HomeMy WebLinkAboutC2018-624 - 5/22/2018 - Approved DocuSign Envelope ID:C21 FEB96-6432-4B8E-AF85-25F3AAA009A0
DEPARTMENT OF STATE HEALTH SERVICES
CONTRACT No.537-18-0147-00001
AMENDMENT No.01
RENEWAL
THE DEPARTMENT OF STATE HEALTH SERVICES ("System Agency") and CORPUS CHRISTI-
NUECES COUNTY PUBLIC HEALTH DISTRICT(CITY) ("Grantee"), who are collectively referred
to herein as the "Parties" or singularly as the "Party," to that certain grant contract to provide
funding for Level 3 chemical laboratory surge capacity activities, effective July 1, 2017, and
denominated System Agency Contract No. 537-18-0147-00001 ("Contract"), now desire to
amend the Contract.
WHEREAS, System Agency has elected to extend the term of the Contract an additional Fiscal
Year to allow continued support of the projects in accordance with Section III of the Contract
Signature Document;
WHEREAS,the Parties desire to correct the numbering in the Signature Document;
WHEREAS,the Parties desire to specify the legal authority;
WHEREAS, the Parties desire to revise the Budget to add funds for the Contract period
beginning July 1, 2018, through June 30, 2019 ("Fiscal Year 2019" or"FY2019"); and
WHEREAS, the Parties desire to add the FY2019 Statement of Work.
Now,THEREFORE, the Parties hereby amend and modify the Contract as follows:
1. The section numbering in the Signature Document is hereby corrected to reflect a
sequential order.
2. SECTION III of the Signature Document,DURATION,is hereby amended to reflect a revised
termination date of June 30, 2019.
3. SECTION IV of the Signature Document, BUDGET, is hereby amended to add Two
HUNDRED ONE THOUSAND ONE HUNDRED TWENTY-THREE DOLLARS ($201,123.00) in
C2018-624 stem Agency Contract No.537-18-0147-00001 Page 1 of 4
5/22/18
Ord. 031444
TX Dept of State Health Services
SCANNED
DocuSign Envelope ID:C21FEB96-6432-4B8E-AF85-25F3AAA009A0
federal funding with the Grantee providing a total of TWENTY THOUSAND ONE HUNDRED
THIRTEEN DOLLARS($20,113.00)in match funds, for a revised total Contract amount not
to exceed of FOUR HUNDRED TWO THOUSAND TWO HUNDRED FORTY-SIX DOLLARS
($402,246.00). All expenditures under the Contract will be in accordance with the revised
budget set forth herein. Funds provided in support of one Contract activity may only be
used for that activity and may not be comingled with other funds provided under this
Contract.
4. SECTION VI of the Signature Document, LEGAL NOTICES, is amended to replace the
System Agency information in its entirety with the following:
Department of State Health Services
Attention: General Counsel
1100 W. 49th Street, MC 1911
Austin, TX 78756
5. SECTION VII of the Signature Document, ADDITIONAL GRANT INFORMATION, is
supplemented with the following grant information:
Federal Award Identification Number(FAIN): 1 NU90TP921879-01-00
Awarding Official Contact Information:
Stephany Vento
1600 Clifton Road, MS D29
DSLR
Atlanta, GA 30329
Phone: 404-960-9023
DUNS: 069457786
6. The Parties agree to add the following new Section VIII to the Signature Document:
VIII.NOTICE TO PROCEED
Funding for this Contract is dependent on the award of the applicable federal grant. No
FY2019 work may begin and no charges may be incurred until the System Agency issues
a written notice to proceed to Grantee. This Notice to Proceed may include an amended or
ratified budget which will be incorporated into this Contract by a subsequent amendment,
as necessary. Notwithstanding the preceding, at the discretion of the System Agency,
Grantee may be eligible to receive reimbursement for eligible expenses incurred during the
period of performance as defined by 2 CFR §200.309.
