HomeMy WebLinkAboutPR 19083: THE DEPARTMENT OF STATE HEALTH SERVICES, IMMUNIZATION BRANCH-LOCALS IN THE AMOUNT $162,630 City of
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Texas
DATE: July 24, 2015
To: Brian McDougal, City Manager
From: Judith A. Smith, RN, BSN, Director of Health Services 9S
RE: Contract Approval between the City of Port Arthur and the Department of State Health
Services Immunization Branch.
Nature of the Request: This contract approval for renewal will allow the Health Department to
continue its immunization program for children, adolescents and adults to eliminate barriers,
expand immunization delivery, and establish uniform policies. The award is the same as FY
2014 and covers the period between September 1, 2015 and August 31, 2016.
Staff Analysis, Considerations: This grant funds 3 full-time employees.
Recommendations: It is recommended that the City Council approve P.R. No.19083, approving
the contract between the City of Port Arthur and the Department of State Health Services,
Immunization Branch-locals, to continue the immunization program for children, adolescents,
and adults.
Budget Considerations: The total grant award is $162,630 for personnel, fringe benefits,
supplies and travel.
"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. 19083
07/24/2015-js
RESOLUTION NO.
A RESOLUTION APPROVING THE FY 2015-2016 CONTRACT
BETWEEN THE CITY OF PORT ARTHUR AND THE DEPARTMENT
OF STATE HEALTH SERVICES, IMMUNIZATION BRANCH-LOCALS
IN THE AMOUNT $162,630
WHEREAS, the contract between the City of Port Arthur and the Department of State
Health Services provides financial assistance to the Port Arthur City Health Department to
supplement the delivery of public health services; and,
WHEREAS, this contract renewal will allow the City's Health Department to continue
an immunization program for children, adolescents, and adults to eliminate barriers, expand
immunization delivery, and establish uniform policies.
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 renewal between the City of Port Arthur and the Department of State Health Services.
Section 3. That, the City Council deems it is in the best interest of the City to
approve and authorize the City Manager and the Director of the City's Health Department to
execute the contract between the Department of State Health Services and the City of Port
Arthur, Texas,to continue the immunization program 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.
EXHIBIT "A"
Memorandum of Understanding
Regarding Mass Prophylaxis Dispensing
This Memorandum of Understandin�g (MOU) is enter d into as of this /0 day of/Mae-!L,
20/5 by and between /UrAL / loele/utc f A__ ereinafter POD Host, and The
City of Port Arthur Health Department to support mass prophylaxis of a designated population
affected by a disaster or public health emergency. This MOU is entered into voluntarily by both
parties and is not intended to be a legally binding contract.
RECITALS
WHEREAS, the Centers for Disease Control and Prevention (CDC) has established a program to
require LPHDs to prepare in the event of a catastrophic biological incident; and
WHEREAS, the CDC, through state health departments, will provide assets from the Strategic
National Stockpile (SNS), which includes medications and medical supplies to the LPHD to be
distributed to local employers; and
WHEREAS, POD Host and LPHD each have a desire to assist local communities to prepare for and
respond to a bioterrorism release or other communicable disease threat; and
WHEREAS, POD Host and LPHD wish to collaborate to enhance their ability to respond to a
catastrophic biological incident or other public health disaster to protect POD Host employees
and their families.
WHEREAS, POD Host agrees to become a "Program Planner" as that term is used in the federal
Public Readiness and Emergency Preparedness Act (The PREP Act) and is entitled to all the
protections from liability contained therein, as well as the protections of any state or local laws
or regulations that may apply.
NOW THEREFORE, the parties hereto agree as follows:
DEFINITIONS
Closed POD: A dispensing site location operated by a private organization such as POD Host for a
specific population, (i.e., its employees, contractors (if any), and their families) not open to the
general public.
Event: A public health emergency.
Mass Dispensing Operations (MDOs). A program to dispense SNS medications to large groups of
people during an Event.
Point of Dispensing (POD): Location where vaccines, antibiotics or other medication may be
quickly dispensed to a large group of people during a public health emergency.
