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Home My WebLink AboutC2018-721 - 12/11/2018 - Approved Dom;Sign Envelope ID:9D91 C6F8-DOED-4818-BF8E-5BF3BA4403D 1 DEPARTMENT OF STATE HEALTH SERVICES CONTRACT No.HHS000036000002 AMENDMENT No. 1 The DEPARTMENT OF STATE HEALTH SERVICES ("System Agency" or "DSHS") and CORPUS CHRISTI-NUECES COUNTY PUBLIC HEALTH DISTRICT ("Grantee")who are collectively referred to herein as the"Parties,"to that certain grant Contract effective January 1,2018,and denominated DSHS Contract No. HHS000036000002, 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 January 1,2019,through December 31,2019(hereinafter referred to as"Fiscal Year 2019"or"FY 2019"); WHEREAS, the Parties desire to revise the Statement of Work. Now,THEREFORE, the Parties hereby amend and modify the Contract as follows: 1. SECTION IV of the Signature Document,BUDGET,is hereby amended to add FORTY-EIGHT THOUSAND THREE HUNDRED FORTY-FIVE DOLLARS ($48,345.00) in DSHS funding with the grantee providing a total of NINE THOUSAND SIX HUNDRED SIXTY-NINE DOLLARS ($9,669.00) in matching funds, for a total Contract amount not to exceed ONE HUNDRED SIXTEEN THOUSAND TWENTY-EIGHT DOLLARS($116,028.00). 2. SECTION I.G.of ATTACHMENT A,STATEMENT OF WORK,is hereby amended to add the following: "During the term of this Contract, DSHS reserves the right to decrease funding amounts as a result of the Grantee's budgetary shortfalls and/or due to the Grantee lapsing more than 1%of total funds." 3. 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: CMSinvoicesAdshs.texas.gov. 4. Section III.B. of ATTACHMENT A,STATEMENT OF WORK,is hereby amended to add the following: "Contractor must submit final FSR and a reimbursement or final payment request no later than forty-five(45)calendar days following the end of the Contract term." 5. The Parties agree to add to the Contract ATTACHMENT B-1,FY 2019 BUDGET, which is attached to this Amendment and incorporated into the Contract as if fully set forth therein. All FY 2019 expenditures shall be made in accordance with Attachment B-1. C2018-721 12/11/18 Ord. 031630 TX Dept of State Health Services 1 SCANNED DocuSign Envelope ID:9D91 C6F8-DOED-4818-BF8E-5BF3BA4403D 1 6. ATTACHMENT A, STATEMENT OF WORK, is hereby amended to add the following SECTION IV: IV.PROGRAMMATIC REPORTING REQUIREMENTS Report Name Frequency Period Begin Period End Due Date FY18 Narrative Annually January 1, 2018 December 31, 2018 April 1, 2019 Report FY19 Narrative Annually January 1,2019 December 31,2019 April 1,2020 Report Financial Status Quarterly January 1,2019 March 31, 2019 April 30, 2019 Report(FSR) &Match Reimbursement/ Certification Form(B-13A) Financial Status Quarterly April 1,2019 June 30, 2019 July 31,2019 Report(FSR) &Match Reimbursement/ Certification Form(B-13A) Financial Status Quarterly July 1,2019 September 30,2019 October 31,2019 Report(FSR) &Match Reimbursement/ Certification Form(B-13A) Financial Status Quarterly October 1, 2019 December 31,2019 February 17, Report(FSR) 2020 &Match Reimbursement/ Certification Form(B-13A) 7. ATTACHMENT D,SUPPLEMENTAL AND SPECIAL CONDITIONS is hereby amended to add the following new Section 1.16 under the Special Conditions: SECTION 1.16 CONTRACTOR'S PROPERTY INVENTORY REPORT. Grantee shall 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's Contractor's Property Inventory Report to the assigned DSHS Contract Manager and DSHS Contract Oversight and Support (email address: COSequip(adshs.texas.gov) by electronic mail no later than October 15 of each year. The Contractor's Property Inventory Report may be found at: http://www.dshs.texas.gov/contracts/forms.shtm. 2 Docu§ign Envelope ID:9D91 C6F8-DOED-4818-BF8E-5BF3BA4403D 1 8. Except as amended and modified by this Amendment No. 1, all terms and conditions of the Contract shall remain in full force and effect. 