System Agency Contract No.537-18-0147-00001 Page 2 of 4
DocuSign Envelope ID:C21 FEB96-6432-4B8E-AF85-25F3AAA009A0
7. ATTACHMENT B,BUDGET, is hereby amended by deleting the budget table in its entirety
and replacing it with the following:
Budget Categories FY18 Budget FY19 Budget Total Budget
Summary Summary Summary
(7/1/17—6/30/18) (7/1/18—6/30/19)
Personnel $96,660.00 $99,077.00 $195,737.00
Fringe Benefits $39,940.00 $42,425.00 $82,365.00
Travel $14,096.00 $10,427.00 $24,523.00
Equipment $0.00 $0.00 $0.00
Supplies $19,567.00 $15,514.00 $35,081.00
Contractual $0.00 $0.00 $0.00
Other $50,973.00 $53,793.00 $104,766.00
Sum of Direct Costs $221,236.00 $221,236.00 $442,472.00
Indirect Costs $0.00 $0.00 $0.00
Sum of Direct Costs $221,236.00 $221,236.00 $442,472.00
and Indirect Costs
Less Match (Cash or $20,113.00 $20,113.00 $40,226.00
In-Kind)
TOTAL $201,123.00 $201,123.00 $402,246.00
It is agreed that Grantee shall provide matching funds in the amount of$40,226.00 for the
Contract term.
8. The Parties agree to add ATTACHMENT A.1, FY2019 STATEMENT OF WORK, which is
attached to this Amendment and incorporated into the Contract as if fully set forth therein.
9. This Amendment No. 1 shall be effective as of the date last signed below.
10. Except as amended and modified by this Amendment No. 1, all terms and conditions of
the Contract shall remain in full force and effect.
11. Any further revisions to the Contract shall be by written agreement of the Parties.
SIGNATURE PAGE FOLLOWS
System Agency Contract No.537-18-0147-00001 Page 3 of 4
DocuSign Envelope ID:C21 FEB96-6432-4B8E-AF85-25F3AAA009A0
SIGNATURE PAGE FOR AMENDMENT No.01
SYSTEM AGENCY CONTRACT No. 537-18-0147-00001
DEPARTMENT OF STATE HEALTH SERVICES CORPUS CHRISTI-NUECES COUNTY PUBLIC
HEALTH DISTRICT(CITY)
cDocuSigned by: a—DocuSigned by:
By: iitAx tt, I?e41.Vt',1,tt'j
`—B113A6B1CFEC4CE `-4FC9D92742CE414_.
David Gruber Name:Annette Rodriquez
Title:Health Director
Associate Commissioner
Regional and Local Health
Operations
Date of Execution:May 23, 2018 Date of Execution:May 2 3, 2018
THE FOLLOWING ATTACHMENTS ARE ATTACHED AND INCORPORATED AS PART OF THE
CONTRACT:
ATTACHMENT A.1- FY2019 STATEMENT OF WORK
ATTACHMENT C - FFATA
System Agency Contract No.537-18-0147-00001 Page 4 of 4
DocuSign Envelope ID:C21FEB96-6432-4B8E-AF85-25F3AAA009A0
SIGNATURE PAGE FOR AMENDMENT No.01
SYSTEM AGENCY CONTRACT No.537-18-0147-00001
DEPARTMENT OF STATE HEALTH SERVICES CORPUS CHRISTI-NUECES COUNTY PUBLIC
HEALTH DISTRICT(CITY)
TO 6-k 4AeCiL tVL
BY: I_1 4_ / .i i
1
David Gruber Name:
Titl •
-
Associate Commissioner
Regional and Local Health
Operations
Date of Execution: Date of Execution:
tifTEST: 111 ' I= — is
REa.ECCA HUERTA
CITY SECRETARY
THE FOLLOWING ATTACHMENTS ARE ATTACHED AND INCORPORATED AS PART OF THE
CONTRACT:
ATTACHMENT A.1 - FY2019 STATEMENT OF WORK
Approved as to form: S /%
ATTACHMENT C - FFATA
ssistant City Atto
For City Attorney
O‘rd 0
.......�...1..AU I tiUKlci..
