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PR 22419: CONTRACT WITH THE HEALTH AND HUMAN SERVICES COMMISSION AN THE CITY OF PORT ARTHUR, NO CASH MATCH
Energy City of% cery ort rthu�_ Te.tu.ti Date: August 18, 2022 To: Ron Burton, City Manager From: Judith A. Smith, RN, BSN, Director of Health RE: Approval To Approve the Contract Between The Health and Human Services Commission and the City of Port Arthur. NO CASH MATCH Nature of the Request: This is a request to approve the contract between The Health and Human Services Commission and the City of Port Arthur. The total amount of this Contract will not exceed $ 364,746.00 with $68,530 being allocated toward the contract period of September 1, 2022, through August 31, 2023. This Primary Health Care contract provides preventive health services, including immunizations, diagnosis and treatment of acute illnesses, health education, and diagnostic tests including lab and x-rays for eligible participants at or below 200 % of the current federal poverty guidelines. Analysis, Considerations: The contract period starts 09/01/2022 and ends 08/31/2023 and provides for the salary and fringe benefits for one full-time eligibility/billing clerk, office supplies and travel expenses. Recommendations: It is recommended that the City Council approve P.R. No. 22419 for the FY 2022-2023 contract between the Health and Human Services Primary Health Care Program and the City of Port Arthur program to provide primary and preventive health care services. Budget Considerations: The total budget is $364,746.00. This is to cover the cost to operate the Primary Health Care clinic for the City of Port Arthur. "REMEMBER WE ARE HERE TO SERVE THE CITIZENS OF PORT ARTHUR" P.O.BOX 1089•PORT ARTHUR,TX 77641-1089.409/983-8101•FAX 409/982-6743 P.R.No. 22419 08/18/2022 js RESOLUTION NO. A RESOLUTION APPROVING THE FY 2023 CONTRACT BETWEEN THE CITY OF PORT ARTHUR AND THE DEPARTMENT OF HEALTH SERVICES PRIMARY HEALTH CARE PROGRAM,HUMAN FOR THE AMOUNT NOT TO EXCEED $364,746.00, OF WHICH $68,530 IS ALLOCATED TOWARD THE CONTRACT PERIOD SEPTEMBER 1, 2022 THROUGH AUGUST 31,2023. NO CASH MATCH REQUIRED. WHEREAS, this program provides preventive health services including immunizations, diagnosis and treatment of acute illnesses, family planning,health education, and diagnostic tests including lab and x-rays for eligible participants at or below 200% of the current federal poverty guidelines: and, WHEREAS, the total amount of the contract is not to exceed $364,746.00 with $68,530 being allocated for FY 2023. This budget covers the cost of the operations of the Primary Health Care Clinic. This contract period is from September 1, 2022 through August 31, 2023. NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF PORT ARTHUR: Section 1. That, the facts and opinions in the preamble are true and correct. 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 Health and Human Services Commission. Section 3. That, the City Council deems it is in the best interest of the City to approve and authorize the City Manager to execute the contract amendment between the Department of Health and Human Services Commission and the City of Port Arthur for Primary Health Care Services, as delineated in Exhibit"A." IF P.R.No. 22419 08/18/2022 js 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 August, 2022 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: • Thurman Bartie, Mayor ATTEST: Sherri Bellard, City Secretary APPROVED AS TO FORM: (i:EtLe (dit � / � / / 7.1 Tize CityAttorney S �� Y APPROVED FOR ADMINISTRATION: ad, 4 sii4tYl;±/ Ron Burton, City Manager er Ju Jth Smith, BSN, RN, Director of Health P.R. No. 22419 08/18/2022-js APPROVED AS TO AVAILABILITY OF FUNDS: I Kandy Daniel, Director of Finance EXHIBIT "A" DocuSign Envelope ID:8F738420-9B0B 4DD2-B3FB-88F48FD2D4CB HEALTH AND HUMAN SERVICES COMMISSION CONTRACT No. HHS000697900024 AMENDMENT No. 4 The Health and Human Services Commission ("HHSC" or "System Agency") and City of Port Arthur ("Grantee" or"Provider"), collectively referred to as the "Parties"to that certain Primary Health Care (PHC) Services agreement denominated as HHSC Contract No. HHS000697900024 (the "Contract"), now want to further amend the Contract. Whereas, HHSC has chosen to exercise its option to renew the Contract; Whereas, the Parties want to amend the Contract to include new not-to-exceed amounts for FY 2023 and the Contract term; and The Parties agree as follows: 1. The Contract is renewed for the period September 1, 2022 through August 31, 2023, unless the Contract is renewed, extended or terminated sooner. 2. Section V of the Contract, Payment for Services Provided, is hereby amended as follows: The total amount of this Contract will not exceed $364,746.00. Expenditures for FY 2023 shall not exceed $68,530.00 and shall be in accordance with Attachment B-2, FY 2023 Budget. Grantee is not required to provide matching funds. Budget adjustments, if any, will not affect Grantee's approved indirect cost rate. 3. Attachment A, Section 6.6, Statement of Work, is amended as follows: Grantee will be reimbursed for FY 2023 costs according to Attachment B-2,FY 2023 Budget, and the PHC 225 Report Forms. Per Section 8 of the Statement of Work,Grantee shall submit the PHC 225 Report Form monthly no later than the last business day of the month following service. 