HomeMy WebLinkAboutPR 23812: AMENDMENT NO. 8 DEPT. OF HEALTH AND HUMAN SERICES PRIMARY HEALTH CARE PROGRAM City of c4r
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Date: July 18, 2024
To: Ron Burton, CPM, City Manager
From: Judith A. Smith, RN,BSN, Director of Health )i
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 $344,255.00 with $68,530.00 being allocated toward the contract period of
September 1, 2024, through August 31, 2025. 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 09/01/2024 and ends 08/31/2025 and provides for salaries 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. 23812 for the
FY 2024-2025 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 will not exceed $344,255.00. The breakdown for this
grant includes $68,530 for FY 2025. This is to cover the cost of operating 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•PORTARTHUR,TX 77641-I089-409/983-8101•FAX 409/982-6743
PR No. 23812
06/18/2024 js
RESOLUTION NO.
A RESOLUTION AUTHORIZING AMENDMENT NO. 8 TO THE
CONTRACT BETWEEN THE CITY OF PORT ARTHUR AND THE
DEPARTMENT OF HEALTH AND HUMAN SERVICES PRIMARY
HEALTH CARE PROGRAM, FOR THE AMOUNT NOT TO EXCEED
$344,255.00, OF WHICH $68,530.00 IS ALLOCATED TOWARD THE
CONTRACT PERIOD SEPTEMBER 1, 2024, THROUGH AUGUST 31,
2025. 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 $344,255.00 with
$68,530.00 being allocated for FY 2025. This budget covers the cost of the operations of the
Primary Health Care Clinic. This contract period is from September 1, 2024, through August 31,
2025.
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
PR No. 23812
06/18/2024 Is
Department of Health and Human Services Commission and the City of Port Arthur for Primary
Health Care Services, as delineated in 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 July,2024
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:
s M. Black,Interim Ci'y Attorney
PR No. 23812
06/18/2024 js
FOR ADNIINI ON:
Ron Burton, PM Judt i Smith,BSN, RN,
City Manager Director of Health
APPROVED AS TO AVAILABILITY OF FUNDS:
Lynda(Lyn)Boswell, MA, ICM-CM
Director of Finance
DocuSign Envelope ID:CO3F0D98-48B1-4216-AD70-9637421C4ADA
FY25 PHC Renewal Amendment
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
City of Port Arthur
(HHSC CONTRACT No.HHS000697900024)
AMENDMENT NO. 8
The Health and Human Services Commission("HHSC"or"System Agency") and City of Port
Arthur("Grantee"), collectively referred to as the"Parties"to that certain Primary Health Care
(PHC) Services Contract that was effective September 1, 2020, and denominated as HHSC
Contract No. HHS000697900024 (the"Contract"), as amended, now desire to further amend the
Contract.
Whereas, the Parties desire to revise the Budget and revise the Statement of Work; and
Whereas, the Parties have chosen to exercise their option to extend the term of and amend the
Contract in accordance with Section 9.1 of Attachment C to the Contract.
Now,therefore,the Parties amend and modify the Contract as follows:
1. Section IV,Duration, of the Contract is amended to show a revised expiration date of
August 31, 2025,unless renewed, extended, or terminated earlier pursuant to the terms and
conditions of the Contract.
2. Section V, Payment for Services Provided,of the Contract is amended to add funding for
state fiscal year 2025 in the amount of$68,530.00. The total not-to-exceed amount of this
Contract is increased to $344,255.00. All expenditures under the Contract must be in
accordance with Table 1,Budget Categories for Primary Health Care Services.
3. Attachment B-4, Budget,Revised Payment for Services Provided, Table 1, is deleted and
replaced with the following:
Table 1 —Budget Categories for Primary Health Care Services
FY 2021 FY 2022 FY 2023 FY 2024 FY 2025
Number of
Clients to be 281 274 274 274 274
served
Average
cost per $250.00 $250.00 $250.00 $250.00 $250.00
client,
Total $
4 Amount for $70,135.00 $68,530.00 $68,530.00 $68,530.00 $68,530.00
all services
provided*
DocuSign Envelope ID:CO3F0D98-48B1-4216-AD70-9637421C4ADA
FY25 PHC Renewal Amendment
4.Attachment A-1, Statement of Work, of the Contract is deleted in its entirety and replaced with
Attachment A-2,Revised Statement of Work.
5. Attachment E, Contract Affirmations, of the Contract is deleted in its entirety and replaced
with Attachment E-1, HHS Contract Affirmations, Version 2.3, which is attached to this
Amendment and incorporated into and made part of the Contract for all purposes.