sY COUNCIL
SECRETARY
System Agency Contract No.537-18-0147-00001 Page 4 of 4
DocuSign Envelope ID:C21FEB96-6432-468E-AF85-25F3AAA009A0
ATTACHMENT A.1
STATEMENT OF WORK
July 1,2018 through June 30,2019
L GRANTEE RESPONSIBILITIES
Grantee will:
A. Perform activities in support of the Public Health Emergency Preparedness Cooperative
Agreement and the Office of the Assistant Secretary for Preparedness and Response
(OASPR)from the Centers for Disease Control and Prevention(CDC).Activities include but
are not limited to: continuing Level 3 chemical laboratory surge capacity activities;
complying with new Laboratory Readiness Network (LRN) requirements for biological
laboratories; coordinating with cross-cutting public health preparedness partners, and
analyzing real-time clinical specimens. CDC's five-year Public Health Emergency
Preparedness(PHEP)—Hospital Preparedness Program(HPP)Cooperative Agreement seeks
to align PHEP and HPP programs and advance public health and healthcare preparedness and
ensure jurisdictions are capable of providing a standard battery of tests for high priority
biological threats and emerging infectious diseases.
B. Perform activities in the following counties (hereinafter referred to as the "service area"):
San Patricio County,Nueces County,Aransas County,Jim Wells County,Kleberg County,
Victoria County, Bee County, Calhoun County, Goliad County,Jackson County,Live Oak
County, and Refugio County.
C. Comply with new biological laboratory requirements in accordance with the revised CDC
policy for LRN-B Reference Level Laboratories.Laboratories must attain and maintain LRN-
B Member Standard Level as detailed in the LRN Checklist of Laboratory Requirements.
Minimum standards are required for testing capabilities,administrative activities,emerging
infectious disease preparedness, and instrumentation and equipment.
D. Provide matching funds for each fiscal year of this Contract not less than ten percent(10%)
of the allocation amount for each fiscal year. Cash match is defined as an expenditure of
cash by the Grantee on allowable costs of this Contract that are borne by the Grantee.In-kind
match is defined as the dollar value of non-cash contributions by a third party given in goods,
commodities, or services that are used in activities that benefit this Contract's project and
that are contributed by non-federal third parties without charge to the Grantee. The criteria
for match must:
1. Be an allowable cost under the applicable federal cost principle;
2. Be necessary and reasonable for the efficient accomplishment of project or program
objectives;
3. Be verifiable within the Grantee's (or subcontractor's)records;
4. Be documented,including methods and sources,in the approved budget(applies only
to cost reimbursement contracts);
5. Not be included as contributions toward any other federally-assisted project or
program(match can count only once per fiscal year);
System Agency Contract No. 537-18-0147-00001
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DocuSign Envelope ID:C21 FEB96-6432-4B8E-AF85-25F3AAA009A0
ATTACHMENT A.1
STATEMENT OF WORK
July 1,2018 through June 30,2019
6. Not be paid by the federal government under another award,except where authorized
by federal statute to be used for cost sharing or match;
7. Conform to other provisions of governing circulars/statutes/regulations as applicable
for the Contract;
8. Be adequately documented;
9. Follow procedures for generally accepted accounting practices as well as meet audit
requirements; and
10. Value the in-kind contributions reported and must be supported by documentation
reflecting the use of goods and/or services during the Contract term.
Grantee must match funds awarded for this Contract 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 Grantee incurs in fulfilling the 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 92.24.
E. Notify System Agency in advance of Grantee's plans to participate in or conduct local
exercises, in a format specified by System Agency. Grantee will participate in statewide
exercises planned by System Agency as needed to assess the capacity of Grantee to respond
to bioterrorism, other outbreaks of infectious disease, and other public health threats and
emergencies. Grantee will prepare after-action reports, documenting and correcting any
identified gaps or weaknesses in preparedness plans identified during exercise, in a form
specified by System Agency.
F. Cooperate with System Agency to coordinate all planning,training and exercises performed
under this Contract with the Governor's Division of Emergency Management of the State of
Texas, or other points of contact at the discretion of the Division for Regional and Local
Health Operations,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.
G. In the event of a public health emergency involving a portion of the state, Grantee will
mobilize and dispatch staff or equipment purchased with funds from the previous PHEP
cooperative agreement that are not performing critical duties in the jurisdiction served to the
affected area of the state upon receipt of a written request from System Agency.
