HomeMy WebLinkAboutPR 21314: TO APPROVE THE CONTRACT AMENDMENT FOR PUBLIC HEALTH EMERGENCY PREPAREDNESS PROGRAM INTEROFFICE MEMORANDUM
Date: March 5, 2020
To: The Honorable Mayor and City Council
Through: Ron Burton, City Manager
From: Judith A. Smith, RN, BSN, Director of Health Services
RE: Authorization to approve the Contract Amendment for Public Health
Emergency Preparedness Program to extend the contract and add funds of
$103,507.00 for the contract period July 1, 2020 through June 30, 2021.
Requires a 10%City Match of$10,351.
Introduction:
The intent of this Agenda Item is to seek the City Council's approval for the City Manager to
amend the contract for Public Health Emergency Preparedness Program adding funds for the
contract period July 1, 2020 through June 30, 2021.
Background: This contract amendment for FY 2021 between the City of Port Arthur and the
Department of State Health services Public Health Emergency Preparedness Program will
continue to allow the City of Port Arthur Health Department to perform and support activities
and develop interventions to prevent human illness related to chemical,biological, radiological
agents, naturally occurring health threats and other public health emergencies. The amending
contract will add $103,507 to cover FY 2021 contract period from July 1, 2020 through June
30, 2021 and will require a city match of$10,351.
Budget Impact: This grant requires a 10%city match of$10,351 for FY 2021.
Staff Analysis, Considerations: This funding supports the salary and fringe for one (1) full
time Epidemiologist.
Recommendation: It is recommended that the City Council approve P.R. No.21314,
approving the contract amendment between the City of Port Arthur and the Department of
State Health Services to add funds for contract period July 1, 2020 through June 30, 2021.
P. R. No. 21314
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RESOLUTION NO.
A RESOLUTION APPROVING THE FY 2021 CONTRACT
AMENDMENT BETWEEN THE CITY OF PORT ARTHUR
AND THE DEPARTMENT OF STATE HEALTH SERVICES
FOR THE PUBLIC HEALTH EMERGENCY
PREPAREDNESS PROGRAM BY ADDING $103,507.00 IN
FEDERAL FUNDING WITH A 10% CITY MATCH OF
$10,351.00 AND EXTENDING THE CONTRACT TO END
JUNE 30, 2021.
WHEREAS, the contract between the City of Port Arthur and the Department of
State Health Services provides financial assistance to the Port Arthur City Health
Department to supplement the delivery of public health services including responding to
bioterrorism, outbreaks of infectious disease, and other public health threats and
emergencies in accordance with an established set of public health preparedness
capabilities; and,
WHEREAS, pursuant to Resolution No. 17-067, Council approved the FY 2017-
2018 contract, and pursuant to Resolution No. 18-137, Council approved FY 2018-2019
contract, and pursuant to Resolution No. 19-177, Council approved FY 2020-2021
contract, and now the Department of State Health Services desires to amend the contract
to add $103,507.00 to cover contract period July 1, 2020 through June 30, 2021, and with
a 10%city match of$10,351.00.
NOW THEREFORE BE IT RESOLVED BY THE CITY COUNCIL OF
THE CITY OF PORT ARTHUR:
Section 1. That, the facts and opinions are true and correct.
P. R. No. 21314
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Section 2. That, the City Council of the City of Port Arthur hereby approves
the contract amendment between the City of Port Arthur and the Department of State
Health Services for the Public Health Preparedness Program.
Section 3. That, the City Council deems it is in the best interest of the City to
approve and authorize the City Manager and the Director of the City's Health
Department to execute the contract amendment between the Department of State Health
Services and the City of Port Arthur, TX in substantially the same form as attached hereto
as Exhibit"A".
Section 4. That, a copy of the caption of this Resolution be spread upon the
Minutes of the City Council.
