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CONTRACT FOR PUBLIC HEALTH SERVICES DSHS DOCUMENT NO. 7560005286 2006
Contract Issued by: DEPARTMENT OF STATE HEALTH SERVICES DB
(RECEIVING AGENCY) 1100 WEST 49'STREET
AUSTIN,TEXAS 78756-3199
Legal Authority to Contract: Chapters 12 and 121,Health and Safety Code.
Venue: The provisions of this Contract shall be interpreted in accordance with Texas law. Venue for any court disputes shall be in Travis County,
Texas.
PERFORMING AGENCY NAME: FORT WORTH DEPARTMENT OF PUBLIC HEALTH
MAILING ADDRESS: 1800 UNIVERSITY DR FORT WORTH TX 76107-3405
STREET ADDRESS: t800 UNIVERSITY DR FORT WORTH TX 76107-3405
NAME OF AUTHORIZED
CONTRACTING ENTITY: CITY OF FORT WORTH
(If different from PERFORMING AGENCY)
PAYEE DATA(If not the same as PERFORMING AGENCY or AUTHORIZED CONTRACTING ENTITY; must be on file with the Texas State
Comptroller's Office.):
NAME: CITY OF FORT WORTH
ADDRESS: 1000 THROCKMORTON ST FORT WORTH TX 76102-6311
(City,State,Zip)
State of Texas Vendor Identification No.(14 digits) PAYEE AGENCY Fiscal
17560005286051 Year Ending Month: December
PAYEE BUSINESS INFORMATION FOR STATISTICAL REPORTING: Please check the categories that apply to your business.
Small Business-A corporation,sole proprietorship,or other legal entity formed for the purpose of making a profit which is
independently owned and operated and has fewer than 100 employees or has less than$1,000,000 in annual gross receipts.
_ Historically Underutilized Business (HUB) - A corporation, sole proprietorship, or joint venture formed for the purpose of making a
profit in which at least 51%of all classes of the shares of stock or other equitable securities are owned by one or more persons who have
been historically underutilized (socially disadvantaged)because of their identification as members of certain groups: Black American,
Hispanic American, Asian Pacific American, Native American, and Women. The HUB must be certified by Texas Building and
Procurement Commission or another entity.
For Profit Organization
SUMMARY OF CONTRACT DOCUMENTATION:
COVER PAGE 1 -Receiving and Performing Agency Data GENERAL PROVISIONS—6/2004
COVER PAGE 2-Details of Attachment(s) ATTACHMENT(S)
COVER PAGE 3-Authorized Signatures EXHIBITS, IF APPLICABLE
Cover Page I.
k 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'
01 RLSS/LPHS 09/01/05 02/28/06 State 20,000.00 0.00 20,000.00
0000309849
DSHS Document No.7560005286 2006 Totals
$20,000.00 $ 0.00 $20,000.00
*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.
Cover Page 2
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 NAME: RECEIVING AGENCY NAME:
FORT WORTH DEPARTMENT OF PUBLIC DEPARTMENT OF STATE HEALTH
HEALTH SERVICES
By: By:
(Signal of p V
n autho to 4n contracts) (Signature of person authorized to sign contracts)
Joe Paniagua, Assistant City Manager Bob Burnette,Director
Client Services Contractinp,Unit
(Name and Title) (Name and Title)
Date: �/ 1 Date: !D/
RECOMMENDED:
Y
(PERFORMING AGENCY Director,if different
from person authorized to sign contract)
DSHS Document No: 7560005286 2006
Arte'te`113y.
Contract ,author action.
Date
')�aL—HendrLxrty
City Secretary
Cover Page 3
DOCUMENT NO. 7560005286-2006
ATTACHMENT NO. 01
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: February 28, 2006
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY shall improve or strengthen local public health infrastructure within
the State of Texas by:
• Developing objective(s) to address a public health issue;
• Utilizing resources provided through this contract Attachment to conduct activities
and services that provide or support the delivery of essential public health services;
• Assessing, monitoring, and evaluating the essential public health activities and
services provided through this contract Attachment; and
• Developing strategies to improve the delivery of essential public health service(s) to
identified service area.
