Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Title of Authorized Representative New Braunfels, TX 78130 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Email Address DUNS Number 00-0000000 17424406498 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Texas Franchise Tax Number Texas Secretary of State Filing Number Health and Human Services (HHS) Additional Provisions – Grant Funding Version 1.0 Effective: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions are incorporated into and made a part of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.
Appears in 1 contract
Samples: Health and Human Services
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Wichita Falls - Wichita County Public Health District Legal Name of Contractor Comal Wichita Falls - Wichita County Family Violence Shelter Inc. Public Health District Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Wichita Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24June 9, 2021 2023 Signature of Authorized Representative Date Signed Xxx Xxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director of Health Title of Authorized Representative New Braunfels0000 Xxxxx Xx. Xxxxxxx Xxxxx, TX 78130 XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels0000 Xxxxx Xx. Wichita Falls, TX 78131 76301 Mailing Address, if different City, State, Zip Code 000-000-0000 940,761.78 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxx.xxxxx@xxxxxxxxxxxxxx.xxx Email Address DUNS Number 001-0000000 17424406498 75-6000-714-2000 1-75-6000-714-2000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 1-75-6000-714-2000 1-75-6000-714-2000 Texas Franchise Tax Number Texas Secretary of State Filing Number R737LBFW8T13 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions – Uniform Terms and Conditions - Grant Funding Version 1.0 Effective3.2 Published and Effective July 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant ContractManagement Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Xxxx Xxxxxx Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24May 31, 2021 2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Xxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Interim City Manager Title of Authorized Representative New Braunfels0000 Xxxxxxx Xxxxxx Xxxxxx, TX 78130 XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 N/A N/A Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxx@xx.xxxxxx.xx.xx 618150460 Email Address DUNS Number 00-0000000 17424406498 17460015732 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number HWX7C56NNUV1 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.1 Published and Effective – Grant Funding Version 1.0 EffectiveApril 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxxxxx Xxxxxx County Public Health District Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. filed August 243, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxx Xxxxxxx Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director 000 Xxxx Xxxxx Xx Title of Authorized Representative New BraunfelsXxxxxx, TX 78130 Xxxxx 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels000 Xxxx Xxxxx Xx Jasper, TX 78131 Texas 75951 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxxx@xxxxxxxxxxx.xxx 078708416 Email Address DUNS Number 00-0000000 17424406498 746001457 17460014578 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 na na Texas Franchise Tax Number Texas Secretary of State Filing Number Health Electronic Record and Human Services Signature Disclosure created on: 9/14/2020 7:10:18 PM Parties agreed to: Xxxxx Xxxxxxx, Xxxxx Xxxxxxx, Xxxxx Xxxxxxxxxx, Xxxxx Xxxxxxxx, Xxxxx Xxxxxx ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, DSHS Contract Management Section (HHSwe, us or Company) Additional Provisions – Grant Funding Version 1.0 Effective: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1may be required by law to provide to you certain written notices or disclosures. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The Described below are the terms and conditions for providing to you such notices and disclosures electronically through the DocuSign system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to this Electronic Record and Signature Disclosure (ERSD), please confirm your agreement by selecting the check-box next to ‘I agree to use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign system. Getting paper copies At any time, you may request from us a paper copy of these Additional Provisions any record provided or made available electronically to you by us. You will have the ability to download and print documents we send to you through the DocuSign system during and immediately after the signing session and, if you elect to create a DocuSign account, you may access the documents for a limited period of time (usually 30 days) after such documents are incorporated into first sent to you. After such time, if you wish for us to send you paper copies of any such documents from our office to you, you will be charged a $0.00 per-page fee. You may request delivery of such paper copies from us by following the procedure described below. Withdrawing your consent If you decide to receive notices and disclosures from us electronically, you may at any time change your mind and tell us that thereafter you want to receive required notices and disclosures only in paper format. How you must inform us of your decision to receive future notices and disclosure in paper format and withdraw your consent to receive notices and disclosures electronically is described below. Consequences of changing your mind If you elect to receive required notices and disclosures only in paper format, it will slow the speed at which we can complete certain steps in transactions with you and delivering services to you because we will need first to send the required notices or disclosures to you in paper format, and then wait until we receive back from you your acknowledgment of your receipt of such paper notices or disclosures. Further, you will no longer be able to use the DocuSign system to receive required notices and consents electronically from us or to sign electronically documents from us. All notices and disclosures will be sent to you electronically Unless you tell us otherwise in accordance with the procedures described herein, we will provide electronically to you through the DocuSign system all required notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made a part available to you during the course of our relationship with you. To reduce the chance of you inadvertently not receiving any notice or disclosure, we prefer to provide all of the Grant Contractrequired notices and disclosures to you by the same method and to the same address that you have given us. Terms included Thus, you can receive all the disclosures and notices electronically or in these Additional Provisions paper format through the paper mail delivery system. If you do not agree with this process, please let us know as described below. Please also see the paragraph immediately above that describes the consequences of your electing not to receive delivery of the notices and disclosures electronically from us. How to contact DSHS Contract Management Section: You may contact us to let us know of your changes as to how we may contact you electronically, to request paper copies of certain information from us, and to withdraw your prior consent to receive notices and disclosures electronically as follows: To contact us by email send messages to: xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx To advise DSHS Contract Management Section of your new email address To let us know of a change in your email address where we should send notices and disclosures electronically to you, you must send an email message to us at xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state: your previous email address, your new email address. We do not otherwise defined have require any other information from you to change your email address. If you created a DocuSign account, you may update it with your new email address through your account preferences. To request paper copies from DSHS Contract Management Section To request delivery from us of paper copies of the meanings assigned notices and disclosures previously provided by us to them you electronically, you must send us an email to xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in HHS Uniform Terms the body of such request you must state your email address, full name, mailing address, and Conditionstelephone number. We will xxxx you for any fees at that time, Attachment C.if any. To withdraw your consent with DSHS Contract Management Section To inform us that you no longer wish to receive future notices and disclosures in electronic format you may:
Appears in 1 contract
Samples: Interlocal Cooperation Contract
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Lifetime Independence for Everyone, Inc. Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative 08/02/2023 Date Signed Xxxxxxxx Xxxxx Xxxx Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Title of Authorized Representative New Braunfels0000 Xxxxxx Xxx. Lubbock, TX 78130 Texas 79423 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code (000-) 000-0000 (000-) 000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxxx.xxxxx@xxxxxxx.xxx 839934742 Email Address DUNS Number 00-0000000 17424406498 17522178353 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 30010837505 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number Health EYT7D31P5HL6 XXX.xxx Unique Entity Identifier (UEI) View Burden Statement ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2025 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Hidalgo County Legal Name of Contractor Comal Hidalgo County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal Hidalgo County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxx X. Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director December 1, 2023 Signature of Authorized Representative Date Signed Hidalgo County Judge Title of Authorized Representative New Braunfels000 Xxxx Xxxx Xxxxxxxx, TX 78130 Texas 78539 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 N/A N/A Mailing Address, if different City, State, Zip Code (000-) 000-0000 (000-) 000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 countyjudge@co xxxxxxx.xx.xx 00-000-0000 Email Address DUNS Number 00-0000000 17424406498 17460007176 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number LHACK1UL6NR3 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx The University of Texas Health Science Center at San Antonio Legal Name of Contractor Comal County Family Violence Shelter Inc. n/a Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County n/a Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24November 21, 2021 2023 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxx Xxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Associate Director, Sponsored Programs Title of Authorized Representative New Braunfels0000 Xxxxx Xxxx Drive, MSC 7828 San Antonio, TX 78130 78229-3900 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 n/a n/a Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 n/a Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxx@xxxxxxx.xxx 800772162 Email Address DUNS Number 00-0000000 17424406498 37457457457002 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 37457457457002 37457457457002 Texas Franchise Tax Number Texas Secretary of State Filing Number Health and Human Services C3KXNLTAAY98 XXX.xxx Unique Entity Identifier (HHSUEI) Additional Provisions – Grant Funding Version 1.0 Effective: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions are incorporated into and made a part of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have the meanings assigned Attachment E UT System Supplemental Conditions to them in HHS Uniform Terms and ConditionsConditions – Grant, Attachment C.Version 3.2 (Effective July 2022) The HHS Uniform Terms and Conditions - Grant, Version 3.2, are revised, modified, or supplemented as shown herein. In addition, all references in this document to ‘Governmental Entity’ or ‘Performing Agency’ mean ‘Grantee,’ and all references to the ‘Contract’ mean ‘Grant Agreement.’
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx South Plains Public Health District Legal Name of Contractor Comal County Family Violence Shelter Inc. N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Xxxxxx, Yoakum, Xxxxxx and Xxxxx Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24rized Representative March 21, 2021 2023 Signature of Authorized Representative Autho Date Signed Xxxxx Xxxx Xxxxxxx Xxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Title of Authorized Representative New Braunfels000 X Xxxx Xxxxxx Xxxxxxxxxx, TX 78130 XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels112 Brownfield, TX 78131 7360 Mailing Address, if different City, State, Zip Code 000-000-000 000 0000 000-000-000 000 0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxxxxx@xxxxx.xxx 009898441 Email Address DUNS Number 00-0000000 17424406498 17560024717 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number KQ6LKJKH5A15 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx South Texas Family Planning & Health Corporation Legal Name of Contractor Comal County Family Violence Shelter Inc. N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24April 9, 2021 2024 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxx X. Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Title of Authorized Representative New Braunfels4455 So. Padre Island Dr., TX 78130 #00 Xxxxxx Xxxxxxx, XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Same Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxxxxxxx@xxxxxx.xxx 012532271 Email Address DUNS Number 00-0000000 17424406498 17417286212 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) N/A 00308146 Texas Franchise Tax Number Texas Secretary of State Filing Number UUC2CM9V1CJ3 XXX.xxx Unique Entity Identifier (UEI) Attachment D Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – Grant Funding Version 1.0 EffectiveNovember 2023 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Medina County Legal Name of Contractor Comal County Family Violence Shelter Inc. N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24horized Representative May 2, 2021 2023 Signature of Authorized Representative Aut Date Signed Xxxxx Xxxx Xxxxxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Medina County Health Unit Director Title of Authorized Representative New Braunfels0000 00xx Xx Xxxxx, TX 78130 Xxxxx, 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels0000 00xx Xx Xxxxx, TX 78131 Xxxxx, 00000 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxxx xxxxxxx@xxxxxxxx.xxx 080272057 Email Address DUNS Number 00-0000000 17424406498 17460011061 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number TRVPZC6NT9E4 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Northeast Texas Public Health District Legal Name of Contractor Comal County Family Violence Shelter Inc. Northeast Texas Public Health District Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24g Xxxxxx X Xxxxxxx, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xx. Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. April 10, 2023 ed Representative Date Signed Chief Executive Director Officer Title of Authorized Representative New Braunfels000 X. Xxxxxxxx #000 Xxxxx, TX 78130 XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels000 X. Xxxxxxxx #000 Xxxxx, TX 78131 XX 00000 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxxx@xxxxxx.xxx 144656753 Email Address DUNS Number 00-0000000 17424406498 752254544 17522545445 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number QYUMYH4V9EK5 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxxxxxx Xxxxxxx Legal Name of Contractor Comal County Family Violence Shelter Inc. Central Counties Center for MHMR Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Central Counties Services Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24October 25, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Title of Authorized Representative New Braunfels, TX 78130 Xxxxxxx Xxxxxxx Executive Director Physical Street Address City, State, Zip Code PO Box 310344 New BraunfelsTemple, TX 78131 76501 Mailing Address, if different City, State, Zip Code 000 Xxxxx 00xx Xxxxxx Xxxxxx, XX 00000 Phone Number Fax Number 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Email Address DUNS Number 00-0000000 17424406498 xxxxxxx.xxxxxxx@xxx0000.xxx 0 59 057 927 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 00-0000000 00-0000000 Texas Franchise Tax Number Texas Secretary of State Filing Number Health ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Barrio Comprehensive Family Health Care Center, Inc. Legal Name of Contractor Comal County Barrio Comprehensive Family Violence Shelter Health Care Center, Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County CommuniCare Health Centers Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24April 3, 2021 2024 Signature of Authorized Representative Date Signed Xxxxx Xxxx X. Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director President and CEO Title of Authorized Representative New Braunfels0000 Xxxx Xxxxxxxx Xx. Xxx Xxxxxxx, TX 78130 XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels000 Xxxxx Xx. San Antonio, TX 78131 78216 Mailing Address, if different City, State, Zip Code (000-) 000-0000 (000-) 000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxx@xxxxxxxxxxxxx.xxx 039844741 Email Address DUNS Number 00-0000000 17424406498 7417243916 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 17417243916 00048364301 Texas Franchise Tax Number Texas Secretary of State Filing Number Health MCDDPAH9XZK3 XXX.xxx Unique Entity Identifier (UEI) ASSURANCES - CONSTRUCTION PROGRAMS OMB Number: 4040-0009 Expiration Date: 02/28/2025 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0042), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant:, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Paso del Norte Children's Development Center Legal Name of Contractor Comal County Family Violence Shelter Inc. PdN Children's Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal El Paso County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24December 9, 2021 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxx X. Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Chief Executive Director Officer Title of Authorized Representative New Braunfels0000 X. Xxxxxxxx El Paso, TX 78130 Texas 79902 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Same Same Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xx.xxxxxxx@xxxxxxxxxxxx.xxx 009928018 Email Address DUNS Number 00-0000000 17424406498 17413123138001 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 17413123188 9759301 Texas Franchise Tax Number Texas Secretary of State Filing Number CZQ1D53PK614 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx RN/Director Legal Name of Contractor Comal Sweetwater Nolan County Family Violence Shelter Inc. Health Department Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County none Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed A Xxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive March 21, 2024 uthorized Representative Date Signed Director Title of Authorized Representative New Braunfels301E.12th Sweetwater, TX 78130 Texas 79556-2317 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfelssame Sweetwater, TX 78131 Texas 79556-2317 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 jmena@nolancountyhealth 623055506 Email Address DUNS Number 00-0000000 17424406498 17560010948003 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) NONE 17560010948003 Texas Franchise Tax Number Texas Secretary of State Filing Number GSAFSD7952544 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – Grant Funding Version 1.0 EffectiveNovember 2023 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Tarrant County Legal Name of Contractor Comal Tarrant County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal Tarrant County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Judge Xxx X’Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director March 13, 2024 Signature of Authorized Representative Date Signed County Judge Title of Authorized Representative New Braunfels000 X. Xxxxxxxxxxx St. Fort Worth, TX 78130 76196 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels000 X. Xxxxxxxxxxx St. Fort Worth, TX 78131 76196 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 n/a Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxxx.xxx 68365220 Email Address DUNS Number 00-0000000 17424406498 17560011706 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) n/a n/a Texas Franchise Tax Number Texas Secretary of State Filing Number DBH1UNN8U5J3 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx City Of Wichita Falls Texas Legal Name of Contractor Comal County Family Violence Shelter Inc. Same Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County none Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24June 7, 2021 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxx Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director of Health Title of Authorized Representative New Braunfels0000 Xxxxx Xxxxxx Xxxxxxx Xxxxx Xx 00000 Xxxxxxxx Xxxxxx Xxxxxxx Xxxx, TX 78130 Physical Street Address CityXxxxx, State, Zip Xxx Code PO Box 310344 New Braunfels, TX 78131 xx xxx 0000 Xxxxxxx Xxxxx XX 00000 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxx.xxxxxxxx@xxxxxxxxxxxxxx.xxx 059463133 Email Address DUNS Number 00-0000000 17424406498 756000714 17560007142 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 756000714 17560007142 Texas Franchise Tax Number Texas Secretary of State Filing Number R737LBFW8T13 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.1 Published and Effective – Grant Funding Version 1.0 EffectiveApril 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Texas Association Against Sexual Assault, Inc. Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24June 10, 2021 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director CEO Title of Authorized Representative New Braunfels0000 Xxxxx Xxxxx Xxxxx, TX 78130 Xxx. 000 Xxxxxx, XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxx@xxxxx.xxx 958608895 Email Address DUNS Number 00-0000000 17424406498 17519571560 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 32037265165 0065668701 Texas Franchise Tax Number Texas Secretary of State Filing Number KADJXT653Z4 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.1 Published and Effective – Grant Funding Version 1.0 EffectiveApril 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx X. Xxxxx Xxxx Xx. Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 242, 2021 2022 Signature of Authorized Representative Date Signed Xxxxxx X. Xxxxx Xxxx Xx. Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director C.E.O. Title of Authorized Representative New Braunfels000 Xxxxxxxx Xx. Xxxxxxxx, TX 78130 Xxxxx 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 Phone Number Fax Number xxxxxx@xxxxxxxxxxxxxxxx.xxx 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Email Address DUNS Number 00-0000000 17424406498 089191733 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 17429191780 17429191780 Texas Franchise Tax Number Texas Secretary of State Filing Number FAD2VQEUNYQ3 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Bell County Public Health District Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Au Xxxxx Xxxx X Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director 000 Xxxxx 0xx Xxxxxx August 19, 2021 thorized Representative Date Signed 08/18/21 Title of Authorized Representative New BraunfelsTemple, TX 78130 Texas 76501 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels2149 Temple, TX 78131 Texas 76503 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxx@xxxxxxxxxxxxxxxx.xxx 08387-2259 Email Address DUNS Number 00-0000000 17424406498 17460003480 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 NH23IP922616 17460003480 Texas Franchise Tax Number Texas Secretary of State Filing Number Health ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx COUNTY OF WISE Legal Name of Contractor Comal County Family Violence Shelter Inc. WISE COUNT OF TEXAS Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Xxxxx Repr Xxx XxXxxxxxx/ Xxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director March 27, 2024 esentative Date Signed Auditor Title of Authorized Representative New Braunfels, TX 78130 Xxx XxXxxxxxx Wise County Auditor Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels000 X. Xxxxxx Xxxxxx Xxxxxxx, TX 78131 Xxxxx 00000 Mailing Address, if different City, State, Zip Code P.O. Box 899 Decatur, Texas 76234 Phone Number Fax Number 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Email Address DUNS Number 00-0000000 17424406498 xxxxxxx@xx.xxxx.xx.xx 190300764 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 756001203 756001203 Texas Franchise Tax Number Texas Secretary of State Filing Number LN8YVNU9GCK7 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – Grant Funding Version 1.0 EffectiveNovember 2023 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xx. Xxxxxx Xxxx Legal Name of Contractor Comal Corpus Christi Nueces County Family Violence Shelter Inc. Public Health District Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal Corpus Christi Nueces County Public Health District Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24June 7, 2021 2023 Signature of Authorized Representative Date Signed Xxxxx Xxxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director of Public Health Title of Authorized Representative New Braunfels, TX 78130 Xx. Xxxxxx Xxxx Public Health Director Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 0000 Xxxxx Xx Xxxxxx Christi Texas 78413 Mailing Address, if different City, State, Zip Code 0000 Xxxxx Xx Xxxxxx Christi Texas 78413 Phone Number Fax Number 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Email Address DUNS Number 00-0000000 17424406498 xxxxxxx@xxxxxxx.xxx 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 74-60000574 74-60000574 Texas Franchise Tax Number Texas Secretary of State Filing Number XEBTBTPKCL895 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx XXXXX XXXXXXXXX Legal Name of Contractor Comal County Family Violence Shelter Inc. XXXXXXXXXX COUNTY CRISIS CENTER INC Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. XXXXX XXXXXXXXX September 27, 2021 Signature of Authorized Representative Date Signed Executive Director Title of Authorized Representative New Braunfels, TX 78130 EXECUTIVE DIRECTOR Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels000 X 0XX XX XXXXX 000 XXXXXX, TX 78131 XX 00000 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 PO BOX 182 BORGER, TX 79008 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 0000000000 8062749528 Email Address DUNS Number 00-0000000 17424406498 XXXXXXXXXX@XXXXXXXX0.XXX 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 752592305 17525923052 Texas Franchise Tax Number Texas Secretary of State Filing Number FY22-FY23 Residential and Nonresidential Services Contracts Amendment 3 Attachment M: Revised FY 2022-2023 Budget Workbooks System Agency Contract No. HHS000380000017 DocuSign Envelope ID: 3C55C059-0FAC-4028-9748-5A8F68D3FCC1 Family Violence Program Budget FY22 Salaries Contractor: Xxxxxxxxxx County Crisis Center, Inc A B C D E F G Staff Position Justification Monthly Salary No. of Months Annual Salary Percent applied to HHSC contract Amount budgeted to HHSC contract 1 Executive Director Staff supervisor and director of operations, direct service provider, educational/awareness programs. HHSC budgeted amount determined by previous year's allocated amount of time spent on this grant. DV 55%, SA 45%, with 25% allocated to HHSC. $ 7,641.00 12 $ 91,692.00 25.00% $ 22,923.00 2 Program Director This position is responsible for all grant related reporting and financial duties, data entry, FVNet uploads, direct services, Shelter Advocate supervisor. HHSC budget amount determined by previous year's allocated amount of time spent on this grant. DV 65%, SA 35% with 40% allocated to HHSC. $ 6,765.00 12 $ 81,180.00 40.00% $ 32,472.00 3 Child Adovcate/Prevention Educator This position is responsible for child advocate, prevention educator provdiing awareness to the community, direct services, assist with FVNet and data entry, Bilingual advocate. HHSC budgeted amount determined by previous year's allocated amount of time spent on this grant. DV 30%, SA 65% with 15% allocated to HHSC. $ 2,792.00 12 $ 33,504.00 15.00% $ 5,025.60 4 Office Assistant This position assists other staff as needed, Bi-lingual advocate, direct services, answering phones, administrative duties, incoming donation. HHSC budgeted amount determined by previous year's allocated amount of time spent on this grant. DV 65%, SA 35%, with 35% allocated to HHSC. $ 1,933.00 12 $ 23,196.00 35.00% $ 8,118.60 5 Shelter Advocate Part time - Bilingual - This position answers hotline calls, provides direct services to resident victims 24/7, upkeep of shelter facility and grounds. HHSC budgeted amount determined by previous year's allocated amount. DV 65%, SA 35% with 35% allocated to HHSC. $ 2,104.00 12 $ 25,248.00 35.00% $ 8,836.80 6 Shelter Advocate Part time - This position answers hotline calls, provides direct services to resident victims 24/7, upkeep of shelter facility and grounds. HHSC budgeted amount determined by previous year's allocated amount. DV 65%, SA 35% with 35% allocated to HHSC. $ 1,500.00 6 $ 9,000.00 35.00% $ 3,150.00 DocuSign Envelope ID: 3C55C059-0FAC-4028-9748-5A8F68D3FCC1 Family Violence Program Budget FY22 Fringe Benefits - Employer Paid Portion Contractor: Xxxxxxxxxx County Crisis Center, Inc A B C D E F G H I J K Staff Position FICA & Medicare Workers' Compensation State Unemployment Insurance Health Insurance Life Insurance Dental Insurance Retirement Other - See Supplemental Justification Page Subtotals 1 Executive Director Gross $ 7,014.44 $ - $ 42.00 $ 5,000.00 $ - $ - $ - $ - $ 12,056.44 25.00% $ 1,753.61 $ - $ 10.50 $ 1,250.00 $ - $ - $ - $ - $ 3,014.11 2 Program Director Gross $ 6,210.27 $ - $ 42.00 $ 6,300.00 $ - $ - $ - $ - $ 12,552.27 40.00% $ 2,484.11 $ - $ 16.80 $ 2,520.00 $ - $ - $ - $ - $ 5,020.91 3 Child Adovcate/Preve ntion Educator Gross $ 2,563.06 $ - $ 42.00 $ 3,600.00 $ - $ - $ - $ - $ 6,205.06 15.00% $ 384.46 $ - $ 6.30 $ 540.00 $ - $ - $ - $ - $ 930.76 4 Office Assistant Gross $ 1,774.49 $ - $ 42.00 $ - $ - $ - $ - $ 1,816.49 35.00% $ 621.07 $ - $ 14.70 $ - $ - $ - $ - $ - $ 635.77 5 Shelter Advocate Gross $ 1,931.47 $ - $ 43.00 $ - $ - $ - $ - $ - $ 1,974.47 35.00% $ 676.01 $ - $ 15.05 $ - $ - $ - $ - $ - $ 691.06 6 Shelter Advocate Gross $ 688.50 $ - $ 42.00 $ - $ - $ - $ - $ - $ 730.50 35.00% $ 240.98 $ - $ 15.05 $ - $ - $ - $ - $ - $ 256.03 7 Shelter Advocate Gross $ 1,560.60 $ - $ 42.00 $ - $ - $ - $ - $ - $ 1,602.60 35.00% $ 546.21 $ - $ 14.70 $ - $ - $ - $ - $ - $ 560.91 8 Shelter Advocate Gross $ 918.00 $ - $ 42.00 $ - $ - $ - $ - $ - $ 960.00 35.00% $ 321.30 $ - $ 14.70 $ - $ - $ - $ - $ - $ 336.00 9 0 Gross $ - $ - $ - $ - $ - $ - $ - $ - $ - 0.00% $ - $ - $ - $ - $ - $ - $ - $ - $ - 10 0 Gross $ - $ - $ - $ - $ - $ - $ - $ - $ - 0.00% $ - $ - $ - $ - $ - $ - $ - $ - $ - 11 0 Gross $ - $ - $ - $ - $ - $ - $ - $ - $ - 0.00% $ - $ - $ - $ - $ - $ - $ - $ - $ - Gross $ - $ - $ - $ - $ - $ - $ - $ - $ - DocuSign Envelope ID: 3C55C059-0FAC-4028-9748-5A8F68D3FCC1 Family Violence Program Budget FY22 Other Contractor: Xxxxxxxxxx County Crisis Center, Inc A B C D E Description Justification Cost Percent Applied to HHSC Contract Amount Budgeted to HHSC Contract 1 shelter maintenance Daily upkeep/repairs/regular maintenance to shelter facility as needed: extinguisher updates, plumbing, electrical, yard equipment. 50% DV, 50% Sa with 65% allocated to HHSC. $ 5,000.00 65.00% $ 3,250.00 2 shelter security system Shelter facility monitoring system/camera system for safety 24 hours/day. $32.50/month for 12 months with 85% allocated to HHSC. 70% DV, 30% SA. $ 390.00 85.00% $ 331.50 3 shelter cell, phones, internet Phone system, cell phone, internet services necessary for daily running of facility/hotline services. $400/month @ 12 months 70% DV, 30% SA with 50% allocated to HHSC $ 4,800.00 50.00% $ 2,400.00 4 office cell, phones, internet Phone system, 2 cell phones, internet services necessary for daily running of facility. $250/month @ 12 months 70% DV, 30% SA with 48.10% allocated to HHSC $ 2,999.96 48.10% $ 1,442.98 5 office space rental office space rental; $3100/month @ 12 months. 65% DV, 35% SA with 40% allocated to HHSC $ 37,200.00 40.00% $ 14,880.00 6 insurance required insurance costs for agency - liability, auto, D&O, based on previous year's expenses. 75% DV, 30% SA with 50% allocated to HHSC $ 12,500.00 50.00% $ 6,250.00 7 shelter utilities Utility costs for shelter facility - water, gas, electric $510/month; gas $100 monthly average, electric $260 monthly average, water $150 monthly average. 70% DV, 30% SA, with 35% allocated to HHSC. $ 6,120.00 35.00% $ 2,142.00 8 Xerox lease monthly leasing of Xerox copiers (3) for every day administrative needs and Human Services for clients needs; $200.00 per month @ 12 months; 75% DV 25% SA WITH 50% ALLOCATED TO HHSC $ 2,400.00 50.00% $ 1,200.00 9 $ - 0.00% $ - 10 $ - 0.00% $ - 11 $ - 0.00% $ - 12 $ - 0.00% $ - 13 $ - 0.00% $ - 14 $ - 0.00% $ - 15 $ - 0.00% $ - 16 $ - 0.00% $ - 17 $ - 0.00% $ - DocuSign Envelope ID: 3C55C059-0FAC-4028-9748-5A8F68D3FCC1 Family Violence Program Budget FY22 Supplemental Justification Contractor: Xxxxxxxxxx County Crisis Center, Inc Cost Category Item # Justification 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 24 25 DocuSign Envelope ID: 3C55C059-0FAC-4028-9748-5A8F68D3FCC1 Family Violence Program Budget FY23 Salaries Contractor: Xxxxxxxxxx County Crisis Center, Inc A B C D E F G Staff Position Justification Monthly Salary No. of Months Annual Salary Percent applied to HHSC contract Amount budgeted to HHSC contract 1 Executive Director Staff supervisor and director of operations, direct service provider, educational/awareness programs. HHSC budgeted amount determined by previous year's allocated amount of time spent on this grant. DV 55%, SA 45%, with 25% allocated to HHSC. $ 7,641.00 12 $ 91,692.00 25.00% $ 22,923.00 2 Program Director This position is responsible for all grant related reporting and financial duties, data entry, FVNet uploads, direct services, Shelter Advocate supervisor. HHSC budget amount determined by previous year's allocated amount of time spent on this grant. DV 65%, SA 35% with 40% allocated to HHSC. $ 6,765.00 12 $ 81,180.00 40.00% $ 32,472.00 3 Child Advocate/Prevention Educator This position is responsible for child advocate, prevention educator provdiing awareness to the community, direct services, assist with FVNet and data entry, Bilingual advocate. HHSC budgeted amount determined by previous year's allocated amount of time spent on this grant. DV 35%, SA 65% with 15% allocated to HHSC. $ 2,792.00 12 $ 33,504.00 15.00% $ 5,025.60 4 Office Assistant This position assists other staff as needed, Bi-lingual advocate, direct services, answering phones, administrative duties, incoming donation. HHSC budgeted amount determined by previous year's allocated amount of time spent on this grant. DV 65%, SA 35%, with 35% allocated to HHSC. $ 1,933.00 12 $ 23,196.00 35.00% $ 8,118.60 5 Shelter Advocate Part time - Bilingual - This position answers hotline calls, provides direct services to resident victims 24/7, upkeep of shelter facility and grounds. HHSC budgeted amount determined by previous year's allocated amount. DV 65%, SA 35% with 35% allocated to HHSC. $ 2,104.00 12 $ 25,248.00 35.00% $ 8,836.80 6 Shelter Advocate Part time -This position answers hotline calls, provides direct services to resident victims 24/7, upkeep of shelter facility and grounds. HHSC budgeted amount determined by previous year's allocated amount. DV 65%, SA 35% with 35% allocated to HHSC. $ 1,500.00 6 $ 9,000.00 35.00% $ 3,150.00 DocuSign Envelope ID: 3C55C059-0FAC-4028-9748-5A8F68D3FCC1 Family Violence Program Budget FY23 Fringe Benefits - Employer Paid Portion Contractor: Xxxxxxxxxx County Crisis Center, Inc A B C D E F G H I J K Staff Position FICA & Medicare Workers' Compensation State Unemployment Insurance Health Insurance Life Insurance Dental Insurance Retirement Other - See Supplemental Justification Page Subtotals 1 Executive Director Gross $ 7,014.44 $ - $ 42.00 $ 5,000.00 $ - $ - $ - $ - $ 12,056.44 25.00% $ 1,753.61 $ - $ 10.50 $ 1,250.00 $ - $ - $ - $ - $ 3,014.11 2 Program Director Gross $ 6,210.27 $ - $ 42.00 $ 6,300.00 $ - $ - $ - $ - $ 12,552.27 40.00% $ 2,484.11 $ - $ 16.80 $ 2,520.00 $ - $ - $ - $ - $ 5,020.91 3 Child Advocate/Preve ntion Educator Gross $ 2,563.06 $ - $ 42.00 $ 3,600.00 $ - $ - $ - $ - $ 6,205.06 15.00% $ 384.46 $ - $ 6.30 $ 540.00 $ - $ - $ - $ - $ 930.76 4 Office Assistant Gross $ 1,774.49 $ - $ 42.00 $ - $ - $ - $ - $ - $ 1,816.49 35.00% $ 621.07 $ - $ 14.70 $ - $ - $ - $ - $ - $ 635.77 5 Shelter Advocate Gross $ 1,931.47 $ - $ 43.00 $ - $ - $ - $ - $ - $ 1,974.47 35.00% $ 676.01 $ - $ 15.40 $ - $ - $ - $ - $ - $ 691.41 6 Shelter Advocate Gross $ 688.50 $ - $ 42.00 $ - $ - $ - $ - $ - $ 730.50 35.00% $ 240.98 $ - $ 14.70 $ - $ - $ - $ - $ - $ 255.68 7 Shelter Advocate Gross $ 1,560.60 $ - $ 42.00 $ - $ - $ - $ - $ - $ 1,602.60 35.00% $ 546.21 $ - $ 14.70 $ - $ - $ - $ - $ - $ 560.91 8 Shelter Advocate Gross $ 918.00 $ - $ 42.00 $ - $ - $ - $ - $ - $ 960.00 35.00% $ 321.30 $ - $ 14.70 $ - $ - $ - $ - $ - $ 336.00 9 0 Gross $ - $ - $ - $ - $ - $ - $ - $ - $ - 0.00% $ - $ - $ - $ - $ - $ - $ - $ - $ - 10 0 Gross $ - $ - $ - $ - $ - $ - $ - $ - $ - 0.00% $ - $ - $ - $ - $ - $ - $ - $ - $ - 11 0 Gross $ - $ - $ - $ - $ - $ - $ - $ - $ - 0.00% $ - $ - $ - $ - $ - $ - $ - $ - $ - Gross $ - $ - $ - $ - $ - $ - $ - $ - $ - DocuSign Envelope ID: 3C55C059-0FAC-4028-9748-5A8F68D3FCC1 Family Violence Program Budget FY23 Other Contractor: Xxxxxxxxxx County Crisis Center, Inc A B C D E Description Justification Cost Percent Applied to HHSC Contract Amount Budgeted to HHSC Contract 1 shelter maintenance Daily upkeep/repairs/regular maintenance to shelter facility as needed: extinguisher updates, plumbing, electrical, yard equipment. 