 Sole Remedy. The contested case process provided in Tex. Gov. Code Chapter 2260, subchapter C, is Contractor's sole and exclusive process for seeking a remedy for any and all alleged breaches of contract by DSHS if the Parties are unable to resolve their disputes under this Article. Section 15.04 Condition Precedent to Suit. Compliance with the contested case process provided in Tex. Gov. Code Chapter 2260, subchapter C, is a condition precedent to seeking consent to sue from the Legislature under Tex. Civ. Prac. & Rem. Code Chapter 107. Neither the execution of this Contract by DSHS nor any other conduct of any representative of DSHS relating to this Contract will be considered a waiver of sovereign immunity to suit. Section 15.05 Performance Not Suspended. Neither the occurrence of an event nor the pendency of a claim constitutes grounds for the suspension of performance by Contractor, in whole or in part. General Provisions (Core Subrecipient) 2013 Rev. 7/12 34 ARTICLE XVI TERMINATION AND TEMPORARY SUSPENSION Section 16.01 Expiration of Contract or Program Attachment(s). Except as provided in the Survivability of Terms section of the General Terms Article, Contractor's service obligations stated in each Program Attachment will end upon the expiration date of that Program Attachment unless extended or renewed by written amendment. Prior to completion of the term of all Program Attachments, all or a part of this Contract may be terminated with or without cause under this Article. Section 16.02 Effect of Termination. Termination is the permanent withdrawal of Contractor's authority to obligate previously awarded funds before that authority would otherwise expire or the voluntary relinquishment by Contractor of the authority to obligate previously awarded funds. Contractor's costs resulting from obligations incurred by Contractor after termination of an award are not allowable unless expressly authorized by the notice of termination. Upon termination of this Contract or Program Attachment, as applicable, Contractor shall cooperate with DSHS to the fullest extent possible to ensure the orderly and safe transfer of responsibilities under this Contract or Program Attachment, as applicable, to DSHS or another entity designated by DSHS. Upon termination of all or part of this Contract, Department and Contractor will be discharged from any further obligation created under the applicable terms of this Contract or the Program Attachment, as applicable, except for the equitable settlement of the respective accrued interests or obligations incurred prior to termination and for Contractor's duty to cooperate with DSHS, and except as provided in the Survivability of Terms section of the General Terms Article. Termination does not, however, constitute a waiver of any remedies for breach of this Contract. In addition, Contractor's obligations to retain records and maintain confidentiality of information will survive this Contract. Section 16.03 Acts Not Constituting Termination. Termination does not include the Department's (1) withdrawal of funds awarded on the basis of Contractor's underestimate of the unobligated balance in a prior period; (2) withdrawal of the unobligated balance at the expiration of the term of a program attachment; (3) refusal to extend a program attachment or award additional funds to make a competing or noncompeting continuation, renewal, extension, or supplemental award; (4) non - renewal of a contract or program attachment at Department's sole discretion; or (5) voiding of a contract upon determination that the award was obtained fraudulently, or was otherwise illegal or invalid from inception. Section 16.04 Termination or Temporary Suspension Without Cause. a) Either Party may terminate this Contract or a Program Attachment, as applicable, with at least thirty (30) calendar days prior written notice to the other Party, except that if Contractor seeks to terminate a Contract or Program Attachment that involves residential client services, Contractor shall give the Department at least ninety (90) calendar days prior written notice and shall submit a transition plan to ensure client services are not disrupted. b) The Parties may terminate this Contract or a Program Attachment by mutual agreement. c) DSHS may temporarily suspend or terminate this Contract or a Program Attachment if funds become unavailable through lack of appropriations, budget cuts, transfer of funds between programs or health and human services agencies, amendments to the Appropriations Act, health and human services consolidations, or any disruption of current appropriated funding for this Contract or Program Attachment. Contractor will be notified in writing of any termination or temporary suspension or of any cessation of temporary suspension. Upon notification of temporary suspension, Contractor shall discontinue performance under the Contract as of the effective date of the suspension, for the duration of the suspension. d) Department may terminate this Contract or a Program Attachment immediately when, in the sole determination of Department, termination is in the best interest of the State of Texas. General Provisions (Core Subrecipient) 2013 Rev. 7/12 35 Section 16.05 Termination For Cause. Either Party may terminate for material breach of this Contract with at least thirty (30) calendar days written notice to the other Party. Department may terminate this Contract, in whole or in part, for