These tasks shall be performed in accordance with PERFORMING AGENCY'S FY 05Local
Public Health System (LPHS) Service Delivery Plan, dated May 27, 2004.
The assessment and/or evaluation activities must include a standard that is identified in
PERFORMING AGENCY'S FY 05 LPHS Service Delivery Plan. Acceptable standards include
the National Public Health Performance Standards approved by the Centers for Disease Control
and Prevention, Performance Standards developed by the Texas Association of Local Health
Officials, Healthy People 2010, and any federal, state or local law or regulation governing the
delivery of essential public health services. Other evaluation methods utilizing standards not
listed in this contract Attachment must be pre-approved by RECEIVING AGENCY.
PERFORMING AGENCY shall comply with all applicable federal and state laws, rules,
regulations and standards including, but not limited to, the following:
• Chapter 23-11 of the Healthy People 2010;
• Section 121.002, Texas Health & Safety Code, definition of ten essential public health
services; and
• Government Code, Section 403.1055, "Permanent Fund for Children and Public Health".
• Texas Administrative Code, Title 25, Chapter 83, Subchapter A "Permanent Fund for
Children and Public Health".
ATTACHMENT—Page 1
PERFORMING AGENCY shall comply with all applicable regulations, standards, and
guidelines in effect on the beginning date of this contract Attachment.
PERFORMING AGENCY may not use funds from the Permanent Fund for Children and Public
Health for lobbying expenses under the Government Code, Section 403.1067.
RECEIVING AGENCY shall inform PERFORMING AGENCY in writing of any changes to
applicable federal and state laws, rules, regulations, standards and guidelines. PERFORMING
AGENCY shall comply with the amended law, rule, regulation, standard or guideline except that
PERFORMING AGENCY shall inform RECEIVING AGENCY Program in writing if it shall
not continue performance under this contract Attachment within thirty (30) days of receipt of an
amended standard(s) or guideline(s). RECEIVING AGENCY may terminate the contract
Attachment immediately or within a reasonable period of time as determined by RECEIVING
AGENCY.
PERFORMANCE NIEASURES
PERFORMING AGENCY shall complete the PERFORMANCE MEASURES as stated in the
FY05 LPHS Service Delivery Plan, and as agreed upon by RECEIVING AGENCY, and hereby
attached as Exhibit A.
PERFORMING AGENCY shall continue performing activities from the FY 2005 Service
Delivery Plan during the period from September 1, 2005 through amendment of this contract
Attachment. To the extent that the FY 2005 Service Delivery Plan contained quantifiable
deliverables, PERFORMING AGENCY shall produce a pro-rated number of these deliverables
during the period from September 1, 2005 through amendment of this contract Attachment.
PERFORMING AGENCY shall provide activities and services as submitted by PERFORMING
AGENCY and approved by RECEIVING AGENCY in the FY06 LPHS Service Delivery Plan in
the following county(ies)/area: Tarrant.
SECTION II. SPECIAL PROVISIONS:
General Provisions, Reports Article, is revised to include the following paragraphs:
PERFORMING AGENCY shall submit quarterly progress reports which describe progress
toward completing the activities and services contained in PERFORMING AGENCY'S
FY06 LPHS Service Delivery Plan and any written revisions. PERFORMING AGENCY
shall submit the first, second and third quarter's progress reports to RECEIVING AGENCY
no later than thirty (30) days after the end of each quarter, and the final report and
improvement plan to RECEIVING AGENCY sixty (60) days after the end of this contract
Attachment term in a format specified by RECEIVING AGENCY.
ATTACHMENT—Page 2
PERFORMING AGENCY shall submit an Annual Budget and Expenditures Report in a
format specified by and to RECEIVING AGENCY by December 15, 2005.