50% DV, 50% Sa with 65% allocated to HHSC. $ 5,000.00 65.00% $ 3,250.00 2 shelter security system Shelter facility monitoring system/camera system for safety 24 hours/day. $32.50/month for 12 months with 85% allocated to HHSC. 70% DV, 30% SA. $ 390.00 85.00% $ 331.50 3 shelter cell, phones, internet Phone system, cell phone, internet services necessary for daily running of facility/hotline services. $400/month @ 12 months 70% DV, 30% SA with 50% allocated to HHSC $ 4,800.00 50.00% $ 2,400.00 4 office cell, phones, internet Phone system, 2 cell phones, internet services necessary for daily running of facility. $250/month @ 12 months 70% DV, 30% SA with 48.10% allocated to HHSC $ 2,999.96 48.10% $ 1,442.98 5 office space rental office space rental; $3100/month @ 12 months. 65% DV, 35% SA with 40% allocated to HHSC $ 37,200.00 40.00% $ 14,880.00 6 insurance required insurance costs for agency - liability, auto, D&O, based on previous year's expenses. 75% DV, 30% SA with 75% allocated to HHSC $ 12,500.00 50.00% $ 6,250.00 7 shelter utilities Utility costs for shelter facility - water, gas, electric $510/month; gas $100 monthly average, electric $260 monthly average, water $150 monthly average. 70% DV, 30% SA, with 35% allocated to HHSC. $ 6,120.00 35.00% $ 2,142.00 8 Xerox copier lease monthly leasing of Xerox copiers (HHS3) Additional Provisions – Grant Funding Version 1.0 Effectivefor every day administrative needs and for clients needs; $175.00 per month @ 12 months; 75% DV 25% SA WITH 50% ALLOCATED TO HHSC $ 2,400.00 50.00% $ 1,200.00 9 $ - 0.00% $ - 10 $ - 0.00% $ - 11 $ - 0.00% $ - 12 $ - 0.00% $ - 13 $ - 0.00% $ - 14 $ - 0.00% $ - 15 $ - 0.00% $ - 16 $ - 0.00% $ - 17 $ - 0.00% $ - DocuSign Envelope ID: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective3C55C059-0FAC-4028-9748-5A8F68D3FCC1 Family Violence Program Budget FY23 Supplemental Justification Contractor: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP Xxxxxxxxxx County Crisis Center, Inc Cost Category Item # Justification 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions are incorporated into and made a part of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.9 10 11 12 13 14 15 16 17 18 19 20 21 22
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Ganesh Shivaramaiyer Legal Name of Contractor Comal County Family Violence Shelter Inc. Dallas County, Texas Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal Dallas County Health and Human Services Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative June 21, 2023 Date Signed Xxxxx Xxxx XXXXXX XXXXXXXXXXXXX Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Deputy Director of Finance & Operations Title of Authorized Representative New Braunfels, TX 78130 XXXXXX XXXXXXXXXXXXX Deputy Director of Finance & Operations Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels0000 X Xxxxxxxx Xxxxxxx, TX 78131 Xxxxx 000 Xxxxxx, Xxxxx 00000 Mailing Address, if different City, State, Zip Code N/A N/A Phone Number Fax Number 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Email Address DUNS Number 00-0000000 17424406498 xxxxxxxx@xxxxxxxxxxxx.xxx 073128597 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 00-0000000 17560009056005 Texas Franchise Tax Number Texas Secretary of State Filing Number ER74JB3UL5E9 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions – Uniform Terms and Conditions - Grant Funding Version 1.0 Effective3.2 Published and Effective July 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant ContractManagement Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxxxxxx Xxxxxxx Legal Name of Contractor Comal County Family Violence Shelter Inc. Gulf Coast Center Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Brazoria and Galveston Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24March 21, 2021 2024 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director CEO Title of Authorized Representative New Braunfels0000 X Xxxx Xx Xxxxxx Xxxx, TX 78130 XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxxx@xxxxxxxxxxxxxxx.xxx 079391082 Email Address DUNS Number 00-0000000 17424406498 741607987 17416079873 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 000000000 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number GKXKJ2L9BK76 XXX.xxx Unique Entity Identifier (UEI) ATTACHMENT D Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – Grant Funding Version 1.0 EffectiveNovember 2023 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xx00xxxxx0 Legal Name of Contractor Comal County Family Violence Shelter Inc. Wor1dWide Inkerprekers, Inc Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24Augusk 27, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xx00xxxx0 Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Xxxxx X Xx00xxxxx0 Presidenk Title of Authorized Representative New Braunfels, TX 78130 Presidenk Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels0000 Xxxxx Xxxx Xxxxx, Xxxxx C245 Houskon, TX 78131 77058 Mailing Address, if different City, State, Zip Code 0000 Xxxxx Xxxx Xxxxx, Xxxxx X000 Xxxxxxx, XX 00000 Phone Number Fax Number 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Email Address DUNS Number 00-0000000 17424406498 suppork§x-xxx.xxx 079557638 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 00-0000000 17605752827 Texas Franchise Tax Number Texas Secretary of State Filing Number Health and Human Services (HHS) Additional Provisions – Grant Funding Version 1.0 Effective: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions are incorporated into and made a part of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.Conditions - Vendor Version 3.2 Effective: April 2021 Responsible Office: Chief Counsel Table of Contents
Appears in 1 contract
Samples: Health and Human Services
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Compass Community Care Inc. Legal Name of Contractor Comal County Family Violence Shelter Inc. N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 2412, 2021 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxx GODDEY XXX XXXXX Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director 08/12/2022 Title of Authorized Representative New Braunfels, TX 78130 0000 XXX XX XXXX XXXXX XXXXX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 0000000000 0000000000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxx@xxxxxxxxxxxxxxxxxxxxxxx.xxx 080318339 Email Address DUNS Number 00-0000000 17424406498 32059382278 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 32059382278 0802373261 Texas Franchise Tax Number Texas Secretary of State Filing Number SNYCKDUHWNC3 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions – Grant Funding Version 1.0 Effective: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions are incorporated into and made a part of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.Conditions - Vendor Version 3.2 Effective: April 2021 Responsible Office: Chief Counsel Table of Contents
Appears in 1 contract
Samples: HHSC Contract
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows HHS Contract No: HHS001024000003 Page 25 of 195 Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxxx Xxxxx Xxxx Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 248, 2021 2022 Signature of Authorized Representative Date Signed Xxxxxxx X. Xxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Market SVP Patient Care Services Title of Authorized Representative New BraunfelsXxxxxxx X Xxxxx Xxxxx, TX 78130 XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Xxxxxxxxxx Xxxxx Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxx.xxxxxxx@xxxxxxxxxxxx.xxx 9797744590 Email Address DUNS Number 00-0000000 17424406498 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 1741282696 0015423901 Texas Franchise Tax Number Texas Secretary of State Filing Number EJUWVLB3PCH1 XXX.xxx Unique Entity Identifier (UEI) HHS Contract No: HHS001024000003 DSHS GRANT AGREEPMagEe 2N6 oTf 195 Attachment E- Uniform Terms and Conditions-- Grant Version 3.0 Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.0 Published and Effective – Grant Funding Version 1.0 EffectiveAugust 2021 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts' agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxxxxx Xxxxx, MD, MPH Legal Name of Contractor Comal County Family Violence Shelter Inc. Dallas County, Texas Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal Dallas County Health and Human Services Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director January 21, 2022 of Authorized Representative Date Signed Director/Health Authority Title of Authorized Representative New Braunfels0000 X. Xxxxxxxx Freeway Dallas, TX 78130 Texas, 75207 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code (000-000-0000 000-) 000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Xxxxxx.Xxxxx@xxxxxxxxxxxx.xxx 073128597 Email Address DUNS Number 00-0000000 17424406498 7560000905 7560000905 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number ER74JB3UL5E9 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.0 Published and Effective – Grant Funding Version 1.0 EffectiveAugust 2021 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Lakes Regional MHMR Center Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24December 27, 2021 2023 Signature of Authorized Representative Date Signed Xxxxx Xxxx X Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director 12/27/23 Title of Authorized Representative New Braunfels000 Xxxxxxx Xx Xxxxxxx, TX 78130 XX. 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels749 Terrell, TX 78131 TX. 75160 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxx@xxxxxxxxxxxxx.xxx 112211854 Email Address DUNS Number 00-0000000 17424406498 17528338233 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 17528338233000 17528338233000 Texas Franchise Tax Number Texas Secretary of State Filing Number 51FB6 XXX.xxx Unique Entity Identifier (UEI) ATTACHMENT D Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Abilene-Taylor County Public Health District Legal Name of Contractor Comal Abilene-Taylor County Family Violence Shelter Inc. Public Health District Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24July 12, 2021 2023 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxxxx Deputy City Manager Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Title of Authorized Representative New Braunfels000 X 0xx Xxxxxxx, TX 78130 XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels60 Abilene, TX 78131 79604 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxx.xxxxxxxx@xxxxxxxxx.xxx Email Address DUNS Number 00-0000000 17424406498 N/A N/A Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 000000000 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number vxvlm73m8pa7 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions – Uniform Terms and Conditions - Grant Funding Version 1.0 Effective3.2 Published and Effective July 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant ContractManagement Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx The University of Texas Health Science Center at San Antonio Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 filed Signature of Authorized Representative Date Signed Xxxxx Xxxx X. Xxxxx, CPA Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director 0000 Xxxxx Xxxx Drive, MSC 7828 September 8, 2021 Representative Date Signed 09/08/21 Title of Authorized Representative New BraunfelsSan Antonio, TX 78130 Texas 78229-3900 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Same Same Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 N/A Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxx@xxxxxxx.xxx 800772162 Email Address DUNS Number 00-0000000 17424406498 17415860315 17415860315 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 17415860315 17415860315 Texas Franchise Tax Number Texas Secretary of State Filing Number Health ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Texas Suicide Prevention Collaborative Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a D.B.A. or ‘doing business as’) Crisis Center of Comal County Xxxxxx Texas County(s) for Assumed Business Name (d/b/a D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative August 27, 2020 Date Signed Xxxxx Xxxx Xxxxxx Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Title of Authorized Representative New Braunfels0000 Xxxxxx Xxxxx Xxxxx Xxxxxx, TX 78130 XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New BraunfelsX.X.Xxx 341523 Austin, TX 78131 78738-1523 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxx@xxxxxxxxxxxxxxxxxxxxxx.xxx 117485241 Email Address DUNS Number 00-0000000 17424406498 000-0000 32071411311 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 32071411311 0803375141 Texas Franchise Tax Number Texas Secretary of State Filing Number Health ATTACHMENT G ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 01/31/2019 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxx X XxXxxxxxx Legal Name of Contractor Comal Wise County Family Violence Shelter Inc. Texas Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal Wise County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Xxxxx g Xxx XxXxxxxxx/Xxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director March 2, 2023 Representative Date Signed Auditor Title of Authorized Representative New Braunfels, TX 78130 Xxx XxXxxxxxx Auditor Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels000 X. Xxxxxx Xxxxxx Xxxxxxx, TX 78131 Xxxxx 00000-0899 Mailing Address, if different City, State, Zip Code P.O. Box 899 Decatur, Texas 76234 Phone Number Fax Number 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Email Address DUNS Number 00-0000000 17424406498 xxxxxxx@xx.xxxx.xx.xx 190300764 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 175-6001203 002 Texas Franchise Tax Number Texas Secretary of State Filing Number LN8YVNU9GCK7 XXX.xxx Unique Entity Identifier (UEI) ATTACHMENT E Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Galveston County Health District - La Marque, TX Legal Name of Contractor Comal Galveston County Family Violence Shelter Inc. Health District - La Marque, TX Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Xxxxxxx Xxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director 9850 A. Xxxxxx X. Xxxxx Expressway January 23, 2024 Signature of Authorized Representative Date Signed Chief Operating Officer Title of Authorized Representative New BraunfelsTexas City Texas, TX 78130 77591 Physical Street Address City, State, Zip Code PO P.O. Box 310344 New Braunfels939 La Marque, TX 78131 77591 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 1,111.11 000.000.0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxx@xxxx.xxx 198751372 Email Address DUNS Number 00-0000000 17424406498 17605214745 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 17605214745.001 N/A Texas Franchise Tax Number Texas Secretary of State Filing Number SK8BQZM1Z5P5 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Collin County Legal Name of Contractor Comal County Family Violence Shelter Inc. N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24September 27, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director County Judge Title of Authorized Representative New Braunfels0000 Xxxxxxxxx Xxxx XxXxxxxx, TX 78130 XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 N/A N/A Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxx@xx.xxxxxx.xx.xx 074873449 Email Address DUNS Number 00-0000000 17424406498 17560008736 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number Health ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxxxxx-Xxxxxx County Mental Health and Mental Retardation Center Legal Name of Contractor Comal County Family Violence Shelter Inc. Integral Care Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Xxxxxx Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24September 1, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director CEO Title of Authorized Representative New Braunfels0000 Xxxxxxx Xxxxxx Austin, TX 78130 78704-2911 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxx.xxxxx@xxxxxxxxxxxx.xxx 5078496213 Email Address DUNS Number 00-0000000 17424406498 741547909 17415479090 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number Health and Human Services (HHS) Additional Provisions – Grant Funding Version 1.0 Effective: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions are incorporated into and made a part of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.