breach of contract or for any other conduct that jeopardizes the Contract objectives, by giving at least thirty (30) calendar days written notice to Contractor. Such conduct may include one or more of the following: a) Contractor has failed to adhere to any laws, ordinances, rules, regulations or orders of any public authority having jurisdiction; b) Contractor fails to communicate with Department or fails to allow its employees or those of its subcontractor to communicate with Department as necessary for the performance or oversight of this Contract; c) Contractor breaches a standard of confidentiality with respect to the services provided under this Contract; d) Department determines that Contractor is without sufficient personnel or resources to perform under this Contract or that Contractor is otherwise unable or unwilling to fulfill any of its requirements under this Contract or exercise adequate control over expenditures or assets; e) Department determines that Contractor, its agent or another representative offered or gave a gratuity (e.g., entertainment or gift) to an official or employee of DSHS or HHSC for the purpose of obtaining a contract or favorable treatment; f) Department determines that this Contract includes financial participation by a person who received compensation from DSHS to participate in developing, drafting or preparing the specifications, requirements or statement(s) of work or Solicitation Document on which this Contract is based in violation of Tex. Gov. Code § 2155.004; or Department determines that Contractor was ineligible to receive this Contract under Tex. Gov. Code §§ 2155.006 or 2261.053 related to certain disaster response contracts; g) Contractor appears to be fmancially unstable. Indicators of financial instability may include one or more of the following: 1) Contractor fails to make payments for debts; 2) Contractor makes an assignment for the benefit of its creditors; 3) Contractor admits in writing its inability to pay its debts generally as they become due; 4) if judgment for the payment of money in excess of $50,000 (that is not covered by insurance) is rendered by any court or governmental body against Contractor, and Contractor does not (a) discharge the judgment, or (b) provide for its discharge in accordance with its terms, or (c) procure a stay of execution within thirty (30) calendar days from the date of entry of the judgment, or (d) if the execution is stayed, within the thirty (30) -day period or a longer period during which execution of the judgment has been stayed, appeal from the judgment and cause the execution to be stayed during such appeal while providing such reserves for the judgment as may be required under Generally Accepted Accounting Principles; 5) a writ or warrant of attachment or any similar process is issued by any court against all or any material portion of the property of Contractor, and such writ or warrant of attachment or any similar process is not released or bonded within thirty (30) calendar days after its issuance; 6) Contractor is adjudicated bankrupt or insolvent; 7) Contractor files a case under the Federal Bankruptcy Code or seeks relief under any provision of any bankruptcy, reorganization, arrangement, insolvency, readjustment of debt, dissolution, receivership or liquidation law of any jurisdiction then in effect, or consents to the filing of any case or petition against it under any such Iaw; 8) any property or portion of the property of Contractor is sequestered by court order and the order remains in effect for more than thirty (30) calendar days after Contractor obtains knowledge of the sequestration; General Provisions (Core Subrecipient) 2013 Rev. 7/12 36 9) a petition is filed against Contractor under any state reorganization, arrangement, insolvency, readjustment of debt, dissolution, receivership or liquidation law of any jurisdiction then in effect, and the petition is not dismissed within thirty (30) calendar days; or 10) Contractor consents to the appointment of a receiver, trustee, or liquidator of Contractor or of all or any part of its property; h) Contractor's management system does not meet the UGMS management standards; or i) Any required license, certification, permit, registration or approval required to conduct Contractor's business or to perform services under this Contract is not obtained or is revoked, is surrendered, expires, is not renewed, is inactivated or is suspended. Section 16.06 Notice of Termination. Either Party may deliver written notice of intent to terminate by any verifiable method. If either Party gives notice of its intent to terminate all or a part of this Contract, Department and Contractor shall attempt to resolve any issues related to the anticipated termination in good faith during the notice period. ARTICLE XVII VOID, SUSPENDED, AND TERMINATED CONTRACTS Section 17.01 Void Contracts. Department may void this Contract upon determination that the award was obtained fraudulently or was otherwise illegal or invalid from its inception. Section 17.02 Effect of Void, Suspended, or Involuntarily Terminated Contract. A Contractor who has been a party to a contract with DSHS that has been found to be void, or is suspended, or is terminated for cause is not eligible for expansion of current contracts, if any, or new contracts or renewals until, in the case of suspension or termination, the Department has determined that Contractor has satisfactorily