HomeMy WebLinkAboutRES 18-107RESOLUTION NO. 18-107
BE IT RESOLVED BY THE CITY COUNCIL
OF THE CITY OF BEAUMONT:
THAT the City Manager, or his designee, be and they are hereby authorized to execute
an amendment to the Contract between the City of Beaumont and the Texas
Department of State Health Services (DSHS) for the Public Health Emergency
Preparedness (PHEP) Grant to assist the Beaumont Public Health Department's Public
Health Emergency Preparedness Program with planning and performing activities and
services that will improve and strengthen the local public health infrastructure within the
State of Texas. The agreement, as amended, is substantially in the form attached
hereto as Exhibit "A" and made a part hereof for all purposes.
The meeting at which this resolution was approved was in all things conducted in
strict compliance with the Texas Open Meetings Act, Texas Government Code, Chapter
551.
PASSED BY THE CITY COUNCIL of the City of Beaumont this the 15th day of
May, 2018.
s
rm
�Uyor Becky Ames —
DocuSign Envelope ID: 558C83BB-61 BA-4382-AED491575CE543D9
DEPARTMENT OF STATE HEALTH SERVICES
CONTRACT No. 537-18-0161-00001
AMENDMENT No. 01
RENEWAL
The DEPARTMENT OF STATE HEALTH SERVICES ("System Agency") and BEAUMONT PUBLIC
HEALTH DEPARTMENT ("Grantee"), who are collectively referred to herein as the "Parties" or
singularly as the "Party" herein, to that certain grant Contract effective July 1, 2017, and
denominated DSHS Contract No. 537-18-0161-00001, now desire to amend the Contract.
WHEREAS, System Agency has elected to extend the term of the Contract in accordance with
Section III of the Contract Signature Document to allow for continued support of the project;
WHEREAS, the Parties desire to correct the numbering in the Contract Signature Document;
WHEREAS, the Parties desire to specify the legal authority;
WHEREAS, the Parties desire to revise the Budget to add funds for the Contract period
beginning July 1, 2018 through June 30, 2019 (hereinafter referred to as "Fiscal Year 2019" or
"FY2019");
WHEREAS, the Parties desire to revise the Fiscal Year 2018 Statement of Work; and
WHEREAS, the Parties desire to add the FY2019 Statement of Work.
Now, THEREFORE, the Parties hereby amend and modify the Contract as follows:
1. The section numbering in the Contract's Signature Document is hereby corrected to reflect
a sequential order..
2. Section H of the Signature Document, LEGAL AUTHORITY is hereby amended to provide
as follows: This Contract is authorized by and in compliance with the provisions under the
authority of the Texas Government Code Chapter 791.
3. SECTION 1H of the Signature Document, DURATION is hereby amended to reflect a revised
termination date of June 30, 2019.
4. SECTION IV of the Signature Document, BUDGET, is hereby amended to add ONE
HUNDRED FORTY-FIVE THOUSAND THREE HUNDRED NINETY-EIGHT DOLLARS
($145,398.00) in federal funding with the Grantee providing a total of FOURTEEN
THOUSAND FIVE HUNDRED THIRTY-EIGHT DOLLARS ($14,538.00) in match funds for a
total Contract amount not to exceed of Two HUNDRED NINETY THOUSAND SEVEN
HUNDRED NINETY-SIX DOLLARS ($290,796.00). All expenditures under the Contract will
be in accordance with the revised budget set forth herein. Funds provided in support of one
Contract activity may only be used for that activity and may not be comingled with other
funds provided under this Contract.
System Agency Contract No. 537-18-0161-00001 Page 1 of 4
EXHIBIT "A"
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5. SECTION VI of the Signature Document, LEGAL. NOTICES, is amended to replace the
System Agency information in its entirety with the following:
Department of State Health Services
Attention: General Counsel
1100 W. 49th Street, MC 1911
Austin, TX 78756
6. SECTION VII of the Signature Document, ADDITIONAL GRANT INFORMATION, is
supplemented with the following grant information:
Federal Award Identification Number (FAIN): 1 NU90TP921879-01-00
Awarding Official Contact Information:
Stephany Vento
1600 Clifton Road, MS D29
DSLR
Atlanta, GA 30329
Phone: 404-960-9023
DUNS: 073901118
7. The Parties agree to add the following new Section VIII to the Signature Document:
VIII. NOTICE TO PROCEED
Funding for this Contract is dependent on the award of the applicable federal grant. No FY
2019 work may begin and no charges may be incurred until the System Agency issues a
written notice to proceed to Grantee. This Notice to Proceed, may include an amended or
ratified budget which will be incorporated into this Contract by a subsequent amendment,
as necessary. Notwithstanding the preceding, at the discretion of the System Agency,
Grantee maybe eligible to receive reimbursement for eligible expenses incurred during the
period of performance as defined by 2 CFR §200.309.
8. ATTACHMENT A - STATEMENT OF WORK, is deleted in its entirety, and replaced with
ATTACHMENT A.1 - FY2018 STATEMENT OF WORK.
System Agency Contract No. 537-18-0161-00001 Page 2 of 41
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9. ATTACHMENT B, BUDGET is hereby amended by deleting the budget table in its entirety
and replacing it with the following:
Budget
Categories
FY18
Budget
Summary
(7/1/17—
(7/1/17-
6/30/18
FY19 Budget
Summary
7/1/18—
(7/1/18—
6/30/19)
Total Budget
Summary
Personnel
$67,725.00
$67,887.00
$135,612.00
Fringe Benefits
$42,077.00
$44,072.00
$86,149.00
Travel
$15,029.00
$18,236.00
$33,265.00
Equipment
$0.00
$0.00
$0.00
Supplies
$18,096.00
$14,637.00
$32,733.00
Contractual
$0.00
$0.00
$0.00
Other
$17,016.00
$15,104.00
$32,120.00
Sum' of Direct
Costs
$159,943.00
$159,936.00
$319,879.00
Indirect Costs
$0.00
$0.00
$0.00
Sum of Total
Direct Costs and
Indirect Costs
$159,943.00
$159,936.00
$319,879.00
Less Match (Cash
or In -Kind
$14,545.00
$14,538.00
$29,083.00
TOTAL
$145,398.00
$145,398.00
$290,796.00
It is agreed that Grantee shall provide matching funds in the amount of $29,083.00.
10. The Parties agree to add ATTAcHmEENT A.2, FY2019 STATEMENT OF WORK, which is
attached to this Amendment and incorporated into the Contract as if fully set forth therein.