Appears in 1 contract
Samples: Health and Human Services Commission
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Gateway Community Health Center,Inc. Legal Name of Contractor Comal County Family Violence Shelter Gateway Community Health Center,Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal Webb County, Zapata County, and Xxx Xxxx County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24January 29, 2021 2024 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxx, Xx. Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Xxxx Xxxxx, Xx. Chief Executive Director Officer Title of Authorized Representative New Braunfels, TX 78130 Chief Executive Officer Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels0000 Xxxxxx Xx. Laredo, TX 78131 78041 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000P.O. Box 3397 Laredo,TX. 00000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 (000) 000-0000 N/A Email Address DUNS Number 00-0000000 17424406498 xxxxx@xxxxxxxxxx.xxx 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 000000000 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number Health RG38ANWB8348 XXX.xxx Unique Entity Identifier (UEI) ASSURANCES - CONSTRUCTION PROGRAMS OMB Number: 4040-0009 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0042), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. Expiration Date: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective02/28/2025 NOTE: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant:, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxxxxxx Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 2420, 2021 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive President / Director Title of Authorized Representative New Braunfels0000 Xxxxxxx Xxxx Xx, TX 78130 Xxxxx # X000 Xxxxxxx, Xxxxx, 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 Phone Number Fax Number xxxxxxxx@xxx-xxxxxxxxxxxx.xxx 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Email Address DUNS Number 00-0000000 17424406498 XXxxxxxx@Xxx-Xxxxxxxxxxxx.xxx 32042813728 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 00-0000000 0801329017 Texas Franchise Tax Number Texas Secretary of State Filing Number HEU7MW4GC1M5 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions – Grant Funding Version 1.0 Effective: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions are incorporated into and made a part of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.Conditions - Vendor Version 3.2 Effective: April 2021 Responsible Office: Chief Counsel Table of Contents
Appears in 1 contract
Samples: HHSC Contract
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxx Xxxxxx Legal Name of Contractor Comal County Family Violence Shelter Inc. Hill Country MHDD Center Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24October 17, 2021 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director CEO Title of Authorized Representative New Braunfels, TX 78130 000 Xxxxx Xxxxxx Xxxxxxxxx XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 NA Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxx@xxxxxxxxxxx.xxx NA Email Address DUNS Number 00-0000000 17424406498 NA NA Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) NA NA Texas Franchise Tax Number Texas Secretary of State Filing Number NA XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Montgomery County, Texas Legal Name of Contractor Comal County Family Violence Shelter Inc. Montgomery County, Texas Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Montgomery County, Texas Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director December 20, 2023 Signature of Authorized Representative Date Signed County Judge Title of Authorized Representative New Braunfels0000 Xxxxxxx Xx Xxxxxx, TX 78130 XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels000 X. Xxxxxxxx St. Suite 401 Conroe, TX 78131 77301 Mailing Address, if different City, State, Zip Code 000-000-0000 000none Phone Number Fax Number xxxx.xxxxxx@xxxx.xxx 00-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Email Address DUNS Number 00-0000000 17424406498 17460005584 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) None 17460005584-000 Texas Franchise Tax Number Texas Secretary of State Filing Number DR3UM2VRE4D XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxxxx Legal Name of Contractor Comal County Family Violence Shelter Inc. Xxxxx Xxxxx Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal Kaufman County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August April 24, 2021 2024 Signature of Authorized Representative Date Signed Xxxx Xxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director County Judge Title of Authorized Representative New Braunfels, TX 78130 Kaufman County Kaufman,TX,75142 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 100 N Washington Kaufma,TX,75142 Mailing Address, if different City, State, Zip Code 000 X Xxxxxxxxxx Xxxxxxx,TX,75142 Phone Number Fax Number 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Email Address DUNS Number 00-0000000 17424406498 xxxxx.xxxxx@xxxxxxxxxxxxx.xxx 083879759 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 00-0000000 17560010369 Texas Franchise Tax Number Texas Secretary of State Filing Number M6EKFHS5NLT3 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – Grant Funding Version 1.0 EffectiveNovember 2023 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx CAMINO REAL COMMUNITY MHMR CENTER Legal Name of Contractor Comal County Family Violence Shelter Inc. CAMINO REAL COMMUNITY SERVICES Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24December 5, 2021 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. 19965 FM3175 N Executive Director Title of Authorized Representative New BraunfelsLYTLE, TX 78130 78052 Physical Street Address City, State, Zip Code PO Box 310344 New BraunfelsBOX 725 LYTLE, TX 78131 78052 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxxx@xxxxxxxxxxxx.xxx 091190004 Email Address DUNS Number 00-0000000 17424406498 17429517547 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 00-0000000 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number QVK5BP6TZSL4 XXX.xxx Unique Entity Identifier (UEI) Attachment D Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Abilene Regional MHMR Center Legal Name of Contractor Comal County Family Violence Shelter Inc. d/b/a Xxxxx Xxxxxxxx Center Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Xxxxxx, Xxxxx, Xxxxxxxx, Xxxxxxxxxxx, Xxxxxxxx Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24December 1, 2021 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director 0000 X. Xxxxx Street CEO Title of Authorized Representative New BraunfelsAbilene, TX 78130 Texas 79606 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 same as above same Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxx@xxxxxxxxxxxxx.xxx 625999326 Email Address DUNS Number 00-0000000 17424406498 751377658 17513776587 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 000000000 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number KQKEHG7ABEE8 XXX.xxx Unique Entity Identifier (UEI) Attachment D Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Ciky of Corpus Chriski Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a D.B.A. or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Augusk 25, 2020 Date Signed Xxxxx Xxxx Xxxxxx Xxxxx and Recreakion Assiskank Direckor Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Title of Authorized Representative New Braunfels0000 Xxxxxxx Xxxxxx Xxxxxx Xxxxxxx, TX 78130 Xxxxx 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 beckyP§xxxxxxx.xxx 069457786 Email Address DUNS Number 00-0000000 17424406498 0000-000 00-0000-000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 NA NA Texas Franchise Tax Number Texas Secretary of State Filing Number ATTACHMENT C STATEMENT OF WORK HEALTH AND HUMAN SERVICES COMMISSION CONTRACT NO. HHS000871100038 I. SCOPE OF SERVICES The Health and Human Services Commission (HHS“System Agency") Additional Provisions – Grant Funding Version 1.0 Effectiveprovides funds under this Agreement which exclusively support the match requirements for the following Senior Corps Programs in the state of Texas: February 2021 Health the Retired and Human Senior Volunteer Program (“RSVP”); the Xxxxxx Grandparent Program (“FGP”); and the Senior Companion Program (“SCP”) (collectively, referred to in this Agreement as the Senior Programs) administered by the Corporation for National and Community Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions are incorporated into and made a part of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.(CNCS).