READ, ADOPTED, AND APPROVED, this day of March, 2020
A.D., at a Regular Meeting of the City Council of the City of Port Arthur, Texas by the
following Vote:
AYES: Mayor:
Councilmembers:
NOES:
Mayor, Thurman Bartie
ATTEST:
Sherri Bellard, City Secretary
P. R. No. 21314
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APPROVED AS TO FORM:
/4A" / e
Val Tizeno, City / orney
APPROVED FOR ADMINISTRATION:
Ronald Burton, City Manager
Judith A. Smith, RN, BSN
Director of Health Services
APPROVED AS TO AVAILABILITY OF FUNDS:
ck�ti 'Jo\,-,..P
Kandy Daniel, I rim Finance Director
P. R. No. 21314
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EXHIBIT "A"
DocuSign Envelope ID:C6736A4F-OAD2-4766-900C-EDD5F84AF5C7
DEPARTMENT OF STATE HEALTH SERVICES
CONTRACT No. 537-18-0120-00001
AMENDMENT No. 4
The DEPARTMENT OF STATE HEALTH SERVICES ("System Agency") and CITY OF PORT
ARTHUR ("Grantee"), collectively the "Parties" to that certain Public Health Emergency
Preparedness ("PHEP") contract effective July 1, 2017 and denominated as DSHS Contract No.
537-18-0120-00001 (the "Contract"), as amended, now want to further amend the Contract.
WHEREAS, System Agency has elected to extend the term of the Contract, to revise the Budget
and to amend the Fiscal Year("FY") 2021 Statement of Work.
The Parties hereby amend and modify the Contract as follows:
1. ARTICLE III of the Signature Document, DURATION, is hereby amended to reflect a revised
termination date of June 30,2021.
2. ARTICLE IV of the Signature Document, BUDGET, is hereby amended to add $103,507.00 in
federal funding to the Contract and with the Grantee providing a total of$10,351.00 in match
funds for Fiscal Year 2021. The total not-to-exceed amount of the Contract is therefore
increased to $447,262.00, of which $406,602.00 represents federal funding and$40,660.00
represents match. All expenditures under the Contract will be in accordance with the revised
budget stated in Article 4 of this Amendment. 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.
3. ARTICLE VIII of the Signature Document, NOTICE TO PROCEED, is hereby deleted in its
entirety and replaced with the following:
VIII.NOTICE TO PROCEED
Funding for this Contract is dependent on the award of the applicable federal grant.No FY2021
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.537-18-0120-00001
DocuSign Envelope ID:C6736A4F-OAD2-4766-900C-EDD5F84AF5C7
4. ATTACHMENT B,BUDGET, is hereby amended by deleting the budget table in its entirety and
replacing it with the following:
FY18 FY19 FY20 FY21
Budget Budget Budget Budget Budget Total
Categories Summary Summary Summary Summary Budget
(7/1/17- (7/1/18- (7/1/19- (7/1/20- Summary
6/30/18) 6/30/19) 6/30/20) 6/30/21)
Personnel $66,984.00 $69,384.00 $70,800.00 $74,376.00 $281,544.00
Fringe Benefits $32,085.00 $30,912.00 $29,496.00 $29,131.00 $121,624.00
Travel $0.00 $0.00 $0.00 $0.00 $0.00
Equipment $0.00 $0.00 $0.00 $0.00 $0.00
Supplies $1,227.00 $0.00 $1,300.00 $0.00 $2,527.00
Contractual $0.00 $0.00 $0.00 $0.00 $0.00
Other $0.00 $0.00 $907.00 $0.00 $907.00
Sum of DSHS $100,296.00 $100,296.00 $102,503.00 $103,507.00 $406,602.00
Direct Costs
Indirect Costs $0.00 $0.00 $0.00 $0.00 $0.00
Sum of DSHS
Direct Costs and $100,296.00 $100,296.00 $102,503.00 $103,507.00 $406,602.00
Indirect Costs
Plus, Required
Match(Cash or $10,030.00 $10,029.00 $10,250.00 $10,351.00 $40,660.00
In-Kind)
Total Contract $110,326.00 $110,325.00 $112,753.00 $113,858.00 $447,262.00
Amount
The Parties agree that Grantee shall provide total matching funds in the amount of$40,660.00.