11. This Amendment No. 01 shall be effective as of the date last signed below.
12. Except as amended and modified by this Amendment No. 01, all terms and conditions of
the Contract, shall remain in full force and effect.
13. Any further revisions to the Contract shall be by written agreement of the Parties.
SIGNATURE PAGE FOLLOWS
System Agency Contract No. 537-18-0161-00001 Page 3 of 4
DocuSign Envelope ID: 558C831313-61 BA-4382-AED4-91575CE543D9
SIGNATURE PAGE FOR AMENDMENT NO. 01
SYSTEM AGENCY CONTRACT No. 537-18-0161-00001
TEXAS DEPARTMENT OF STATE HEALTH BEAUMONT PUBLIC HEALTH DEPARTMENT
SERVICES
David Gruber
LE
Name:
Associate Commissioner Title:
Division for Regional and Local Health
Operations
Date of Execution: Date of Execution:
ARTICLE 1: THE FOLLOWING ATTACHMENTS ARE ATTACHED AND INCORPORATED AS PART
OF THE CONTRACT:
ATTACHMENT A.1 - FY2018 STATEMENT OF WORK
ATTACHMENT A.2 - FY2019 STATEMENT OF WORK
ATTACHMENT C- FFATA
System Agency Contract No. 537-18-0161-00001 Page 4 of 4
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ATTACHMENT A.1
STATEMENT OF WORK
Upon Execution through June 30, 2018
I. GRANTEE RESPONSIBILITIES
Grantee will:
A. Perform activities in support of the PHEP Cooperative Agreement from the Centers for
Disease Control and Prevention (CDC) to align PREP and Hospital Preparedness Programs
(BPP) and advance public health and healthcare preparedness.
B. Perform the activities required under this Contract in the following county: .Jefferson
County.
C. Provide System Agency with situational awareness data generated through interoperable
networks of electronic data systems.
D. Address the following public health preparedness capabilities:
1. Capability 1— Community Preparedness is the ability of communities to prepare for, .
withstand, and recover — in both the short and long terms — from public health
incidents.
2. Capability 2 — Community Recovery is the ability to collaborate with community
partners (e.g., healthcare organizations, business, education, and emergency
management), to plan and advocate for the rebuilding of public health, medical, and
mental/behavioral health systems to at least a level of functioning comparable to pre -
incident levels and improved levels where possible.
3. Capability 3 — Emergency Operations Center Coordination is the ability to direct and
support an event or incident with public health or medical implications by
establishing a standardized, scalable system of oversight, organization, and
supervision consistent with jurisdictional standards and practices with the National
Incident Management System.
4. Capability 4 — Emergency Public Information and Warning is the ability to develop,
coordinate, and disseminate information, alerts, warnings, and notifications to the
public and incident management responders.
5. Capability 5 — Fatality Management is the ability to coordinate with other
organizations (e.g., law enforcement, healthcare, emergency management, and
medical examiner/coroner) to ensure the proper recovery, handling, identification,
transportation, tracking, storage, and disposal of human remains and personal effects;
certify cause of death; and facilitate access to mental/behavioral health services to the
family members, responders, and survivors of an incident.
6. Capability 6 — Information Sharing is the ability to conduct multijurisdictional,
multidisciplinary exchange of health-related information and situational awareness
data among federal, state, local, territorial, and tribal levels of government, and the
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ATTACHMENT A.1
STATEMENT OF WORK
Upon Execution through June 30, 2018
private sector. This capability includes the routine sharing of information as well as
issuing of public health alerts to federal, state, local, territorial, and tribal levels of
government and the private sector in preparation for and in response to events or
incidents of public health significance.
7. Capability 7 — Mass Care is the ability to coordinate with partner agencies to address
the public health, medical, and mental/behavioral health needs of those impacted by
an incident at a congregate location. This capability includes the coordination of
ongoing surveillance and assessment to ensure that local health needs continue to be
met as the incident evolves.
8. Capability 8 — Medical Countermeasure Dispensing is the ability to provide medical
countermeasures (including vaccines, antiviral drugs, antibiotics, antitoxin, etc.) in
support of treatment or prophylaxis (oral or vaccination) to the identified population
in accordance with public health guidelines and/or recommendations.
9. Capability 9 — Medical Materiel Management and Distribution is the ability to
acquire, maintain (e.g., cold chain storage or other storage protocol), transport,
distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and
ventilators) during an incident and to recover and account for unused medical
materiel, as necessary, after an incident.
10. Capability 10 — Medical Surge is the ability to provide adequate medical evaluation
and care during events that exceed the limits of the normal medical infrastructure of
an affected community. It encompasses the ability of the healthcare system to survive
a hazard impact and maintain or rapidly recover operations that were compromised.
11. Capability 11—Non-Pharmaceutical Interventions is the ability to recommend to the
applicable lead agency (if not public health) and implement, if applicable, strategies
for disease, injury, and exposure control. Strategies include the following: isolation.
and quarantine; restrictions on movement and travel advisory/warnings; social
distancing; external decontamination; hygiene; and precautionary behaviors.
12. Capability 12 — Public Health Laboratory Testing is the ability to conduct rapid and
conventional detection, characterization, confirmatory testing, data reporting,
investigative support, and laboratory networking to address actual or potential
exposure to all -hazards. Hazards include chemical, radiological, and biological, and
biological agents in multiple matrices that may include clinical samples, food, and
environmental samples (e.g., water, air, and soil). This capability supports routine
surveillance, including pre -event incident and post -exposure activities.
13. Capability 13 — Public Health Surveillance and Epidemiological Investigations is the
ability to create, maintain, support, and strengthen routine surveillance and detection
systems and epidemiological investigation processes, as well as to expand* these
systems and processes in response to incidents of public health significance:
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ATTACHMENT A.1
STATEMENT OF WORK
Upon Execution through June 30, 2018
14. Capability' 14 — Responder Safety and Health describes the ability to protect public
health agency staff responding to an incident and the ability to support the health and
safety needs of hospital and medical facility personnel, if requested.
15. Capability 15 —Volunteer Management is the ability to coordinate the identification,
recruitment, registration, credential verification, training, and engagement of
volunteers to support the jurisdictional public health agency's response to incidents
of public health significance.
E. Match funds awarded under this Contract with costs or third -party contributions that are not
paid by the federal government under another award, except where authorized by federal
- statute to be used for cost sharing or matching. The non-federal contributions (match) may
be provided directly or through donations from public or private entities and may be in cash
or in-kind donations, fairly evaluated, including plant, equipment, or services. The costs that
the Grantee incurs in fulfilling the matching or cost-sharing requirement are subject to the
same requirements, including the cost principles, that are applicable to the use of Federal
funds, including prior approval requirements and other rules for allowable costs as described
in 45 CFR 74.23 and 45 CFR 92.24, as amended.