resolved the issues underlying the suspension or termination. Additionally, if this Contract is found to be void, any amount paid is subject to repayment. Section 17.03 Appeals Rights. Pursuant to Tex. Gov. Code § 2105.302, after receiving notice from the Department of termination of a contract with DSHS funded by block grant funds, Contractor may request an administrative hearing under Tex. Gov. Code Chapter 2001. ARTICLE XVIII CLOSEOUT Section 18.01 Cessation of Services At Closeout. Upon expiration of this Contract or Program Attachment, as applicable, (and any renewals of this Contract or Program Attachment) on its own terms, Contractor shall cease services under this Contract or Program Attachment; and shall cooperate with DSHS to the fullest extent possible upon expiration or prior to expiration, as necessary, to ensure the orderly and safe transfer of responsibilities under this Contract to DSHS or another entity designated by DSHS. Upon receiving notice of Contract or Program Attachment termination or non - renewal, Contractor shall immediately begin to effect an orderly and safe transition of recipients of services to alternative service providers, as needed. Contractor also shall completely cease providing services under this Contract or Program Attachment by the date specified in the termination or non - renewal notice. Contractor shall not bill DSHS for services performed after termination or expiration of this Contract or Program Attachment, or incur any additional expenses once this Contract or Program Attachment is terminated or has expired. Upon termination, expiration (with no renewal) or non- renewal of this Contract or a Program Attachment, Contractor shall immediately initiate Closeout activities described in this Article. Section 18.02 Administrative Offset. The Department has the right to administratively offset amounts owed by Contractor against billings. Section 18.03 Deadline for Closeout. Contractor shall submit all financial, performance, and other Closeout reports required under this Contract within sixty (60) calendar days after the Contract or Program General Provisions (Core Subrecipient) 2013 Rev. 7/12 37 3$ Attachment end date. Unless otherwise provided under the Final Billing Submission section of the Payment Methods and Restrictions Article, the Department is not liable for any claims that are not received within sixty (60) calendar days after the Contract or Program Attachment end date. Section 18.04 Payment of Refunds. Any funds paid to Contractor in excess of the amount to which Contractor is finally determined to be entitled under the terms of this Contract constitute a debt to the Department and will result in a refund due, which Contractor shall pay within the time period established by the Department. Section 18.05 Disallowances and Adjustments. The Closeout of this Contract or Program Attachment does not affect the Department's right to disallow costs and recover funds on the basis of a later audit or other review or Contractor's obligation to return any funds due as a result of later refunds, corrections, or other transactions. General Provisions (Core Subrecipient) 2013 Rev_ 7/12 38 TEXAS DEPARTMENT OF STATE HEALTH SERVICES CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS The undersigned certifies, to the best of his or her knowledge and belief that: (1) 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, 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. (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 LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) 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 imposed 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 that $10,000 and not more than $100,000 for each such failure. Troy i qq['{ S Print Name of�,iithorized Individual 2013 - 041112 Application or Contract Number CORPUS CHRISTI- NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) Organization Name (22/--- /0.2 CSCU # EF29 -12374 - Revised 08.10.07 I Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: hftp: / /www.dshs .state.tx.us /grants /forms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal DivisionlAccounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: TB/PC -STATE DSHS Contract #: 2013-041112 Payee Account #: Attachment #: 001 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ 1 Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 09/01/2012 To: 11/30/2012 PO Number: 0000385062 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 21,118.00 b. Fringe Benefits 13,687.00 c. Travel 2,916.00 d. Equipment 0.00 e. Supplies 2,888.00 f. Contractual 27,230.00 g. Other 5,437.00 h. Total Direct Charges 73,276.00 i. Indirect Charges 0.00 j. Total Charges 73;276.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) Advance Balance n. ADVANCE Advance Received Repaid this Period Cumulative Repayments o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received #: Prepared By: Title: Phone CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone; DSHS Form GC-4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: http: / /www.dshs.state.tx.us /grants /forms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI- NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: TB/PC -STATE DSHS Contract #: 2013 - 041112 Payee Account #: Attachment #: 001 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ l Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 12/01/2012 To: 02/28/2013 PO Number: 0000385062 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 21,118.00 b. Fringe Benefits 13,687.00 c. Travel 2,916.00 d. Equipment 0.00 e. Supplies 2,888.00 f. Contractual 27,230.00 g. Other 5,437.00 h. Total Direct Charges 73,276.00 i. Indirect Charges 0.00 j. Total Charges 73,276.