H. Develop, implement and maintain a timekeeping system for accurately documenting staff
time and salary expenditures for all staff funded through this Contract,including partial full-
time employees and temporary staff.
System Agency Contract No. 537-18-0147-00001
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DocuSign Envelope ID:C21 FEB96-6432-4B8E-AF85-25F3AAA009A0
ATTACHMENT A.1
STATEMENT OF WORK
July 1,2018 through June 30,2019
I. Maintain a confirmatory bioterrorism testing laboratory with a staff trained and proficient
in CDC's LRN biothreat protocols.
J. Train other Grantee laboratory staff in setting up and performing all diagnostic and reference
testing for select biological agents.
K. Provide test samples from identified service area for biothreat agents and toxins. Once
biological agent is identified,Grantee will be prepared to test for other infectious agents and
for other public health threats and emergencies.
L. Test food samples for select biological agents using conventional and advanced
bacteriological techniques and CDC-LRN protocols.
M. Monitor and evaluate biothreat incidents, outbreaks of infectious disease and other public
health threats and emergencies.
N. Communicate with all other laboratories within the designated service area.
O. Maintain extensive collaboration with local law enforcement,hazardous material and other
emergency responders.In addition,Grantee will prepare Standard Operating Procedures and
Standard Operating Guidelines(SOPs/SOGs)covering interaction with these agencies in the
event of an emergency or incident.
P. Maintain extensive collaboration with all hospitals located in the identified service area to
plan for response activities for biological threats. LRN service regions can be found here:
http://www.dshs.texas.gov/lab/eprLRN.shtm.
Q. Review and approve all current preparedness SOPs/SOGs (copy of the titled, dated, and
initialed/signed review sheet) for use by the respective laboratories with quarterly reports.
R. Utilize System Agency's provided Public Health Laboratory Information Management
System (PHLIMS), or a LIMS that has been configured to be compatible with the CDC
Results Messenger(RM)reporting system, or CDC RM for reporting biothreat testing and
results. This reporting will include sample and laboratory data as well as the final report.
S. Prepare/provide current information during an incident about status on individual samples,
sample load/overload,personnel,reagent, equipment, and facilities.
T. Provide to System Agency a LRN surge capability plan within a timeline designated by
System Agency that details how the LRN laboratory will manage a surge in sample capacity.
The plan should include:work hours,instruments and equipment,personnel and staffing,and
identify essential lab service that must be maintained during an outbreak or emergency event.
System Agency Contract No.537-18-0147-00001
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ATTACHMENT A.1
STATEMENT OF WORK
July 1,2018 through June 30,2019
U. 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 CDC protocols.
V. Maintain a system for safe specimen transport from local laboratories.
W. Explore the capabilities and needs of sentinel laboratories.
X. Inform System Agency of Grantee's plans,via e-mail or telephone,to meet updated LRN-B
program requirements for Standard reference level laboratories as outlined in the Funding
Opportunity Announcement(FOA).
Y. Provide programmatic reports as directed by System Agency in a format specified by System
Agency. Grantee will provide System Agency other reports,including financial reports,and
any other reports that System Agency determines necessary to accomplish the objectives of
this contract and to monitor compliance.
Z. Submit an End-of-Year Performance Report in a format specified by System Agency within
an established timeframe designated by System Agency.
AA. Report as requested by System Agency to satisfy information-sharing requirements set forth
in Texas Government Code,Sections 421.071 and 421.072(b)and(c),as amended.Grantee
shall immediately notify System Agency in writing if Grantee is legally prohibited from
providing any reports required under this Contract.
BB. Initiate the purchase of all equipment approved in writing by the System Agency in the first
quarter of the FY19 Contract term (July 1,2018 —June 30, 2019), 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 in the Contract must be submitted to the assigned System Agency contract manager.
CC. 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.Controlled Assets are considered Supplies.
DD. Maintain an inventory of equipment,supplies defined as Controlled Assets,and real property
and submit an annual cumulative report of the equipment and other property on HHS System
Agency Grantee's Property Inventory Report to the assigned System Agency contract
manager by e-mail not later than October 15 of each year.