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Magnificak House, Inc. Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a D.B.A. or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Sepkember 24, 2020 Date Signed Xxxxx Xxxx Xxxx0xx Campbe11 Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Direckor Sk. Xxxxxx Xxxxx / Magnificak Title of Authorized Representative New Braunfels3307 Auskin Sk, TX 78130 Houskon, Tx 77004 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels2641 Houskon, TX 78131 Tx. 77252-2641 Mailing Address, if different City, State, Zip Code 000-000-0000 kcampbe11§xxxxxxxxxx.xxx 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 kevincampbe11§magnificakhouses.nek 070886106 Email Address DUNS Number 00-0000000 17424406498 1-23-7003471-7 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 NA 25387801 Texas Franchise Tax Number Texas Secretary of State Filing Number Health ATTACHMENT E ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 01/31/2019 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Legal Name of Contractor Comal County Family Violence Shelter Inc. Feeding Texas Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24March 1, 2021 2022 Signature of Authorized Representative Date Signed Xxxxx X Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director CEO Title of Authorized Representative New Braunfels0000 X XX-00, TX 78130 Physical Street Address CityXxxxx 000 Xxxxxx, StateXX 00000 Xxxxxxxx Xxxxxx Xxxxxxx Xxxx, Zip Xxxxx, Xxx Code PO Box 310344 New BraunfelsXxxxxx, TX 78131 XX 00000 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 NA Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxx@xxxxxxxxxxxx.xxx 5125273624 Email Address DUNS Number 00-0000000 17424406498 xxxxx@xxxxxxxxxxxx.xxx 074943319 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 00-0000000 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number 861K8 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.0 Published and Effective – Grant Funding Version 1.0 EffectiveAugust 2021 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxxx Xxxx Legal Name of Contractor Comal Chambers County Family Violence Shelter Inc. Health Department Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal Chambers County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24April 1, 2021 2024 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Health Services Director Title of Authorized Representative New Braunfels000 Xxxxxxx Xxxx Xxxxxxx, TX 78130 XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels670 Anahuac, TX 78131 77514 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 0000000000 0000000000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxx@xxxxxxxxxx.xxx 4092674276 Email Address DUNS Number 00-0000000 17424406498 00-0000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 0n/a 0n/a Texas Franchise Tax Number Texas Secretary of State Filing Number MT52MM4RWCU5 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – Grant Funding Version 1.0 EffectiveNovember 2023 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Cherokee County Department of Public Health Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Xxxxx Aut Xxxxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director 000 Xxxxxxx Xxxxxx October 4, 2021 horized Representative Date Signed 08/13/2021 Title of Authorized Representative New BraunfelsJacksonville, TX 78130 Texas 75766 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 NA NA Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxx@xxxxxxx.xxx 076709013 Email Address DUNS Number 00-0000000 17424406498 17560008546 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 NA NA Texas Franchise Tax Number Texas Secretary of State Filing Number Health ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Uvalde County Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Authoriz Xxxxxxx X. Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director 000 Xxxxx Xxxxx Xxxxxx August 26, 2021 ed Representative Date Signed Uvalde County Judge Title of Authorized Representative New BraunfelsUvalde, TX 78130 Texas 78801 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels#0 Xxxxxxxxxx Xxxxxx Xxxxxx, TX 78131 Xxxxx 00000 Mailing Address, if different City, State, Zip Code 000-000-000 000 0000 000-000-000 000 0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxx@xxxxxxxxxxxx.xxx 074612813 Email Address DUNS Number 00-0000000 17424406498 17460024221 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 n/a n/a Texas Franchise Tax Number Texas Secretary of State Filing Number Health ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Tralee Crisis Center for Women, Inc. Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24September 17, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. 310 X. Xxxxxx Executive Director Title of Authorized Representative New BraunfelsPampa, TX 78130 79065 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Xxxxxxxxx.xxxxxx@xxxxx.xxx 00-000-0000 Email Address DUNS Number 00-0000000 17424406498 751971380 17519713808 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 17519713808 70205001 Texas Franchise Tax Number Texas Secretary of State Filing Number FY22-FY23 Residential and Nonresidential Services Contracts Amendment 3 Attachment M: Revised FY 2022-2023 Budget Workbooks System Agency Contract No. HHS000380000024 DocuSign Envelope ID: 2FC21113-8B71-4308-9B97-1489A090C454 Family Violence Program Budget FY22 Salaries Contractor: Tralee Crisis Center for Women, Inc. A B C D E F G Staff Position Justification Monthly Salary No. of Months Annual Salary Percent applied to HHSC contract Amount budgeted to HHSC contract 1 Executive Director Directs client services, supervises resident and non- resident staff, oversees agency operations, manages grants and contracts. 1FTE=.59DV, .40SA, .01OV. DV program split of 20/80 b/w HHSC and other funding sources $ 4,766.67 12 $ 57,200.04 20.00% $ 11,440.01 2 Assistant Executive Director Manages agency funds, allocates expenses, accounts receivables/payables, payroll functions, supervises volunteer coordinator and oversees volunteer program, oversees agency operations in the absence of Executive Director. 1FTE=.59DV, .40SA, .01OV. DV program split of 20/80 b/w HHSC and other funding sources $ 3,293.33 12 $ 39,519.96 20.00% $ 7,903.99 3 Legal Advocate Intervention, case management, legal assistance, support for non-resident clients. 1FTE=.59DV, .40SA, .01OV. DV program split 20/80 b/w HHSC and other funding sources. $ 2,929.58 12 $ 35,154.96 20.00% $ 7,030.99 4 Advocate 1/Bi-lingual advocate Intervention, case management, bilingual, support for non- resident clients. 1 FTE=.59 DV, .40 SA, .01 OV. DV program funding split 20/80 b/w HHSC and other funding sources $ 2,735.25 12 $ 32,823.00 20.00% $ 6,564.60 5 Advocate 2/Child advocate Intervention, case management, support for adult and child non-resident clients. 1 FTE=.59 DV, .40 SA, .01 OV. DV programing split 20/80 b/w HHSC and other funding sources $ 2,676.00 12 $ 32,112.00 20.00% $ 6,422.40 6 Volunteer Coordinator Recruits, trains and manages direct service and support volunteers, data entry, intervention for non-resident clients as needed. 1 FTE=.59 DV, .40 SA, .01 OV. DV program funding split 20/80 b/w HHSC and other funding sources $ 2,919.67 12 $ 35,036.04 20.00% $ 7,007.21 7 Shelter Supervisor Provides resources, support and data entry for shelter clients, supervises shelter staff, manages shelter facility. 1 FTE=.89 DV, .11 SA. DV program funding split 47/53 b/w HHSC and other funding sources $ 2,927.00 12 $ 35,124.00 47.00% $ 16,508.28 8 Shelter Advocate 1 Provides resources, support and data entry for shelter clients. 1 FTE=.89 DV, .11 SA. DV program funding split 47/53 b/w HHSC and other funding sources $ 2,461.33 12 $ 29,535.96 47.00% $ 13,881.90 DocuSign Envelope ID: 2FC21113-8B71-4308-9B97-1489A090C454 Family Violence Program Budget FY22 Fringe Benefits - Employer Paid Portion Contractor: Tralee Crisis Center for Women, Inc. A B C D E F G H I J K Staff Position FICA & Medicare Workers' Compensation State Unemployment Insurance Health Insurance Life Insurance Dental Insurance Retirement Other - See Supplemental Justification Page Subtotals 1 Executive Director Gross $ 4,375.80 $ 227.97 $ 27.90 $ - $ - $ - $ 1,716.00 $ - $ 6,347.67 20.00% $ 875.16 $ 45.59 $ 5.58 $ - $ - $ - $ 343.20 $ - $ 1,269.53 2 Assistant Executive Director Gross $ 3,023.28 $ 159.02 $ 27.90 $ - $ - $ - $ 910.00 $ - $ 4,120.20 20.00% $ 604.66 $ 31.80 $ 5.58 $ - $ - $ - $ 182.00 $ - $ 824.04 3 Legal Advocate Gross $ 2,689.35 $ 139.93 $ 27.90 $ - $ - $ - $ 650.00 $ - $ 3,507.18 20.00% $ 537.87 $ 27.99 $ 5.58 $ - $ - $ - $ 130.00 $ - $ 701.44 4 Advocate 1/Bi- lingual advocate Gross $ 2,510.96 $ 132.23 $ 27.90 $ - $ - $ - $ - $ - $ 2,671.09 20.00% $ 502.19 $ 26.45 $ 5.58 $ - $ - $ - $ - $ - $ 534.22 5 Advocate 2/Child advocate Gross $ 2,456.57 $ 128.08 $ 27.90 $ - $ - $ - $ - $ - $ 2,612.55 20.00% $ 491.31 $ 25.62 $ 5.58 $ - $ - $ - $ - $ - $ 522.51 6 Volunteer Coordinator Gross $ 2,680.26 $ 134.75 $ 27.90 $ - $ - $ - $ - $ - $ 2,842.91 20.00% $ 536.05 $ 26.95 $ 5.58 $ - $ - $ - $ - $ - $ 568.58 7 Shelter Supervisor Gross $ 2,686.99 $ 272.43 $ 27.90 $ - $ - $ - $ - $ - $ 2,987.32 47.00% $ 1,262.89 $ 128.04 $ 13.11 $ - $ - $ - $ - $ - $ 1,404.04 8 Shelter Advocate 1 Gross $ 2,259.50 $ 228.42 $ 27.90 $ - $ - $ - $ 551.72 $ - $ 3,067.54 47.00% $ 1,061.97 $ 107.36 $ 13.11 $ - $ - $ - $ 259.31 $ - $ 1,441.75 9 Shelter Advocate 2 Gross $ 2,203.82 $ 220.95 $ 27.90 $ - $ - $ - $ 650.00 $ - $ 3,102.67 47.00% $ 1,035.80 $ 103.85 $ 13.11 $ - $ - $ - $ 305.50 $ - $ 1,458.26 10 Shelter Advocate 3 Gross $ 2,148.12 $ 216.22 $ 27.90 $ - $ - $ - $ - $ - $ 2,392.24 47.00% $ 1,009.62 $ 101.62 $ 13.11 $ - $ - $ - $ - $ - $ 1,124.35 11 Shelter Advocate 4 Gross $ 2,148.12 $ 216.22 $ 27.90 $ - $ - $ - $ - $ - $ 2,392.24 47.00% $ 1,009.62 $ 101.62 $ 13.11 $ - $ - $ - $ - $ - $ 1,124.35 Shelter Gross $ 2,148.12 $ 216.22 $ 27.90 $ - $ - $ - $ - $ - $ 2,392.24 DocuSign Envelope ID: 2FC21113-8B71-4308-9B97-1489A090C454 Family Violence Program Budget FY22 Professional/Contract Services Contractor: Tralee Crisis Center for Women, Inc. A B C D E F G H Contractor Name Description Justification No. of Units Rate of Payment Cost Percent Applied to HHSC Contract Amount Budgeted to HHSC Contract 1 Xxxxxx Xxxx, CPA annual audit Annual audit of financial activities, functional expenses and Human cash flows. One time payment after service performed based on contract. Funding split 20/80 b/w HHSC and other funding sources 1 $ 9,200.00 $ 9,200.00 20.00% $ 1,840.00 2 Xxxxxxx & Associates IT Contract services IT support, monthly computer server/network maintenance, cloud back-up and service. Based on monthly payment of 356.00. Funding split 20/80 b/w HHAS and other funding sources 12 $ 356.00 $ 4,272.00 20.00% $ 854.40 3 New Hope Counseling Contract Counseling Services (HHS) Additional Provisions – Grant Professional counseling services for DV victims. Paid monthly @ $75 per hr per client based on contract. Funding Version 1.0 Effectivesplit 35/65 b/w HHSC/other 12 $ 375.00 $ 4,500.00 35.00% $ 1,575.00 4 0 $ - $ - 0.00% $ - 5 0 $ - $ - 0.00% $ - 6 0 $ - $ - 0.00% $ - 7 0 $ - $ - 0.00% $ - 8 0 $ - $ - 0.00% $ - 9 0 $ - $ - 0.00% $ - 10 0 $ - $ - 0.00% $ - 11 0 $ - $ - 0.00% $ - 12 0 $ - $ - 0.00% $ - 13 0 $ - $ - 0.00% $ - 14 0 $ - $ - 0.00% $ - 15 0 $ - $ - 0.00% $ - 16 0 $ - $ - 0.00% $ - 17 0 $ - $ - 0.00% $ - 18 0 $ - $ - 0.00% $ - 19 0 $ - $ - 0.00% $ - 20 0 $ - $ - 0.00% $ - 21 0 $ - $ - 0.00% $ - Other Contractor: February 2021 Health Tralee Crisis Center for Women, Inc. A B C D E Description Justification Cost Percent Applied to HHSC Contract Amount Budgeted to HHSC Contract 1 Copier Lease Lease of copy machine for non-resident services based on previous contract year expenditures. Average monthly expenses of $250. funding split 21/79 b/w HHSC and Human other funding sources $ 3,000.00 21.30% $ 639.00 2 Copier Maintenance service contract for monthly maintenance, ink, toner supplies for office and shelter copier. Average monthly expenses of $83.33. funding split 20/80 b/w HHSC and other funding sources $ 1,000.00 20.00% $ 200.00 3 Office repairs/maintenance Estimated costs for repairs/maintenance to non-resident office based on previous year expenses and anticipated costs for FY 2022. Funding split 20/80 b/w HHSC and other funding sources $ 2,000.00 20.00% $ 400.00 4 Office utilities Estimated cost of electricity, water, sewer and gas for office based on previous contract year expenditures. Average monthly amount of $440.75. Funding split is 20/80 b/w HHSC and other funding sources. $ 5,289.00 20.00% $ 1,057.80 5 Telephone/Communications Estimated cost of telephone service at office facilities based on previous contract year expenditures. Average monthly amount of $401. Funding split is 18/82 b/w HHSC and other funding sources. $ 4,812.00 18.00% $ 866.16 6 Telephone/Communications Estimated cost of on-call cell phone service for on-call staff based on previous contract year expenditures. Average monthly amount of $100. Funding split is 18/82 b/w HHSC and other funding sources. $ 1,200.00 18.00% $ 216.00 7 Security monitoring services Monitoring of fire alarm and security system for office facilities based on previous contract year expenditures. Average monthly expenditure of $30. Funding split 20/80 b/w HHSC and other funding sources $ 360.00 20.00% $ 72.00 8 Internet Services Additional Provisions V.1.0 – Grant Cost to provide internet and wifi services to office facilities for staff and client use. Average monthly amount of $43. Funding Effectivesplit is 25/75 b/w HHSC and other funding sources $ 516.00 25.00% $ 129.00 9 Office liability/hazard insurance Estimated annual premium for building insurance for offfice facility based on previous contract year expenditures. Average monthly premium is $452.95 for 9 months plus 25% down payment of 1358.85.Funding split is 18/82 b/w HHSC and other funding sources $ 5,435.00 18.00% $ 978.30 10 Board/Officer Employee Insurance Estimated annual premium for Directors and officers coverage, employee theft/forgery premium based on previous contract year expenditures. Average monthly premium is $240 for 9 months plus 25% down payment of 718. Funding split is 18/82 b/w HHSC and other funding sources $ 2,871.00 18.00% $ 516.78 11 Special Events DVAM activities to raise community awareness of Domestic Violence prevention. Funding split is 20/80 b/w HHSC and other funding sources $ 650.00 20.00% $ 130.00 12 Shelter repairs/maintenance Estimated costs for repairs/maintenance to shelter based on previous year expenses and anticipated costs for FY 2022. Funding split 28/72 b/w HHSC and other funding sources $ 5,400.00 28.00% $ 1,512.00 13 Shelter Internet Services Cost to provide internet and wifi services to shelter facilities for staff and client use. Average monthly amount of $59.25. Funding split is 25/75 b/w HHSC and other funding sources $ 711.00 25.00% $ 177.75 14 Security monitoring services Monitoring of fire alarm and security system for shelter facilities based on previous contract year expenditures. Average monthly expenditure of $35. Funding split 25/75 b/w HHSC and other funding sources $ 420.00 25.00% $ 105.00 15 Shelter liability/hazard insurance Estimated annual premium for building insurance for shelter facility based on previous contract year expenditures. Average monthly premium is $437.95 for 9 months plus 25% down payment of 1313.85.Funding split is 18/82 b/w HHSC and other funding sources $ 5,255.00 18.00% $ 945.90 16 Shelter utilities Estimated cost of electricity, water, sewer, cable TV and gas for shelter based on previous contract year expenditures. Average monthly amount of $583.33. Funding split is 30/70 b/w HHSC and other funding sources. $ 7,000.00 30.00% $ 2,100.00 17 Telephone/Communications Estimated cost of telephone service at shelter facilities based on previous contract year expenditures. Average monthly amount of $441.66. Funding split is 20/80 b/w HHSC and other funding sources. $ 5,300.00 20.00% $ 1,060.00 18 vehicle insurance Estimated annual premium for vehicle insurance based on previous contract year expenditures. Average monthly premium is $404.42 for 9 months plus 25% down payment of $1213.25.Funding split is 20/80 b/w HHSC and other funding sources $ 4,853.00 20.00% $ 970.60 19 $ - 0.00% $ - 20 $ - 0.00% $ - 21 $ - 0.00% $ - 22 $ - 0.00% $ - 23 $ - 0.00% $ - DocuSign Envelope ID: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions are incorporated into and made a part of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.2FC21113-8B71-4308-9B97-1489A090C454 Family Violence Program Budget FY22