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) Advance Balance n. ADVANCE Advance Received Repaid this Period Cumulative Repayments o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received Prepared By: Phone #: Title: CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC-4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: htto: / /www.dshs.state.tx.us /grants /forms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division /Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: TB/PC -STATE DSHS Contract #: 2013 - 041112 Payee Account #: Attachment #: 001 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 03/01/2013 To: 05/31/2013 PO Number: 0000385062 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 21,118.00 b. Fringe Benefits 13,687.00 c. Travel 2,916.00 d. Equipment 0.00 e. Supplies 2,888.00 f. Contractual 27,230.00 g. Other 5,437.00 h. Total Direct Charges 73,276.00 i. Indirect Charges 0.00 j. Total Charges 73,276.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received Prepared By: Title: Phone #: CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC -4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: htto: / /www.dshs.state.tx.us /qrants /forms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division /Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: TB/PC -STATE DSHS Contract #: 2013- 041112 Payee Account #: Attachment #: 001 Payee Vendor ID: 17460005741027 Basis: [ 1 Cash [ 1 Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OH-'ICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 06/01/2013 To: 08/30/2013 PO Number: 0000385062 Check if Final Report [ i Yes [ [ No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 21,118.00 b. Fringe Benefits 13,687.00 c. Travel 2,916.00 d. Equipment 0.00 e. Supplies 2,888.00 f. Contractual 27,230.00 g. Other 5,437.00 h. Total Direct Charges 73,276.00 i. Indirect Charges 0.00 j. Total Charges 73,276.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) Advance Balance n. ADVANCE Advance Received Repaid this Period Cumulative Repayments o. Total Reimbursement Requested (net of advances) #: p. Total Reimbursement Received Prepared By: Title: Phone CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC -4a (269a) Revised 7/09 Client Services Contracting Unit MC 1886 Department of State Health Services 1100 W 49`x` Street PO Box 149347 Austin TX 78714 -9347 Phone: (512) 456 -7470 Fax: (512) 458 -7351 YOUR DOCUMENTS PLEASE DO NOT RETURN THESE DOCUMENTS TO DSHS. THESE DOCUMENTS ARE TO BE RETAINED FOR YOUR RECORDS. Please retain this set of contract documents and any attached forms for your records. Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: htto: / /www.dshs.state.tx.us /grants /forms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI- NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: PPCPS/LRN -HPP DSHS Contract #: 2013 - 041112 Payee Account #: Attachment #: 002 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 09/01/2012 To: 11/30/2012 PO Number: 0000385246 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 19,092.00 b. Fringe Benefits 6,491.00 c. Travel 7,313.00 d. Equipment 0.00 e. Supplies 4,418.00 f. Contractual 0.00 g. Other 2,700.00 h. Total Direct Charges 40,014.00 i. Indirect Charges 0.00 j. Total Charges 40,014.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received Prepared By: Title: Phone #: CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Narne and Title of Certifying Official Telephone: DSFIS Form GC-4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: htt p:// www. dshs .state.tx.us /grantslforms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI- NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: PPCPS/LRN -HPP DSHS Contract #: 2013 - 041112 Payee Account #: Attachment #: 002 Payee Vendor ID: 17460005741027 Basis: [ 1 Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 12/01/2012 To: 02/28/2013 PO Number: 0000385246 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 19,092.00 b. Fringe Benefits 6,491.00 c. Travel 7,313.00 d. Equipment 0.00 e. Supplies 4,418.00 f. Contractual 0.00 g. Other 2,700.00 h. Total Direct Charges 40,014.00 i. Indirect Charges 0.00 j. Total Charges 40,014.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received Prepared By: Title: Phone #: CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC-4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: http:// www. dshs .state.tx.us /grantslforms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI- NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: PPCPS/LRN -HPP DSHS Contract #: 2013- 041112 Payee Account #: Attachment #: 002 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ 1 Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Tenn: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 03/01/2013 To: 06/30/2013 PO Number: 0000385246 Check if Final Report [ 1 Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 19,092.00 b. Fringe Benefits 6,491.00 c. Travel 7,313.00 d. Equipment 0.00 c. Supplies 4,418.00 f. Contractual 0.00 g. Other 2,700.00 h. Total Direct Charges 40,014.00 i. Indirect Charges 0.00 j. Total Charges 40,014.