Strategic National Stockpile (SNS): A strategic stockpile of medications, medical equipment and
supplies controlled by the federal government to be rapidly deployed to respond to public
health disasters.
1. POD Host agrees to:
a. Complete the Notification of Intent form (See Appendix A) which identifies POD Host's
POD location (where SNS assets would be delivered), how many courses of medicine
would be requested, and three POD Host contacts who would be notified if a public
health emergency were declared.
b. Complete a Closed POD Plan (if template is provided by LPHD).
c. Participate in training, exercises and education events offered by LPHD by an appropriate
number of POD Host's local staff. POD Host, shall determine in its sole discretion the
appropriate number of staff that requires training.
d. Upon declaration of a public health emergency, POD Host agrees to:
i. Take delivery of the SNS medications from the LPHD, to secure said medications
and prepare the site designated by the Affiliate as a POD.
ii. Dispense SNS medications to those groups of individuals it had previously
identified.
iii. Dispense SNS medications in compliance with all state and local laws, including
those identified in Appendix B to be completed by LPHD.
iv. Not charge individuals for SNS medications or administration of SNS medications
that have been provided through this agreement, except as permitted by State or
local law or the CDC.
v. Maintain accurate inventory records of SNS medications received and dispensed
and provide said records to LPHD upon request.
vi. Secure any unused SNS medications until such time as LPHD can make
arrangements for retrieval.
2
vii. Compile and file an after-action report if requested by the LPHD, identifying lessons
learned and accomplishments of the Closed POD operation.
2. The City of Port Arthur Health Department agrees to:
a. Conditionally ensure availability of the appropriate amount of SNS medications in a
reasonable, timely manner and to provide the SNS medications to POD Host as they
become available.
b. Provide Closed POD training and education opportunities to identified POD Host staff.
c. Provide pre-event planning and technical assistance, including a Closed POD plan
template, supply lists, fact sheets, dispensing algorithms, etc.
d. Coordinate with POD Host during a public health disaster to the best of its ability.
e. Supply POD Host with proper medical protocols for dispensing activities, including but
not limited to, dosing, follow-up procedures and releasable information regarding the
public health emergency situation.
f. Assist and consult with POD Host as needed for the given public health emergency.
g. Make arrangements to collect any unused SNS medications, as well as copies of all
medical documentation.
h. Provide POD Host any after-action consultation that is deemed necessary.
3. It is Mutually Agreed That:
a. The confidentiality of patients and patient information will be maintained as much as
possible during the public health event. It is understood that minimal health information
is gathered, but that reasonable efforts should be maintained to keep said information
private.
b. This MOU shall have no expiration date, shall be automatically renewing, but may be
terminated in writing by either party at any time and for any reason.
c. This MOU may be amended by mutual agreement of both parties at any time.
d. This MOU will not supersede any laws, rules or polices of either party.
e. POD Host will be a "Closed" POD, and not an "Open" POD, in that it will not dispense SNS
medications to the general public, but only to identified staff, family members, and other
specific groups outlined in Appendix A.
3
f. It is understood that POD Host's participation is completely voluntary and may not be
available or utilized at the time of the Event. If POD Host is not utilized as a Closed POD,
then its staff, their family members, and other specific groups may attend a Public/Open
POD. POD Host is not required to provide advance notice of termination of this MOU in
order to decline being available or utilized at the time of any Event.
SIGNATURES:
My signature indicates agreement with the above stated document:
City of Port Arthur
Signature of Representative Date
Print Name Title
Company Name: /OMSiOGcf
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Signature of Representative Date
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4
DEPARTMENT OF STATE HEALTH SERVICES
CONTRACT 2016-001079-00
.,
This Contract is entered into by and between the Department of State Health Services (DSHS or
the Department), an agency of the State of Texas, and Port Arthur Health Department (Contractor),
a Governmental, (collectively, the Parties) entity.
1. Purpose of the Contract: DSHS agrees to purchase, and Contractor agrees to provide,
services or goods to the eligible populations.