4. Attachment A, Section 9.1.1, Statement of Work, is amended as follows: For FY 2023, Grantee shall provide PHC services to a minimum 274 unduplicated Clients at an average cost per client of$250.00 for Clients who live or receive services in the following counties: Jefferson. 5. Attachment B-2, FY 2022 Budget, of the Contract is deleted in its entirety and replaced with Attachment B-3, FY23 Budget. All references to Attachment B-2, FY 2022 Budget, in the Contract will be replaced with Attachment B-3, FY23 Budget. 1 DocuSign Envelope ID:8F738420-9BOB-4DD2-B3FB-88F48FD2D4CB 6. Attachment E, Contract Affirmation (v. 2.1 — October 2021), of the Contract is deleted in its entirety and replaced with Attachment E-1 Contract Affirmations (v. 2.2—May 2022)which is attached to this Amendment and incorporated in the Contract for all purposes. 7. This Amendment shall be effective on September 1,2022. 8. Except as modified herein, all terms and conditions of the Contract, as previously amended,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 2 DocuSign Envelope ID:8F738420-9B0B-4DD2-B3FB-88F48FD2D4CB SIGNATURE PAGE AMENDMENT No. 4 HHSC CONTRACT No. HHS000697900024 HEALTH AND HUMAN SERVICES City of Port Arthur COMMISSION By: By: Name: Name: Title: Title: Date of Signature: Date of Signature: THE FOLLOWING DOCUMENTS ARE ATTACHED AND INCORPORATED INTO THE CONTRACT BY REFERENCE: ATTACHMENT B-3—FY 2023 BUDGET ATTACHMENT E-1 —MIS CONTRACT AFFIRMATIONS(V. 2.2—MAY 2022) ATTACHMENTS FOLLOW 3 DocuSign Envelope ID:8F738420-9B0B-4DD2-B3FB-88F48FD2D4CB ATTACHMENT B-3 Table 1 —Budget Categories for Primary Health Care Services FY 2021 FY 2022 FY2023 Number of Clients to 280 249 274 be served Average cost per $250.00 $250.00 $250.00 client Total $Amount for $70,135.00 $62,300.00 $68,530.00 all services provided* 4 'erwerler"rr m c m o u• E -1 .-4 to O _ to 4 ill.O o00 a°+ O N Q w m H v1 +, ccoo N — OA O .a O ��� 01 m O li !-- O c c 7 a) ;a p YI .0 H VI 7 G) i5 O 'a E C CO O a+45 C a+ 3 C O WE E v, T O -a d d O .F. /a Ce t0 u 7 Y) N CC 7 ° O N O) m U m C IV u al a! 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For example, after all the lines on the primary budget template for Personnel (tab labeled Form H - 1 Personnel) have been used,go to the supplemental template labeled "Form H - la Personnel Supp" and if all the lines are used on this template, go to the next template labeled "Form H - lb Personnel".The amounts on each supplemental template will automatically total and the total from both templates will automatically be inserted on the last line of the primary budget template. Form H-1 Personnel Supplemental Form H-2 Travel Supplemental Form H-3 Equipment Supplemental Form H-4 Supplies Supplemental Form H-5 Contractual Supplemental Form H-6 Other Supplemental 0 0 o c-.) C) c.) 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N O v CD U aU '++ OXI w a C d GOB+ CII c 4.> v, C V) N O w > 0 4 o U, O 03 Y 0 �' O L O Nr in a c m a) Y••, N W Y a 'O }' u Ll- m c aiCO 0 7 LL a+ CO— CO CO ° u +, o G u -a m CIO co V OJ � L-' m •+ 5 7 C NLa C 7•- to f0 O L. C O a ' O O m c m a) 'O O o L 0O Y COO 7 L u O ' U 0 'a! — o E Q O N +' CO ti NVI C 0 U. u CO .~u+ Y c a, aci 0a) 4 m V) a u p 'Yip O J2 c O a) (5 N Y •O O Lailav U u y I DocuSign Envelope ID:8F738420-9B0B-4DD2-B3FB-88F48FD2D4CB HEALTH AND HUMAN SERVICES Contract Number HHS000697900024 Attachment E-1 CONTRACT AFFIRMATIONS For purposes of these Contract Affirmations, HHS includes both the Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). System Agency refers to HHSC, DSHS, or both, that will be a party to this Contract. These Contract Affirmations apply to all Contractors and Grantees (referred to as "Contractor") regardless of their business form(e.g., individual, partnership, corporation). By entering into this Contract, Contractor affirms, without exception,understands, and agrees to comply with the following items through the life of the Contract: 1. Contractor represents and warrants that these Contract Affirmations apply to Contractor and all of Contractor's principals, officers, directors, shareholders,partners, owners, agents, employees, subcontractors, independent contractors, and any other representatives who may provide services under, who have a financial interest in, or otherwise are interested in this Contract and any related Solicitation. 2. Complete and Accurate Information Contractor represents and warrants that all statements and information provided to HHS are current, complete, and accurate. This includes all statements and information in this Contract and any related Solicitation Response. 3. Public Information Act Contractor understands that HHS will comply with the Texas Public Information Act (Chapter 552 of the Texas Government Code) as interpreted by judicial rulings and opinions of the Attorney General of the State of Texas. Information, documentation, and other material prepared and submitted in connection with this Contract or any related Solicitation may be subject to public disclosure pursuant to the Texas Public Information Act. In accordance with Section 2252.907 of the Texas Government Code, Contractor is required to make any information created or exchanged with the State pursuant to the Contract, and not otherwise excepted from disclosure under the Texas Public Information Act, available in a format that is accessible by the public at no additional charge to the State. 