9. Any further revisions to the Contract shall be by written agreement of the Parties. SIGNATURE PAGE FOLLOWS 3 DocuSign Envelope ID:9D91 C6F8-DOED-4818-BF8E-5BF3BA4403D1 SIGNATURE PAGE FOR AMENDMENT NO.1 DSHS CONTRACT No.HHS000036000002 DEPARTMENT OF STATE HEALTH SERVICES GRANTEE 1—DocuSugned by: cDoeuSigned by: (iitth I'�l aartitx By AAAe a P&L,*ez '-7B1D18EDD8CD493_ '-4FC9092742CE414__ Imelda M. Garcia Name: Annette Rodriguez Associate Commissioner, LIDS Title: Health Director Date of Execution: December 12, 2018 Date of Execution: December 12, 2018 THE FOLLOWING ATTACHMENTS ARE ATTACHED AND INCORPORATED AS PART OF THE CONTRACT: ATTACHMENT B-1 FY 2019 BUDGET 4 • DocuSign Envelope ID.909106F8-DOED-4818-BF8E-58F3BA440301 SIGNATURE PAGE FOR AMENDMENT NO. 1 DSHS CONTRACT No.HHS000036000002 DEPARTMENT OF STATE HEALTH SERVICES GRANTEE QU By: • ',i 10 Name: Title: Date of Execution: Date of Execution: ATTEST: & el ' i.L . .4 1 RE: CCA HUERTA CITY SECRETARY THE FOLLOWING ATTACHMENTS ARE ATTACHED AND INCORPORATED AS PART OF THE CONTRACT: ATTACHMENT B-1 FY 2019 BUDGET Approved as to form: Oa* sistant City Attorne For City Attorney (-).6 .Q31 �„b fuK a 0 moot� It '► SECRETARY 4 DocuSign Envelope ID:9D91 C6F8-DOED-4818-BF8E-5BF3BA4403D 1 ATTACHMENT B-1 FY 2019 BUDGET Organization Name: Corpus Christi-Nueces County Public Health District Program ID: TB/PC-Federal Contract Number: HHS000036000002—AMENDMENT 1 Budget Categories DSHS Cash Match Category Total Funds Personnel $25,407.00 $9,669.00 $35,076.00 Fringe Benefits $10,879.00 $0.00 $10,879.00 Travel $2,959.00 $0.00 $2,959.00 Equipment $0.00 $0.00 $0.00 $4,006.00 $0.00 $4,006.00 Supplies Contractual $2,877.00 $0.00 $2,877.00 Other $2,217.00 $0.00 $2,217.00 Total Direct Costs $48,345.00 $9,669.00 $58,014.00 Indirect Costs $0.00 $0.00 $0.00 Totals $48,345.00 $9,669.00 $58,014.00 5 Docu5t r. SECURED Certificate Of Completion Envelope Id:9D91C6F8DOED4818BF8E5BF3BA4403D1 Status:Completed Subject:Amending$116,028;HHS000036000002;Corpus Christi-Nueces County Public Health A-1;DSHS/CMS Source Envelope: Document Pages: 14 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: 167.137.1.15 Record Tracking Status:Original Holder:Texas Health and Human Services Location:DocuSign 10/29/2018 1:14:41 PM Commission PCS_DocuSign@hhsc.state.tx.us Signer Events Signature Timestamp Annette Rodriguez �DoCa51gnedby Sent:10/29/2018 1:25:36 PM AnnetteR@cctexas.com A""ed4 P"i^Q,°z Viewed: 11/1/2018 10:43:41 AM Health Director �dFC90927d2CE41d Signed: 12/12/2018 2:03:04 PM Corpus Christi-Nueces County Public Health District Security Level:Email,Account Authentication Signature Adoption:Pre-selected Style (None) Using IP Address:64.201.138.47 Electronic Record and Signature Disclosure: Not Offered via DocuSign Imelda M.Garcia ,--DOLus'gnedby Sent:12/12/2018 2:03:06 PM ImeldaM.Garcia@dshs.texas.gov Watt attnit. Viewed: 12/12/2018 7:05:17 PM Associate Commissioner,LIDS ,—IB1018ED08G0493 Signed: 12/12/2018 7:05:56 PM Security Level:Email,Account Authentication (None) Signature Adoption:Pre-selected Style Using IP Address:24.28.84.209 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 CMU Contracts COPIED Sent:10/29/2018 1:25:35 PM cmucontracts@dshs.texas.gov Viewed:11/8/2018 3:02:00 PM Security Level:Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Carbon Copy Events Status Timestamp Stefanie Jackson COPIED Sent:10/29/2018 1:25:35 PM stefanie.jackson@hhsc.state.tx.us Security Level:Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Ebony White COPIED Sent:10/29/2018 1:25:35 PM Ebony.White@dshs.texas.gov Viewed: 10/29/2018 1:57:11 PM Security Level:Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign William Milan Uhlarik COPIED Sent:10/29/2018 1:25:37 PM WilliamU2@cctexas.com Viewed: 10/29/2018 1:36:52 PM 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 12/12/2018 2:03:06 PM Certified Delivered Security Checked 12/12/2018 7:05:17 PM Signing Complete Security Checked 12/12/2018 7:05:56 PM Completed Security Checked 12/12/2018 7:05:56 PM Payment Events Status Timestamps