6. This Amendment shall be effective as of September 1, 2024.
7. Except as modified by this Amendment, all terms and conditions of the Contract, as previously
amended, shall remain in full force and effect.
8. Each Party represents and warrants that the person executing this Amendment on its behalf has
full power and authority to enter into this Amendment.
9. Any further revisions to the Contract shall be by written agreement of the Parties.
Signature Page Follows
DocuSign Envelope ID:CO3F0D98-48B1-4216-AD70-9637421C4ADA
FY25 PHC Renewal Amendment
HHSC CONTRACT No. HHS000697900024
SIGNATURE PAGE FOR AMENDMENT No.8
HEALTH AND HUMAN SERVICES CITY OF PORT ARTHUR
COMMISSION
By: By:
Name: Name:
Title: Title:
The following Attachments are attached and incorporated as part of the Contract:
Attachment A-2 - Revised Statement of Work
Attachment E-1 - Contract Affirmations,Version 2.3
DocuSign Envelope ID:CO3F0D98-48B1-4216-AD70-9637421C4ADA
Attachment A-2
Revised Statement of Work
Primary Health Care
1. Program Purpose
The purpose of this program is to provide preventive and Primary Health Care(PHC)for individuals
who reside in the state of Texas with a gross family income at or below 200 percent of the federal
poverty level (FPL). Grantee shall provide services regardless of race, color, national origin,
gender, sex, age, religion, disability,political beliefs, and sexual orientation.
2. Grantee Responsibilities
To participate as a provider under this Contract, the Grantee must:
2.1 Ensure compliance with this Contract, including these Grantee requirements;
2.2 Ensure compliance with all applicable federal and state laws, rules, regulations,
standards, guidelines, and policies in effect on the beginning date of this Contract
unless amended, including, but not limited to, Texas Health and Safety Code Chapter
31;
2.3 Ensure compliance with all state and federal statutes and regulations, HHSC rules,
policies, procedures, and guidelines governing the Program, included but not limited
to,Texas Administrative Code(TAC) Title 26, Part 1, Chapter 364, Subchapter A. The
foregoing rules in TAC Title 26 as they relate to the Program may be further modified
and revised- within their existing title-during the term of the Contract. In the event of
such modifications or revision, Grantee shall be required to comply with said rules;
2.4 Ensure compliance at all times with the current Program Policy Manual that is available
online and incorporated into this Contract as Attachment I.Program Policy Manual.
The provisions of the Program Policy Manual may be further modified and revised-
within their existing title- during the term of the Contract. In the event of such
modifications or revision, Grantee shall be required to comply with said rules;
2.5 Ensure compliance with the HHSC Grant Technical Assistance Guide, currently
available online at: https://hhs.texas.gov/doing-business-hhs/grants. HHSC, from time
to time and in its sole discretion,may revise the online link provided in this subsection.
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Grantee is responsible for contacting HHSC at any time that Grantee is not able to
access the online materials to request the updated link. Grantee is always responsible
for complying with the Grant Technical Assistance Guide, including any revisions to
the standards during the Contract term;
2.6 Maintain an appropriate contract administration system to ensure that all terms,
conditions, and specifications of this Contract are met;
2.7 Enroll eligible Texas residents in accordance TAC Title 26, Part 1, Chapter 364,
Subchapter A, §364.9 and §364.11 and the requirements established in the Program
Policy Manual.
3. PHC Services
To meet the mission and objectives of grant funds awarded under this Contract, Grantee must meet
the following requirements:
A Provide comprehensive preventive and primary health care(PHC)services
to eligible Texas. Grantee, at a minimum, shall provide the following
priority services: diagnosis and treatment; emergency medical services;
family planning services; preventive health services including
immunizations; health education; and laboratory, x-ray, nuclearmedicine,
or other appropriate diagnostic services. In addition to priority services,
Grantee may provide the following optional PHC services: nutrition
services, health screening, home health care, dental care, transportation,
prescription drugs, environmental health,podiatry, and social services.
B. Grantee will provide services meeting the parameters described in the
Program rules and the requirements established in the Program Policy
Manual. Grantee will screen all individuals considered for the PHC
program to determine eligibility using a System Agency-approved process
in accordance with the Program Policy Manual. Grantee may not alter
System Agency eligibility forms or use another eligibility form unless it is
submitted to and approved by System Agency. For an individual to receive
PHC services, three(3) criteria shall be met:
1. Texas resident;
2. Gross family income at or below 200% of the adopted Federal
Poverty Level (FPL); and
3. Not eligible for other non-HHSC programs/benefits providing the
same services.
