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Home My WebLink AboutC2017-239 - 8/8/2017 - Approved DocuSign Envelope ID:689C3F6A-82A9-4AA1-8673-722CB9ADCAEE DEPARTMENT OF STATE HEALTH SERVICES CONTRACT No.2016-003808D AMENDMENT No.4 The Department of State Health Services ("DSHS") and Corpus Christi-Nueces County Public Health District (City) ("Contractor"), parties to that certain Texas Healthy Communities Grant contract effective October 1, 2015 and denominated HHSC Contract No. 2016-003808-00 as amended(the "Contract"),now desire to further amend the Contract. • WHEREAS,the Parties wish to revise the Scope of Work, and WHEREAS, the Parties wish to extend the term of the Contract to allow for successful completion of the Project; and WHEREAS, these revisions will result in an increase in contract value. Now,THEREFORE,the Parties hereby amend and modify the Contract as follows: 1. SECTION 2 of the Contract, Total Amount, is amended to add FIFTY THOUSAND DOLLARS ($50,000.00) for the period of October 1, 2017 through September 30, 2018 for a total contract amount not to exceed ONE HUNDRED FIFTY THOUSAND DOLLARS ($150,000). Contractor will be paid on a cost reimbursement basis and in accordance with the budget in ATTACHMENT B.2 of this contract. 2. SECTION 4 of the Contract, Term of the Contract, is hereby amended to reflect a termination date of September 30, 2018. 3. SECTION 7 of the Contract,Performance Measures, is amended to add the following: Contractor shall: 1. Develop, complete and submit a Project Work Plan in conjunction with DSHS. The Work plan must include objectives with supporting activities that address indicators identified in the FY 2017 TXHC assessment as needing improvement. A Project Work Plan Draft must be submitted, reviewed and approved by DSHS prior to the final version submission date. The Project Work Plan draft must be submitted to DSHS on or before October 17, 2017 and the final Project Work Plan submission is due to DSHS on or before October 31,2017. 2.Develop and submit an Evaluation Plan to DSHS. An Evaluation Plan Draft must be reviewed and approved by DSHS prior to the final version submission date. The Evaluation Plan Draft must be submitted on or before November 16, 2017 and the final Evaluation Plan version is due to DSHS on or before November 30, 2017. 2017-239 8/08/17 1 Ord. 031206 TX Dept of State Health Services [INDEXED DocuSign Envelope ID:689C3F6A-82A9-4AA1-8673-722CB9ADCAEE 3. Submit an Interim Progress Report Draft to DSHS for review on or before March 19, 2018. The Report will include summary of all items/activities conducted to date; detailed description of progress toward achieving objectives and activities; and barriers. Submission of the final Interim Report must fully address any feedback from DSHS based on the draft Interim Report and must be submitted on or before March 30, 2018. 4. Conduct, complete and submit the Texas Healthy Communities Assessment Draft in the Performance Management and Tracking System by May 16, 2018. DSHS will review and approve Draft submission prior to submission of final report in Performance Management and Tracking System(PMATS) on or before May 31, 2018. 5. Submit a Final Progress Report Draft to DSHS for review and approval on or before August 31, 2018. Report will include summary of all items/activities conducted to date; detailed description of progress toward achieving objectives and activities; plans for sustaining activities once funding has ended; and barriers/lessons learned. Submission of Final Report must fully address any feedback from DSHS based on draft final report and must be submitted on or before September 14, 2018. 