4. Contracting Information Requirements Contractor represents and warrants that it will comply with the requirements of Section 552.372(a) of the Texas Government Code. Except as provided by Section 552.374(c) of the Texas Government Code, the requirements of Subchapter J (Additional Provisions Related to Contracting Information), Chapter 552 of the Government Code,may apply to the Contract and the Contractor agrees that the Contract can be terminated if the Contractor knowingly or intentionally fails to comply with a requirement of that subchapter. Health and Human Services Contract Affirmations v.2.2 Effective May 2022 Page 1 of 13 DocuSign Envelope ID:8F738420-9B0B-4DD2-B3FB-88F48FD2D4CB 5. Assignment A. Contractor shall not assign its rights under the Contract or delegate the performance of its duties under the Contract without prior written approval from System Agency. Any attempted assignment in violation of this provision is void and without effect. B. Contractor understands and agrees the System Agency may in one or more transactions assign, pledge, or transfer the Contract. Upon receipt of System Agency's notice of assignment, pledge, or transfer, Contractor shall cooperate with System Agency in giving effect to such assignment, pledge, or transfer, at no cost to System Agency or to the recipient entity. 6. Terms and Conditions Contractor accepts the Solicitation terms and conditions unless specifically noted by exceptions advanced in the form and manner directed in the Solicitation, if any, under which this Contract was awarded. Contractor agrees that all exceptions to the Solicitation, as well as terms and conditions advanced by Contractor that differ in any manner from HHS' terms and conditions, if any, are rejected unless expressly accepted by System Agency in writing. 7. HHS Right to Use Contractor agrees that HHS has the right to use, produce, and distribute copies of and to disclose to HHS employees, agents, and contractors and other governmental entities all or part of this Contract or any related Solicitation Response as HHS deems necessary to complete the procurement process or comply with state or federal laws. 8. Release from Liability Contractor generally releases from liability and waives all claims against any party providing information about the Contractor at the request of System Agency. 9. Dealings with Public Servants Contractor has not given, has not offered to give, and does not intend to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in connection with this Contract or any related Solicitation, or related Solicitation Response. 10. Financial Participation Prohibited Under Section 2155.004, Texas Government Code (relating to financial participation in preparing solicitations), Contractor certifies that the individual or business entity named in this Contract and any related Solicitation Response is not ineligible to receive this Contract and acknowledges that this Contract may be terminated and payment withheld if this certification is inaccurate. 11. Prior Disaster Relief Contract Violation Under Sections 2155.006 and 2261.053 of the Texas Government Code (relating to convictions and penalties regarding Hurricane Rita, Hurricane Katrina, and other disasters), the Contractor certifies that the individual or business entity named in this Contract and any related Solicitation Response is not ineligible to receive this Contract Health and Human Services Contract Affirmations v.2.2 Effective May 2022 Page 2 of 13 DocuSign Envelope ID:8F738420-9B0B-4DD2-B3FB-88F48FD2D4CB and acknowledges that this Contract may be terminated and payment withheld if this certification is inaccurate. 12. Child Support Obligation Under Section 231.006(d) of the Texas Family Code regarding child support, Contractor certifies that the individual or business entity named in this Contract and any related Solicitation Response is not ineligible to receive the specified payment and acknowledges that the Contract may be terminated and payment may be withheld if this certification is inaccurate. If the certification is shown to be false, Contractor may be liable for additional costs and damages set out in 231.006(f). 13. Suspension and Debarment Contractor certifies that it and its principals are not suspended or debarred from doing business with the state or federal government as listed on the State of Texas Debarred Vendor List maintained by the Texas Comptroller of Public Accounts and the System for Award Management (SAM)maintained by the General Services Administration. This certification is made pursuant to the regulations implementing Executive Order 12549 and Executive Order 12689, Debarment and Suspension, 2 C.F.R. Part 376, and any relevant regulations promulgated by the Department or Agency funding this project. This provision shall be included in its entirety in Contractor's subcontracts, if any, if payment in whole or in part is from federal funds. 14. Excluded Parties Contractor certifies that it is not listed in the prohibited vendors list authorized by Executive Order 13224, "Blocking Property and Prohibiting Transactions with Persons Who Commit, Threaten to Commit, or Support Terrorism,"published by the United States Department of the Treasury, Office of Foreign Assets Control.' 15. Foreign Terrorist Organizations Contractor represents and warrants that it is not engaged in business with Iran, Sudan, or a foreign terrorist organization, as prohibited by Section 2252.152 of the Texas Government Code. 16. Executive Head of a State Agency In accordance with Section 669.003 of the Texas Government Code, relating to contracting with the executive head of a state agency, Contractor certifies that it is not(1) the executive head of an HHS agency, (2) a person who at any time during the four years before the date of this Contract was the executive head of an HHS agency, or(3) a person who employs a current or former executive head of an HHS agency. 