3.1 Grantee will maintain documentation of all services provided in accordance with the
Program rules and the requirements established in the Program Policy Manual.
3.2 Grantee will administer treatment protocols in accordance with the Program rules and
the requirements established in the Program Policy Manual.
DocuSign Envelope ID:CO3F0D98-48B1-4216-AD70-9637421C4ADA
3.3 Grantee will maintain client and family participation requirements in accordance with
the Program rules and the requirements established in the Program Policy Manual.
3.4 Grantee will assist HHSC in performing a client satisfaction survey in accordance with
the requirements established in the Program Policy Manual.
3.5 Grantee will comply with Texas Family Code§261.101,which requires reporting of all
suspected cases of child abuse to local law enforcement authorities and to the Texas
Department of Family and Protective Services. Grantee will ensure that all program
personnel and sub-contractors are properly trained and adhere to this Contract
requirement and compliance with Texas Family Code§261.101 and in accordance with
the Program Policy Manual.
3.6 Grantee will cooperate fully with HHSC investigations or monitoring reviews
regarding Grantee's PHC services, and when applicable as determined by HHSC and
any other entity on behalf of HHSC, develop a corrective action plan to address
identified issues in accordance with Program Policy Manual.
3.7 Grantee shall maintain an emergency response plan that complies with all applicable
local, state, and federal laws, rules and regulations governing provision of services
under this Contract.
4. Telehealth and Telemedicine Medical Services
4.1 Grantee may use telehealth services ("a health service, other than a telemedicine
medical service, delivered by a health professional licensed, certified, or otherwise
entitled to practice in the state of Texas and acting within the scope of the health
professional's license, certification, or entitlement to a patient at a different physical
location than the health professional using telecommunications or information
technology,") and telemedicine medical services ("a health care service delivered by a
physician licensed in the state of Texas, or a health professional acting under the
delegation and supervision of a physician licensed in the state of Texas, and acting
within the scope of the physician's or health professional's license to a patient at a
different physical location than the physician or health professional using
telecommunications or information technology")as defined in Texas Government Code
§531.001(7) (using the meaning assigned by Texas Occupations Code §111.001) as
provided through Texas Medicaid.
4.2 Grantee must comply with all of the following:
a. Families must give written consent that they agree to receive services via telehealth
and telemedicine;
b. Telehealth and telemedicine services must comply with all Texas Medicaid
requirements for telehealth, as well as the licensure/practice act requirements for
each provider; and
c. Technology used to provide telehealth services must be compliant with the Family
Educational Rights and Privacy Act of 1974 (FERPA) and the Health Insurance
Portability and Accountability Act(HIPAA).
5. Eligible Ponulation
5.1 Program eligibility is determined by applicable law set forth in Program rules and the
requirements established in the Program Policy Manual.
DocuSign Envelope ID:CO3F0D98-48B1-4216-AD70-9637421C4ADA
5.2 If during the Contract period it is foreseen that the Grantee might be unable to serve
the contracted number of children, HHSC may reduce the Grantee's grant award
amount.
6. Personnel Standards and Requirements
6.1 Grantee must maintain qualified staff in accordance with Program rules and the
requirements established in the Program Policy Manual.
6.2 Grantee must conduct a criminal background check in accordance with Program rules
and the requirements established in the Program Policy Manual.
6.3 Grantee must provide staff training and development in accordance with the
requirements established in the Program Policy Manual.
6.4 Grantee must notify HHSC of changes in CEO, CFO, program director, and key
personnel,of a vacancy funded under this contact in accordance with the requirements
established in the Program Policy Manual. Grantees contract award may be subject to
a decrease equal to the salary savings (salary and benefits) realized as a result of the
vacancy.
7. Cost Reimbursement. Client Co-Pays
7.1 Contract funds must be expended within the current Contract period. Rollover of
unexpended funds to the succeeding Contract periods will not be allowed.
7.2 Grantee will be reimbursed for expenditures submitted on their Monthly Voucher
Packet. The Monthly Voucher Packet must be submitted no later than the last business
day of the month following service.
7.3 Grantee may assess a Client Co-Pay in accordance with Program rules and the
requirements established in the Program Policy Manual. Grantee may not deny a
service due to inability to pay. The Grantee shall waive the fee if a client self-declares
inability to pay. Grantee shall submit the PHC client co-pay and fee schedules to the
finance mailbox at fcs finance@hhs.texas.gov for review and approval by September
30 of each Contract year.
7.4 HHSC is "payer of last resort" in accordance with Program rule and the requirements
established in the Program Policy Manual. Before submitting claims for allowable
costs,the Grantee shall make reasonable efforts to investigate all other sources of third-
party funding available to,or identified by the client and assist the client with applying
for these alternative funding sources.
