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Home My WebLink AboutC2018-628 - 6/26/2018 - Approved DocuSign Envelope ID:118B7B23-FDDE-497D-94DC-96A0A71A9366 DEPARTMENT OF STATE HEALTH SERVICES CONTRACT No. 537-18-0032-00001 AMENDMENT No. 1 THE DEPARTMENT OF STATE HEALTH SERVICES ("System Agency" or DSHS") and CORPUS CHRISTI-NUECES COUNTY PUBLIC HEALTH DISTRICT (CITY) ("Grantee") who are collectively referred to herein as the "Parties," to that certain grant Contract effective September 1, 2017 and denominated DSHS Contract No. 537-18-0032-00001, now desire to amend the Contract. WHEREAS, the System Agency has chosen to exercise its option to renew the Contract in accordance with Section III of the Contract Signature Document; WHEREAS, the Parties desire to revise the Budget to add funds for the period beginning September 1, 2018 through August 31, 2019 (hereinafter referred to as "Fiscal Year 2019" or "FY2019"); Whereas, the Parties desire to revise the Statement of Work; and Whereas the Parties desire to add to the Supplemental and Special Conditions. Now,THEREFORE, the Parties hereby amend and modify the Contract as follows: 1. SECTION III of the Signature Document, DURATION, is hereby amended to reflect a revised termination date of August 31, 2019. 2. SECTION IV of the Signature Document, BUDGET is hereby amended to add SIXTY-ONE THOUSAND SIX HUNDRED FORTY-FIVE DOLLARS ($61,645.00) in DSHS funding with the Grantee providing a total of TWELVE THOUSAND THREE HUNDRED TWENTY-NINE DOLLARS($12,329.00)in matching funds, for a total Contract amount not to exceed ONE HUNDRED FORTY-SEVEN THOUSAND NINE HUNDRED FORTY-EIGHT DOLLARS ($147,948.00). 3. SECTION I.G.of ATTACHMENT A,STATEMENT OF WORK is hereby deleted in its entirety and replaced with the following: G. Not lapse more than 1%of the total funded amount of the Contract. C2018-628 6/26/18 m Agency Contract No.537-18-0032-00001 Page 1 of 4 Ord. 031468 TX Dept of State Health Services SCANNED DocuSign Envelope ID 118B7B23-FDDE-497D-94DC-96A0A71A9366 4. SECTION III.A. of ATTACHMENT A, STATEMENT OF WORK is hereby amended to add the following email address to which vouchers and any supporting documentation must also be submitted by electronic mail: CMSinvoicesna,dshs.texas.gov. 5. The Parties agree to add to the Contract ATTACHMENT B-1, FY2019 BUDGET, which is attached to this Amendment and incorporated into the Contract as if fully set forth therein. All FY2019 expenditures shall be made in accordance with Attachment B-1. 6. ATTACHMENT D,SUPPLEMENTAL AND SPECIAL CONDITIONS is hereby amended to add the following new Section 1.16 under the Special Conditions: SECTION 1.16 GRANTEE'S CERTIFICATION OF MEETING OR EXCEEDING TOBACCO- FREE WORKPLACE POLICY MINIMUM STANDARDS. Grantee certifies that it has adopted and enforces a Tobacco-Free Workplace Policy that meets or exceeds all of the following minimum standards of: a) Prohibiting the use of all forms of tobacco products, including but not limited to cigarettes, cigars, pipes, water pipes (hookah), bidis, kreteks, electronic cigarettes, smokeless tobacco, snuff and chewing tobacco; b) Designating the property to which this Policy applies as a "designated area," which must at least comprise all buildings and structures where activities funded under this Contract are taking place, as well as Grantee owned, leased, or controlled sidewalks, parking lots, walkways, and attached parking structures immediately adjacent to this designated area; c) Applying to all employees and visitors in this designated area; and d) Providing for or referring its employees to tobacco use cessation services. If Grantee cannot meet these minimum standards,it must obtain a waiver from the System Agency. 7. This Amendment No. 1 shall be effective as of September 1,2018. 8. Except as amended and modified by this Amendment No. 1, all terms and conditions of the Contract, as amended, shall remain in full force and effect. In the event of a conflict between the Contract and the terms of this Amendment, the terms of this Amendment shall control. 