17. Human Trafficking Prohibition Under Section 2155.0061 of the Texas Government Code, Contractor certifies that the individual or business entity named in this Contract is not ineligible to receive this Contract and acknowledges that this Contract may be terminated and payment withheld if this certification is inaccurate. Health and Human Services Contract Affirmations v.2.2 Effective May 2022 Page 3 of 13 DocuSign Envelope ID:8F738420-9B0B-4DD2-B3FB-88F48FD2D4CB 18. Franchise Tax Status Contractor represents and warrants that it is not currently delinquent in the payment of any franchise taxes owed the State of Texas under Chapter 171 of the Texas Tax Code. 19. Debts and Delinquencies Contractor agrees that any payments due under this Contract shall be applied towards any debt or delinquency that is owed to the State of Texas. 20. Lobbying Prohibition Contractor represents and warrants that payments to Contractor and Contractor's receipt of appropriated or other funds under this Contract or any related Solicitation are not prohibited by Sections 556.005, 556.0055, or 556.008 of the Texas Government Code (relating to use of appropriated money or state funds to employ or pay lobbyists, lobbying expenses, or influence legislation). 21. Buy Texas Contractor agrees to comply with Section 2155.4441 of the Texas Government Code, requiring the purchase of products and materials produced in the State of Texas in performing service contracts. 22. Disaster Recovery Plan Contractor agrees that upon request of System Agency, Contractor shall provide copies of its most recent business continuity and disaster recovery plans. 23. Computer Equipment Recycling Program If this Contract is for the purchase or lease of computer equipment,then Contractor certifies that it is in compliance with Subchapter Y, Chapter 361 of the Texas Health and Safety Code related to the Computer Equipment Recycling Program and the Texas Commission on Environmental Quality rules in 30 TAC Chapter 328. 24. Television Equipment Recycling Program If this Contract is for the purchase or lease of covered television equipment, then Contractor certifies that it is compliance with Subchapter Z, Chapter 361 of the Texas Health and Safety Code related to the Television Equipment Recycling Program. 25. Cybersecurity Training A. Contractor represents and warrants that it will comply with the requirements of Section 2054.5192 of the Texas Government Code relating to cybersecurity training and required verification of completion of the training program. B. Contractor represents and warrants that if Contractor or Subcontractors, officers, or employees of Contractor have access to any state computer system or database,the Contractor, Subcontractors,officers, and employees of Contractor shall complete cybersecurity training pursuant to and in accordance with Government Code,Section 2054.5192. Health and Human Services Contract Affirmations v.2.2 Effective May 2022 Page 4 of 13 DocuSign Envelope ID:8F738420-9B0B-4DD2-B3FB-88F48FD2D4CB 26. Restricted Employment for Certain State Personnel Contractor acknowledges that,pursuant to Section 572.069 of the Texas Government Code, a former state officer or employee of a state agency who during the period of state service or employment participated on behalf of a state agency in a procurement or contract negotiation involving Contractor may not accept employment from Contractor before the second anniversary of the date the Contract is signed or the procurement is terminated or withdrawn. 27. No Conflicts of Interest A. Contractor represents and warrants that it has no actual or potential conflicts of interest in providing the requested goods or services to System Agency under this Contract or any related Solicitation and that Contractor's provision of the requested goods and/or services under this Contract and any related Solicitation will not constitute an actual or potential conflict of interest or reasonably create an appearance of impropriety. B. Contractor agrees that, if after execution of the Contract, Contractor discovers or is made aware of a Conflict of Interest, Contractor will immediately and fully disclose such interest in writing to System Agency. In addition, Contractor will promptly and fully disclose any relationship that might be perceived or represented as a conflict after its discovery by Contractor or by System Agency as a potential conflict. System Agency reserves the right to make a final determination regarding the existence of Conflicts of Interest, and Contractor agrees to abide by System Agency's decision. 