System Agency Contract No. 537-18-0147-00001
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ATTACHMENT A.1
STATEMENT OF WORK
July 1,2018 through June 30,2019
EE. Not use System Agency funds to purchase buildings or real property without prior written
approval from the System Agency.Any costs related to the initial acquisition of the buildings
or real property are not allowable without written pre-approval.
FF. At the expiration or termination of this Contract for any reason, title to any remaining
equipment and supplies purchased with funds under this Contract reverts to System Agency.
Title may be transferred to any other party designated by System Agency. The System
Agency may,at its option and to the extent allowed by law,transfer the reversionary interest
to such property to Grantee.
GG. In the event of a local, state, or federal emergency the Grantee has the authority to utilize
approximately five percent(5%) of the Grantee's staff's time supporting this Contract for
response efforts. System Agency will reimburse Grantee up to five percent of this Contract
funded by CDC for personnel costs responding to an emergency event.Grantee will maintain
records to document the time spent on response efforts for auditing purposes. Allowable
activities also include participation of drills and exercises in the pre-event time period.
Grantee will notify the Assigned Contract Manager in writing when this provision is
implemented.
HH. Comply with all applicable federal and state laws, rules, and regulations, as amended,
including,but not limited to,the following:
1. Public Law 107-188,Public Health Security and Bioterrorism Preparedness and
Response Act of 2002;
2. Public Law 113-05,Pandemic and All-Hazards Preparedness Reauthorization Act; and
3. Texas Health and Safety Code Chapter 81.
II. Comply with the following documents and resources,as amended,which are incorporated by
reference and made a part of this Contract:
1. System Agency and CDC Public Health Emergency Preparedness Cooperative
Agreement;
2. Public Health Preparedness Capabilities: National Standards for State and Local
Planning,March 2011:
http://www.cdc.gov/phpr/capabilities/DSLR capabilities July.pdf;
3. Presidential Policy Directive 8/PPD-8, March 30,2011: http://www.hlswatch.com/wp-
content/uploads/2011/04/PPD-8-Preparedness.pdf;
4. Homeland Security Exercise and Evaluation Plan(HSEEP)Documents:
https://www.preptoolkit.org/web/hseep-resources
5. Ready or Not? Have a Plan; Surviving Disaster: How Texans Prepare(videos):
http://www.texasprepares.org/survivingdisaster.htm;
6. Preparedness Program Guidance(s)as provided by System Agency and CDC; and
7. FY2017 Office of the Assistant Secretary for Preparedness and Response(OASPR)
System Agency Contract No. 537-18-0147-00001
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DocuSign Envelope ID:C21FEB96-6432-4B8E-AF85-25F3AAA009A0
ATTACHMENT A.1
STATEMENT OF WORK
July 1,2018 through June 30,2019
Hospital Preparedness Program—CFDA Number 93.074:
http://www.phe.gov/preparedness/planning/hpp/pages/default.aspx.
IL PERFORMANCE MEASURES
A. System Agency will monitor the Grantee's compliance with the requirements in this Contract
and failure to meet these requirements may result in withholding a portion of the current
LRN base awards.
B. Grantee must demonstrate adherence to reporting deadlines and the capability to receive,
stage, store, distribute and dispense materiel during a public health emergency. The initial
reporting requirement schedule for the requirements are subject to change as System Agency
and CDC may modify requirements and due dates. System Agency will send a requirements
schedule within thirty(30)days of the Fiscal Year start date.
IILINVOICE AND PAYMENT
A. Grantee will request monthly payment using the Excel version of the State of Texas Purchase
Voucher(Form B-13)and Support Document including any acceptable additional supporting
documentation for reimbursement of the required services/deliverables. Additionally, the
Grantee will submit the Excel version of the Financial Status Report(FSR-269A). Vouchers,
supporting documentation and Financial Status Reports should be mailed or e-mailed to the
addresses below.