5. ATTACHMENT A.4, FY2020 STATEMENT OF WORK, is hereby amended and replaced in its
entirety with ATTACHMENT A.5,FY2021 STATEMENT OF WORK.
6. This Amendment shall be effective on July 1, 2020.
7. Except as amended by this Amendment, all terms and conditions of the Contract, as amended,
shall remain in full force and effect.
8. Any further revisions to the Contract shall be by written agreement of the Parties.
SIGNATURE PAGE FOLLOWS
System Agency Contract No.537-18-0120-00001
DocuSign Envelope ID:C6736A4F-OAD2-4766-900C-EDD5F84AF5C7
SIGNATURE PAGE FOR AMENDMENT NO.4
SYSTEM AGENCY CONTRACT No.537-18-0120-00001
DEPARTMENT OF STATE HEALTH SERVICES CITY OF PORT ARTHUR
By:
Name:
Title:
Date of Signature: Date of Signature:
THE FOLLOWING DOCUMENTS ARE ATTACHED TO THIS AMENDMENT AND THEIR RESPECTIVE
TERMS ARE HEREBY INCORPORATED INTO THE CONTRACT BY REFERENCE:
ATTACHMENT A.5- FY2021 STATEMENT OF WORK
ATTACHMENT C- FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT
System Agency Contract No.537-18-0120-00001
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ATTACHMENT A.5
FY2021 STATEMENT OF WORK
July 1,2020 through June 30,2021
I. GRANTEE RESPONSIBILITIES
Grantee will:
A. Perform activities in support of the Public Health Emergency Preparedness ("PHEP")
Cooperative Agreement from the Centers for Disease Control and Prevention ("CDC") to
advance public health preparedness.
B. Perform the activities required under this Contract in the following county/ies: Jefferson
County.
C. Provide System Agency with situational awareness data generated through interoperable
networks of electronic data systems.
D. Address the following public health emergency preparedness capabilities:
1. Capability 1 — Community preparedness is the ability of communities to prepare for,
withstand, and recover from public health incidents in both the short and long term.
2. Capability 2—Community recovery is the ability of communities to identify critical assets,
facilities, and other services within public health, emergency management, health care,
human services, mentaUbehavioral health, and environmental health sectors that can guide
and prioritize recovery operations.
3. Capability 3 — Emergency operations coordination is the ability to coordinate with
emergency management and to direct and support an incident or event with public health
or health care implications by establishing a standardized, scalable system of oversight,
organization, and supervision that is consistent with jurisdictional standards and practices
and the National Incident Management System ("NIMS").
4. Capability 4 — Emergency public information and warning is the ability to develop,
coordinate, and disseminate information, alerts, warnings, and notifications to the public
and incident management personnel.
5. Capability 5 —Fatality management is the ability to coordinate with partner organizations
and agencies to provide fatality management services to ensure the proper recovery and
preservation of remains; identification of the deceased; determination of cause and manner
of death;release of remains to an authorized individual;and provision of mental/behavioral
health assistance for the grieving. The role also may include supporting activities for the
identification, collection, documentation, retrieval, and transportation of human remains,
personal effects, and evidence to the examination location or incident morgue.
6. Capability 6 — Information sharing is the ability to conduct multijurisdictional and
multidisciplinary exchange of health-related information and situational awareness data
among federal, state, local, tribal, and territorial levels of government and the private
sector. This capability includes the routine sharing of information as well as issuing of
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ATTACHMENT A.5
FY2021 STATEMENT OF WORK
July 1,2020 through June 30,2021
public health alerts to all levels of government and the private sector in preparation for and
in response to events or incidents of public health significance.
7. Capability 7 — Mass care is the ability of public health agencies to coordinate with and
support partner agencies to address, within a congregate location (excluding shelter-in-
place locations), the public health, health care, mental/behavioral health, and human
services needs of those impacted by an incident. This capability includes coordinating
ongoing surveillance and public health assessments to ensure that health needs continue to
be met as the incident evolves.