28. Fraud,Waste, and Abuse Contractor understands that HHS does not tolerate any type of fraud, waste, or abuse. Violations of law, agency policies, or standards of ethical conduct will be investigated, and appropriate actions will be taken. Pursuant to Texas Government Code, Section 321.022, if the administrative head of a department or entity that is subject to audit by the state auditor has reasonable cause to believe that money received from the state by the department or entity or by a client or contractor of the department or entity may have been lost, misappropriated, or misused, or that other fraudulent or unlawful conduct has occurred in relation to the operation of the department or entity, the administrative head shall report the reason and basis for the belief to the Texas State Auditor's Office (SAO). All employees or contractors who have reasonable cause to believe that fraud, waste, or abuse has occurred (including misconduct by any HHS employee, Grantee officer, agent, employee, or subcontractor that would constitute fraud, waste, or abuse) are required to immediately report the questioned activity to the Health and Human Services Commission's Office of Inspector General. Contractor agrees to comply with all applicable laws, rules,regulations, and System Agency policies regarding fraud, waste, and abuse including, but not limited to, HHS Circular C-027. A report to the SAO must be made through one of the following avenues: • SAO Toll Free Hotline: 1-800-TX-AUDIT • SAO website: http://sao.fraud.state.tx.us/ All reports made to the OIG must be made through one of the following avenues: Health and Human Services Contract Affirmations v.2.2 Effective May 2022 Page 5 of 13 DocuSign Envelope ID:8F738420-9B0B-4DD2-B3FB-88F48FD2D4CB • OIG Toll Free Hotline 1-800-436-6184 • OIG Website: ReportTexasFraud.com • Internal Affairs Email: InternalAffairsReferral@hhsc.state.tx.us • OIG Hotline Email: OIGFraudHotline@hhsc.state.tx.us. • OIG Mailing Address: Office of Inspector General Attn: Fraud Hotline MC 1300 P.O. Box 85200 Austin, Texas 78708-5200 29. Antitrust The undersigned affirms under penalty of perjury of the laws of the State of Texas that: A. in connection with this Contract and any related Solicitation Response, neither I nor any representative of the Contractor has violated any provision of the Texas Free Enterprise and Antitrust Act, Tex. Bus. & Comm. Code Chapter 15; B. in connection with this Contract and any related Solicitation Response, neither I nor any representative of the Contractor has violated any federal antitrust law; and C. neither I nor any representative of the Contractor has directly or indirectly communicated any of the contents of this Contract and any related Solicitation Response to a competitor of the Contractor or any other company, corporation, firm, partnership or individual engaged in the same line of business as the Contractor. 30. Legal and Regulatory Actions Contractor represents and warrants that it is not aware of and has received no notice of any court or governmental agency proceeding, investigation, or other action pending or threatened against Contractor or any of the individuals or entities included in numbered paragraph 1 of these Contract Affirmations within the five (5) calendar years immediately preceding execution of this Contract or the submission of any related Solicitation Response that would or could impair Contractor's performance under this Contract, relate to the contracted or similar goods or services, or otherwise be relevant to System Agency's consideration of entering into this Contract. If Contractor is unable to make the preceding representation and warranty, then Contractor instead represents and warrants that it has provided to System Agency a complete, detailed disclosure of any such court or governmental agency proceeding, investigation, or other action that would or could impair Contractor's performance under this Contract, relate to the contracted or similar goods or services, or otherwise be relevant to System Agency's consideration of entering into this Contract. In addition, Contractor acknowledges this is a continuing disclosure requirement. Contractor represents and warrants that Contractor shall notify System Agency in writing within five (5)business days of any changes to the representations or warranties in this clause and understands that failure to so timely update System Agency shall constitute breach of contract and may result in immediate contract termination. Health and Human Services Contract Affirmations v.2.2 Effective May 2022 Page 6 of 13 DocuSign Envelope ID:8F738420-9B0B-4DD2-B3FB-88F48FD2D4CB 31. No Felony Criminal Convictions Contractor represents that neither Contractor nor any of its employees, agents, or representatives, including any subcontractors and employees, agents, or representative of such subcontractors, have been convicted of a felony criminal offense or that if such a conviction has occurred Contractor has fully advised System Agency in writing of the facts and circumstances surrounding the convictions. 32. Unfair Business Practices Contractor represents and warrants that it has not been the subject of allegations of Deceptive Trade Practices violations under Chapter 17 of the Texas Business and Commerce Code, or allegations of any unfair business practice in any administrative hearing or court suit and that Contractor has not been found to be liable for such practices in such proceedings. Contractor certifies that it has no officers who have served as officers of other entities who have been the subject of allegations of Deceptive Trade Practices violations or allegations of any unfair business practices in an administrative hearing or court suit and that such officers have not been found to be liable for such practices in such proceedings. 33. Entities that Boycott Israel Contractor represents and warrants that(1) it does not, and shall not for the duration of the Contract, boycott Israel or(2) the verification required by Section 2271.002 of the Texas Government Code does not apply to the Contract. If circumstances relevant to this provision change during the course of the Contract, Contractor shall promptly notify System Agency. 