Grantee will provide matching in the amount of at least ten percent (10%) of the allocation
amount. Cash match is defined as an expenditure of cash by the Grantee on allowable costs
of this Contract that are borne by the Grantee. In-kind match is defined as the dollar value of
non-cash contributions by a third party given in goods, commodities, or services that are used
in activities that benefit this Contract's project and that are contributed by non-federal third
parties without charge to the Grantee. The criteria for match must:
1. Be an allowable cost under the applicable federal cost principle;
2. Be necessary and reasonable for the efficient accomplishment of project or program
objectives;
3. Be verifiable within the Grantee's (or subcontractor's) records;
4. Be documented, including methods and sources, in the approved budget (applies only
to cost reimbursement contracts);
5. Not be included as contributions toward any other federally -assisted project or
program (match can count only once);
6. Not be paid by the federal government under another award, except where authorized
by federal statute to be used for cost sharing or match;
7. Conform to other provisions of governing circulars/statutes/regulations as applicable
for the Contract;
8. Be adequately documented;
9. Follow procedures for generally accepted accounting practices as well as meet audit
requirements; and
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ATTACHMENT A.1
STATEMENT OF WORK
Upon Execution through June 30, 2018
10. Value the in-kind contributions reported and must be supported by documentation
reflecting the use of goods and/or services during the Contract term.
F. In the event of a public health emergency involving a portion of the state, mobilize and
dispatch staff or equipment purchased with funds from previous PHEP cooperative
agreements and not currently performing critical duties in the jurisdiction served, to the
affected area of the state upon receipt of a written request from System Agency.
G. Inform System Agency in writing if Grantee will not continue performance under this
Contract within 3 0 days of receipt of an amended standard(s) or guideline(s). System Agency
may terminate this Contract immediately or within a reasonable period of time as determined
by System Agency.
H. Develop, implement and maintain a timekeeping system for accurately documenting staff
time and salary expenditures for all staff funded through this Contract, including partial full-
time employees and temporary staff.
I. Complete and submit programmatic reports as directed by System Agency in a format
specified by System Agency. Due dates will be listed in the most current System Agency
reporting schedule, to be released within thirty (30) days of the Contract start date. Grantee
will provide System Agency other reports, including financial reports, that System Agency
determines necessary to accomplish the objectives of this Contract and to monitor
compliance.
J. Submit Performance Measures to System Agency within an established timeframe designated
by System Agency as required by the CDC.
K. Submit the work plan that encompasses the Contract term, due to System Agency within an
established timeline designated by System Agency.
L. Conduct, or participate in, an annual Training and Exercise Planning Workshop (TEPW)
with all applicable agencies in accordance with Homeland Security Exercise and Evaluation
Program (HSEEP) guidelines to develop a strategy and structure for a multi-year Training
and Exercise Plan (TEP). Prepare, maintain, and upon request, submit a copy of the TEPW
agenda and participant roster as documentation of TEPW attendance.
M. Submit a current Multi -Year Training & Exercise Plan that covers FYI through FY23 (July
1, 2017, through June 30, 2022) to System Agency within an established timeframe
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ATTACHMENT A.1
STATEMENT OF WORK
Upon Execution through June 30, 2018
designated by System Agency, using the template provided by System Agency.
N. Conduct, or participate in, at least one annual Preparedness Exercise consistent with their
TEP. Submit a Notification of Exercise (NOE) form to the System Agency Preparedness
Exercise inbox atpreparednessexercisegdshs.texas.gov no later than sixty (60) days prior to
the start of the exercise.
O. Submit at least one (1) After Action Review/Improvement Plan (AAR/IP). All AAR/IPs
must be submitted to the System Agency Preparedness Exercise inbox,
preparednessexercisendshs.texas.gov within sixty (60) days of the completion of the
exercise to System Agency Exercise Team and no later than June 30, 2018. AAR%IPs must
be completed in accordance with the System Agency Exercise Guide.
P. Complete and submit the Operational Readiness Review (ORR) and all supporting
documents provided by System Agency to System Agency SNS SharePoint twenty (20)
business days prior to review.
1. Provide updated Point of Dispensing (POD) standards data for submission to System
Agency SNS SharePoint by April 1, 2018;
2. Perform and submit metrics on each of the three (3) SNS operation drills (at pre-
identified POD locations and existing call down rosters) and submit After Action
Reviews/Improvements sixty (60) days after completion of the drill or by April 1,
2018 to the preparednessexercise@dshs.texas.gov inbox. Acceptable drills include:
a. Staff Call Down;
b. Facility Set-up; and"
c. POD Activation.
Q. Submit the Mid -Year Report due to System Agency within an established timeframe
designated by System Agency.
R. Complete an End -Of -Year Performance Report in a format specified by System Agency
no later than August 15, 2018.
S. Designate a member of the PHEP program to attend, in person, three (3) PREP quarterly
meetings during the Contract term. If the designee is unable to attend any of the meetings in
person, the Grantee must notify System Agency in writing as to the reason for non-
compliance.
T. Designate a member of the PHEP program to attend, in person, four regional healthcare
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ATTACHMENT A.1
STATEMENT OF WORK
Upon Execution through June 30, 2018
coalition meetings during the term of the Contract from July 1, 2017, to June 30, 2018.
Submit sign -in sheets from meetings as evidence of attendance.
U. Immediately notify System Agency in writing if Grantee is legally prohibited fromproviding
any report under this Contract.