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received Phone #: Prepared By: Title: CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC-4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: httpllwww. dshs .state.tx.uskirants /forms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: PPCPSILRN -HPP DSHS Contract #: 2013 - 041112 Payee Account #: Attaclunent #: 002 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 07/01/2013 To: 08/31/2013 PO Number: 0000385246 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 19,092.00 b. Fringe Benefits 6,491.00 c. Travel 7,313.00 d. Equipment 0.00 e. Supplies 4,418.00 f. Contractual 0.00 g. Other 2,700.00 h. Total Direct Charges 40,014.00 i. Indirect Charges 0.00 j. Total Charges 40,014.00 Less: k. Program Income Collected 1. Non -DSHS Funding . m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received Prepared By: Title: Phone #: CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC-4a (269a) Revised 7/09 Client Services Contracting Unit MC 1886 Department of State Health Services 1100 W 491h Street PO Box 149347 Austin TX 78714 -9347 Phone: (512) 458 -7470 Fax: (512) 458 -7351 YOUR DOCUMENTS PLEASE DO NOT RETURN THESE DOCUMENTS TO DSHS. THESE DOCUMENTS ARE TO BE RETAINED FOR YOUR RECORDS. Please retain this set of contract documents and any attached forms for your records. Texas Department of State Health Services Financial Status Report FSR269A An Excel version of This form can be downloaded at: http: / /www.dshs.state.tx.us /grants /forrns.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: PPCPS/LRN -PHEP DSHS Contract #: 2013-041112 Payee Account #: Attachment it 003 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 09/01/2012 To: 11/30/2012 PO Number: 0000385688 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 68,052.00 b. Fringe Benefits 23,138.00 c. Travel 17,768.00 d. Equipment 0.00 e. Supplies 21,760.00 f. Contractual 0.00 g. Other 46,418.00 h. Total Direct Charges 177,136.00 i. Indirect Charges 17,713.00 j. Total Charges 194,849.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) #: p. Total Reimbursement Received Prepared By: Title: Phone CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC -4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: http:ll www. dshs .state.tx.us /grants/forms.shtm P.O. Box 149347 Austin, Texas 78714-9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: PPCPSILRN -PHEP DSHS Contract #: 2013 - 041112 Payee Account #: Attachment #: 003 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 12/01/2012 To: 02/28/2013 PO Number: 0000385688 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 68,052.00 b. Fringe Benefits 23,138.00 c. Travel 17,768.00 d. Equipment 0.00 e. Supplies 21,760.00 f. Contractual 0.00 g. Other 46,418.00 h. Total Direct Charges 177,136.00 i. Indirect Charges 17,713.00 j. Total Charges 194,849.00 Less: k. Program Income Collected I. Non -DSHS Funding m. In -Kind (See Instructions) Advance Balance n. ADVANCE Advance Received Repaid this Period Cumulative Repayments o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received #: Prepared By: Title: Phone CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC-4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: http:// www. dshsstate .tx.us /grantslforms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: PPCPS/LRN-PHEP DSHS Contract #: 2013 - 041112 Payee Account #: Attachment #: 003 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/0112012 To: 08/31/2013 Period Covered in Report: From: 03/01/2013 To: 06/30/2013 PO Number: 0000385688 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 68,052.00 b. Fringe Benefits 23,138.00 c. Travel 17,768.00 d. Equipment 0.00 e. Supplies 21,760.00 f. Contractual 0.00 g. Other 46,418.00 h. Total Direct Charges 177,136.00 i. Indirect Charges 17,713.00 j. Total Charges 194,849.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received #: Prepared By: Title: Phone CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted I I Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC -4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: http: / /www.dshs.state.tx.us /grants /forms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI- NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: PPCPS/LRN -PHEP DSHS Contract #: 2013 - 041112 Payee Account #: Attachment #: 003 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 07/01/2013 To: 08/31/2013 PO Number: 0000385688 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 68,052.00 b. Fringe Benefits 23,138.00 c. Travel 17,768.00 d. Equipment 0.00 e. Supplies 21,760.00 f. Contractual 0.00 g. Other 46,418.00 h. Total Direct Charges 177,136.00 i. Indirect Charges 17,713.00 j. Total Charges 194,849.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received #: Prepared By: Title: Phone CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC-4a (269a) Revised 7/09 Client Services Contracting Unit MC 1886 Department of State - Health Services 1100 W 49`" Street PO Box 149347 Austin TX 78714 -9347 Phone: (512) 458 -7470 Fax: (512) 458 -7351 YOUR DOCU MENTS PLEASE DO NOT RETURN THESE DOCUMENTS TO DSHS. THESE DOCUMENTS ARE TO BE RETAINED FOR YOUR RECORDS. Please retain this set of contract documents and any attached forms for your records. Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: http:Ifwww.dshs.state.tx.uslc rantslforms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: IDCU/FLU -LAB DSHS Contract #: 2013- 041112 Payee Account #: Attachment #: 004 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 09/01/2012 To: 11/30/2012 PO Number: 0000386017 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 0.00 b. Fringe Benefits 0.00 c. Travel 0.00 d. Equipment 0.00 e. Supplies 4,700.00 f. Contractual 0.00 g. Other 300.00 h. Total Direct Charges 5,000.00 i. Indirect Charges 0.00 j. Total Charges 5,000.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received Prepared By: Title: Phone #: CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC -4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: http: //www.dshs.state.tx.us /grants /torms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division /Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI- NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: IDCU/FLU -LAB DSHS Contract #: 2013 - 041112 Payee Account #: Attachment #: 004 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 12/01/2012 To: 02/28/2013 PO Number: 0000386017 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 0.00 b. Fringe Benefits 0.00 c. Travel 0.00 d. Equipment 0.00 e. Supplies 4,700.00 f. Contractual 0.00 g. Other 300.00 h. Total Direct Charges 5,000.00 i. Indirect Charges 0.00 j. Total Charges 5,000.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) #: p. Total Reimbursement Received Title: Phone Prepared By: CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSBS Form GC -4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: http:// www. dshs .state.tx.uskirantslforms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: IDCU/FLU -LAB DSHS Contract #: 2013-041112 Payee Account #: Attachment #: 004 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ 1 Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 03/01/2013 To: 05/31/2013 PO Number: 0000386017 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 0.00 b. Fringe Benefits 0.00 c. Travel 0.00 d. Equipment 0.00 e. Supplies 4,700.00 f. Contractual 0.00 g. Other 300.00 h. Total Direct Charges 5,000.00 i. Indirect Charges 0.00 j. Total Charges 5,000.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received Phone #: Title: Prepared By: CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC -4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: http:// www. dshs .state.tx.usfgrants /forms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division /Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI- NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: IDCUIFLU -LAB DSHS Contract #: 2013 - 041112 Payee Account #: Attachment #: 004 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 06/01/2013 To: 08/30/2013 PO Number: 0000386017 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 0.00 b. Fringe Benefits 0.00 c. Travel 0.00. d. Equipment 0.00 e. Supplies 4,700.00 f. Contractual 0.00 g. Other 300.00 h. Total Direct Charges 5,000.00 i. Indirect Charges 0.00 j. Total Charges 5,000.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) n_ ADVANCE Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received #: Prepared By: Title: Phone CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed.or Printed Name and Title of Certifying Official Telephone: DSHS Form GC-4a (269a) Revised 7/09 — i.... ..........................-..-..... ••••......,.. - :.':•.:.-..-.......:•:1................••••;.-.•:-••••::::-:-:'.,..: :.,• :',' :...:,.......... •:....-.:::•:•-•:.....• •.--:'.. :',...i...:-.:.-':::.....--'-'.'-.. •.::' '.....:•.:'::..f.r....... : .. '. .............' : ......'.... ' -.....-..••••• :, .:' !-.. •••••••••• ., :•.. '..' 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'• • : '.. :.:...'. ".. ' .. .-.• '......-:.:. :'. , .. • . _ . . .• ......• ':_:..i,'..-:•........:...:....,--i.•::..-.....•• -.... • I ''......- '''.....'.. . :.. . - -..- •••• ,-.-......-••• ..:•'::',-. ,-••••••••• .:......1.-••• :.. . ::....:. ...... r....... . . ••• • :. • ...•:' -.:..,.....-...:..••••••... . ..' .. _ • - . • Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: htttxlwww. dshs .state_tx.uslgrants /forms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI- NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: IMM /LHD CCA DSHS Contract #: 2013- 041112 Payee Account #: Attachment #: 005 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 09/01/2012 To: 11/30/2012 PO Number: 0000385634 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 185,703.00 b. Fringe Benefits 45,906.00 c. Travel 10,205.00 d. Equipment 0.00 e. Supplies 8,675.00 f. Contractual 0.00 g. Other 3,648.00 h. Total Direct Charges 254,137.00 i. Indirect Charges 0.00 j. Total Charges 254,137.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) n. ADVANCE • Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received Prepared By: Title: Phone #: CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC-4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: http:llwww.dshs .state.tx.us /grants/forms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: IMM/LHD CCA DSHS Contract #: 2013-041112 Payee Account #: Attachment #: 005 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 12/01/2012 To: 02/28/2013 PO Number: 0000385634 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) . Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 185,703.00 b. Fringe Benefits 45,906.00. c. Travel 10,205.00 d. Equipment 0.00 e. Supplies 8,675.00 f. Contractual 0.00 g. Other 3,648.00 h. Total Direct Charges 254,137.00 i. Indirect Charges 0.00 j. Total Charges 254,137.