6. Participate in twelve (12) monthly feedback calls (monthly project status reports) with DSHS Program to be conducted on or before the following dates: October 31St, November 28th, December 31st, January 30th, February 28th, March 31st, April 30th, May 29th, June 30th, July 31St, August 31St, and September 30th. Contractor will submit written monthly reports as directed by DSHS. 4. SECTION 15 of the Contract, PROGRAMMATIC REPORTING REQUIREMENTS, is amended to add the following: Report Name Frequency Period Begin Period End Due Date Project Work Plan Nonrecurring 10/31/2017 Evaluation Plan . Nonrecurring 11/30/2017 Interim Progress Report Annually 10/01/2017 03/15/2018 03/30/2018 Texas Healthy Nonrecurring 05/31/2018 Communities Assessment Report Final Progress Report Nonrecurring 10/01/2017 . 08/31/2018 09/14/2018 Financial Status Report Quarterly 10/01/2017 12/31/2017 01/31/2018 (FSR) Financial Status Report Quarterly 01/01/2018 03/31/2018 04/30/2018 Financial Status Report Quarterly 04/01/2018 06/30/2018 07/31/2018 Financial Status Report Quarterly 07/01/2018 09/30/2018 11/15/2018 2 DocuSign Envelope ID:689C3F6A-82A9-4AA1-8673-722CB9ADCAEE 1. This Amendment No. 4 shall be effective as of October 01, 2017. 2. Except as amended and modified by this Amendment No. 4, all terms and conditions of the Contract, as amended, shall remain in full force and effect. 3. Any further revisions to the Contract shall be by written agreement of the Parties. SIGNATURE PAGE FOLLOWS 3 DocuSign Envelope ID:689C3F6A-82A9 4AA1-8673-722CB9ADCAEE SIGNATURE PAGE FOR AMENDMENT No.4 • HHSC CONTRACT No.2016-003808D DSHS CONTRACTOR �DocuSigned by: DocuSigned by: . Bcii,...A. 11303D85CC75116... By. 703DADA012014C3... Name: Janna Zumbrun, M.S.S.W Name: Annette Rodriguez Title: Associate Commissioner for Disease Title: Di rector of Public Health Control and Prevention 8/14/2017 1 10:20 AM CDT - 8/14/2017 1 10:14 AM CDT Date of Execution: Date of Execution: • THE FOLLOWING ATTACHMENTS ARE ATTACHED AND INCORPORATED AS PART OF THE CONTRACT: ATTACHMENT B.2-CATEGORICAL BUDGET 4 SIGNATURE PAGE FOR AMENDMENT No.4 HHSC CONTRACT No. 2016-003808D DSHS CONTRACTOR C'tcyvv"PaIke :n� ' By: Annette Rodriguez Name: Janna Zumbrun, M.S.S.W Name: Title: Associate Commissioner for Disease Title: Director of Public Health Control and Prevention Date of Execution: Date of Execution: THE FOLLOWING ATTACHMENTS ARE ATTACHED AND INCORPORAT D AS PART OF THE CONTRACT: ATTEST: Ate\ ATTACHMENT B.2-CATEGORICAL BUDGET REB CCA HUERTA CITY SECRETARY Approved as,o form: __ •a_ Fu r Tk) BY .�...�..�..... ARr 4 DocuSign Envelope ID 689C3F6A-82A9-4AA1-8673-722CB9ADCAEE Attachment B.2 Contract No. 2016-003808D Categorical Budget: PERSONNEL $32,328.00 FRINGE BENEFITS $9,537.00 TRAVEL $2,529.00 EQUIPMENT $0.00 SUPPLIES $5,606.00 CONTRACTUAL $0.00 OTHER $0.00 TOTAL DIRECT CHARGES $50,000.00 INDIRECT CHARGES $0.00 TOTAL $50,000.00 Total Budget $50,000.00 Docu ,z; • SECURED Certificate Of Completion Envelope Id:689C3F6A82A94AA18673722CB9ADCAEE Status:Completed Subject:REVISED;DSHS AMEND NO.2016-003808D;Corpus Christi-Nueces County PHD;HPCDP-TXHC Source Envelope: Document Pages: 15 Signatures:2 Envelope Originator: Supplemental Document Pages:0 Initials:0 Josalyn Wilson Certificate Pages:3 AutoNav:Enabled Payments:0 1860 Michael Faraday Dr Envelopeld Stamping:Enabled Reston,VA 20190 Time Zone:(UTC-06:00)Central Time(US& josalyn.wilson@hhsc.state.tx.us Canada) IP Address: 167.137.1.15 Record Tracking Status:Original Holder:Josalyn Wilson Location:DocuSign 4/28/2017 1 4:04 PM josalyn.wilson@hhsc.state.tx.us Signer Events Signature Timestamp Patty Melchior Completed Sent:4/28/2017 14:23 PM Patty.Melchior@dshs.state.tx.us Viewed:5/1/2017 1 2:21 PM Resource Director Signed:5/1/2017 1 2:22 PM Department State Health Services Using IP Address: 160.42.85.9 Security Level:Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Joe James Completed Sent:5/1/2017 1 2:23 PM joe.james@hhsc.state.tx.us Viewed:5/8/2017 1 10:43 AM Texas