V. Use the Texas ,Disaster Volunteer Registry (TDVR), which is Texas' version of the
Emergency System for the Advanced Registration of Volunteer Health Professionals (ESAR-
VHP), as their main volunteer management tool, if utilizing Medical Reserve Corps or other
volunteer groups. If Grantee uses volunteers as provided in the Section, the Grantee must
either:
1. Request access to the TDVR from the State ESAR-VHP System Administrator, enter
all volunteer data into the system using the Intermedix Data Input Form, and submit
the form to the State ESAR-VHP System Administrator; or
2. Petition System Agency in writing for an exemption from using the TDVR.
Successful petitioners must be currently using a fully operational, ESAR-VHP-
compliant, web -based volunteer management.system. If petitioning System Agency
to use a fully operational, ESAR-VHP-compliant, web-bas6d volunteer management
system, then the substitute system must meet, but is not limited to, the following
federal requirements:
a. Must offer Internet -based registration;
b. Volunteer information is collected and maintained in a manner consistent
with all federal, state and local laws governing security and
confidentiality;
c. Must be able to register and collect the credentials and qualifications of
health professionals that are then verified with the issuing entity or
appropriate authority;
d. Must be able to verify the credentials of the 20 mandated professions;
e. Must be able to assign to one of four emergency credential levels;
f. Must be able to identify volunteers willing to participate in a federally
coordinated emergency response;
g. Must be able to re -verify professional credentials every 6 months;
h. Must have the ability to include the differing scope of work information
for each of the 20 mandated professions;
i. Must be able to record all volunteer health professional affiliations; and
j. Must be able to verify that all volunteers across all credential levels not .
be included on the U.S. Department'of Health and Human Services,
Office of the Inspector General's List of Excluded Individuals/Entities
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ATTACHMENT A.1
STATEMENT OF WORK
Upon Execution through June 30, 2018
(LEIS).
k. Additionally, the fully operational, ESARNHP-compliant, web -based
volunteer management system must be able to register, collect, and verify
the credentials and qualifications of the health professionals entered into
the system.
W. Grantee may not use funds for research, clinical care, fund-raising activities or lobbying,
construction or major renovations, reimbursement of pre -award costs, to supplant existing
state or federal funds for activities, payment or reimbursement of backfilling costs for staff,
purchase of vehicles of any kind, or funding an award to another parry or provider who is
ineligible.
X. Cooperate'with System Agency to coordinate all planning, training and exercises performed
under this Contract with local emergency management and the Texas Division of Emergency
Management (TDEM) District Coordinators assigned to the Grantee's sub -state region, to
ensure consistency and coordination of requirements at the local level and eliminate
duplication of effort between the various domestic preparedness funding sources in the state.
Y. Coordinate all risk communication activities with the System Agency Communications Unit
by using System Agency's core messages posted on the System Agency website, and
submitting copies of draft risk communication materials to System Agency for coordination
prior to dissemination.
Z. Initiate the purchase of approved equipment no later than June 30, 2018, as documented by
issue of apurchase order or written order confirmation from the vendor on or before June 30,
2018. In addition, all equipment and supplies must be received not later than 45 calendar
days following the end of the Contract term.
A.A. Comply with all applicable federal and state laws, rules, and regulations including, but not
limited to, the following:
1. Public Law 107-188, Public Health Security and Bioterrorism Preparedness and
Response Act of 2002;
2. Public Law 113-05, Pandemic and All -Hazards Preparedness Reauthorization Act;
and
3. Texas Health and Safety Code Chapter 81.
BB. Comply with all applicable regulations, standards and guidelines in effect on the beginning
date of the Term of this Contract.
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ATTACHMENT A.1
STATEMENT OF WORK
Upon Execution through June 30, 2018
CC. Submit a current Texas Preparedness and Evaluation Process (TxPEP) report to System
Agency within an established timeframe designated by System Agency, using the template
provided by System Agency.
DD. Submit a report on the Jurisdiction's vulnerable population outreach activities to System
Agency within an established timeframe designated by System Agency, using a template
provided by System Agency.
EE. Work with the Regional Health Care Coalition to develop comprehensive preparedness
strategies. Plans will be submitted to DSHS by the Health Care Coalition.
H. PERFORMANCE MEASURES
System Agency will monitor the Grantee's performance. of the requirements and compliance with the
Contract's terms and conditions. Grantee must demonstrate adherence to PHEP reporting deadlines
and the capability to receive, stage, store, distribute, and dispense materiel during a public health
emergency. Failure to meet these requirements may result in withholding a portion of the current
PHEP base awards.
The initial reporting requirement schedule for the requirements is subject to change as System
Agency and CDC may modify requirements and due dates. System Agency will send Grantee a
requirements schedule within thirty (30) days of the Contract start date.
M. INVOICE AND PAYMENT
A. Grantee will request payment using the State of Texas Purchase Voucher (Form B-13) on a
monthly basis and acceptable supporting documentation for reimbursement of the required
services/deliverables. Additionally, the Grantee will submit the Financial Status Report
(FSR -269A) and the Match Certification Form (B -13A). Vouchers, supporting
documentation, Financial Status Reports, and Match Certification Forms should be mailed or
emailed to the addresses below.
Department of State Health Services
Claims'Processing Unit, MC 1940
1100 West 49th Street
P.O. Box 149347
Austin, TX 78714-9347
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ATTACHMENT A.1
STATEMENT OF WORK
Upon Execution through June 30, 2018
FAX: (512) 458-7442
EMAI invoiceskdshs.texas.gov, Php.vouchersupportkdshs.texas.gov &
CMSInvoicesna,dshs.texas. gov
B-13, B -13A, and supporting documentation should be sent to: invoicesndshs.texas.gov,
Php.vouchersupportgdshs.texas.gov & CMSInvoiceskdshs.texas. ov
FSRs should be sent to: invoices@dshs.texas.gov, Php.vouchersupport@a,dshs.texas.gov,
FSRGrantsndshs.texas.gov & CMSInvoices@dshs.texas.gov
B. Grantee will be paid on a monthly basis and in accordance with Attachment B, Budget.
C. System Agency reserves the right, where allowed by legal authority, to redirect funds in the
event of financial shortfalls. System Agency will monitor Grantee's expenditures on a
quarterly basis. If expenditures are below that projected in Grantee's total Contract amount,
Grantee's budget may be subject to a decrease for the remainder of the Term of the Contract.
Vacant positions existing after ninety -days may result in a decrease in funds.
D. Grantee may request a one-time working capital advance not to exceed 12% of the total
amount of the Contract funded by DSHS. All advances must be expended by the end of the
Contract term. Advances not expended by the end of the Contract term must be refunded to
DSHS.
Grantee will repay all or part of advance funds at any time during the Contract's term.
However, if the advance has not been repaid prior to the last three months of the Contract
term, the Grantee must deduct at least one-third of the remaining advance from each of the
last three months' reimbursement requests. If the advance is not repaid prior to the last three
months of the Contract term, DSHS will reduce the reimbursement request.by one-third of
the remaining balance of the advance.
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ATTACHMENT A.2
STATEMENT OF WORK
July 1, 2018 through June 30, 2019
I. GRANTEE RESPONSIBILITIES
Grantee will:
A. Perform activities in support of the PHEP Cooperative Agreement from the Centers for
Disease Control and Prevention (CDC) to align PHEP and Hospital Preparedness Programs
(HPP) and advance public health and healthcare preparedness.