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxxxxx Xxxxxxxx Legal Name of Contractor Comal Denton County Family Violence Shelter Inc. MHMR Center Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24November 21, 2021 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxx X Xxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Title of Authorized Representative New Braunfels2519 Scripture Denton, TX 78130 Texas76266 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 0000000000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxx@xxxxxxxxxx.xxx 148007529 Email Address DUNS Number 00-0000000 17424406498 xxx@xxxxxxxxxx.xxx 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 32050326282 17513681514 Texas Franchise Tax Number Texas Secretary of State Filing Number NZCFBZKFA6W8 XXX.xxx Unique Entity Identifier (UEI) ATTACHMENT D Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Outreach Health Community Care Services, LP Legal Name of Contractor Comal County Family Violence Shelter Inc. Outreach Home Care Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County All Counties in Texas Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24September 7, 2021 2023 Signature of Authorized Representative Date Signed Xxxxxx X. Xxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Chief Operating Officer Title of Authorized Representative New Braunfels000 Xxxxxx Xxxxxxx Richardson, TX 78130 75080 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Xxxxxx.Xxxxx@xxxxxxxxxxxxxx.xxx 080303848 Email Address DUNS Number 00-0000000 17424406498 742950392 17429503927 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 32036169517 00000000 Texas Franchise Tax Number Texas Secretary of State Filing Number PKSRK5YKMWD5 XXX.xxx Unique Entity Identifier (UEI) ATTACHMENT F Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Andrews County Health Department Legal Name of Contractor Comal Andrews County Family Violence Shelter Inc. Health Department Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal Andrews County Health Department Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24rized Representative March 21, 2021 2023 Signature of Authorized Representative Autho Date Signed Xxxxx Xxxx Xxxxxx Xxxxxxxx Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Title of Authorized Representative New Braunfels208 N. W. 2nd ST Andrews, TX 78130 Texas, 79714 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels000 X. X 0xx XX. Andrews, TX 78131 Texas, 79714 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxxxx@xx.xxxxxxx.xx.us 041817961 Email Address DUNS Number 00-0000000 17424406498 756000815 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 756000815 756000815 Texas Franchise Tax Number Texas Secretary of State Filing Number K18FSMULJU17 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Tarrant County Legal Name of Contractor Comal Tarrant County Family Violence Shelter Inc. Public Health Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24June 26, 2021 2023 Signature of Authorized Representative Date Signed Xxxxx Xxxx Judge Xxx X'Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common 000 X. Xxxxxxxxxxx St. Executive Director Room 5069 County Judge Title of Authorized Representative New Braunfels, TX 78130 County Judge Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels0000 X Xxxx Xx Fort Worth, TX 78131 76196 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 0000000000 N/A Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxxxxxxxxxxxx@xxxxxxxxxxxxx.xxx Email Address DUNS Number 00-0000000 17424406498 xxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxxx.xxx 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number DBH1UNN8U5J3 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions – Uniform Terms and Conditions - Grant Funding Version 1.0 Effective3.2 Published and Effective July 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant ContractManagement Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Comal County Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Repre Xxxxxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director 000 Xxxx Xxxxx August 26, 2021 sentative Date Signed County Judge Title of Authorized Representative New Braunfels, TX Texas 78130 Physical Street Address City, State, Zip Code PO Box 310344 000 X. Xxxxxx Avenue New Braunfels, TX 78131 Texas 78130 Mailing Address, if different City, State, Zip Code 000-000(000)000-0000 000-000(000)000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxx@xx.xxxxx.xx.xx 098824758 Email Address DUNS Number 00-0000000 17424406498 1-74-60011775-3 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 n/a 023 Texas Franchise Tax Number Texas Secretary of State Filing Number Health ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx City of Midland Health Department Legal Name of Contractor Comal County Family Violence Shelter Inc. City of Midland Health Department Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center City of Comal County Midland Health Department Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Repre Xxxxxxx X. Xxxxx, DrPH, MPH Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director March 23, 2023 sentative Date Signed Health Services Manager Title of Authorized Representative New Braunfels0000 X. Xxxxxxxx Xxx Xx. 00 Xxxxxxx, TX 78130 XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels000 X. Xxxxxxx Xx Xxxxxxx, TX 78131 XX 00000 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxx@xxxxxxxxxxxx.xxx 073186579 Email Address DUNS Number 00-0000000 17424406498 17560006086016 17560006086 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 17560006086 000 Texas Franchise Tax Number Texas Secretary of State Filing Number CPZ1T3B85A64 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxxxxx, CRA, MBA Legal Name of Contractor Comal County Family Violence Shelter Inc. The University of Texas Health Science Center at Tyler Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County n/a Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed R Xxxxx Xxxx Xxxxxx, MBA, CRA Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director June 28, 2022 epresentative Date Signed Director, Office of Sponsored Programs Title of Authorized Representative New BraunfelsXxxxx X Xxxxxx Director, TX 78130 Office of Sponsored Programs Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels00000 XX Xxxxxxx 000 Xxxxx, TX 78131 XX 00000-3154 Mailing Address, if different City, State, Zip Code same same Phone Number Fax Number Xxxxx.Xxxxxx@xxxxx.xxx 000-000-0000 000Email Address DUNS Number grants.@xxxxx.xxx 00-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Email Address DUNS Number 00-0000000 17424406498 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 00-0000000 37857857850 005 Texas Franchise Tax Number Texas Secretary of State Filing Number XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.0 Published and Effective – Grant Funding Version 1.0 EffectiveAugust 2021 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx The Xxxxxx Center for Mental Health and IDD Legal Name of Contractor Comal County Family Violence Shelter Inc. N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director November 9, 2021 Signature of Authorized Representative Date Signed CEO Title of Authorized Representative New Braunfels0000 Xxxxxxxxx Xxxxxxx, TX 78130 Xxxxxxx, Xx 00000 CEO Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxx.xxxxx@xxxxxxxxxxxxxxx.xxx 020800595 Email Address DUNS Number 00-0000000 17424406498 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number Health ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx West Texas Centers for Mental Health and Mental Retardation Legal Name of Contractor Comal County Family Violence Shelter Inc. West Texas Centers Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Xxxxxx Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24January 2, 2021 2024 Signature of Authorized Representative Date Signed Xxxxxxx Xxxxx Xxxx 01/02/2024 Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Title of Authorized Representative New Braunfels, TX 78130 319 Xxxxxxx Chief Executive Officer Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Xxxxxxx.Xxxxx@xxxxxxx.xxx 006712053 Email Address DUNS Number 00-0000000 17424406498 7526061696 17526061696 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) N/A 17526061696003 Texas Franchise Tax Number Texas Secretary of State Filing Number MBKXFMLQ9337 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx My Health My Resources of Tarrant County Legal Name of Contractor Comal MHMR of Tarrant County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24May 8, 2021 2023 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director CEO Title of Authorized Representative New Braunfels0000 Xxxxx Xxxxxx Fort Worth, TX 78130 76107 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 000.000.0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxx@xxxxxx.xxx 020333597 Email Address DUNS Number 00-0000000 17424406498 1751249456 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 30119759329 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number LJ9ENHUAKHV3 XXX.xxx Unique Entity Identifier (UEI) ATTACHMENT D Health and Human Services (HHS) Additional Provisions – Grant Funding Version 1.0 Effective: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions are incorporated into and made a part of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.Conditions - Governmental Entity Version 3.2 Published and Effective - May 2020 Responsible Office: Chief Counsel Table of Contents
Appears in 1 contract
Signature Authority. Contractor By submitting this Response, Respondent represents and warrants that the individual signing submitting this Contract Affirmations document and the documents made part of this Response is authorized to sign such documents on behalf of Contractor the Respondent and to bind the ContractorRespondent under any contract that may result from the submission of this Response. Signature Page Follows Authorized representative on behalf of Contractor Respondent must complete and sign the following: Xxxxx Xxxx Xxxxxx-Xxxxxx Legal Name of Contractor Comal Respondent Matagorda County Family Violence Shelter Inc. Women's Crisis Center Assumed Business Name of ContractorRespondent, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Represen ative 02/04/2022 u e of Authori ed Represent Date Signed Xxxxx Xxxx X. Xxxxxx-Xxxxxx Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Title of Authorized Representative New Braunfels0000 0xx Xxxxxx Xxx Xxxx, TX 78130 XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New BraunfelsXX Xxx 0000 Xxx Xxxx, TX 78131 XX 00000 Mailing Address, if different City, State, Zip Code (000-) 000-0000 (000-) 000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxx@xxxxxxxxx.xxx 800512840 Email Address DUNS Number 00-0000000 17424406498 00-0000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 174423163199 0069550301 Texas Franchise Tax Number Texas Secretary of State Filing Number 800512840 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.0 Published and Effective – Grant Funding Version 1.0 EffectiveAugust 2021 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxxxxxx Xxxxxx Legal Name of Contractor Comal County Family Violence Women's Shelter Inc. of South Texas Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County dba The Purple Door Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24September 21, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director President and CEO Title of Authorized Representative New Braunfels, TX 78130 Xxxxxxx X Xxxxxx President and CEO Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels813 Xxxxxx Corpus Christi, TX 78131 78404 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000P.O. Box 3368 Corpus Christi, TX 00000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxx@xxxxxxxxxxxx.xxx 000-000-0000 Email Address DUNS Number 00-0000000 17424406498 xxxxxxx@xxxxxxxxxxxx.xxx 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 00-0000000 17419433986 Texas Franchise Tax Number Texas Secretary of State Filing Number Health FY22-FY23 Residential and Human Nonresidential Services (HHS) Additional Provisions – Grant Funding Version 1.0 EffectiveContracts Amendment 3 Attachment M: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Revised FY 2022-2023 Budget Workbooks System Agency Contract No. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions are incorporated into and made a part of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.HHS000380000072
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Galveston County Health District Legal Name of Contractor Comal County Family Violence Shelter Inc. N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed g u Xxxxx Xxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. March 14, 2023 thorized Representative Date Signed Executive Director of Public Health Services Title of Authorized Representative New Braunfels0000 X Xxxxxx X Xxxxx Expressway Texas City, TX 78130 77591 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels939 La Marque, TX 78131 77568-0939 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxx@xxxx.xxx 198751372 Email Address DUNS Number 00-0000000 17424406498 17605214745 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) NA NA Texas Franchise Tax Number Texas Secretary of State Filing Number SK8BQZM1Z5P5 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Chambers County Health Department Legal Name of Contractor Comal Chambers County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal Chambers County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24March 27, 2021 2023 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Health Services Director Title of Authorized Representative New Braunfels000 Xxxxxxx Xxxx Xxxxxxx, TX 78130 XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels670 Anahuac, TX 78131 77514 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxx@xxxxxxxxxx.xxx 00-000-0000 Email Address DUNS Number 00-0000000 17424406498 00-0000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 0n/a 0n/a Texas Franchise Tax Number Texas Secretary of State Filing Number MT52MM4RWCU5 XXX.xxx Unique Entity Identifier (UEI) ATTACHMENT E Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Harris County, Texas Legal Name of Contractor Comal County Family Violence Shelter Inc. N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Xxxxx Repr Xxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director 1001 Xxxxxxx 9th Floor December 6, 2021 esentative Date Signed County Judge Title of Authorized Representative New Braunfels, Houston TX 78130 77002 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 same same Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 same Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 cjograntsnotification@hctx net 072206378 Email Address DUNS Number 00-0000000 17424406498 760454514 76454514 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number Health Attachment F ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Samples: Interlocal Cooperation Contract