7.5 HHSC, at its sole discretion, may approve fund transfers between categories upon
Grantee's written request. Requests must include a detailed explanation that supports
the need for the fund transfer. Grantee must seek HHSC's written approval prior to
making any fund transfers.
DocuSign Envelope ID:CO3F0D98-48B1-4216-AD70-9637421C4ADA
8. HHSC Reimbursement and Invoicing Processes
8.1 HHSC will reimburse Grantee for all charges determined and invoiced in accordance
with the terms and conditions of this Contract. All payments by HHSC under this
Contract will be made in accordance with the "Texas Prompt Payment Act," Chapter
2251 of the Texas Government Code.
8.2 Grantee must submit the Monthly Voucher Packet which includes, Form MR, Report
Form 225, and Form 4116 by the last business day of the month following service.
8.3 Grantee must submit Monthly Voucher Packet to HHSC for review and approval in a
secure, non-alterable electronic format emailed to: fcs_finance@hhs.texas.gov with the
"Grantee's full name, month and year of invoice" in the subject line. Upon approval, HHSC
will submit the Monthly Voucher Packet to Accounts Payable.
8.4 Monthly Voucher Packet Requirements.Each invoice submitted be in accordance with
be in accordance with TAC Title 34, Part 1, Chapter 20, Subchapter F, Division 1,
§20.487, Invoicing Standards, which should include, but is not limited to, as
applicable:
• Grantee's Legal Name;
• State of Texas vendor number or federal tax identification number;
• Grantee's Telephone number;
• HHSC Contract Number;
• Total amount of invoice
• The name and telephone number of a person designated by the
Contract to answer questions regarding the invoice.
8.5 All services shall be performed to the satisfaction of HHSC. HHSC shall not be liable
for any payment for services that HHSC deems unsatisfactory,that fail to adhere to the
terms of this Contract, or that have not been approved by HHSC.
8.6 Grantee must submit a final invoice at the end of each Contract period by October 15th.
8.7 Grantee must comply with HHSC's rules,policies,Contract provisions,and applicable
instruction manuals regarding the collection and timely submission of complete and
accurate data.
9. Reporting Requirements and Monitoring
9.1 Grantee shall report financial and programmatic information to
fcs financeaa hhs.texas.gov as follows:
DocuSign Envelope ID:CO3F0D98-48B1-4216-AD70-9637421C4ADA
Report Title Submission Frequency Due Date
Monthly Monthly The last business day of the month
Reporting following service.
Packet
Financial Status Quarterly
Report(FSR)
Q1: September 1 —Nov 30 Q1: December 31
Q2: December 1 —February Q2: March 31
28/29
Q3: June 30
Q3: March 1 —May 31
Q4: October 15
Q4: June 1 —August 31
PHC 325 Annual Annually-within sixty October 30
Report (60) days after the end of
the contract term
9.2 The Grantee and/or any subcontractors associated with this Contract agree to permit
on-site monitoring visits and desk reviews, as deemed necessary by HHSC to review
all financial or other records and management control systems relevant to the provision
of goods and services under this Contract. The Grantee will include this requirement
in any subcontract associated with this Contract.
10. Performance Measures
HHSC will actively monitor Grantee's performance under this Contract including, but not
limited to, the requirements as set forth in Attachment A to this Contract. All services and
deliverables under the Contract shall be provided at an acceptable quality level and in a
manner consistent with acceptable industry standard, custom, and practice.
10.1 Additionally, the following specific performance measure will be used to assess, in
part, Grantee's effectiveness in providing the services described in this Contract,
without waiving the enforceability of any of the other terms of this Contract:
a) Grantee shall provide services to a number of unduplicated clients at an average
cost per client in the service area designated in this Contract.
10.2 System Agency will monitor Grantee's performance measure activity. If the number
of unduplicated clients served is less than that projected in Grantee's final approved
Application, Grantee's funding award may be subject to a decrease for the remainder
of the Contract year.
DocuSign Envelope ID:CO3F0D98-48B1-4216-AD70-9637421C4ADA
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.2.3
Effective August 2023
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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
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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.2.3
Effective August 2023
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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.
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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/
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All reports made to the OIG must be made through one of the following avenues:
• 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.
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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.
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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.
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39. Gender Transitioning and Gender Reassignment Procedures and Treatments for
Certain Children—Prohibited Use of Public Money; Prohibited State Health Plan
Reimbursement.