B. Perform the activities required under this Contract in the following county: Jefferson County.
C.' Provide System Agency with situational awareness data generated through interoperable
networks of electronic data systems.
D. Address the following public health preparedness capabilities:
1. Capability 1— Community Preparedness is the ability of communities to prepare for,
withstand, and recover — in both the short and long terms — from public health
incidents.
2. Capability 2 — Community Recovery is the ability to collaborate with community
partners (e.g., healthcare organizations, business, education, and emergency
management) to plan and advocate for the rebuilding of public health, medical, and
mentalibehavioral health systems to at least a level of functioning comparable to pre -
incident levels and improved levels where possible.
3. Capability 3 — Emergency Operations Center Coordination is the ability to direct and
support an event or incident with public health or medical implications by
establishing a standardized, scalable system of oversight, organization, and
supervision.consistent with jurisdictional standards and practices with the National
Incident Management System.
4. Capability 4 — Emergency Public Information and Warning is the ability to develop,
coordinate, and disseminate information, alerts, warnings, and notifications to the
public and incident management responders.
5. Capability 5 — Fatality Management is the ability to coordinate with other
organizations (e.g., law enforcement, healthcare, emergency management, and
medical examiner/coroner) to ensure the proper recovery, handling, identification,
transportation, tracking, storage, and disposal of human remains and personal effects;
certify cause of death; and facilitate access to mental/behavioral health services to the -
family members, responders, and survivors of an incident.
6. Capability 6 — Information Sharing is the ability to conduct multijurisdictional,
multidisciplinary exchange of health-related information and situational awareness
data among federal, state, local, territorial, and tribal levels of government, and the
private sector. This capability includes the routine sharing of information as well as
System Agency Contract No. 537-18-0161-00001
v. 11.15.2016 Page 1
DocuSign Envelope ID: 558C83BB-61BA-4382-AED4-91575CE543D9
ATTACHMENT A.2
STATEMENT OF WORK
July 1, 2018 through June 30, 2019
issuing of public health alerts to federal, state, local, territorial, and tribal levels of
government and the private sector in preparation for and in response to events or
incidents of public health significance.
7. Capability 7 — Mass Care is the ability to coordinate with partner agencies to address
the public health, medical, and mental/behavioral health needs of those impacted by
an incident at a congregate location. This capability includes the coordination of
ongoing surveillance and assessment to ensure that local health needs continue to be
met as the incident evolves.
8.-, Capability 8 — Medical Countermeasure Dispensing is the ability to provide medical
countermeasures (including vaccines, antiviral drugs, antibiotics, antitoxin, etc.) in
support of treatment or prophylaxis (oral or vaccination) to the identified population
in accordance with public health guidelines and/or recommendations.
9. Capability 9 — Medical Materiel Management and Distribution is the ability to
acquire, maintain (e.g., cold chain storage or other storage protocol), transport,
distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and
ventilators) during an incident and to recover and account for unused medical
materiel, as necessary, after an incident.
10. Capability 10 — Medical Surge is the ability to provide adequate medical evaluation
and care during events that exceed the limits of the normal medical infrastructure of
an affected community. It encompasses the ability of the healthcare system,to survive
a hazard impact and maintain or rapidly recover operations that were compromised.
11. Capability 11—Non-Pharmaceutical Interventions is the ability to recommend to the
applicable lead agency (if not public health) and implement, if applicable, strategies
for disease, injury, and exposure control. Strategies include the following: isolation
and quarantine; restrictions on movement and travel advisory/warnings; social
distancing; external decontamination; hygiene; and precautionary behaviors.
12. Capability 12 — Public Health Laboratory Testing is the ability to conduct rapid and
conventional detection, characterization, confirmatory testing, data reporting,
investigative support, and laboratory networking to address actual or potential
exposure to all -hazards. Hazards include chemical, radiological, and biological, and
biological agents in multiple matrices that may include clinical samples, food, and
environmental samples (e.g., water, air, and soil). This capability supports routine
surveillance, including pre -event incident and post -exposure activities.
13. Capability 13 — Public Health Surveillance and Epidemiological Investigations is the
ability to create, maintain, support, and strengthen routine surveillance and detection
systems and epidemiological investigation processes, as well as to. expand these
systems and processes in response to incidents of public health significance.
14. Capability 14 — Responder Safety and Health describes the ability to protect public
System Agency Contract No. 537-18-0161-00001
v. 11.15.2016 Page 2
DocuSign Envelope ID: 558C83BB-61 BA-4382-AED4-91575CE543D9
ATTACHMENT A.2
STATEMENT OF WORK
July 1, 2018 through June 30,'2019
health agency staff responding to an incident and the ability to support the health and
safety needs of hospital and medical facility personnel, if requested.
15. Capability 15 — Volunteer Management is the ability to coordinate the identification,
recruitment, registration, credential verification, training, and engagement of
volunteers to support the jurisdictional public health agency's response to incidents
of public health significance.
E. Match funds awarded under this Contract with costs or third -party contributions that are not
paid by the federal government under another award, except where authorized by federal
statute to be used for cost sharing or matching. The non-federal contributions (match) may
be provided directly or through donations from public or private entities and may be in cash
or in-kind donations, fairly evaluated, including plant, equipment, or services. The costs that
the Grantee incurs in fulfilling the matching or cost-sharing requirement are subject to the
same requirements, including the cost principles, that are applicable to the use of Federal
funds, including prior approval requirements and other rules for allowable costs as described
in 45 CFR 74.23 and 45 CFR 92.24, as amended.
Grantee will provide matching in the amount of at least ten percent (10%) of the allocation
amount. Cash match is defined as an expenditure of cash by the Grantee on allowable costs
of this Contract that are borne by the Grantee. In-kind match is defined as the dollar value of
non-cash contributions by a third party given in goods, commodities, or services that are used
in activities that benefit this Contract's project and that are contributed by non-federal third
parties without charge to the Grantee. The criteria for match must:
1. Be an allowable cost under the applicable federal cost principle;
2. Be necessary and reasonable for the efficient accomplishment of project or program
objectives;
3. Be verifiable within the Grantee's (or subcontractor's) records;
4. Be documented, including methods and sources, in the approved budget (applies only
to cost reimbursement contracts);
5. Not be included as contributions toward anyother federally -assisted project or
program (match can count only once);
6. Not be paid by the federal government under another award, except where authorized
by federal statute to be used for cost sharing or match;
7. Conform to other provisions of governing circulars/statutes/regulations as applicable
for the Contract;
8. Be adequately documented;
9.' Follow procedures for generally accepted accounting practices as well as meet audit
requirements; and ,
10. Value the in-kind contributions reported and must be supported by documentation
System Agency Contract No. 537-18-0161-00001
v. 11.15.2016 Page 3
DocuSign Envelope ID: 558C83BB-61BA-4382-AED4-91575CE543D9
ATTACHMENT A.2
STATEMENT OF WORK
July 1, 2018 through June 30, 2019
reflecting the use of goods and/or services during the Contract term.