Health and Human Services Commission Signed:5/8/2017 1 10:43 AM Security Level:Email,Account Authentication Using IP Address: 167.137.1.16 (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Annette Rodriguez cDocuS'gnedby I�� Sent:5/8/2017 10:44 AM annetter@cctexas.com Qlnant{{t' r �t 7 Viewed:5/8/2017 1 2:50 PM `-703DADA9E2814E3 Director of Public Health Signed:8/14/2017 1 10:14 AM Security Level:Email,Account Authentication (None) Using IP Address:64.201.138.24 Electronic Record and Signature Disclosure: Not Offered via DocuSign Janna Zumbrun "Signed by Sent:8/14/2017 1 10:14 AM Janna.Zumbrun@dshs.state.tx.us �^Awa �^`^^ Viewed:8/14/2017 1 10:19 AM 143030850075416 Associate Commissioner for Disease Control and Signed:8/14/2017 1 10:20 AM Prevention 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 Jonah Wilczynski COPIED Sent:4/28/2017 14:23 PM jonah.wilczynski@dshs.state.tx.us Viewed:5/1/2017 1 8:07 AM Contract Manager Texas Health and Human Services Commission Security Level:Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Justin Davis COPIED Sent:4/28/2017 14:23 PM justin.davis@dshs.state.tx.us Department of State Health Services Security Level:Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Amy Greene COPIED Sent:4/28/2017 14:23 PM amy.greene@hhsc.state.tx.us Contract Specialist V Texas Health and Human Services Commission Security Level:Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Susana Garcia COPIED • Sent:4/28/2017 14:23 PM susana.garcia@dshs.state.tx.us Unit Director Texas Health and Human Services Commission Security Level:Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign William M.Uhlarik COPIED Sent:5/8/2017 1 10:44 AM williamu2@cctexas.com Viewed:8/15/2017 1 1:37 PM Assistant Director of Public Health Corpus Christi-Nueces County P.H.D. Security Level:Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign DSHS CMU Inbox COPIED Sent:8/14/2017 1 10:20 AM CMUContracts@dshs.texas.gov Viewed:8/14/2017 1 10:57 AM 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 Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 8/14/2017 110:20 AM Certified Delivered Security Checked 8/14/2017 110:20 AM Signing Complete Security Checked 8/14/2017 110:20 AM Completed Security Checked 8/14/2017 110:20 AM Payment Events Status Timestamps DocuSign Envelope ID:689C3F6A-82A9-4AA1-8673-722CB9ADCAEE TEXAS 0 v v Texas Department of State Health Services . Servith ces andd Human SeryJohn Hetlerstedt.M.D. Commissioner April 24, 2017 Ms. Annette Rodriguez Corpus Christi-Nueces County Public Health District (City) 1702 Home Road Corpus Christi, Texas 78416 RE: Notice of Void Contract - Contract No. 2016-003808D Dear Ms. Rodriguez: The Department of State Health Services ("System Agency") recently became aware that the individual who signed the above-referenced contract amendment was not authorized to sign on behalf of and to bind the Corpus Christi-Nueces County Public Health District ("Contractor"). Accordingly, this letter is to notify you that the System Agency considers the above-referenced contract amendment void and not valid for any reason. Enclosed please find a new Contract No. 2016-003808D for Texas Healthy Communities Grant Funding. Please ensure this contract is executed by your duly authorized representative and returned to my attention as soon as possible. Please let me know if you have any questions or need additional information. Sincerely, at/A4), Shari,CTCM Branch Manager DCP/RLHS Contract Management Unit T-505.10, Mail Code 1990 P. 0. Box 149347 P.O.Box 149347 • Austin.Texas 787149347 • Phone:888 963-7111 • TTY:800-735.2889 • wwwdshs.texos.gov DocuSign Envelope ID:689C3F6A-82A9-4AA1-8673-722CB9ADCAEE Ms. Annette Rodriguez April 24, 2017 Page 2 Austin, TX 78714-9347 Phone: (512) 776-2640 Fax: (512) 776-7391 Email: kathv.sharp@dshs.texas.gov