ATTACHMENT—Page 3
SECTION 111. BUDGET:
PERSONNEL $11,232.00
FRINGE BENEFITS 2,808.00
TRAVEL 60.00
EQUIPMENT 0.00
SUPPLIES 5,900.00
CONTRACTUAL 0.00
OTHER 0.00
TOTAL $20,000.00
Total reimbursements will not exceed $20,000.00.
Financial status reports are due the 30th of December, and the 30th of May.
ATTACHMENT—Page 4
Exhibit A
PERFORMANCE MEASURES:
PERFORMING AGENCY: City of Fort Worth Public Health Department
Essential Public Health Services
Objective 1.1: PERFORMING AGENCY shall facilitate increased awareness of
community-based nutrition and physical activity programs.
Performance Measure 1.1: Publish and distribute community-based nutrition
and physical activity program information for partners, as well as general
audiences.
Objective 1.2: PERFORMING AGENCY shall develop partnership with
business community.
Performance Measure 1.2: Recruit 10 business partners who agree to implement
physical activity and/or nutrition programs with their employees.
Objective 1.3: PERFORMING AGENCY shall develop partnerships with faith-
based community.
Performance Measure 1.3: Recruit 12 faith-based partners who agree to
implement physical activity and/or nutrition programs with their congregations.
Objective 1.4: PERFORMING AGENCY shall develop partnership with
educational community.
Performance Measure 1.4: Recruit 3 education partners who agree to
implement physical activity and/or nutrition programs with their faculty, staff, and
students/partners.
Essential Public Health Threats
Objective 1.1: PERFORMING AGENCY shall provide the public with
information on the presence of pathogens in drinking water and dairy products.
Performance Measure 1.1: The laboratory will provide a minimum of 36,000
water and dairy tests.
Objective 1.2: PERFORMING AGENCY shall provide the department with
rapid turn-around on all tests performed.
Exhibit A—Page I
Performance Measure 1.2: The lab will meet turn-around standards a minimum
of 95% of the time.
Objective 1.3: PERFORMING AGENCY shall provide the public and clinicians
with tests on blood lead levels and presence of air contaminants.
Performance Measure 1.3: The laboratory will provide a minimum of 15,000
blood and environmental lead and air pollution tests.
Objective 1.4: PERFORMING AGENCY shall provide the public with
information about contaminants in drinking water.
Performance Measure 1.4: The laboratory will provide a minimum of 33,000
water chemistry tests.
Objective 1.5: PERFORMING AGENCY shall provide the department's clinical
patients and staff with clinical chemistry and hematology tests.
Performance Measure 1.5: The laboratory will provide a minimum of 87,000
clinical chemistry and hematology tests.
Objective 1.6: PERFORMING AGENCY shall provide the department's clinical
patients and staff with serological tests for maternity and STD.
Performance'Measure 1.6: The laboratory will provide a minimum of 20,000
serological tests for maternity and STD clients.
Objective 2: PERFORMING AGENCY shall ensure the community's health and
safety through increased awareness of health risks from the use of tobacco.
Performance Measure 2: 10 high schools, 32 middle and elementary schools
will participate in anti-tobacco education services.
Objective 3: PERFORMING AGENCY shall collect and analyze data from 700
women on barriers to prenatal care.
Performance Measure 3: 1) Establish follow-up system for cases of hepatitis B
and C, and 2) Develop partnerships with at least three organizations including
advocacy, treatment and prevention groups.
Exhibit A—Page 2
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 12/6/2005
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 $20,000.00
(VARIOUS) 050301057010
Submitted for City Manager's Office bv: Joe Paniagua (6140)
Originating Department Head: Daniel Reimer (871.7201)
Additional Information Contact: Susan Whittenberger (871.6658)
http://www.cfwnet.org/council_packet/Reports/mc_print.asp 12/6/2005