HomeMy WebLinkAboutContract 33237 CITY SECRETARYq
CONTRACT NO.
DEPARTMENT OF STATE HEALTH SERVICES
1100 WEST 49TH STREET
AUSTIN,TEXAS 78756-3199
STATE OF TEXAS DSHS Document No.7560005286 2006
COUNTY OF TRAVIS Contract Change Notice No. 04
The Department of State Health Services, hereinafter referred to as RECEIVING AGENCY,did heretofore enter into a contract in
writing with FORT WORTH DEPARTMENT OF PUBLIC HEALTH hereinafter referred to as PERFORMING AGENCY. The
arties thereto now desire to amend such contract attachment(s)as follows:
SUMMARY OF TRANSACTION:
ATT NO.01A: RLSS-LOCAL PUBLIC HEALTH SYSTEM
All terms and conditions not hereby amended remain in full force and effect.
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
CITY OF FORT WORTH
Authorized Contracting Entity(type above if different
from PERFORMING AGENCY)for and in behalf of:
PERFORMING AGENCY: RECEIVING AGENCY :
FORT WORTH DEPA ENT OF PUBLIC DEPARTMENT OF STATE HEALTH SERVICES
HEALTH
By: �
By:
(SignaturefVrS
ut or ed to sign) (Signature of person authorized to sign)
Joe Paniags t ity Manager
Bob Burnette,Director
Client Services Contracting_Unit
(Name and Title) (Name and Title)
Date: 101 Date: �-j!o'o b
Attested Bv;
RECOMME ED:
&6
��� P
By. v" /
(PERFORMING AGENCY Director,if different
from person authorized to sign contract Marty HendrL
Citv Secretary
JC CSCU-Rev.6/05
APPROVED AS TO Cort act_ Aut_15ization
F RM AND LEGALITY- -�
Date
Anal ANT CITY AT 0 Y
Cover Page 1
DETAILS OF ATTACHMENTS
Att/ DSHS Program ID/ Term Financial Assistance Direct Total Amount
Amd DSHS Purchase Assistance (DSHS Share)
No. Order Number Begin End Source of Amount
Funds*
01A RLSS/LPHS 09/01/05 08/31/06 State 93.991 36,508.00 0.00 36,508.00
0000309849
02 DIAB/CDSP 09/01/05 08/31/06 State 80,000.00 0.00 80,000.00
0000309271
03 IMM/LOCALS 09/01/05 08/31/06 State 93.268 57,305.00 0.00 57,305.00
0000309148
04 CPSBIOTERR 09/01/05 08/31/06 93.283 497,463.00 0.00 497,463.00
0000310525
DSHS Document No.7560005286 2006 Totals $671,276.00 $ 0.00 $671,276.00
Change No.04
*Federal funds are indicated by a number from the Catalog of Federal Domestic Assistance(CFDA),if applicable. REFER TO
BUDGET SECTION OF ANY ZERO AMOUNT ATTACHMENT FOR DETAILS.
c -nr
Cover Page 2 as �.
DOCUMENT NO. 7560005286-2006
ATTACHMENT NO. 01 A
PURCHASE ORDER NO. 0000309849
PERFORMING AGENCY: FORT WORTH DEPARTMENT OF PUBLIC HEALTH
RECEIVING AGENCY PROGRAM: REGIONAL AND LOCAL SERVICES
SECTION
TERM: September 01, 2005 THRU: August 31, 2006
It is mutually agreed by and between the contracting parties to amend the conditions of
Document No. 7560005286 2006 -01as written below. All other conditions not hereby
amended are to remain in full force and effect.
SECTION I. SCOPE OF WORK is revised to include the following:
PERFORMING AGENCY shall comply with applicable RECEIVING AGENCY
programmatic guidelines in accordance with activities outlined in the final
accepted FY06 Service Delivery Plan.
PERFORMANCE MEASURES
PERFORMING AGENCY shall complete the PERFORMANCE MEASURES as
stated in the FY 06 LPHS Service Delivery Plan, and as agreed upon by
RECEIVING AGENCY, and hereby attached as Exhibit B.
SECTION I. SCOPE OF WORK, fourth paragraph, is revised to add the following
bulleted items:
• PERFORMING AGENCY'S FY 06 LPHS Service Delivery Plan;
• FY 05 Texas Application for Preventive Health and Health Services Block
Grant Funds; and
• Government Code section 403.1055, "Permanent Fund for Children and
Public Health".
SECTION II. SPECIAL PROVISIONS, second paragraph, is revised to add the
following:
PERFORMING AGENCY shall submit an Annual Budget and Expenditures
Report in a format specified by and to RECEIVING AGENCY by December 15,
2006.