8. Capability 8 — Medical countermeasure dispensing and administration is the ability to
provide medical countermeasures to targeted population(s)to prevent,mitigate,or treat the
adverse health effects of a public health incident, according to public health guidelines.
This capability focuses on dispensing and administering medical countermeasures, such as
vaccines, antiviral drugs, antibiotics, and antitoxins.
9. Capability 9 — Medical materiel management and distribution is the ability to acquire,
manage,transport, and track medical materiel during a public health incident or event and
the ability to recover and account for unused medical materiel, such as pharmaceuticals,
vaccines, gloves, masks, ventilators, or medical equipment after an incident.
10. Capability 10 — Medical surge is the ability to provide adequate medical evaluation and
care during events that exceed the limits of the normal medical infrastructure of an affected
community. It encompasses the ability of the health care system to endure a hazard impact,
maintain or rapidly recover operations that were compromised, and support the delivery of
medical care and associated public health services, including disease surveillance,
epidemiological inquiry, laboratory diagnostic services, and environmental health
assessments.
11. Capability 11 —Nonpharmaceutical interventions are actions that people and communities
can take to help slow the spread of illness or reduce the adverse impact of public health
emergencies. This capability focuses on communities, community partners, and
stakeholders recommending and implementing nonpharmaceutical interventions in
response to the needs of an incident,event,or threat.Nonpharmaceutical interventions may
include isolation; quarantine; restrictions on movement and travel advisories or warnings;
social distancing; external decontamination; hygiene; and precautionary protective
behaviors.
12. Capability 12 — Public health laboratory testing is the ability to implement and perform
methods to detect, characterize, and confirm public health threats. It also includes the
ability to report timely data,provide investigative support, and use partnerships to address
actual or potential exposure to threat agents in multiple matrices, including clinical
specimens and food, water, and other environmental samples. This capability supports
passive and active surveillance when preparing for, responding to, and recovering from
biological, chemical, and radiological (if a Radiological Laboratory Response Network is
established)public health threats and emergencies.
13. Capability 13 —Public health surveillance and epidemiological investigation is the ability
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ATTACHMENT A.5
FY2021 STATEMENT OF WORK
July 1,2020 through June 30,2021
to create, maintain, support, and strengthen routine surveillance and detection systems and
epidemiological investigation processes.It also includes the ability to expand these systems
and processes in response to incidents of public health significance.
14. Capability 14—Responder safety and health is the ability to protect public health and other
emergency responders during pre-deployment, deployment, and post-deployment.
15. Capability 15 — Volunteer management is the ability to coordinate with emergency
management and partner agencies to identify, recruit, register, verify, train, and engage
volunteers to support the jurisdictional public health agency's preparedness, response, and
recovery activities during pre-deployment, deployment, and post-deployment.
E. Match funds awarded under this Contract with 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 45 CFR 92.24, as amended.
Grantee will provide matching funds in the amount of ten percent (10%) of the Contract
amount as set forth in Attachment B,Budget. 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 subgrantee'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);
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;
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ATTACHMENT A.5
FY2021 STATEMENT OF WORK
July 1,2020 through June 30,2021
9. Follow procedures for generally accepted accounting practices as well as meet audit
requirements; and
10. Value the in-kind contributions reported and be supported by documentation reflecting
the use of goods and/or services during the Contract term.
F. 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 the 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 in drills and exercises in the pre-event time
period. Grantee will notify the Assigned Contract Manager in writing when this provision is
implemented.
G. In the event of a public health emergency involving a portion of the state,mobilize and dispatch
staff or equipment purchased with funds from previous PHEP cooperative agreements,and not
currently performing critical duties in the jurisdiction served, to the affected area of the state
upon receipt of a written request from System Agency.