2. Total Amount: The total amount of this Contract is $162,630.00.
3. Funding Obligation: This Contract is contingent upon the continued availability of funding. If
funds become unavailable through lack of appropriations, budget cuts, transfer of funds between
programs or health and human services agencies, amendment to the Appropriations Act, health
and human services agency consolidation, or any other disruptions of current appropriated funding
for this Contract, DSHS may restrict, reduce, or terminate funding under this Contract.
4. Term of the Contract: This Contract begins on 09/01/2015 and ends on 08/31/2016. DSHS
has the option, in its sole discretion, to renew the Contract. DSHS is not responsible for payment
under this Contract before both parties have signed the Contract or before the start date of the
Contract, whichever is later.
5.Authority: As applicable, DSHS enters into this Contract under the authority of Texas Health
and Safety Code Chapter 12 or 1001 or Texas Government Code Chapters 531, 771, 791 or
2155.
6. Program Name: IMM/LOCALS Immunization Branch-Locals
Page 1 of 13
7. Statement of Work:
Contractor shall implement and operate an immunization program for children, adolescents, and adults,
with special emphasis on accelerating interventions to improve the immunization coverage of children three
(3)years of age or younger(birth to 35 months of age). Contractor shall incorporate traditional and
non-traditional systematic approaches designed to eliminate barriers, expand immunization capacity, and
establish uniform operating policies, as described herein.
Contractor shall be enrolled as a provider in the Texas Vaccines for Children (TVFC) and the Adult Safety
(ASN) Programs by the effective date of this Program Attachment. This includes a signed Deputization
Addendum Form (E6-102) and adherence to the TVFC Operations Manual and associated TVFC policy
guidelines provided by DSHS (located at http://www.dshs.state.tx.us/immunize/tvfc/tvfc_manual.shtm).
Contractor shall comply with written policies and procedures provided by DSHS in managing vaccines
supplied through the ASN and TVFC Programs, including guidelines for proper storage, handling, and
safeguarding of vaccines in the event of natural disaster. Contractor shall comply with all requirements laid
out in the final, approved Work Plan (Exhibit A).
• Contractor will use the current vaccine management system as described in the TVFC Operations
Manual.
• Contractor shall notify ASN and TVFC providers of changes to vaccine storage and handling, vaccine
management reporting, and present updates and training to providers, as requested by DSHS.
• Contractor shall plan and implement community-based activities and collaborations to accomplish the
required tasks as specified in the final, approved Work Plan (Exhibit A).
Contractor shall report all notifiable conditions as specified in 25 Texas Administrative Code (TAC) Part I §
§97.1-97.6 and §§97.101-97.102, and as otherwise required by law.
Contractor shall report all vaccine adverse event occurrences in accordance with the 1986 National
Childhood Vaccine Injury Act (NCVIA)42 U.S.C. § 300aa-25 (located at http://vaers.hhs.gov/or
1-800-822-7967).
Contractor shall inform and educate the public about vaccines and vaccine-preventable diseases, as
described in the DSHS Immunization Contractors Guide for Local Health Departments (located at
http://www.dshs.state.tx.us/immunize/docs/contractor/E11-13985_FY2016_ContractorsGuide.pdf).
Contractor shall conduct outreach and collaborative activities with American Indian tribes located within the
boundaries of the contractor's jurisdiction.
Contractor shall work to promote a health care workforce within the Local Health Department's service area
(including Contractor's staff)that is knowledgeable about vaccines, vaccine safety, vaccine-preventable
diseases, and delivery of immunization services.
Contractor shall not deny vaccinations to recipients because they do not reside within Contractor's
jurisdiction or because of an inability to pay an administration fee.
Contractor shall comply with all applicable federal and state regulations and statutes, including but not
limited to:
• Human Resources Code §42.043, VTCA;
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• Education Code §§38.001-38.002, VTCA;
• Health and Safety Code §§12.032, 81.023 and 161.001-161.009, VTCA;
• 25 TAC Chapter 97;
• 25 TAC, Chapter 96;
• 25 TAC, Chapter 100;
•42 USC §§247b and 300 aa-25;
• Omnibus Budget Reconciliation Act of 1993, 26 USC §4980B; and
• Senate Bill 346.