Contractor understands, acknowledges, and agrees that, pursuant to Section 161.704 of
the Texas Health and Safety Code (eff. Sept. 1, 2023),public money may not directly or
indirectly be used, granted,paid, or distributed to any health care provider, medical
school,hospital,physician, or any other entity, organization, or individual that provides
or facilitates the provision of a procedure or treatment to a child that is prohibited under
Section 161.702 of the Texas Health and Safety Code. Contractor also understands,
acknowledges, and agrees that, pursuant to Section 161.705 of the Texas Health and
Safety Code(eff. Sept. 1, 2023), HHSC may not provide Medicaid reimbursement and
the child health plan program established under Chapter 62 may not provide
reimbursement to a physician or health care provider for provision of a procedure or
treatment to a child that is prohibited under Section 161.702 of the Texas Health and
Safety Code. Contractor certifies that it is not ineligible to contract with System Agency
under the terms of Chapter 161, Subchapter X, of the Texas Health and Safety Code.
40. 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.
41. 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.
42. COVID-19 Vaccinations
Contractor understands, acknowledges, and agrees that,pursuant to Article II of the
General Appropriations Act, none of the General Revenue Funds appropriated to the
Department of State Health Services (DSHS)may be used for the purpose of promoting
or advertising COVID-19 vaccinations in the 2024-25 biennium. It is also the intent of
the legislature that to the extent allowed by federal law, any federal funds allocated to
DSHS shall be expended for activities other than promoting or advertising COVID-19
vaccinations. 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.
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43. Entities that Boycott Energy Companies
In accordance with Senate Bill 13, Acts 2021, 87th Leg., R.S.,pursuant to Section
2274.002 (eff. Sept. 1, 2023, Section 2276.002, pursuant to House Bill 4595,Acts 2023,
88th Leg., R.S.) 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 (eff. Sept. 1, 2023,
Section 2276.002, pursuant to House Bill 4595,Acts 2023, 88th Leg., R.S.) 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.
44. 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.
45. 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.
46. 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.
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47. 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) (eff. Apr. 1, 2025, Section 544.0106,pursuant to House
Bill 4611,Acts 2023, 88th Leg., R.S.) is applicable to this Contract, Contractor affirms
that it possesses the necessary occupational licenses and experience.
48. 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.
49. Foreign-Owned Companies in Connection with Critical Infrastructure
If Texas Government Code, Section 2274.0102(a)(1) (eff. Sept. 1, 2023, Section
2275.0102(a)(1),pursuant to House Bill 4595, Acts 2023, 88th Leg., R.S.) (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 (eff. Sept. 1, 2023, Section 2275.0102, pursuant to House Bill 4595,Acts
2023, 88th Leg., R.S.), 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 (eff.
Sept. 1, 2023, Section 2275.0103, pursuant to House Bill 4595, Acts 2023, 88th Leg.,
R.S.), or(2)headquartered in any of those countries.
50. 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
access to or control of critical infrastructure, as defined by Section.113.001 of the Texas
Business & Commerce Code, in this state.
51. 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.
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52. 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.
53. 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.
54. 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.
55. 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.
56. Equal Employment Opportunity
Contractor represents and warrants its compliance with all applicable duly enacted state
and federal laws governing equal employment opportunities.
57. 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).
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58. 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
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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)
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DocuSign
Certificate Of Completion
Envelope Id:CO3F0D9848B14216AD709637421C4ADA Status:Sent
Subject:Amending$344,255.00;HHS000697900024;CITY OF PORT ARTHUR A-8;HHSC/CPSO/FHS/FCS
Procurement Number:
Source Envelope:
Document Pages:32 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: 168.60.140.220
Record Tracking
Status:Original Holder:Texas Health and Human Services Location: DocuSign
6/11/2024 8:54:50 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:6/11/2024 9:09:05 AM
ron.burton@portarthurtx.gov
City Manager
City of Port Arthur
Security Level:Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Faith Sandberg-Rodriguez
faith.sandberg-rodriguez@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
Janete Olague COPIED Sent:6/11/2024 9:09:04 AM
janete.olague01@hhs.texas.gov
Security Level:Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Carbon Copy Events Status Timestamp
Veronica Euresti COPIED Sent:6/11/2024 9:09:04 AM
veronica.euresti01@hhs.texas.gov
Contract Manager
HHSC
Security Level:Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Judith A.Smith COPIED Sent:6/11/2024 9:09:05 AM
judith.smith@portarthurtx.gov Viewed:6/11/2024 9:41:47 AM
Director of Health Services
City of Port Arthur
Security Level:Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Aparna Aavula
aparna.aavula@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 6/11/2024 9:09:04 AM
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