34. E-Verify Contractor certifies that for contracts for services, Contractor shall utilize the U.S. Department of Homeland Security's E-Verify system during the term of this Contract to determine the eligibility of: 1. all persons employed by Contractor to perform duties within Texas; and 2. all persons, including subcontractors, assigned by Contractor to perform work pursuant to this Contract within the United States of America. 35. Former Agency Employees—Certain Contracts If this Contract is an employment contract, a professional services contract under Chapter 2254 of the Texas Government Code, or a consulting services contract under Chapter 2254 of the Texas Government Code, in accordance with Section 2252.901 of the Texas Government Code, Contractor represents and warrants that neither Contractor nor any of Contractor's employees including,but not limited to, those authorized to provide services under the Contract,were former employees of an HHS Agency during the twelve (12) month period immediately prior to the date of the execution of the Contract. Health and Human Services Contract Affirmations v.2.2 Effective May 2022 Page 7 of 13 DocuSign Envelope ID:8F738420-9B0B-4DD2-B3FB-88F48FD2D4CB 36. Disclosure of Prior State Employment—Consulting Services If this Contract is for consulting services, A. In accordance with Section 2254.033 of the Texas Government Code, a Contractor providing consulting services who has been employed by, or employs an individual who has been employed by, System Agency or another State of Texas agency at any time during the two years preceding the submission of Contractor's offer to provide services must disclose the following information in its offer to provide services. Contractor hereby certifies that this information was provided and remains true, correct, and complete: 1. Name of individual(s) (Contractor or employee(s)); 2. Status; 3. The nature of the previous employment with HHSC or the other State of Texas agency; 4. The date the employment was terminated and the reason for the termination; and 5. The annual rate of compensation for the employment at the time of its termination. B. If no information was provided in response to Section A above, Contractor certifies that neither Contractor nor any individual employed by Contractor was employed by System Agency or any other State of Texas agency at any time during the two years preceding the submission of Contractor's offer to provide services. 37. Abortion Funding Limitation Contractor understands, acknowledges, and agrees that, pursuant to Article IX of the General Appropriations Act(the Act), to the extent allowed by federal and state law, money appropriated by the Texas Legislature may not be distributed to any individual or entity that, during the period for which funds are appropriated under the Act: 1. performs an abortion procedure that is not reimbursable under the state's Medicaid program; 2. is commonly owned,managed, or controlled by an entity that performs an abortion procedure that is not reimbursable under the state's Medicaid program; or 3. is a franchise or affiliate of an entity that performs an abortion procedure that is not reimbursable under the state's Medicaid program. The provision does not apply to a hospital licensed under Chapter 241, Health and Safety Code, or an office exempt under Section 245.004(2), Health and Safety Code. Contractor represents and warrants that it is not ineligible, nor will it be ineligible during the term of this Contract, to receive appropriated funding pursuant to Article IX. 38. Funding Eligibility Contractor understands, acknowledges, and agrees that,pursuant to Chapter 2272 (eff. Sept. 1, 2021, Ch. 2273) of the Texas Government Code, except as exempted under that Chapter, HHSC cannot contract with an abortion provider or an affiliate of an abortion provider. Contractor certifies that it is not ineligible to contract with HHSC under the terms of Chapter 2272 (eff. Sept. 1, 2021, Ch. 2273) of the Texas Government Code. Health and Human Services Contract Affirmations v.2.2 Effective May 2022 Page 8 of 13 DocuSign Envelope ID:8F738420-9B0B-4DD2-B3FB-88F48FD2D4CB 39. Prohibition on Certain Telecommunications and Video Surveillance Services or Equipment(2 CFR 200.216) Contractor certifies that the individual or business entity named in this Response or Contract is not ineligible to receive the specified Contract or funding pursuant to 2 CFR 200.216. 40. COVID-19 Vaccine Passports Pursuant to Texas Health and Safety Code, Section 161.0085(c), Contractor certifies that it does not require its customers to provide any documentation certifying the customer's COVID-19 vaccination or post-transmission recovery on entry to, to gain access to, or to receive service from the Contractor's business. Contractor acknowledges that such a vaccine or recovery requirement would make Contractor ineligible for a state-funded contract. 41. Entities that Boycott Energy Companies In accordance with Senate Bill 13, Acts 2021, 87th Leg.,R.S.,pursuant to Section 2274.002 of the Texas Government Code(relating to prohibition on contracts with companies boycotting certain energy companies), Contractor represents and warrants that: (1) it does not, and will not for the duration of the Contract,boycott energy companies or(2)the verification required by Section 2274.002 of the Texas Government Code does not apply to the Contract. If circumstances relevant to this provision change during the course of the Contract, Contractor shall promptly notify System Agency. 