H. Coordinate activities and response plans within the jurisdiction with the state, regional, and
other local jurisdictions, among local agencies, and with hospitals and major health care
entities,jurisdictional Metropolitan Medical Response Systems, and Councils of Government.
I. Inform System Agency in writing if Grantee will not continue performance under this Contract
within thirty (30) days of receipt of an amended standard(s) or guideline(s). System Agency
may terminate this Contract immediately or within a reasonable period of time as determined
by System Agency.
J. 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.
K. Complete and submit programmatic reports as directed by System Agency in a format specified
by System Agency and as needed to satisfy information-sharing requirements set forth in Texas
Government Code, Sections 421.071 and 421.072(b)and(c),as amended.Grantee will provide
System Agency other reports, including financial reports, that System Agency determines
necessary to accomplish the objectives of this Contract and to monitor compliance.
L. Submit the work plan and vulnerable populations plan that encompass the Contract term to the
System Agency via the Department of State Health Services ("DSHS") Center for Health
Emergency Preparedness and Response ("CHEPR") External SharePoint site within an
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ATTACHMENT A.5
FY2021 STATEMENT OF WORK
July 1,2020 through June 30,2021
established timeframe designated by the Contractual Requirements Schedule.
M. Conduct, or participate in, an annual Training and Exercise Planning Workshop ("TEPW")
with all applicable agencies in accordance with Homeland Security Exercise and Evaluation
Program("HSEEP") guidelines to develop a strategy and structure for a Multi-Year Training
and Exercise Plan ("MYTEP"). Prepare, maintain, and, upon request, submit a copy of the
TEPW agenda and participant roster as documentation of TEPW attendance.
N. Submit a current MYTEP to the System Agency via the DSHS CHEPR External SharePoint
site within an established timeframe designated by the Contractual Requirements Schedule,
using the template provided by System Agency.
0. Conduct, or participate in, at least one annual Preparedness Exercise consistent with their
MYTEP. Submit a Notification of Exercise("NOE") form to the System Agency no later than
60 calendar days prior to the start of the exercise via the DSHS CHEPR External SharePoint
site.
P. Submit at least one After Action Review/Improvement Plan ("AAR/IP"). All AAR/IPs must
be submitted to the System Agency via the DSHS CHEPR External SharePoint site within 60
calendar days, or 90 calendar days for Real World Incident("RWI"), of the completion of the
exercise/response to the System Agency Exercise Team within an established timeframe
designated by the Contractual Requirements Schedule. AAR/IPs must be completed in
accordance with Notification and Reporting of Exercise Grant.
Q. Complete and submit the current Operational Readiness Review("ORR")Evidence Form and
provide supporting documentation to the System Agency via the DSHS CHEPR External
SharePoint site by April 1, 2021. Documentation is required within an established timeframe
designated by the Contractual Requirements Schedule.
R. Provide updated Transportation Spreadsheet for submission to the DSHS CHEPR External
SharePoint site by April 1, 2021.
S. Perform and submit metrics (data collection sheets) on each of the three Strategic National
Stockpile ("SNS") operation drills to the DSHS CHEPR External SharePoint site by April 1,
2021. Acceptable drills include:
1. Staff Call Down;
2. Facility Set-Up; and
3. Site Activation.
T. Submit the Mid-Year Report to the System Agency via the DSHS CHEPR External SharePoint
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ATTACHMENT A.5
FY2021 STATEMENT OF WORK
July 1,2020 through June 30,2021
site within an established timeframe designated by the Contractual Requirements Schedule.
U. Submit the End-of-Year Performance Report to the System Agency via the DSHS CHEPR
External SharePoint site within an established timeframe designated by the Contractual
Requirements Schedule.
V. Designate a member of the PHEP program to attend, in person, two PHEP quarterly meetings
during the Contract term. If the designee is unable to attend any of the meetings in person, the
Grantee must notify System Agency in writing of the reason for noncompliance.