Contractor shall comply with current applicable state and federal standards, policies and guidelines,
including but not limited to DSHS's Standards for Public Health Clinic Services, revised August 31, 2004
(located at http://www.dshs.state.tx.us/qmb/default.shtm#public).
Contractor shall be responsible for identification and case management to all surface antigen positive
pregnant women and timely newborn post exposure prophylaxis (PEP)with hepatitis B vaccine and
hepatitis B immune globin (HBIG) as well as timely completion of doses two and three of hepatitis B
vaccine and completion of post-vaccination serology testing (PVST).
Contractor shall be responsible for conducting outreach regarding vaccinations for children (19 through 35
months of age in the Contractor's jurisdiction) included on the list distributed to Contractor by the ImmTrac
Group at DSHS. Lists are distributed through ImmTrac at the start of each quarterly reporting period
(September 01, 2015; December 01, 2015; March 01, 2016; and June 01, 2016).
Contractor shall be responsible for conducting outreach to17-year-olds included on the lists distributed to
the Contractor by DSHS to explain the lifetime registry and obtain their consent as an adult to be included
in ImmTrac. Lists are distributed on October 1, 2015; December 1, 2015; February 1, 2016; April 1, 2016;
June 1, 2016; and August 1, 2016.
Contractor shall be responsible for conducting outreach to new ImmTrac providers who have logged into
ImmTrac within 30 days of registering. Lists of these providers are distributed at the beginning of each
month.
Contractor shall be responsible for conducting outreach to existing ImmTrac providers that have not logged
in into ImmTrac in the last 90 days. Lists are distributed on September 1, 2015; November 1, 2015;
January 1, 2016; March 1, 2016; May 1, 2016; and July 1, 2016.
Contractor must receive written approval from DSHS before varying from applicable policies, procedures,
protocols, and/or work plans, and must update and disseminate its implementation documentation to its
staff involved in activities under this contract within forty-eight (48) hours of making approved changes.
Contractor shall review monthly contract funding expenditures and salary savings from any contract-paid
staff vacancies and revise spending plan to ensure that all funds will be properly expended under this
contract before the end of the contract term on August 31, 2016.
USE OF FUNDS
• Funds shall not be used for purchase of vaccines, inpatient care, construction of facilities, or debt
retirement.
• Contractor is authorized to pay employees who are not exempt under the Fair Labor Standards Act
(FLSA), 29 USC, Chapter 8, §201 et seq., for overtime or compensatory time at the rate of time and
one-half per FLSA.
Page 3 of 13
• Contractor is authorized to pay employees who are exempt under FLSA on a straight time basis for work
performed on a holiday or for regular compensatory time hours when the taking of regular compensatory
time off would be disruptive to normal business operations.
•Authorization for payment under this provision is limited to work directly related to immunization activities
and shall be in accordance with the amount budgeted in this contract Attachment. Contractor shall
document proper authorization or approval for any work performed by exempt or non-exempt employees in
excess of forty (40) hours per work week.
•All revenues directly generated by this Program Attachment or earned as a result of this Program
Attachment during the term of this Program Attachment are considered program income; including income
generated through Medicaid billings for immunization related clinic services. The Contractor shall use this
program income to further the scope of work detailed in this Program Attachment, and must keep
documentation to demonstrate such to DSHS's satisfaction. This program income may not be used to take
the place of existing local, state, or federal program funds. Program income shall not be used for purchase
of vaccines, inpatient care, construction of facilities, or debt retirement.
DSHS reserves the right, where allowed by legal authority, to redirect funds in the event of financial
shortfalls. DSHS will monitor Contractor's expenditures on a monthly basis. If expenditures are below what
is projected in Contractor's total Program Attachment amount, Contractor's budget may be subject to a
decrease for the remainder of the Contract term. Vacant positions existing after ninety (90) days may result
in a decrease in funds.
Contractor agrees to read DSHS Contractor Financial Procedures Manual (CFPM) and work with DSHS
staff regarding the management of funds received under this Contract.
http://www.dshs.state.tx.us/contracts/cfpm.shtm.
Contractor shall perform the activities required under this Program Attachment in the Service Area
designated in the most recent version of Section 8. "Service Area" of this contract.