Department of State Health Services
Claims Processing Unit,MC 1940
P.O. Box 149347
Austin,TX 78714-9347
FAX: (512)458-7442
EMAIL: invoices@dshs.texas.gov,Php.vouchersupport(2I dshs.texas.gov &
CMSInvoices(ai,dshs.texas.gov
B-13, B-13A,and supporting documentation should be sent to: invoices(aidshs.texas.gov,
Php.vouchersupportAdshs.texas.gov&CMSInvoices(2I dshs.texas.gov
FSRs should be sent to: invoices( dshs.texas.gov, Php.vouchersupportAdshs.texas.gov,
FSRGrantsna,dshs.texas.gov &CMSlnvoices@dshs.texas.gov
B. Grantee will be reimbursed on a monthly basis and in accordance with the Budget in
Attachment B of this Contract.
C. System Agency reserves the right,where allowed by legal authority,to redirect funds in the
event of financial shortfalls. System Agency will monitor Grantee's expenditures on a
System Agency Contract No.537-18-0147-00001
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ATTACHMENT A.1
STATEMENT OF WORK
July 1,2018 through June 30,2019
quarterly basis. If expenditures are below that projected in Grantee's total Contract amount,
Grantee's budget may be subject to a decrease for the remainder of the Term of the Contract.
Vacant positions existing after ninety days may result in a decrease in funds.
D. Grantee may request a one-time working capital advance not to exceed 12% of the total
amount of the Contract funded by System Agency. All advances must be expended by the
end of the contract term. Advances not expended by the end of the contract term must be
refunded to System Agency.
Grantee will repay all or part of advance funds at any time during the Contract's term.
However, if the advance has not been repaid prior to the last three months of the Contract
term,the Grantee must deduct at least one-third of the remaining advance from each of the
last three months' reimbursement requests.If the advance is not repaid prior to the last three
months of the Contract term,System Agency will reduce the reimbursement request by one-
third of the remaining balance of the advance.
E. For the purposes of this Contract, the Grantee may not use funds for fundraising activities,
lobbying,research,construction,major renovations and reimbursement of pre-award costs,
clinical care,purchase of vehicles of any kind,funding an award to another party or provider
who is ineligible,backfilling costs for staff or the purchase of incentive items.
System Agency Contract No. 537-18-0147-00001
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DocuSign Envelope ID:C21 FEB96-6432-4B8E-AF85-25F3AAA009A0
Fiscal Federal Funding Accountability and Transparency Act
(FFATA) CERTIFICATION
The certifications enumerated below represent material facts upon which DSHS relies when reporting
information to the federal government required under federal law. If the Department later determines
that the Contractor knowingly rendered an erroneous certification, DSHS may pursue all available
remedies in accordance with Texas and U.S. law. Signor further agrees that it will provide immediate
written notice to DSHS if at any time Signor learns that any of the certifications provided for below were
erroneous when submitted or have since become erroneous by reason of changed circumstances. If the
Signor cannot certify all of the statements contained in this section, Signor must provide written
notice to DSHS detailing which of the below statements it cannot certify and why.
Legal Name of Contractor: FFATA Contact#1 Name,Email and Phone Number:
city of corpus Christi Constance Sanchez
Constancep@cctexas.com
361-826-3227
Primary Address of Contractor: FFATA Contact#2 Name, Email and Phone Number:
1702 Horne Road Blandina Costley
Corpus Christi , Texas 78416 Blandinac@cctexas.com
361-826-7252
ZIP Code:9-digits Required www.usps.com DUNS Number:9-digits Required www.sam.gov
78416-1902 - 069457786
State of Texas Comptroller Vendor Identification Number(VIN) 14 Digits
07460005741027
Printed Name of Authorized Representative Signature of Authorized Representative
,-DocuSigned by:
Annette Rodriquez QIAkt
4FCODb2742CE41
Title of Authorized Representative Date
Health Director May 23, 2018
- 1-
Department of State Health Services Form 4734—June 2013
DocuSign Envelope ID:C21 FEB96-6432-4B8E-AF85-25F3AAA009A0
Fiscal Federal Funding Accountability and Transparency Act
(FFATA) CERTIFICATION
As the duly authorized representative (Signor)of the Contractor, I hereby certify that
the statements made by me in this certification form are true, complete and correct to
the best of my knowledge.