W. Designate a member of the PHEP program to attend, in person, four regional healthcare
coalition meetings during the Contract term. Submit sign-in sheets from meetings as evidence
of attendance, within an established timeframe designated by the Contractual Requirements
Schedule.
X. Upon request, submit a current Texas Preparedness and Evaluation Process ("TxPEP") report
to System Agency within an established timeframe designated by System Agency, using the
template provided by System Agency.
Y. Immediately notify System Agency in writing if Grantee is legally prohibited from providing
any report under this Contract.
Z. Have plans, processes, and training in place to meet NIMS compliance requirements.
AA. When using volunteers during the Contract term, the Grantee must designate a Texas
Disaster Volunteer Registry ("TDVR") State Emergency System for the Advanced
Registration of Volunteer Health Professionals ("ESAR-VHP") System Administrator,
participate in required administrator trainings, and utilize the system to identify volunteers.
BB. Grantee may not use funds for research, clinical care, fund-raising activities or lobbying,
construction or major renovations,reimbursement of pre-award costs,to supplant existing state
or federal funds for activities,payment or reimbursement of backfilling costs for staff,purchase
of vehicles of any kind,uniforms or furniture, or funding an award to another party or provider
who is ineligible.
CC. None of the funds made available under this agreement may be used to promote or advocate
the legalization or practice of prostitution or sex trafficking.Nothing in the preceding sentence
shall be construed to preclude the provision to individuals of palliative care,treatment,or post-
exposure pharmaceutical prophylaxis, and necessary pharmaceuticals and commodities,
including test kits, condoms, and,when proven effective, microbicides.
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ATTACHMENT A.5
FY2021 STATEMENT OF WORK
July 1,2020 through June 30,2021
DD. Cooperate with System Agency to coordinate all planning, training and exercises
performed under this Contract with the Texas Division of Emergency Management("TDEM"),
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.
EE. Coordinate all risk communication activities with the System Agency Communications
Unit by using System Agency's core messages posted on the System Agency website and
submitting copies of draft risk communication materials to System Agency for coordination
prior to dissemination.
FF. Initiate the purchase of all equipment approved in writing by the System Agency in the first
quarter of the Contract 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 in the Contract must be
submitted to the assigned System Agency contract manager.
GG. Maintain an inventory of equipment, supplies defined as Controlled Assets, and real
property.Grantee shall 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 email not later than October 15 of each year. 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.
HH. 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.
II. 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.
JJ. Comply with all applicable federal and state laws, rules, and regulations, as amended,
including, but not limited to, the following:
1. Public Law 109-417, Pandemic and All-Hazards Preparedness and Advancing
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ATTACHMENT A.5
FY2021 STATEMENT OF WORK
July 1,2020 through June 30,2021
Innovation Act("PAHPAI");
2. Texas Health and Safety Code Chapter 81; and
3. Section 319C-1 of the Public Health Service (PHS) Act (47 USC § 247d-3a), as
amended.
KK. Comply with all applicable regulations, standards and guidelines in effect on the beginning
date of the term of this Contract.
LL. Submit other reports as required by System Agency. The initial reporting schedule for the
requirements is subject to change as System Agency and CDC may modify requirements and
due dates.
MM. Work with the Regional Health Care Coalition to develop comprehensive preparedness
strategies. Plans will be submitted to System Agency by the Health Care Coalition.
II. PERFORMANCE MEASURES
A. The System Agency will monitor the Grantee's performance of the requirements in Attachment
A.5 and compliance with the Contract's terms and conditions.
B. Grantee will meet and report Performance Measures based on requirements that are developed
in coordination with System Agency for the Grantee's project as provided in Section 1.Grantee
must also demonstrate adherence to PHEP reporting deadlines and the capability to receive,
stage, store,distribute,and dispense materiel during a public health emergency. Failure to meet
these requirements may result in withholding a portion of the current fiscal year PHEP base
award.
C. System Agency will send a Contractual Requirements Schedule for reporting these
Performance Measures within thirty(30)days of the Contract start date.