9. Any further revisions to the Contract shall be by written agreement of the Parties. Signature Page Follows. System Agency Contract No.537-18-0032-00001 Page 2 of 4 DocuSign Envelope ID: 11867623-FDDE-497D-94DC-96A0A71A9366 SIGNATURE PAGE FOR AMENDMENT No. 1 SYSTEM AGENCY CONTRACT No.537-18-0032-00001 DEPARTMENT OF STATE HEALTH SERVICES GRANTEE c—DocuSigned by: (,DocuSigned by: }a k By: L '14 evet "-14303D85CC75416 4FC9092742CE414... Janna Zumbrun Name: Annette Rodriguez Associate Commissioner for Laboratory and irifinieoatilhDimiscetagryices Date of Execution: July 5, 2018 Date of Execution: July 5, 2018 THE FOLLOWING ATTACHMENT IS ATTACHED AND INCORPORATED AS PART OF THE CONTRACT: ATTACHMENT B-1 FY2019 BUDGET System Agency Contract No.537-18-0032-00001 Page 3 of 4 DocuSign Envelope ID: 118B7B23-FDDE-497D-94DC-96A0A71A9366 SIGNATURE PAGE FOR AMENDMENT No. 1 SYSTEM AGENCY CONTRACT No.537-18-0032-00001 DEPARTMENT OF STATE HEALTH SERVICES GRANTEE By: I• 1. C L co-1-e p e_- Name: Title: Date of Execution: Date of Execution: ATTEST: RE ECCA HUERTA CITY SECRETARY THE FOLLOWING ATTACHMENT IS ATTACHED AND INCORPORATED AS PART OF THE CONTRACT: ATTACHMENT B-1 FY2019 BUDGET Approved as to fo c,11`1 Assistant City Attorney For City Attorney ��; � AUTHORIL I n tact. _NL_�/ eFC'r System Agency Contract No.537-18-0032-00001 Page 3 of 4 DocuSign Envelope ID:118B7B23-FDDE-497D-94DC-96A0A71A9366 ATTACHMENT B-1 FY2019 BUDGET Organization Name: Corpus Christi-Nueces County Public Health District (City) Program ID: TB/State Contract Number: 537-18-0032-00001—AMENDMENT 1 Budget Categories DSHS Cash Match Category Total Funds Personnel $25,440.00 $12,329.00 $37,769.00 Fringe Benefits $10,893.00 $0.00 $10,893.00 Travel $1,812.00 $0.00 $1,812.00 Equipment $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Supplies Contractual $18,000.00 $0.00 $18,000.00 Other $5,500.00 $0.00 $5,500.00 Total Direct Costs $61,645.00 $12,329.00 $73,974.00 Indirect Costs $0.00 $0.00 $0.00 Totals $61,645.00 $12,329.00 $73,974.00 System Agency Contract No.537-18-0032-00001 Page 4 of 4 Docuy g`"`• • SECURED Certificate Of Completion Envelope Id: 118B7B23FDDE497D94DC96A0A71A9366 Status:Completed Subject:Amending$123,290;537-18-0032-00001 Corpus Christi-Nueces A-1;DSHS/CMS Source Envelope: Document Pages:9 Signatures:2 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 March 29,2018 Commission PCS_DocuSign@hhsc.state.tx.us Signer Events Signature Timestamp Annette Rodriguez �DucuSivedby Sent:March 29,2018 annetter@cctexas.com Am/44 F"'t^SJfz Viewed:March 29,2018 `-4FC9D92742CE414 Health Director Signed:July 5,2018 City of Corpus Christi Security Level:Email,Account Authentication Using IP Address:64.201.138.47 (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Janna Zumbrun p—DocuS "dbyi Sent:July 5,2018 janna.zumbrun@dshs.texas.gov Viewed:July 5,2018 `—14303085CC75416. Associate Commissioner for Laboratory and Signed:July 5,2018 Infectious Disease Services Texas Health and Human Services Commission Using IP Address: 160.42.85.8 Security Level:Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Stefanie Jackson COPIED Sent:March 29,2018 stefanie.jackson@hhsc.state.tx.us Security Level:Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign • Carbon Copy Events Status Timestamp Ebony White COPIED Sent:March 29,2018 Ebony.White@dshs.texas.gov Viewed:April 23,2018 Security Level:Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign CMU Contract Inbox COPIED Sent:March 29,2018 cmucontracts@dshs.texas.gov Viewed:April 4,2018 Security Level:Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign William Uhlarik COPIED Sent:March 29,2018 williamu2@cctexas.com Viewed:March 30,2018 Security Level:Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted July 5,2018 Certified Delivered Security Checked July 5,2018 Signing Complete Security Checked July 5,2018 Completed Security Checked July 5,2018 Payment Events Status Timestamps