ATTACHMENT—Page 1 25t SIT
r 0 J,
J
DEPARTMENT OF STATE HEALTH SERVICES
RECEIVING AGENCY PROGRAM: REGIONAL AND LOCAL SERVICES SECTION
PERFORMING AGENCY: FORT WORTH DEPARTMENT OF PUBLIC HEALTH
CONTRACT TERM:09/01/05 THRU: 08/31/06 BUDGET PERIOD:09/01/05 THRU 08/31/06
DSHS DOC. NO. 7560005286 200601 A CHG. 04
REVISED CONTRACT BUDGET
FINANCIAL ASSISTANCE
OBJECT CLASS CATEGORIES CURRENT APPROVED CHANGE NEW OR REVISED
BUDGET(A) REQUESTED(B) BUDGET(C)
Personnel $11,232.00 $4,397.00 $15,629.00
Fringe Benefits 2,808.00 ( 1,022.00) 1,786.00
Travel 60.00 243.00 303.00
Equipment 0.00 0.00 0.00
Supplies 5,900.00 12,890.00 18,790.00
Contractual 0.00 0.00 0.00
Other 0.00 0.00 0.00
Total Direct Charges $20,000.00 $16,508.00 $36,508.00
Indirect Charges 0.00 0.00 0.00
TOTAL $20,000.00 $16,508.00 $36,508.00
PERFORMING AGENCY SHARE:
Program Income 0.00 0.00 0.00
Other Match 0.00 0.00 0.00
RECEIVING AGENCY SHARE $20,000.00 $16,508.00 $36,508.00
PERFORMING AGENCY SHARE $0.00 $0.00 $0.00
Detail on Indirect Cost Rate Type:
Rate 0.00 Base $0.00 Total $0.00
Budget Justification: Amendment is to extend end term from 02/28/06 to 08/31/06 and budget funds for additional 6 months.
Revised Number to be Served/Units of Service: 25,500
Form No.GC-9 ECPS-Rev. 10/04
Financial status reports are due the 30th of December,30th of March,30th of June,and the 30th of November.
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Page 1 of 2
City of Fort Worth, Texas
Mayor and Council Communication
COUNCIL ACTION: Approved on 9/27/2005 - Ordinance No. 16620-09-2005
DATE: Tuesday, September 27, 2005
LOG NAME: 50LPHSGRANT REFERENCE NO.: **C-21032
SUBJECT:
Authorize Execution of a Contract with the Texas Department of State Health Services, Regional
and Local Services Section/Local Public Health System, for "000" Local Public Health System
Development Funds; Authorize an Interfund Loan; and Adopt Appropriation Ordinance
RECOMMENDATION:
It is recommended that the City Council:
1. Authorize the City Manager to execute a contract with Texas Department of State Health Service
(DSHS) Regional and Local Services Section/Local Public Health System for $20,000.00 to provide
essential public health services from September 1, 2005 to February 28, 2006;
2. Authorize a non-interest bearing interfund loan from the General Fund to the Grants Fund in the
amount of $5,000.00 for the interim financing of this grant pending contract execution to provide for
transition from one grant funding period to the next;
3. Adopt the attached appropriation ordinance increasing estimated receipts and appropriations in the
Grants Fund by $20,000.00; and
4. Waive indirect costs of 10% to allow maximum use of funds for delivery of services to the community.
DISCUSSION:
The Texas Department of State Health Services (DSHS) provides grant funds to local health departments
across the state to provide essential public health services. Upon receipt of this grant the City of Fort Worth
Public Health Department's Health Promotion & Education section will complete a service delivery plan
aimed at increasing awareness of the benefits of regular physical activity and proper nutrition, as they apply
to reducing the risk of developing or dying from some of the leading causes of death and illness i.e. cancer,
high blood pressure and cardiovascular disease to reduce obesity in children and adult populations; to
assist the community in identifying risk behaviors that contribute to the development or increase the burden
of chronic diseases; and to continue fostering Public Health community partnerships by addressing these
essential health functions, as defined by the DSHS including:
1. Inform, educate and empower people about health status; and
2. Mobilize community partnerships to identify and solve health problems
This program serves all COUNCIL DISTRICTS.
http://www.cfwnet.org/council_packet/Reports/mc_print.asp 3/6/2006
Page 2 of 2
FISCAL INFORMATION/CERTIFICATION:
The Finance Director certifies that upon approval of the above recommendations, receipt of the grant and
adoption of the appropriation ordinance, funds will be available in the current operating budget, as
appropriated, of the Grants Fund. Upon execution of the grant contract, the interim inter-fund loan will be
returned to the General Fund.
TO Fund/Account/Centers FROM Fund/Account/Centers
GR76 451923 050301057000 $20,000.00 GG01 136076 0000000 $5,000.00
GR76 220001 000301057000 $5,000.00
GR76 5
(VARIOUS) 050301057010 $20.000.00
Submitted for City Manager's Office by. Joe Paniagua (6140)
Originating Department Head: Daniel Reimer(871.7201)
Additional Information Contact: Susan Whittenberger (871.6658)
http://www.cfwnet.org/council_packeVP,eports/mc_print.asp 3/6/2006