III. INVOICE AND PAYMENT
A. Grantee will request payment using the State of Texas Purchase Voucher(Form B-13)monthly
and acceptable supporting documentation for reimbursement of the required
services/deliverables. The Grantee will submit the Financial Status Report (FSR-269A).
Additionally, the Grantee will submit the Match Certification Form(B-13A), at the end of the
fourth quarter. Vouchers, supporting documentation, Financial Status Reports, and Match
Certification Forms should be mailed or emailed to the addresses below.
Department of State Health Services
Claims Processing Unit, MC 1940
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ATTACHMENT A.5
FY2021 STATEMENT OF WORK
July 1,2020 through June 30,2021
1100 West 49th Street
P.O. Box 149347
Austin, TX 78714-9347
FAX: (512)458-7442
EMAIL: invoicesAdshs.texas.gov &CMS1nvoicesAdshs.texas.gov
B-13s and supporting documentation should be sent to: invoicesAdshs.texas.gov &
CMSInvoices@a,dshs.texas.gov.
FSRs should be sent to: FSRGrants(a,dshs.texas.gov &CMSInvoices@dshs.texas.gov.
B. Grantee will be reimbursed on a monthly basis and in accordance with Attachment B,Budget.
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
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 Contract term. Vacant
positions existing after ninety(90) days may result in a decrease in funds.
D. Grantee may request a one-time working capital advance not to exceed twelve percent (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.
System Agency Contract No. 537-18-0120-00001
Page 9
DocuSign Envelope ID:C6736A4F-OAD2-4766-900C-EDD5F84AF5C7
Attachment C
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:
Primary Address of Contractor: FFATA Contact#2 Name, Email and Phone Number:
ZIP Code:9-digits Required www.usps.com DUNS Number: 9-digits Required www.sam.gov
State of Texas Comptroller Vendor Identification Number (VIN) 14 Digits
Printed NameofAuthorized Representative Signature of Authorized Representative
Judith Smit
Title of Authorized Representative Date
Director of Health Services
- 1 -
Department of State Health Services Form 4734—June 2013
DocuSign Envelope ID:C6736A4F-OAD2-4766-900C-EDD5F84AF5C7
Attachment C
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? ri Yes 0 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? n Yes n 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? I I Yes I I 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? ( I Yes n 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.
For example:
John BIum:500000;Mary Redd:50000;Eric Gant:400000;Todd Platt:300000;
Sally Tom:300000
Provide compensation information here:
- 2 -
Department of State Health Services Form 4734—June 2013
Docu
■ £Icuiao
Certificate Of Completion
Envelope Id:C6736A4F0AD24766900CEDD5F84AF5C7 Status:Sent
Subject:Amending$447,262.00;537-18-0120-00001;City of Port Arthur A-4:Dshs/CPS/Hazards
Source Envelope:
Document Pages: 19 Signatures:0 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: 167.137.1.11
Record Tracking
Status:Original Holder:Texas Health and Human Services Location: DocuSign
3/2/2020 9:39:31 AM Commission
PCS_DocuSign@hhsc.state.tx.us
Signer Events Signature Timestamp
Ron Burton Sent:3/2/2020 9:45:56 AM
ron.burton@portarthurtx.gov
Interim City Manager
Security Level:Email.Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Judith Smith Sent:3/2/2020 9:45:57 AM
judith.smith@portarthurtx.gov Viewed:3/4/2020 12:38:20 PM
Director of Health Services
City of Port Arthur
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(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
David Gruber
david.gruber@dshs.texas.gov
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
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CMS COPIED Sent:3/2/2020 9:45:56 AM
CMUcontracts@dshs.texas.gov
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(None)
Electronic Record and Signature Disclosure:
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Quynh-Nhi Ge COPIED Sent:3/2/2020 9:45:56 AM
Quynhnhi.Ge@dshs.texas.gov Viewed:3/2/2020 9:47:40 AM
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Witness Events Signature Timestamp
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Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 3/2/2020 9:45:57 AM
Payment Events Status Timestamps