42. Entities that Discriminate Against Firearm and Ammunition Industries In accordance with Senate Bill 19,Acts 2021, 87th Leg., R.S.,pursuant to Section 2274.002 of the Texas Government Code(relating to prohibition on contracts with companies that discriminate against firearm and ammunition industries), Contractor verifies that: (1) it does not, and will not for the duration of the Contract, have a practice, policy, guidance,or directive that discriminates against a firearm entity or firearm trade association or(2)the verification required by Section 2274.002 of the Texas Government Code does not apply to the Contract. If circumstances relevant to this provision change during the course of the Contract, Contractor shall promptly notify System Agency. 43. Security Controls for State Agency Data In accordance with Senate Bill 475,Acts 2021, 87th Leg.,R.S.,pursuant to Texas Government Code, Section 2054.138, Contractor understands, acknowledges, and agrees that if, pursuant to this Contract, Contractor is or will be authorized to access,transmit, use, or store data for System Agency, Contractor is required to meet the security controls the System Agency determines are proportionate with System Agency's risk under the Contract based on the sensitivity of System Agency's data and that Contractor must periodically provide to System Agency evidence that Contractor meets the security controls required under the Contract. Health and Human Services Contract Affirmations v.2.2 Effective May 2022 Page 9 of 13 DocuSign Envelope ID:8F738420-9B0B-4DD2-B3FB-88F48FD2D4CB 44. Cloud Computing State Risk and Authorization Management Program(TX-RAMP) In accordance with Senate Bill 475,Acts 2021, 87th Leg.,R.S.,pursuant to Texas Government Code, Section 2054.0593, Contractor acknowledges and agrees that, if providing cloud computing services for System Agency,Contractor must comply with the requirements of the state risk and authorization management program and that System Agency may not enter or renew a contract with Contractor to purchase cloud computing services for the agency that are subject to the state risk and authorization management program unless Contractor demonstrates compliance with program requirements. If providing cloud computing services for System Agency that are subject to the state risk and authorization management program, Contractor certifies it will maintain program compliance and certification throughout the term of the Contract. 45. Office of Inspector General Investigative Findings Expert Review In accordance with Senate Bill 799, Acts 2021, 87th Leg.,R.S., if Texas Government Code, Section 531.102(m-1)(2) is applicable to this Contract, Contractor affirms that it possesses the necessary occupational licenses and experience. 46. Contract for Professional Services of Physicians,Optometrists, and Registered Nurses In accordance with Senate Bill 799, Acts 2021, 87th Leg., R.S., if Texas Government Code, Section 2254.008(a)(2) is applicable to this Contract, Contractor affirms that it possesses the necessary occupational licenses and experience. 47. Foreign-Owned Companies in Connection with Critical Infrastructure If Texas Government Code, Section 2274.0102(a)(1) (relating to prohibition on contracts with certain foreign-owned companies in connection with critical infrastructure) is applicable to this Contract,pursuant to Government Code Section 2274.0102, Contractor certifies that neither it nor its parent company,nor any affiliate of Contractor or its parent company, is: (1)majority owned or controlled by citizens or governmental entities of China, Iran,North Korea, Russia, or any other country designated by the Governor under Government Code Section 2274.0103, or(2)headquartered in any of those countries. 48. Critical Infrastructure Subcontracts For purposes of this Paragraph,the designated countries are China, Iran,North Korea, Russia, and any countries lawfully designated by the Governor as a threat to critical infrastructure. Pursuant to Section 113.002 of the Business and Commerce Code, Contractor shall not enter into a subcontract that will provide direct or remote access to or control of critical infrastructure,as defined by Section 113.001 of the Texas Business and Commerce Code,in this state, other than access specifically allowed for product warranty and support purposes to any subcontractor unless (i)neither the subcontractor nor its parent company, nor any affiliate of the subcontractor or its parent company, is majority owned or controlled by citizens or governmental entities of a designated country; and(ii) neither the subcontractor nor its parent company,nor any affiliate of the subcontractor or its parent company, is headquartered in a designated country. Contractor will notify the System Agency before entering into any subcontract that will provide direct or remote Health and Human Services Contract Affirmations v.2.2 Effective May 2022 Page 10 of 13 DocuSign Envelope ID:8F738420-9B0B-4DD2-B3FB-88F48FD2D4CB access to or control of critical infrastructure, as defined by Section 113.001 of the Texas Business & Commerce Code, in this state. 49. Enforcement of Certain Federal Firearms Laws Prohibited In accordance with House Bill 957, Acts 2021, 87th Leg., R.S., if Texas Government Code, Section 2.101 is applicable to Contractor, Contractor certifies that it is not ineligible to receive state grant funds pursuant to Texas Government Code, Section 2.103. 