F. In the event of a public health emergency involving a portion of the state, mobilize and
dispatch staff or equipment purchased with funds from previous PHEP cooperative
agreements and not currently performing critical duties in the jurisdiction served, to the
affected area of the state upon receipt of a written request from System Agency.
G. Inform System Agency in writing if Grantee will not continue performance under this
Contract within 30 days of receipt of an amended standard(s) or guideline(s). System Agency
may terminate this Contract immediately or within a reasonable period of time as determined
by System Agency.
H. Develop, implement and maintain a timekeeping system for accurately documenting staff
time and salary expenditures for all staff funded through this Contract, including partial full-
time employees and temporary staff.
I. Complete and submit programmatic reports as directed by System Agency in a format
specified by System Agency. Due dates will be listed in the most current System Agency
reporting schedule, to be released within thirty (30) days of the Contract start date. Grantee
will provide System Agency other reports, including financial reports, that System Agency
determines necessary to accomplish the objectives of this Contract and to monitor
compliance.
J. Submit Performance Measures to System Agency within an established timeframe designated
by System Agency as required by the CDC.
K. Submit the work plan that encompasses the Contract term, due to System Agency within an
established timeline designated by System Agency.
L. Conduct, or participate in, an annual Training and Exercise Planning Workshop (TEPW)
with all applicable agencies in accordance with Homeland Security Exercise and Evaluation
Program (HSEEP) guidelines to develop a strategy and structure for a multi-year Training
and Exercise Plan (TEP). Prepare, maintain, and upon request, submit a copy of the TEPW
agenda and participant roster as documentation of TEPW attendance.
M. Submit a current Multi -Year Training & Exercise Plan that covers FY19 through FY23 (July
1, 2018, through June 30, 2023) to System Agency within an established timeframe
designated by System Agency, using the template provided by System Agency.
System Agency Contract No. 537-18-0161-00001
v. 11.15.2016 Page 4
DocuSign Envelope ID: 558C83BB-61 BA-4382-AED4-91575CE543D9
ATTACHMENT A.2
STATEMENT OF WORK
July 1, 2018 through June 30, 2019
N. Conduct, or participate in, at least one annual Preparedness Exercise consistent with their
TEP. Submit a Notification of Exercise (NOE) form to System Agency Preparedness
Exercise inbox at preparednessexercisegdshs.texas.gov no later than sixty (60) days prior to
the start of the exercise.
O. Submit at least one (1) After Action Review/Improvement Plan (AAR/IP). All AAR/IPs
must . be submitted to System Agency Preparedness Exercise inbox,
preparednessexercisegdshs.texas.gov within sixty (60) days of the completion of the
exercise to System Agency Exercise Team and no later than June 30, 2019. AAR/1Ps must
be completed in accordance with System Agency Exercise Guide.
P. Complete and submit all supporting documents for the Operational Readiness Review (ORR)
twenty (20) business days prior to review date. The review takes place every.other year,
however documentation will still be required annually.
1.1 Provide updated distribution data document (official name to be determined) for
submission to System Agency SNS SharePoint by April 1, 2019;
2. Perform and submit metrics (data collection sheets) on each of the three (3) SNS
operation drills (at pre -identified Point of Dispensing [POD] locations and existing
call down rosters) to DSHS SharePoint and submit After Action
Reviews/Improvements sixty (60) days after drill completion or by April 1, 20191 -to
the preparednessexercise@dshs.texas.gov inbox. Acceptable drills include:
a. Staff Call Down;
b. Facility Set-up; _
c. POD Activation; and
d. Participate in and attend the regional MCM seminar, .when held.
Q. Submit the Capabilities Planning Guide assessment due to System Agency. within an
established timeframe designated by System Agency.
R. Submit the Texas Public Health Risk Assessment Tool due to System Agency within an
established timeframe designated by System Agency.
S. Submit the Mid -Year Report due to System Agency within an established timeframe
designated by System Agency.
T. Complete an End -Of -Year Performance Report in a format specified by System Agency
no later than August 15, 2019.
System Agency Contract No. 537-18-0161-00001
v. 11.15.2016 Page 5
DocuSign Envelope ID: 558C83BB-61BA-4382-AED4-91575CE543D9
ATTACHMENT A.2
STATEMENT. OF WORK
July 1, 2018 through June 30, 2019
U. Designate a member, of the PHEP program to attend, in person, three (3) PHEP quarterly
meetings during the Contract term. If the designee is unable to attend any of the meetings in
person, the Grantee must notify System Agency in writing as to the reason for non-
compliance.
V. Designate a member of the PHEP program to attend, in person, four regional healthcare
coalition meetings during the term of the Contract from July 1, 2018, to June 30, 2019.
Submit sign -in sheets from meetings as evidence of attendance.
W. Immediately notify System Agency in writing if Grantee is legally prohibited from providing
. any report under this Contract.
X. Use the Texas Disaster Volunteer Registry (TDVR), which is Texas' version of the
Emergency System for the Advanced Registration of Volunteer Health Professionals (ESAR-
VHP) as their main volunteer management tool, if utilizing Medical Reserve Corps or other
volunteer groups. If Grantee uses volunteers as provided in the Section, the Grantee must
either:
1. Request access to the TDVR from the State ESAR-VHP System Administrator, enter
all volunteer data into the system using the Intermedix Data Input Form, and submit
the form to the State ESAR-VHP System Administrator; or
2. Petition System Agency in writing for an exemption from using the TDVR. Successful
petitioners must be currently using a fully operational, ESAR-VHP-compliant, web -
based volunteer management system. If petitioning System Agency to use a fully
operational, ESAR-VHP-compliant, web -based volunteer management system, then
the substitute system must meet, but is not limited to, the following federal
requirements:
a. Must offer Internet -based registration;
b. Volunteer information is collected and maintained in a manner consistent with
all federal, state and local laws governing security and confidentiality;
c. Must be able to register and collect the credentials and qualifications of health
professionals that are then verified with the issuing entity or appropriate
authority;
d. Must be able to verify the credentials of the 20 mandated professions;
e. Must be able to assign to one of four emergency credential levels;
f. Must be able to identify volunteers willing ' to participate in a federally
coordinated emergency response;
g. Must be able to re -verify professional credentials every 6 months;
System Agency Contract No. 537-18-0161-00001
v. 11. 15.2016 Page 6
DocuSign Envelope ID: 558C83BB-61BA-4382-AED4-91575CE543D9
ATTACHMENT A.2
STATEMENT OF WORK
July 1, 2018 through June 30, 2019
h. Must have the ability to include the differing scope of work information for
each of the 20 mandated professions;
i. Must be able to record all volunteer health professional affiliations; and
j. Must be able to verify that all volunteers across all credential levels not be
included on the U.S. Department of Health and Human Services, Office of the
Inspector General's List of Excluded Individuals/Entities (LEIS).
k. Additionally, the fully operational, ESAR-VHP-compliant, web -based
volunteer management system must be able to register, collect, and verify the
credentials and qualifications of the health professionals entered into the
system.