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received Prepared By: Title: Phone #: CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC-4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: http: / /www. dshs .state.tx.us /grants /forms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI- NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: IMM/LHD CCA DSHS Contract #: 2013 - 041112 Payee Account #: Attachment #: 005 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 03/01/2013 To: 05/31/2013 PO Number: 0000385634 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 185,703.00 b. Fringe Benefits 45,906.00 c. Travel 10,205.00 d. Equipment 0.00 e. Supplies 8,675.00 f. Contractual 0.00 g. Other 3,648.00 h. Total Direct Charges ; 254,137.00 i. Indirect Charges 0.00 j. Total Charges 254,137.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) Advance Balance n. ADVANCE Advance Received Repaid this Period Cumulative Repayments o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received Prepared By: Title: Phone #: CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC -4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: http:llwww. dshs .state.tx.us /grantslforms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI- NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program:. IMM/LIID CCA DSHS Contract #: 2013 - 041112 Payee Account #: Attachment #: 005 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ J Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 06/01/2013 To: 08/31/2013 PO Number: 0000385634 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (I) Budget Categories (2) Approved Budget (3) This Period (4). Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel . 185,703.00 b. Fringe Benefits 45,906.00 c. Travel 10,205.00 d. Equipment 0.00 e. Supplies 8,675.00 f. Contractual 0.00 g. Other 3,648.00 h. Total Direct Charges 254,137.00 i. Indirect Charges 0.00 j. Total Charges 254,137.00 -Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received Prepared By: Title: Phone #: CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC-4a (269a) Revised 7/09 Client Services Contracting Unit MC 1886 Department of State Health Services 1100 W 49t Street PO Box 149347 Austin TX 78714 -9347 Phone: (5 €2) 458 -7470 Fax: (512) 458 -7351 YOUR DOCUMENTS PLEASE DO NOT RETURN THESE DOCUMENTS TO DSHS. THESE DOCUMENTS ARE TO BE RETAINED FOR YOUR RECORDS. Please retain this set of contract documents and any attached forms for your records. Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: http:// www. dshs _state.tx.us /orants/fomis.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name;. CORPUS CHRISTI- NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: RLSS/LPHS -PnP DSHS Contract #: 2013 - 041112 Payee Account #: Attachment #: 006 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: PO BOX 9277 City, ST, Zip: CORPUS CHRISTI, TX 78469 -9277 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 09/01/2012 To: 11/30/2012 PO Number: 0000385670 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 128,191.00 b. Fringe Benefits 35,842.00 c. Travel 0.00 d. Equipment 0.00 e. Supplies 335.00 f. Contractual 0.00 g. Other 0.00 h. Total Direct Charges 164,368.00 i. Indirect Charges 0.00 j. Total Charges 164,368.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received Prepared By: Title: Phone #: CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC -4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: httn:// www. dshs .state.tx.us /arants/forms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: RLSS/LPHS -PnP DSHS Contract #: 2013 - 041112 Payee Account #: Attachment #: 006 Payee Vendor ID: - 17460005741027 Basis: [ ] Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: PO BOX 9277 City, ST, Zip: CORPUS CHRISTI, TX 78469 -9277 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 12/01/2012 To: 02/28/2013 PO Number: 0000385670 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) ! Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 128,191.00 b. Fringe Benefits 35,842.00 c. Travel 0.00 d. Equipment 0.00 e. Supplies 335.00 f. Contractual 0.00 g. Other 0.00 h. Total Direct Charges 164,368.00 i. Indirect Charges 0.00 j. Total Charges 164,368.00 Less: k. Program Income Collected Advance Balance L Non -DSHS Funding m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received Prepared By: Title: Phone #: CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC-4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: http: / /www.dshs.state.tx. us /ci rants/forms.shtm P.O. Box 149347 Austin, Texas 78714-9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI- NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: RLSS/LPHS -PnP DSHS Contract #: 2013- 041112 Payee Account #: Attachment #: 006 Payee Vendor ID: 17460005741027 Basis: [ 1 Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: PO BOX 9277 City, ST, Zip: CORPUS CHRISTI, TX 78469 -9277 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 03/01/2013 To: 05/31/2013 PO Number: 0000385670 Check if Final Report [ 1 Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 128,191.00 b. Fringe Benefits 35,842.00 c. Travel 0.00 d. Equipment 0.00 e. Supplies 335.00 f. Contractual 0.00 g. Other 0.00 h. Total Direct Charges 164,368.00 i. Indirect Charges 0.00 j. Total Charges 164,368.00 Less: k. Program Income Collected I. Non -DSHS Funding m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received Prepared By: Title: Phone #: CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC -4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: http: / /www.dshs.state.tx.us /grants /forms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: RLSS/LPHS -PnP DSHS Contract #: 2013- 041112 Payee Account #: Attachment #: 006 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: PO BOX 9277 City, ST, Zip: CORPUS CHRISTI, TX 78469 -9277 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 06/01/2013 To: 08/31/2013 PO Number: 0000385670 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 128,191.00 b. Fringe Benefits 35,842.00 c. Travel 0.00 d. Equipment 0.00 e. Supplies 335.00 f. Contractual 0.00 , g: Other 0.00 h. Total Direct Charges 164,368.00 i. Indirect Charges 0.00 j. Total Charges 164,368.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) #: p. Total Reimbursement Received Prepared By: Title: Phone CER 1'1I (CATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC -4a (269a) Revised 7/09 Texas Department of State Health. Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: http: / /www.dshs .state.tx.us /prants/forms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: TB/PC -FED DSHS Contract #: 2013- 041112 Payee Account #: Attachment #: 007 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 09/01/2012 To: 12/31/2012 PO Number: 0000385352 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 22,065.00 b. Fringe Benefits 13,901.00 c. Travel 1,998.00 d. Equipment 0.00 e. Supplies 3,522.00 f. Contractual 13,352.00 g. Other 6,897.00 h. Total Direct Charges 61,735.00 i. Indirect Charges 0.00 j. Total Charges 61,735.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) #: p. Total Reimbursement Received Prepared By; Phone Title: CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form CC -4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: http:// www. dshs .state.tx.us /Orants/forms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: TB/PC-FED DSHS Contract #: 2013- 041112 Payee Account #: Attachment #: 007 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ 1 Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 01/01/2013 To: 03/29/2013 PO Number: 0000385352 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 22,065.00 b. Fringe Benefits 13,901.00 c. Travel 1,998.00 d. Equipment 0.00 e. Supplies 3,522.00 f. Contractual 13,352.00 g. Other 6,897.00 h. Total Direct Charges 61,735.00 i. Indirect Charges 0.00 j. Total Charges 61,735.00 Less: k. Program Income Collected 1. Non -DSHS Funding - m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received #: Title: Prepared By: Phone CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC-4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: htt0: / /www.dshs.state.tx.us /grants /forms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: TB/PC -FED DSHS Contract #: 2013 - 041112 Payee Account #: Attachment #: 007 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31/2013 Period Covered in Report: From: 04/01/2013 To: 06/28/2013 PO Number: 0000385352 Check if Final Report [ 1 Yes [ ] No Project Cost per General Ledger (I) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 22,065.00 b. Fringe Benefits 13,901.00 c. Travel 1,998.00 d. Equipment 0.00 e. Supplies 3,522.00 f. Contractual 13,352.00 g. Other 6,897.00 h. Total Direct Charges 61,735.00 i. Indirect Charges 0.00 j. Total Charges 61,735.00 Less: k. Program Income Collected 1. Non -DSHS Funding Advance Balance m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received Prepared By: Phone #: Title: CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC -4a (269a) Revised 7/09 Texas Department of State Health Services Financial Status Report FSR269A An Excel version of this form can be downloaded at: http:l/www.dshs.state.tx.us /grants /forms.shtm P.O. Box 149347 Austin, Texas 78714 -9347 Fiscal Division/Accounts Payable Phone (512)458 -7435 Contractor Name: CORPUS CHRISTI - NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) DSHS Program: TB/PC -FED DSHS Contract #: 2013 -041112 Payee Account #: Attachment #: 007 Payee Vendor ID: 17460005741027 Basis: [ ] Cash [ ] Accrual Payee Name: CITY OF CORPUS CHRISTI Address: VITAL RECORDS OFFICE ATTN TERE ESCALANTE City, ST, Zip: CORPUS CHRISTI, TX 78469 -9727 Contract Term: From: 09/01/2012 To: 08/31 /2013 Period Covered in Report: From: 07/01/2013 To: 08/31/2013 PO Number: 0000385352 Check if Final Report [ ] Yes [ ] No Project Cost per General Ledger (1) Budget Categories (2) Approved Budget (3) This Period (4) Cumulative (5) Remaining Budget Balance (2 minus 4) a. Personnel 22,065.00 b. Fringe Benefits 13,901.00 c. Travel 1,998.00 d. Equipment 0.00 e. Supplies 3,522.00 f. Contractual 13,352.00 g. Other 6,897.00 h. Total Direct Charges 61,735.00 i. Indirect Charges 0.00 j. Total Charges 61,735.00 Less: k. Program Income Collected 1. Non -DSHS Funding m. In -Kind (See Instructions) n. ADVANCE Advance Received Repaid this Period Cumulative Repayments Advance Balance o. Total Reimbursement Requested (net of advances) p. Total Reimbursement Received Phone #: Title: Prepared By: CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. Signature of Authorized Certifying Official Date Submitted / / Typed or Printed Name and Title of Certifying Official Telephone: DSHS Form GC -4a (269a) Revised 7/09