50. Prohibition on Abortions Contractor understands, acknowledges, and agrees that,pursuant to Article II of the General Appropriations Act, (1) no funds shall be used to pay the direct or indirect costs (including marketing, overhead,rent, phones, and utilities) of abortion procedures provided by contractors of HHSC; and(2)no funds appropriated for Medicaid Family Planning, Healthy Texas Women Program, or the Family Planning Program shall be distributed to individuals or entities that perform elective abortion procedures or that contract with or provide funds to individuals or entities for the performance of elective abortion procedures. Contractor represents and warrants that it is not ineligible,nor will it be ineligible during the term of this Contract, to receive appropriated funding pursuant to Article II. 51. False Representation Contractor understands, acknowledges, and agrees that any false representation or any failure to comply with a representation, warranty, or certification made by Contractor is subject to all civil and criminal consequences provided at law or in equity including, but not limited to, immediate termination of this Contract. 52. False Statements Contractor represents and warrants that all statements and information prepared and submitted by Contractor in this Contract and any related Solicitation Response are current, complete, true, and accurate. Contractor acknowledges any false statement or material misrepresentation made by Contractor during the performance of this Contract or any related Solicitation is a material breach of contract and may void this Contract. Further, Contractor understands, acknowledges, and agrees that any false representation or any failure to comply with a representation, warranty, or certification made by Contractor is subject to all civil and criminal consequences provided at law or in equity including, but not limited to, immediate termination of this Contract. 53. Permits and License Contractor represents and warrants that it will comply with all applicable laws and maintain all permits and licenses required by applicable city, county, state, and federal rules, regulations, statutes, codes, and other laws that pertain to this Contract. 54. Equal Employment Opportunity Contractor represents and warrants its compliance with all applicable duly enacted state and federal laws governing equal employment opportunities. Health and Human Services Contract Affirmations v.2.2 Effective May 2022 Page 11 of 13 DocuSign Envelope ID:8F738420-9B0B-4DD2-B3FB-88F48FD2D4CB 55. Federal Occupational Safety and Health Law Contractor represents and warrants that all articles and services shall meet or exceed the safety standards established and promulgated under the Federal Occupational Safety and Health Act of 1970, as amended(29 U.S.C. Chapter 15). 56. Signature Authority Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Health and Human Services Contract Affirmations v.2.2 Effective May 2022 Page 12 of 13 DocuSign Envelope ID:8F738420-9B0B-4DD2-B3FB-88F48FD2D4CB Authorized representative on behalf of Contractor must complete and sign the following: Legal Name of Contractor Assumed Business Name of Contractor, if applicable (d/b/a or 'doing business as') Texas County(s) for Assumed Business Name (d/b/a or `doing business as') Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. Signature of Authorized Representative Date Signed Printed Name of Authorized Representative Title of Authorized Representative First, Middle Name or Initial, and Last Name Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code Phone Number Fax Number Email Address DUNS Number Federal Employer Identification Number Texas Identification Number (TIN) Texas Franchise Tax Number Texas Secretary of State Filing Number SAM.gov Unique Entity Identifier(UEI) Health and Human Services Contract Affirmations v.2.2 Effective May 2022 Page 13 of 13 DocuSign Certificate Of Completion Envelope Id:8F7384209B0B4DD2B3FB88F48FD2D4CB Status:Sent Subject:Amending $364,746.00;HHS000697900024;City of Port Arthur A-4;HHSC/HDS/HDIS/OPSH Procurement Number: Source Envelope: Document Pages:52 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: 167.137.1.15 Record Tracking Status:Original Holder:Texas Health and Human Services Location:DocuSign 8/17/2022 7:32:31 AM Commission PCS_DocuSign@hhsc.state.tx.us Security Appliance Status:Connected Pool:FedRamp Storage Appliance Status:Connected Pool:Texas Health and Human Services Location:DocuSign Commission Signer Events Signature Timestamp Ron Burton Sent:8/17/2022 7:40:05 AM ron.burton@portarthurtx.gov City of Port Arthur Security Level:Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Lindsay Rodgers Lindsay.Rodgers@hhs.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 Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Donna Hendricks COPIED Sent:8/17/2022 7:40:05 AM donna.hendricks01@hhs.texas.gov Security Level:Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Carbon Copy Events Status Timestamp Judith Smith COPIED Sent:8/17/2022 7:40:05 AM judith.smith@portarthurtx.gov Viewed:8/17/2022 9:31:32 AM Director of Health Services City of Port Arthur Security Level:Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Jennifer Kim Jennifer.Kim@hhs.texas.gov Security Level:Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 8/17/2022 7:40:05 AM Payment Events Status Timestamps