SECTION II: PERFORMANCE MEASURES:
The following performance measure(s)will be used, in part, to assess Contractor's effectiveness in
providing the services described in this Program Attachment, without waiving the enforceability of any of
the terms of the Contract.
Contractor shall:
• Investigate and document, in accordance with DSHS Emerging and Acute Infectious Disease
Investigation Guidelines (located at http://www.dshs.state.tx.us/idcu/investigation/conditions/) and NBS
Data Entry Guidelines, at least 90% of confirmed or probable reportable vaccine-preventable disease
cases within thirty (30) days of initial report to public health.
• Complete 100% of the follow-up activities, designated by DSHS, for TVFC provider quality assurance
site visits assigned by DSHS.
• Ship overstocked vaccines and vaccines approaching expiration to alternate providers for immediate use
when instructed to do so by the DSHS Health Service Region (HSR) Immunization Program Manager to
avoid vaccine waste. Contractor is responsible for covering the cost to ship overstocked vaccines and
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vaccines approaching expiration.
• Contact and provide case management to 100% of the number of hepatitis B surface antigen-positive
pregnant women identified.
• Contact 3% or 250 children per FTE (whichever is more)who are not up-to-date on their immunizations
according to the ImmTrac-generated client list provided to the contractor by DSHS at the beginning of each
reporting period.
• Perform outreach and education activities targeting adolescents 14 to 18 years of age and their parents
via health-care providers, health-care clinics, hospitals, and any other health-care facility providing health
care to adolescents 14 to 18 years of age to satisfy Texas Health and Safety Code Chapter 161,
Subsection A, Section 161.0095 requirements. Outreach and education activities must focus on the
immunization registry and the option for an individual who is 18 years of age or older to consent to having
their immunization records stored within the immunization registry. Additional outreach and educational
activities may focus on high schools, colleges, and universities.
• Participate in at least one collaborative meeting concerning tribal health issues, concerns, or needs with
American Indian tribal members during the contract term if American Indian tribes are in their jurisdiction.
• Report outreach done, and collaborative efforts made, with the American Indian tribes in the contractor's
jurisdiction.
• Review 100% of monthly biological reports, vaccine orders (when applicable), and temperature recording
forms for accuracy to ensure the vaccine supply is appropriately maintained and within established
maximum stock levels. Review and approval for vaccines orders (when applicable) must be documented in
the Electronic Vaccine Inventory system.
• Complete 100% of child-care facility and Head Start center assessments, in accordance with the
Immunization Population Assessment Manual, as assigned by DSHS.
• Complete 100% of public and private school assessments, retrospective surveys, and validation surveys,
in accordance with the Immunization Population Assessment Manual, as assigned by DSHS.
• Report number of doses administered to underinsured children monthly, as directed by DSHS.
• Report the number of unduplicated underinsured clients served, as directed by DSHS.
Contractor shall utilize the Assessment, Feedback, Incentives, and eXchange (AFIX)on line tool and
methodology, found in the Immunization Quality Assurance Tool Resource Manual, (located at
http://www.dshs.state.tx.us/immunize/docs/QA_site_visit.pdf)to assess immunization practices and
coverage rates for all sub-contracted entities and non-local health department clinics. Immunization
provider coverage rates will be generated using the Comprehensive Clinic Assessment Software
Application (CoCASA), as specified by DSHS.
Contractor shall utilize the Centers for Disease Control and Prevention (CDC) Provider education,
Assessment, and Reporting (PEAR) system and directly enter data into PEAR to document NFC quality
assurance site-visits for all sub-contracted entities and non-local health department clinics. The
Contractor shall submit the final assessment results in the PEAR system within twenty-four(24) hours of
conducting the visit.
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Contractor shall utilize the CDC PEAR system and directly enter data into PEAR to document TVFC
unannounced storage and handling visits conducted at TVFC provider offices. The Contractor shall submit
the final unannounced storage and handling visit results in the PEAR system within twenty-four (24) hours of
conducting the visit.