Y. Grantee may not use funds for research, clinical care, fund-raising activities or lobbying,
construction or major renovations, reimbursement of pre -award costs, to supplant existing
state or federal funds for activities, payment or reimbursement of backfilling costs for staff,
purchase of vehicles of any kind, or funding an award to another party, or provider who is
ineligible.
Z. Cooperate with System Agency to coordinate all planning, training and exercises performed
under this Contract with local emergency management and the Texas Division of Emergency
Management (TDEM) District Coordinators assigned to the Grantee's sub -state region, to
ensure consistency, and coordination of requirements at the local level and eliminate
duplication of effort between the various domestic preparedness funding sources in the state.
AA. Coordinate all risk communication activities with the System Agency Communications Unit
by using System Agency's core messages posted on the System Agency website, and
submitting copies of draft risk communication materials'to System Agency for coordination
prior to dissemination.
BB. Initiate the purchase of all equipment approved in writing by the System Agency in the first
quarter of the FYI Contract term (July 1, 2018 — June 30, 2019), as applicable. Failure to
timely initiate the purchase of equipment may result in the loss of availability of funds for the
purchase of equipment. Requests to purchase previously approved equipment after the first
quarter in the Contract must be submitted to the assigned System Agency contract manager.
CC. Controlled Assets include firearms, regardless of the acquisition cost, and the following
assets with an acquisition cost of $500 or more, but less than $5,000: desktop and laptop
computers (including notebooks, tablets and similar devices), non-portable printers and
System Agency Contract No. 537-18-0161-00001
v. 11.15.2016 Page 7
DocuSign Envelope ID: 558C83BB-61 BA-4382-AED4-91575CE543D9
ATTACHMENT A.2
STATEMENT OF WORK
July. 1, 2018 through June 30, 2019
copiers, emergency management equipment, communication devices and systems, medical
and laboratory equipment, and media equipment. Controlled Assets are considered Supplies.
DD. Grantee shall maintain an inventory of equipment, supplies defined as Controlled Assets, and
real property and submit an annual cumulative report of the equipment and other property on
HHS System Agency Grantee's Property Inventory Report to the assigned System Agency
contract manager by email not later than October 15 of each year.
EE. System Agency fluids must not be used to purchase buildings or real property without prior
written approval from the System Agency. Any costs related to the initial acquisition of the
buildings or real property are not allowable without written pre -approval.
FF. At the expiration or termination of this Contract for any reason, title to any remaining
equipment and supplies purchased with funds under this Contract reverts to System Agency.
Title may be transferred to any other party designated by System Agency. The System
Agency may, at its option and to the extent allowed by law, transfer the reversionary interest
to such property to Grantee.
GG. Comply with all applicable federal and state laws, rules, and regulations including, but not
limited to, the following:
1. Public Law 107-188, Public Health Security and Bioterrorism Preparedness and
Response Act of 2002;
2. Public Law 113-05, Pandemic and All -Hazards Preparedness Reauthorization Act;
and
3. Texas Health and Safety Code Chapter 81.
HH. Comply with all applicable regulations, standards and guidelines in effect on,the beginning
date of the Term of this Contract.
11. Submit a current Texas Preparedness and Evaluation Process (TxPEP) report to System
Agency within an established timeframe designated by System Agency, using the template
provided by System Agency.
JJ. Submit a report on the Jurisdiction's vulnerable population outreach activities to System
Agency within an established timeframe designated by System Agency, using a template
provided by System Agency.
KK. Submit other reports as required by System Agency. The initial reporting schedule for the
System Agency Contract No. 537-18-0161-00001
v. 11.15.2016 Page 8
DocuSign Envelope ID: 558C83BB-61 BA-4382-AED4-91575CE543D9
ATTACHMENT A.2
STATEMENT OF WORK
July' 1, 2018 through June 30, 2019
requirements is subject to change as System Agency and CDC may modify requirements and
due dates.
LL. Work with the Regional Health Care Coalition to develop comprehensive preparedness
strategies. Plans will be submitted to System Agency by the Health Care Coalition.
H. PERFORMANCE MEASURES
System Agency will monitor the Grantee's performance of the requirements and compliance with the
Contract's terms and conditions. Grantee must demonstrate adherence to PHEP reporting deadlines
and the capability to receive, stage, store, distribute, and dispense materiel during a public health
emergency. Failure to meet these requirements may result in withholding a portion of the current
PEEP base awards.
M. INVOICE AND PAYMENT
A.. Grantee will request payment using the State of Texas Purchase Voucher (Form B-13) on a
monthly basis and acceptable supporting documentation for reimbursement of the required
services/deliverables. Additionally, the Grantee will submit the Financial Status Report
(FSR -269A) and the Match Certification Form (B -13A). Vouchers, supporting
documentation, Financial Status Reports, and Match Certification Forms should be mailed or
emailed to the addresses below.
Department of State Health Services
Claims Processing Unit, MC 1940
1100 West 49th Street
P.O. Box 149347
Austin, TX 78714-9347
FAX: (512) 458-7442
EMAIL: invoicesgdshs.texas.gov, Php.vouchersupport,dshs.texas.gov &
CMSInvoicesgdshs.texas. gov
B-13, B -13A, and supporting documentation should be sent to: invoiceskdshs.texas.gov,
Php.vouchersupportkdshs.texas.gov &,CMSInvoicesgdshs.texas.gov
FSRs should be sent to: invoices e,dshs.texas.gov, Php.vouchersupportgdshs.texas.gov,
System Agency Contract No. 537-18-0161-00001
v. 11.15.2016 Page 9
DocuSign Envelope ID: 558C83BB-61BA-4382-AED4-91575CE543D9
ATTACHMENT A.2
STATEMENT OF WORK
July 1, 2018 through June 30, 2019
FSRGrantsgdshs.texas.gov & CMSInvoices@dshs.texas.gov
B. Grantee will be paid on a monthly basis and in accordance with Attachment B, Budget.
C. System Agency reserves the right, where allowed by legal authority, to redirect funds in the
event of financial shortfalls. System Agency will monitor Grantee's expenditures on a
quarterly basis. If expenditures are below that projected in Grantee's total Contract amount,
Grantee's budget maybe subject to a decrease for the remainder of the Term of the Contract.