Did your organization have a gross income, from all sources, of less than $300,000 in
your previous tax year? n Yes Q No
If your answer is "Yes", skip questions "A", "B", and "C" and finish the certification.
If your answer is "No", answer questions "A" and "B".
A. Certification Regarding%of Annual Gross from Federal Awards.
Did your organization receive 80% or more of its annual gross revenue from federal
awards during the preceding fiscal year? ❑Yesx❑ No
B. Certification Regarding Amount of Annual Gross from Federal Awards.
Did your organization receive $25 million or more in annual gross revenues from federal
awards in the preceding fiscal year? ❑Yes n No
If your answer is "Yes"to both question "A" and "B",you must answer question "C".
If your answer is "No" to either question "A" or "B", skip question "C" and finish the
certification.
C. Certification Regarding Public Access to Compensation Information.
Does the public have access to information about the compensation of the senior
executives in your business or organization (including parent organization, all branches,
and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d)
of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the
Internal Revenue Code of 1986? n Yes ❑ No
If your answer is "Yes"to this question,where can this information be accessed?
If your answer is "No" to this question, you must provide the names and total
compensation of the top five highly compensated officers below.
Provide compensation information here:
-2-
Department of State Health Services Form 4734—June 2013
Docu ;
: SECURED
Certificate Of Completion
Envelope Id:C21 FEB9664324B8EAF8525F3AAA009A0 Status:Completed
Subject:Amending$402,246;537-18-0147-00001 Corpus Christi-Nueces County PHD A-1;DSHS/CMS/CPS/LRN-PHEP
Source Envelope:
Document Pages:26 Signatures:3 Envelope Originator:
Certificate Pages:2 Initials:0 Texas Health and Human Services Commission
AutoNav:Enabled 1100 W.49th St.
Envelopeld Stamping:Enabled Austin,TX 78756
Time Zone:(UTC-06:00)Central Time(US&Canada) PCS_DocuSign@hhsc.state.tx.us
IP Address: 167.137.1.16
Record Tracking
Status:Original Holder:Texas Health and Human Services Location:DocuSign
May 10,2018 Commission
PCS_DocuSign@hhsc.state.tx.us
Signer Events Signature Timestamp
Annette Rodriquez D°`uSigned°y. I�- Sent:May 10,2018
annetter@cctexas.com Qt t, rdyi1 Viewed:May 23,2018
.-4FC9D92742CE414 Signed:May Director 9 23,2018
City of Corpus Christi
Using IP Address:64.201.138.47
Security Level:Email,Account Authentication
(None)
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Associate Commissioner for RLHS fie"nea,cFEc4ce Signed:May 23,2018
Texas Health and Human Services Commission
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TEXAS
?v • Texas Department of State Health Services
tk Health and Human
``J4 ` Services John Hellerstedt,M.D.
Commissioner
June 28, 2018
Annette Rodriguez
Corpus Christi-Nueces County Public Health District (City)
1702 Home Road
Corpus Christi, Texas 78416
VIA Email to: annetter@ cctexas.com and williamu2@cctexas.com
RE: NOTICE TO PROCEED
Dear Ms. Rodriguez:
Corpus Christi-Nueces County Public Health District (City) is authorized to
proceed with the Level 3 chemical laboratory surge capacity grant year two
activities occurring July 1, 2018, through June 30, 2019 ("FY2019"), for the
Laboratory Readiness Network-Public Health Emergency Preparedness
Program, Contract No. 537-18-0147-00001 (the "Contract"), as of receipt of
this Notice to Proceed.
The Contract is fully funded for FY2019 at $201,123.00, and the Budget
remains the same.
This Notice to Proceed is an official Notice under your Contract and becomes
part of your Contract file. Please let us know if you have any questions or
need additional information. We look forward to working with you.
Sincerely,
)441A,(11k/i)?
Jona Wilczynski, CTCM
Unit irector, Admin./RLHO/Consumer Protection Unit
Contract Management Section
Department of State Health Services
P.O.Box 149347•Austin,Texas 78714-9347• Phone:888-963-7111•TTY:800-735-2989• dshs.texas.gov