Contractor is required to complete and submit Immunization Inter-Local Agreement (ILA) Quarterly Report
form, utilizing the format provided by the DSHS Program and available at
http://www.dshs.state.tx.us/immunize/providers.shtm, by the report due date.
See programmatic Reporting Requirements section for required reports.
SECTION III: SOLICITATION DOCUMENT:
Governmental Entity
SECTION IV: RENEWALS:
There are no renewals.
SECTION V: PAYMENT METHOD:
Cost Reimbursement
Funding is further detailed in the attached Categorical Budget and, if applicable, Equipment List.
SECTION V: BILLING INSTRUCTIONS:
Contractor shall request payment using the State of Texas Purchase Voucher(Form B-13) and acceptable
supporting documentation for reimbursement of the required services/deliverables. The Form B-13 can be
found at the following link http://www.dshs.state.tx.us/grants/forms/bI3form.doc. Vouchers and supporting
documentation should be mailed or submitted by fax or electronic mail to the addresses/number below.
Department of State Health Services
Claims Processing Unit MC 1940
1100 West 49th Street
P. O. Box 149347
Austin, Texas 78714-9347
The fax number for submitting State of Texas Purchase Voucher(Form B-13) to the Claims Processing
Unit is (512)458-7442. The email address is invoices@dshs.state.tx.us.
SOURCE OF FUNDS: STATE and CFDA# 93.268
HCR Immunization and Vaccines for Children Program
Page 6 of 13
8. Service Area
Jefferson County
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This section intentionally left blank.
Page 8 of 13
10. Procurement method:
Non-Competitive Interagency/Interlocal
GST-2012-Solicitation-00022 DCPS "GOLIVE" IMMUNIZATION LOCALS
PROPOSAL
11. Renewals:
Number of Renewals Remaining: 0 Date Renewals Expire: 08/31/2016
12. Payment Method:
Cost Reimbursement
13. Source of Funds:
93.268, 93.268, 93.268, 93.268, 93.268, 93.268, STATE
14. DUNS Number:
137134909
Page 9 of 13
15. Programmatic Reporting Requirements:
Report Name Frequency Period Begin Period End Due Date
LHD ILA Quarterly Quarterly 09/01/2015 11/30/2015 12/31/2015
Report
LHD ILA Quarterly Quarterly 12/01/2015 02/29/2016 03/31/2016
Report
LHD ILA Quarterly Quarterly 03/01/2016 05/31/2016 06/30/2016
Report
LHD ILA Quarterly Quarterly 06/01/2016 08/31/2016 09/30/2016
Report
Financial Status Quarterly 09/01/2015 11/30/2015 12/31/2015
Report
Financial Status Quarterly 12/01/2015 02/29/2016 03/31/2016
Report
Financial Status Quarterly 03/01/2016 05/31/2016 06/30/2016
Report
Financial Status Quarterly 06/01/2016 08/31/2016 10/15/2016
Report
Submission Instructions:
LHD ILA Quarterly Reports should be submitted electronically to
dshsimmunizationcontracts@dshs.state.tx.us according to the time frames stated above.
Financial Status Reports shall be sent to invoices@dshs.state.tx.us.
Page 10 of 13
16. Special Provisions
General Provisions, ARTICLE III SERVICES, Section 3.02 Disaster Services, is revised to include the
following:
In the event of a local, state, or federal emergency the Contractor has the authority to utilize approximately
5% of staffs time supporting this Program Attachment for response efforts, as pre-approved in writing by
DSHS. DSHS shall reimburse Contractor up to 5% of this Program Attachment funded by Center for
Disease Control and Prevention (CDC)for personnel costs responding to an emergency event. Contractor
shall maintain records to document the time spent on response efforts for auditing purposes. Allowable
activities also include participation of drills and exercises in the pre-event time period. Contractor shall notify
the Assigned Contract Manager in writing when this provision is implemented.
General Provisions, ARTICLE XIV. GENERAL TERMS, Section 14.12 Amendment, is amended to include
the following:
Contractor must submit all amendment and revision requests in writing to the Division Contract Management
Unit at least ninety (90) days prior to the end of the term of this Program Attachment.