Vacant positions existing after ninety days may result in a decrease in funds.
D. Grantee may request a one-time working capital advance not to exceed 12% of the total
amount of the Contract funded by System Agency. All advances must be expended by the
end of the Contract term. Advances not expended by the end of the Contract term must be
refunded to System Agency.
E. Grantee will repay all or part of advance funds at any time during the Contract's term.
However, if the advance has not been repaid prior to the last three months of the Contract
term, the Grantee must deduct at least one-third of the remaining advance from each of the
last three months' reimbursement requests. If the advance is not repaid prior to the last three
months of the Contract term, System Agency will reduce the reimbursement request by one-
third of the remaining balance of the advance.
System Agency Contract No. 537-18-0161-00001
v. 11.15.2016 Page 10
DocuSign Envelope ID: 558C83BB-61 BA-4382-AED4-91575CE543D9
Fiscal Federal Funding Accountability and Transparency Act
(FFATA) CERTIFICATION
The certifications enumerated below represent material facts upon which DSHS relies when reporting
information to the federal government required under federal law. If the Department later determines
that the Contractor knowingly rendered an erroneous certification, DSHS may pursue all available
remedies in accordance with Texas and U.S. law. Signor further agrees that it will provide. immediate
written notice to DSHS if at any time Signor learns that any of the certifications provided for below were
erroneous when submitted or have since become erroneous by reason of changed circumstances. If the
Signor cannot certify all of the statements contained in this section, Signor must provide written
notice to DSHS detailing which of the below statements it cannot certify and why.
Legal Name of Contractor:
FFATA Contact # 1 Name, Email and Phone Number:
Primary'Address of Contractor:
FFATA Contact #2 Name, Email and Phone Number:
ZIP Code: 9 -digits Required www.usps.com
DUNS Number: 9 -digits Required www.sam.gov
State of Texas Comptroller Vendor Identification Number (VIN) 14 Digits
Printed Name of Authorized Representative
Signature of Authorized Representative
Title of Authorized Representative
Date
-1-
Department of State Health Services Form 4734 — June 2013
DocuSign Envelope ID: 558C83BB-61BA-4382-AED4-91575CE543D9
Fiscal Federal Funding Accountability and Transparency Act
(FFATA) CERTIFICATION
As the duly authorized representative (Signor) of the Contractor, I hereby certify that
the statements made by me in this certification form are true, complete and correct to
the best of my knowledge.
Did your organization `have a gross income, from all sources, of less than $300,000 in
your previous tax year? ❑ Yes ❑ No
If your answer is "Yes", skip questions "A", "B", and "C" and finish the certification.
If your answer is "No", answer questions "A" and "B".
A. Certification Regarding % of Annual Gross from Federal Awards.
Did your organization receive 80% or more of its annual gross revenue from federal
awards during the preceding fiscal year? ❑ Yes ❑ No
B. Certification Regarding Amount of Annual Gross from Federal Awards.
Did your organization receive $25 million or more in annual gross revenues from federal
awards in the preceding fiscal year? ❑ Yes ❑ No
If your answer is "Yes" to both question "A" and "B", you must answer question ":C".
If your answer is "No" to either question "A" or "B", skip question "C" and finish the
certification.
C. Certification Regarding Public Access to Compensation Information.
Does the public have access to information about the compensation of the senior
executives in your business or organization (including parent organization, all branches,
and, all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d)
of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the
Internal Revenue Code of 1986? ❑ Yes ❑ No
If your answer is "Yes" to this question, where can this information be accessed?
If your answer is "No" to this question, you must provide the names and. total
compensation of the top five highly compensated officers below.
Provide compensation information here:
-2-
Department of State Health Services Form 4734 — June 2013
�is64uREo
Certlficate�Of'_Completioni .
L_..-�_...}:i.._-ta._.
Envelope Id: 558C83BB61 BA4382AED491575CE543D9
Status: Sent
Subject: Amending $290,796; 537-18-0161-00001 Beaumont Public Health Department A-1; DSHS/CPS/HAZARDS
Source Envelope:
Document Pages: 34 Signatures: 0 Envelope Originator.
Certificate Pages: 2 Initials: 0 Texas Health and Human Services Commission
AutoNav: Enabled 1100 W. 49th St.
Envelopeld Stamping: Enabled
Time Zone: (UTC -06:00) Central Time (US & Canada)
RecorclrtTracking ` '''' _�
Austin, TX 78756
PCS—DocuSign@hhsc.state.tx.us
IP Address: 167.137.1.16
Status: Original Holder. Texas Health and Human. Services Location: DocuSign
May 3, 2018 Commission
PCS—DocuSign@hhsc.state.b(.us
SignerlE�ents `tF ° _ Slgnaturer Tlmestamp
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Todd Simoneaux Sent: May 3, 2018
tsimoneaux@BeaumontTexas.gov Viewed: May 4, 2018
CFO
City of Beaumont
Security Level: Email, Account Authentication
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Electronic Record and Signature Disclosure:
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David Gruber
david.gruber@dshs.texas.gov
Security Level: Email, Account Authentication
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Electronic Record and Signature Disclosure:
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InPerson Signer Events -Signature
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Gracie PereCOPIED
Sent: May 3, 2018
gracie.perez@hhsc.state.tx.us
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Carboith Copy;Even#s� � Status Timestamp '
Deserie Burrell Sent: May 3, 2018
deserie urrell@dshsstate.tx.us COPIED viewed: May 3, 2018
Contract Manager
Texas Health and Human Services Commission
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
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CMU Contract Inbox
cmucontracts@dshs.texas.gov
Security Level: Email, Account Authentication
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Electronic Record and Signature Disclosure:
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Kenneth Coleman, Sr.
kenneth.coleman@beaumonftexas.gov
Security Level: Email, Account Authentication
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Electronic Record and Signature Disclosure:
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O PI E ® I
Sent: May 3, 2018
COPIED .Sent: May 3, 2018
Viewed: May 4, 2018
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May 3, 2018
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