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17. Documents Forming Contract. The Contract consists of the following:
a. Contract (this document) 2016-001079-00
b. General Provisions Subrecipient General Provisions
c. Attachments Budget
d. Declarations Certification Regarding Lobbying, Fiscal Federal Funding
Accountability and Transparency Act (FFATA) Certification
e. Exhibits
Any changes made to the Contract, whether by edit or attachment, do not form part of the Contract
unless expressly agreed to in writing by DSHS and Contractor and incorporated herein.
18. Conflicting Terms. In the event of conflicting terms among the documents forming this Contract, the
order of control is first the Contract, then the General Provisions, then the Solicitation Document, if any, and
then Contractor's response to the Solicitation Document, if any.
19. Payee. The Parties agree that the following payee is entitled to receive payment for services rendered
by Contractor or goods received under this Contract:
Name: Port Arthur City Health Dept
Vendor Identification Number: 17460018850
20. Entire Agreement. The Parties acknowledge that this Contract is the entire agreement of the Parties
and that there are no agreements or understandings, written or oral, between them with respect to the
subject matter of this Contract, other than as set forth in this Contract.
I certify that I am authorized to sign this document and I have read and agree to all parts of the contract,
Department of State Health Services Port Arthur Health Department
By: By:
Signature of Authorized Official Signature of Authorized Official
Date Date
Name and Title Name and Title
1100 West 49th Street
Address Address
Austin, TX 78756-4204
City, State, Zip City, State, Zip
Telephone Number Telephone Number
E-mail Address E-mail Address
Page 12 of 13
Budget Summary
Organization Name: Port Arthur Health Department Program ID: IMM/LOCALS
Contract Number: 2016-001079-00
Budget Categories
Budget Categories DSHS Funds Cash Match In Kind Match Category Total
Requested Contributions
Personnel $110,400.00 $0.00 $110,400.00
Fringe Benefits $52,230.00 $0.00 $52,230.00
Travel $0.00 $0.00 $0.00
Equipment $0.00 $0.00 $0.00
Supplies $0.00 $0.00 $0.00
Contractual $0.00 $0.00 $0.00
Other $0.00 $0.00 $0.00
Total Direct Costs $162,630.00 $0.00 $0.00 $162,630.00
Indirect Costs $0.00 $0.00 $0.00
Totals $162,630.00 $0.00 $0.00 $162,630.00
Page 13 of 13
DCPS FY16 IMMUNIZATION LOCALS RENEWAL
Organization: Port Arthur Health Department DCPS-2016-IMM/LOCALS-00012
Budget Summary
Organization Name: Port Arthur Health Department Program ID: IMM/LOCALS
Contract Number: 2016-001079-00 Procurement ID: GST-2012-Solicitation-000
22
Proposal ID: DCPS-2016-IMM/LOCALS-00012 Procurement Name: DCPS "GOLIVE"
IMMUNIZATION LOCALS
PROPOSAL
Budget Categories
Budget Categories DSHS Funds Cash Match In Kind Category
Requested Match Total
Personnel $110,400 $0 $110,400
Fringe Benefits $52,230 $0 $52,230
Travel $0 $0 $0
Equipment $0 $0 $0
Supplies $0 $0 $0
Contractual $0 $0 $0
Other $0 $0 $0
Total Direct Costs $162,630 $0 $0 $162,630
Indirect Costs $0 $0 $0
Totals: $162,630 $0 $0 $162,630
Subcontracting
Subcontracting Percentage: 0.00%
Match Contributions
Applicable Match Amount: $0
Required Match Percentage: 0.00%
Required Match Amount: $0 Calculated Match Amount: $0
Source of Cash Match Funds
Source of In Kind Match Funds
Program Income
Projected Earnings: $0
07/21/2015 Page 1 of 2
DCPS FY16 IMMUNIZATION LOCALS RENEWAL
Organization: Port Arthur Health Department DCPS-2016-IMM/LOCALS-00012
Budget Summary
Source of Earnings
Non DSHS Funding
Direct Federal Funds: $0
Other State Agency Funds: $0
Local Funding Sources: $0
Other Funds: $0
Total Projected Non DSHS Funding: $0
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