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Northeast Texas Public Health District Legal Name of Contractor Comal County Family Violence Shelter Inc. Northeast Texas Public Health District Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24Xxxxxx X Xxxxxxx, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. May 23, 2023 Signature of Authorized Representative Date Signed Chief Executive Director Officer Title of Authorized Representative New Braunfels000 X. Xxxxxxxx #000 Xxxxx, TX 78130 XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels000 X. Xxxxxxxx #000 Tyler, TX 78131 75702 Mailing Address, if different City, State, Zip Code 000-000-0000 9,035,350,036.00 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxxx@xxxxxx.xxx Email Address DUNS Number 00-0000000 17424406498 752254544 17522545445 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number QYUMYH4V9EK5 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions – Uniform Terms and Conditions - Grant Funding Version 1.0 Effective3.2 Published and Effective July 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant ContractManagement Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Williamson County and Cities Health District Legal Name of Contractor Comal County Family Violence Shelter Inc. N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24April 17, 2021 2024 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Title of Authorized Representative New Braunfels000 Xxxxx Xxxxxx Xxxxx Xxxx, TX 78130 XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 N/A N/A Mailing Address, if different City, State, Zip Code 000-000-000 000 0000 000-000-0000 0000000000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxxx.xxxxxxx@xxxxx.xxx 179403910 Email Address DUNS Number 00-0000000 17424406498 17428969061 17428969061 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number UR5GAJLAQGJ6 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – Grant Funding Version 1.0 EffectiveNovember 2023 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxxxxxx X Xxxxxx Legal Name of Contractor Comal County Family Violence Shelter Inc. Twin City Mission, Inc Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24September 23, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director 0000 X Xxxxxxx Xxx CEO Title of Authorized Representative New BraunfelsBryan, TX 78130 77801 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels3490 Bryan, TX 78131 77805 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxx@xxxxxxxxxxxxxxx.xxx 010801827 Email Address DUNS Number 00-0000000 17424406498 17415336399 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 0026924180 0019982301 Texas Franchise Tax Number Texas Secretary of State Filing Number Health FY22-FY23 Residential and Human Nonresidential Services (HHS) Additional Provisions – Grant Funding Version 1.0 EffectiveContracts Amendment 3 Attachment M: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding EffectiveRevised FY 2022-2023 Budget Workbooks System Agency Contract No. HHS000380000073 Page 5 of 6 DocuSign Envelope ID: February 2021 TABLE OF CONTENTS 165AC4587-DF67-4CD7-B4F0-CB109997AB62 Family Violence Program Budget FY22 Salaries Contractor: Twin City Mission A B C D E F G Staff Position Justification Monthly Salary No. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions are incorporated into and made a part Months Annual Salary Percent applied to HHSC contract Amount budgeted to HHSC contract 1 Program Director Overall responsibility for operation of the Grant ContractDVS program and ensuring compliance with all contractual obligations. Terms included $ 5,386.33 12 $ 64,635.96 90.00% $ 58,172.36 2 Volunteer Coodinator Responsible for coordination of DVS volunteer program - $ 1,256.66 12 $ 15,079.92 25.00% $ 3,769.98 3 Shelter Monitor FT GG Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in these Additional Provisions the shelter; $ 2,291.00 12 $ 27,492.00 100.00% $ 27,492.00 4 Shelter Monitor FT DP Responsible for answering 24 hour hot line; client intake supervision and not otherwise defined have meeting immediate needs of clients in the meanings assigned shelter; $ 2,291.00 12 $ 27,492.00 100.00% $ 27,492.00 5 Shelter Monitor PT GP Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 776.00 12 $ 9,312.00 100.00% $ 9,312.00 6 Shelter Monitor PT Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 492.16 12 $ 5,905.92 100.00% $ 5,905.92 7 Shelter Monitor PT Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 492.16 12 $ 5,905.92 100.00% $ 5,905.92 8 Shelter Monitor PT Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 492.16 12 $ 5,905.92 100.00% $ 5,905.92 9 Shelter Monitor PT Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 492.16 12 $ 5,905.92 100.00% $ 5,905.92 10 $ - 100.00% $ - 11 $ - 0.00% $ - 12 $ - 0 $ - 0.00% $ - 13 $ - 0 $ - 0.00% $ - 14 $ - 0 $ - 0.00% $ - 15 $ - 0 $ - 0.00% $ - 16 $ - 0 $ - 0.00% $ - 17 $ - 0 $ - 0.00% $ - 18 $ - 0 $ - 0.00% $ - DocuSign Envelope ID: 65AC4587-DF67-4CD7-B4F0-CB109997AB62 Family Violence Program Budget FY22 Other Contractor: Twin City Mission A B C D E Description Justification Cost Percent Applied to them HHSC Contract Amount Budgeted to HHSC Contract 1 Postage HHSC program and client mail; $10 per month x 12 months; HHSC = 100% Based on Historical Data. $ 120.00 0.00% $ - 2 Printing Business cards, brochures and other informational material for DVS clients; $129.7858 per month x 12 months; HHSC = 100% Based on Historical Data. $ 1,557.43 0.00% $ - 3 Waste Disposal disposal for client shelter; $231.7458 per month x 12 months; HHSC = 100% Based on Historical Data. $ 2,780.95 100.00% $ 2,780.95 4 Small tools and equipment needed small tools for client shelter upkeep (vaccum, cooker, doorbell, etc.); $68.10 per month x 12 months; HHSC = 100% Based on Historical Data. $ 817.21 100.00% $ 817.21 5 Family Assistance direct client assistance (transportation:trolley tickets,parking,fuel, oil, other mass transit/childcare/Diapers & formula/Clothing & Shoes/Eye, Dental and Medical Assistance/ Identification & Birth Certificates/Prescription and Non-Prescription Medications/Pet support food and care/language translation; $ 2,618.00 0.00% $ - 6 Program Vehicles - Fuels and Lubricants Vehicle used for client transport; $44 per month x 12 months ; HHSC = 100% Based on Historical Data. $ 528.00 100.00% $ 528.00 7 Program Vehicles - Maint and Repairs Vehicle used for client transport; $50 per month x 12 months; HHSC = 100% Based on Historical Data. $ 600.00 100.00% $ 600.00 8 Program Vehicles - Insurance Vehicle used for client transport; $242 per month x 12 months; HHSC = 100% Based on Historical Data. $ 2,904.00 100.00% $ 2,904.00 9 Utilities Client shelter/Advocacy Center; $875.5858 per month x 12 months; HHSC = 100% Based on Historical Data. $ 10,507.03 100.00% $ 10,507.03 10 Phone Client shelter/Advocacy Center; $334 per month x 12 months; HHSC = 100% Based on Historical Data. $ 4,008.00 100.00% $ 4,008.00 11 Cell Phone Direct client provider use; $90.1667 per month x 12 months; HHSC = 100% Based on Historical Data. $ 1,082.00 100.00% $ 1,082.00 12 Cable TV Client Shelter; $102.545 per month x 12 months ; HHSC = 100% Based on Historical Data. $ 1,230.54 100.00% $ 1,230.54 13 Storage Space Rental Offsite storage for DVS material; $8 per month x 12 months; HHSC = 100% Based on Historical Data. $ 96.00 100.00% $ 96.00 14 Building Repair/Maint-general Client shelter/Advocacy Center; $678.3333 per month x 12 months; HHSC = 40% Based on Historical Data. $ 8,140.00 100.00% $ 8,140.00 DocuSign Envelope ID: 65AC4587-DF67-4CD7-B4F0-CB109997AB62 Family Violence Program Budget FY22 Supplemental Justification Contractor: Twin City Mission Cost Category Item # Justification 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 DocuSign Envelope ID: 65AC4587-DF67-4CD7-B4F0-CB109997AB62 Family Violence Program Budget FY23 Salaries Contractor: Twin City Mission A B C D E F G Staff Position Justification Monthly Salary No. of Months Annual Salary Percent applied to HHSC contract Amount budgeted to HHSC contract 1 Program Director Overall responsibility for operation of the DVS program and ensuring compliance with all contractual obligations. $ 5,386.33 12 $ 64,635.96 90.00% $ 58,172.36 2 Volunteer Coodinator Responsible for coordination of DVS volunteer program - $ 1,256.66 12 $ 15,079.92 25.00% $ 3,769.98 3 Shelter Monitor FT GG Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in HHS Uniform Terms the shelter; $ 2,291.00 12 $ 27,492.00 100.00% $ 27,492.00 4 Shelter Monitor FT DP Responsible for answering 24 hour hot line; client intake supervision and Conditionsmeeting immediate needs of clients in the shelter; $ 2,291.00 12 $ 27,492.00 100.00% $ 27,492.00 5 Shelter Monitor PT GP Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 776.00 12 $ 9,312.00 100.00% $ 9,312.00 6 Shelter Monitor PT Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 492.16 12 $ 5,905.92 100.00% $ 5,905.92 7 Shelter Monitor PT Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 492.16 12 $ 5,905.92 100.00% $ 5,905.92 8 Shelter Monitor PT Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 492.16 12 $ 5,905.92 100.00% $ 5,905.92 9 Shelter Monitor PT Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 492.16 12 $ 5,905.92 100.00% $ 5,905.92 10 $ - 0 $ - 0.00% $ - 11 $ - 0 $ - 0.00% $ - 12 $ - 0 $ - 0.00% $ - 13 $ - 0 $ - 0.00% $ - 14 $ - 0 $ - 0.00% $ - 15 $ - 0 $ - 0.00% $ - 16 $ - 0 $ - 0.00% $ - 17 $ - 0 $ - 0.00% $ - 18 $ - 0 $ - 0.00% $ - DocuSign Envelope ID: 65AC4587-DF67-4CD7-B4F0-CB109997AB62 Family Violence Program Budget FY23 Consumable Supplies Contractor: Twin City Mission A B C D E Description Justification Cost Percent Applied to HHSC Contract Amount Budgeted to HHSC Contract 1 Housekeeping supplies supplies for cleaning, Attachment C.bath and floor products; $113.34 per month x 12 months = $1,360.11; HHSC = 90% Based on Historical Data.. $ 1,360.11 90.00% $ 1,245.52 2 Laundry Supplies supplies to launder shelter linens, sheets, towels, blankets, etc..; $55 per month x 12 months = $660; HHSC = 100% Based on Historical Data. $ 660.00 100.00% $ 660.00 3 Medical Supplies Non-prescription medical items for clients of DVS program; $50 per month x 12 months = $600; HHSC = 100% Based on Historical Data. $ 600.00 100.00% $ 600.00 4 Office Supplies HHSC staff funded office supplies, such as paper, envelopes, pens, pencils, calenders, notebooks, paperclips, etc…$85 per month x 12 months = $1,020; HHSC = 80% Based on Historical Data. $ 1,020.00 80.00% $ 816.00 5 IT Supplies HHSC staff funded supplies, such as printer cartridges, antivirus software, etc….$20 per month x 12 months = $240; HHSC = 100% Based on Historical Data. $ 240.00 100.00% $ 240.00 6 Commercial Supplies supplies for kitchen area such as paper goods, plasticware, food storage containers, etc…$100 per month x 12 months = $1,200; HHSC = 100% Based on Historical Data. $ 1,200.00 100.00% $ 1,200.00 7 Activity Supplies arts and crafts, games for group activities; $41.94 per month x 12 months = $503.35; HHSC = 100% Based on Historical Data. $ 503.35 100.00% $ 503.35 8 $ - 0.00% $ - 9 $ - 0.00% $ - 10 $ - 0.00% $ - 11 $ - 0.00% $ - 12 $ - 0.00% $ - 13 $ - 0.00% $ - 14 $ - 0.00% $ - 15 $ - 0.00% $ - 16 $ - 0.00% $ - 17 $ - 0.00% $ - 18 $ - 0.00% $ - 19 $ - 0.00% $ - DocuSign Envelope ID: 65AC4587-DF67-4CD7-B4F0-CB109997AB62 Family Violence Program Budget FY23 Other Contractor: Twin City Mission A B C D E Description Justification Cost Percent Applied to HHSC Contract Amount Budgeted to HHSC Contract 1 Postage HHSC program and client mail; $10 per month x 12 months; HHSC = 100% Based on Historical Data. $ 120.00 0.00% $ - 2 Printing Business cards, brochures and other informational material for DVS clients; $129.7858 per month x 12 months; HHSC = 100% Based on Historical Data. $ 1,557.43 0.00% $ - 3 Waste Disposal disposal for client shelter; $231.7458 per month x 12 months; HHSC = 100% Based on Historical Data. $ 2,780.95 100.00% $ 2,780.95 4 Small tools and equipment needed small tools for client shelter upkeep (vaccum, cooker, doorbell, etc.); $68.10 per month x 12 months; HHSC = 100% Based on Historical Data. $ 817.21 100.00% $ 817.21 5 Family Assistance direct client assistance (transportation:trolley tickets,parking,fuel, oil, other mass transit/childcare/Diapers & formula/Clothing & Shoes/Eye, Dental and Medical Assistance/ Identification & Birth Certificates/Prescription and Non-Prescription Medications/Pet support food and care/language translation; $ 2,618.00 0.00% $ - 6 Program Vehicles - Fuels and Lubricants Vehicle used for client transport; $44 per month x 12 months ; HHSC = 100% Based on Historical Data. $ 528.00 100.00% $ 528.00 7 Program Vehicles - Maint and Repairs Vehicle used for client transport; $50 per month x 12 months; HHSC = 100% Based on Historical Data. $ 600.00 100.00% $ 600.00 8 Program Vehicles - Insurance Vehicle used for client transport; $242 per month x 12 months; HHSC = 100% Based on Historical Data. $ 2,904.00 100.00% $ 2,904.00 9 Utilities Client shelter/Advocacy Center; $875.5858 per month x 12 months; HHSC = 100% Based on Historical Data. $ 10,507.03 100.00% $ 10,507.03 10 Phone Client shelter/Advocacy Center; $334 per month x 12 months; HHSC = 100% Based on Historical Data. $ 4,008.00 100.00% $ 4,008.00 11 Cell Phone Direct client provider use; $90.1667 per month x 12 months; HHSC = 100% Based on Historical Data. $ 1,082.00 100.00% $ 1,082.00 12 Cable TV Client Shelter; $102.545 per month x 12 months ; HHSC = 100% Based on Historical Data. $ 1,230.54 100.00% $ 1,230.54 13 Storage Space Rental Offsite storage for DVS material; $8 per month x 12 months; HHSC = 100% Based on Historical Data. $ 96.00 100.00% $ 96.00 14 Building Repair/Maint-general Client shelter/Advocacy Center; $678.3333 per month x 12 months; HHSC = 40% Based on Historical Data. $ 8,140.00 100.00% $ 8,140.00 DocuSign Envelope ID: 65AC4587-DF67-4CD7-B4F0-CB109997AB62 Family Violence Program Budget FY23 Supplemental Justification Contractor: Twin City Mission Cost Category Item # Justification 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor By submitting this Response, Respondent represents and warrants that the individual signing submitting this Contract Affirmations document and the documents made part of this Response is authorized to sign such documents on behalf of Contractor the Respondent and to bind the ContractorRespondent under any contract that may result from the submission of this Response. Signature Page Follows Authorized representative on behalf of Contractor Respondent must complete and sign the following: Xxxxx Xxxx TMF Health Quality Institute Legal Name of Contractor Comal County Family Violence Shelter Inc. Respondent Assumed Business Name of ContractorRespondent, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Title of Authorized Representative New Braunfels, TX 78130 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Email Address DUNS Number 00-0000000 17424406498 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 30018101 Texas Franchise Tax Number Texas Secretary of State Filing Number Health XXX.xxx Unique Entity Identifier (UEI) ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2025 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Northeast Texas Public Health District Legal Name of Contractor Comal County Family Violence Shelter Inc. Northeast Texas Public Health District Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24May 19, 2021 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxx X. Xxxxxxx, Xx. Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Chief Executive Director Officer Title of Authorized Representative New Braunfels000 X. Xxxxxxxx #000 Xxxxx, TX 78130 Physical Street Address CityXX 00000-0000 Xxxxxxxx Xxxxxx Xxxxxxx Xxxx, StateXxxxx, Zip Xxx Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxxx@xxxxxx.xxx 144656753 Email Address DUNS Number 00-0000000 17424406498 752254544 17522545445 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) n/a n/a Texas Franchise Tax Number Texas Secretary of State Filing Number MYCADLKPTXM4 XXX.xxx Unique Entity Identifier (UEI) DocuSign Envelope ID: 5369A510-D824-4EBF-9AAF-2E0CD4D70112 Attachment D Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.0 Published and Effective – Grant Funding Version 1.0 EffectiveAugust 2021 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx City of Amarillo Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed A Xxxxx Xxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director 601 S Xxxxxxxx August 12, 2021 uthorized Representative Date Signed Assistant City Manager/CFO Title of Authorized Representative New BraunfelsAmarillo, TX 78130 79101 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels1971 Amarillo, TX 78131 79105 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxx.xxxxxx@xxxxxxxx.xxx 065032807 Email Address DUNS Number 00-0000000 17424406498 17560004446 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 17460000890002 17460000890002 Texas Franchise Tax Number Texas Secretary of State Filing Number Health ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx City of Garland Public Health Department Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24July 28, 2021 2023 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive 000 Xxxxxx Xxxxxx Director of Operations and Emergency Mgmt Title of Authorized Representative New BraunfelsGarland, TX 78130 75040 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxx@xxxxxxxxx.xxx Email Address DUNS Number 00756000534 756000534-0000000 17424406498 1847361 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 756000534 7361 756000534-7361 Texas Franchise Tax Number Texas Secretary of State Filing Number F2DLUDKRCN98 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions – Uniform Terms and Conditions - Grant Funding Version 1.0 Effective3.2 Published and Effective July 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant ContractManagement Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Denton County Public Health Legal Name of Contractor Comal County Family Violence Shelter Inc. Same Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Same Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24April 5, 2021 Signature of Authorized Representative 2023 g presentative Date Signed Xxxxx County Judge Xxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director 000 X. Xxxx 000, Xxxxx 0000 Denton County Judge Title of Authorized Representative New BraunfelsDenton, TX 78130 76205 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 same same Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Xxxx.Xxxxxx@xxxxxxxxxxxx.xxx 074863127 Email Address DUNS Number N/A 00-0000000 17424406498 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number HDKNE4T1LXG7 XXX.xxx Unique Entity Identifier (UEI) ATTACHMENT E Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 filed Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxx Xxxxxxxxx MPH Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Health Director Title of Authorized Representative New Braunfels, TX 78130 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Email Address DUNS Number 00-0000000 17424406498 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Texas Franchise Tax Number Texas Secretary of State Filing Number Certificate Of Completion Envelope Id: A5DBD287BC214B1A9E39826F3C781313 Status: Sent Subject: HHS001077800001, Corpus Christi-Nueces County Public Health District (COUNTY), Base Contract Source Envelope: Document Pages: 61 Signatures: 0 Envelope Originator: Certificate Pages: 5 Initials: 0 CMS Internal Routing Mailbox AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) 00000 Xxxxxx Xxxxx Xxxx #000 Xxxxxx, XX 00000 XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx IP Address: 160.42.85.11 Record Tracking Status: Original 8/2/2021 3:37:57 PM Holder: CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Location: DocuSign Signer Events Signature Timestamp Xxxxxxx Xxxxxxxxx MPH XxxxxxxX@xxxxxxx.xxx Health Director Corpus Christi-Nueces County Public Health District Security Level: Email, Account Authentication (None) Electronic Record and Human Services Signature Disclosure: Accepted: 8/2/2021 3:50:58 PM ID: 096941c4-5cca-41ca-8062-fadf8ccbdd97 Xxxxxxx Xxxxxxxxx MPH XxxxxxxX@xxxxxxx.xxx Security Level: Email, Account Authentication (HHSNone) Additional Provisions – Grant Funding Version 1.0 EffectiveElectronic Record and Signature Disclosure: February 2021 Health Accepted: 8/2/2021 3:50:58 PM ID: 096941c4-5cca-41ca-8062-fadf8ccbdd97 Xxxxx Xxxxxxxxxx Xxxxx.Xxxxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Human Services Additional Provisions V.1.0 – Grant Funding EffectiveSignature Disclosure: February 2021 TABLE OF CONTENTS 1Accepted: 8/2/2021 11:46:13 AM ID: 8e6586d9-b216-4504-9187-3a51cfefadfd Xxxxx Xxxxxxxx Xxxxx.Xxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 8/2/2021 12:17:45 PM ID: d82d1e7c-a072-4b17-a0b9-63d90d3ed840 Xxxx Gruber Xxxxx.Xxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 1/3/2021 4:48:45 PM ID: bd2f4497-b4dc-4c51-9974-71b86780cff4 Sent: 8/2/2021 3:45:10 PM Viewed: 8/2/2021 3:50:58 PM In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Xxxxxxxx Xxxxx Xxxxxxxx.Xxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign CMS Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxxxx Xxxxxx Xxxxxxx.Xxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxx Xxxxxx xxxxx@xxxxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign CMS Inbox xxxxxxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 8/2/2021 3:45:10 PM Payment Events Status Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on: 9/14/2020 7:10:18 PM Parties agreed to: Xxxxxxx Xxxxxxxxx MPH, Xxxxxxx Xxxxxxxxx MPH, Xxxxx Xxxxxxxxxx, Xxxxx Xxxxxxxx, Xxxx Xxxxxx ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, DSHS Contract Management Section (we, us or Company) may be required by law to provide to you certain written notices or disclosures. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The Described below are the terms and conditions for providing to you such notices and disclosures electronically through the DocuSign system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to this Electronic Record and Signature Disclosure (ERSD), please confirm your agreement by selecting the check-box next to ‘I agree to use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign system. Getting paper copies At any time, you may request from us a paper copy of these Additional Provisions any record provided or made available electronically to you by us. You will have the ability to download and print documents we send to you through the DocuSign system during and immediately after the signing session and, if you elect to create a DocuSign account, you may access the documents for a limited period of time (usually 30 days) after such documents are incorporated into first sent to you. After such time, if you wish for us to send you paper copies of any such documents from our office to you, you will be charged a $0.00 per-page fee. You may request delivery of such paper copies from us by following the procedure described below. Withdrawing your consent If you decide to receive notices and disclosures from us electronically, you may at any time change your mind and tell us that thereafter you want to receive required notices and disclosures only in paper format. How you must inform us of your decision to receive future notices and disclosure in paper format and withdraw your consent to receive notices and disclosures electronically is described below. Consequences of changing your mind If you elect to receive required notices and disclosures only in paper format, it will slow the speed at which we can complete certain steps in transactions with you and delivering services to you because we will need first to send the required notices or disclosures to you in paper format, and then wait until we receive back from you your acknowledgment of your receipt of such paper notices or disclosures. Further, you will no longer be able to use the DocuSign system to receive required notices and consents electronically from us or to sign electronically documents from us. All notices and disclosures will be sent to you electronically Unless you tell us otherwise in accordance with the procedures described herein, we will provide electronically to you through the DocuSign system all required notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made a part available to you during the course of our relationship with you. To reduce the chance of you inadvertently not receiving any notice or disclosure, we prefer to provide all of the Grant Contractrequired notices and disclosures to you by the same method and to the same address that you have given us. Terms included Thus, you can receive all the disclosures and notices electronically or in these Additional Provisions paper format through the paper mail delivery system. If you do not agree with this process, please let us know as described below. Please also see the paragraph immediately above that describes the consequences of your electing not to receive delivery of the notices and disclosures electronically from us. How to contact DSHS Contract Management Section: You may contact us to let us know of your changes as to how we may contact you electronically, to request paper copies of certain information from us, and to withdraw your prior consent to receive notices and disclosures electronically as follows: To contact us by email send messages to: xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx To advise DSHS Contract Management Section of your new email address To let us know of a change in your email address where we should send notices and disclosures electronically to you, you must send an email message to us at xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state: your previous email address, your new email address. We do not otherwise defined have require any other information from you to change your email address. If you created a DocuSign account, you may update it with your new email address through your account preferences. To request paper copies from DSHS Contract Management Section To request delivery from us of paper copies of the meanings assigned notices and disclosures previously provided by us to them you electronically, you must send us an email to xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in HHS Uniform Terms the body of such request you must state your email address, full name, mailing address, and Conditionstelephone number. We will xxxx you for any fees at that time, Attachment C.if any. To withdraw your consent with DSHS Contract Management Section To inform us that you no longer wish to receive future notices and disclosures in electronic format you may:
Appears in 1 contract
Samples: Interlocal Cooperation Contract
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx HARDIN COUNTY HEALTH SERVICES Legal Name of Contractor Comal County Family Violence Shelter Inc. N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24orized Representative April 13, 2021 2023 Signature of Authorized Representative Auth Date Signed Xxxxx Xxxx XxXxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director County Judge Title of Authorized Representative New Braunfels000 XXXX XXXXXX XX Xxxxxxx, TX 78130 Xxxxx 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 SAME SAME Mailing Address, if different City, State, Zip Code (000-) 000-0000 (000-) 000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Xxxxx.XxXxxxxx@Xx.Xxxxxx.TX.US 082012840 Email Address DUNS Number 0017460015369013 74-0000000 17424406498 600153690 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number CLUMWDLWCLP6 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxxxxxx Xxxxxxxx Legal Name of Contractor Comal County Family Violence Shelter Inc. Crisis Center of the Plains Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24September 27, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxx Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. 000 Xxxx 0xx Xxxxxx Executive Director Title of Authorized Representative New BraunfelsPlainview, TX 78130 Texas 79072 Physical Street Address City, State, Zip Code PO Post Office Box 310344 New Braunfels326 Plainview, TX 78131 Texas 79073 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxxxx@xxxxxxxxx.xxx 948880844 Email Address DUNS Number 00-0000000 17424406498 17519192276 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 n/a n/a Texas Franchise Tax Number Texas Secretary of State Filing Number Health FY22-FY23 Residential and Human Nonresidential Services (HHS) Additional Provisions – Grant Funding Version 1.0 EffectiveContracts Amendment 3 Attachment M: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding EffectiveRevised FY 2022-2023 Budget Workbooks System Agency Contract No. HHS000380000026 DocuSign Envelope ID: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective6B91390F-F638-440A-BDDF-3B917B61B061 Family Violence Program Budget FY22 Salaries Contractor: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions are incorporated into and made a part Crisis Center of the Grant ContractPlains A B C D E F G Staff Position Justification Monthly Salary No. Terms included of Months Annual Salary Percent applied to HHSC contract Amount budgeted to HHSC contract 1 Executive Director Oversees all operations and administration and Safe Home services and recommends to Board of Directors on all matters requiring action $ 3,640.00 12 $ 43,680.00 34.23% $ 14,951.66 2 Assistant Director Assist Executive Director in these Additional Provisions all operations and not otherwise defined have administration, direct supervision of Advocacy and Safe Home services and recommends to Board of Directors on all matters requiring action $ 3,206.67 12 $ 38,480.04 37.49% $ 14,426.17 3 Financial Director Maintains Accounts Receivable/Payables, Bank Statements/Quarterly Reports $ 3,293.33 12 $ 39,519.96 15.62% $ 6,173.02 4 Advocacy Director Oversees advocates in administration and Safe Home, works with survivors/ assists with Legal advocacy with clients. $ 3,033.33 12 $ 36,399.96 19.69% $ 7,167.15 5 Senior Advocate Coordinate Primary presentations work, Advocacy with individuals and recruits and trains volunteers. $ 2,600.00 12 $ 31,200.00 20.92% $ 6,527.04 6 Victims Advocate Coordinate Primary presentations work. Advocacy work with individuals survivors, recuits and trains volunteers through out the meanings assigned year. $ 2,166.67 12 $ 26,000.04 13.22% $ 3,437.21 7 Data Entry-Part Time Data entry clerk on all work with resident and non-resident clients in the Osnium system. $ 866.67 12 $ 10,400.04 76.92% $ 7,999.71 8 Safe Home Director Oversees advocates at Safe Home, reviews all safe home clients files and operations of the safe home. Full time position. Making sure the safe home has maintained compliance with the cleaning and safety of clients during the COVID-19. $ 2,080.00 12 $ 24,960.00 68.29% $ 17,045.18 9 Safe Home Advocate/ Shift Worker/ #1 Maintains safety of the survivors living in the Safe home. Develops Safety Plans and service plans with survivors. Check on clients, makes sure no fever and all requirements. Part time position. $ 1,733.33 12 $ 20,799.96 97.00% $ 20,175.96 10 Safe Home Advocate/ Shift Worker/ #2 Maintains safety of the survivors living in the Safe home. Develops Safety Plans and service plans with survivors. Check on clients, makes sure no fever and all requirements. Part time position. $ 1,733.33 12 $ 20,799.96 97.00% $ 20,175.96 DocuSign Envelope ID: 6B91390F-F638-440A-BDDF-3B917B61B061 Family Violence Program Budget FY22 Fringe Benefits - Employer Paid Portion Contractor: Crisis Center of the Plains A B C D E F G H I J K Staff Position FICA & Medicare Workers' Compensation State Unemployment Insurance Health Insurance Life Insurance Dental Insurance Retirement Other - See Supplemental Justification Page Subtotals 1 Executive Director Gross $ 3,341.52 $ 169.53 $ 108.90 $ 5,224.32 $ 466.80 $ - $ - $ - $ 9,311.07 34.23% $ 1,143.80 $ 58.03 $ 37.28 $ 1,788.28 $ 159.79 $ - $ - $ - $ 3,187.18 2 Assistant Director Gross $ 2,943.72 $ 169.53 $ 108.90 $ 5,224.32 $ 466.80 $ - $ - $ - $ 8,913.27 37.49% $ 1,103.60 $ 63.56 $ 40.83 $ 1,958.60 $ 175.00 $ - $ - $ - $ 3,341.59 3 Financial Director Gross $ 3,023.28 $ 169.53 $ 108.90 $ 5,224.32 $ 466.80 $ - $ - $ - $ 8,992.83 15.62% $ 472.24 $ 26.48 $ 17.01 $ 816.04 $ 72.91 $ - $ - $ - $ 1,404.68 4 Advocacy Director Gross $ 2,784.60 $ 169.53 $ 108.90 $ 5,224.32 $ 292.20 $ - $ - $ - $ 8,579.55 19.69% $ 548.29 $ 33.38 $ 21.44 $ 1,028.67 $ 57.53 $ - $ - $ - $ 1,689.31 5 Senior Advocate Gross $ 2,386.80 $ 169.53 $ 108.90 $ 5,224.32 $ 238.92 $ - $ - $ - $ 8,128.47 20.92% $ 499.32 $ 35.47 $ 22.78 $ 1,092.93 $ 49.98 $ - $ - $ - $ 1,700.48 6 Victims Advocate Gross $ 1,989.00 $ 169.53 $ 108.90 $ 5,224.32 $ 277.88 $ - $ - $ - $ 7,769.63 13.22% $ 262.95 $ 22.41 $ 14.40 $ 690.66 $ 36.74 $ - $ - $ - $ 1,027.16 7 Data Entry-Part Time Gross $ 795.60 $ 169.53 $ 108.90 $ - $ - $ - $ - $ - $ 1,074.03 76.92% $ 611.98 $ 130.40 $ 83.77 $ - $ - $ - $ - $ - $ 826.15 8 Safe Home Director Gross $ 1,909.44 $ 169.53 $ 108.90 $ - $ - $ - $ - $ - $ 2,187.87 68.29% $ 1,303.96 $ 115.77 $ 74.37 $ - $ - $ - $ - $ - $ 1,494.10 9 Safe Home Advocate/ Shift Worker/ #1 Gross $ 1,591.20 $ 169.53 $ 108.90 $ 5,224.32 $ 257.40 $ - $ - $ - $ 7,351.35 97.00% $ 1,543.46 $ 164.44 $ 105.63 $ 5,067.59 $ 249.68 $ - $ - $ - $ 7,130.80 10 Safe Home Advocate/ Shift Worker/ #2 Gross $ 1,591.20 $ 169.53 $ 108.90 $ 5,224.32 $ 257.40 $ - $ - $ - $ 7,351.35 97.00% $ 1,543.46 $ 164.44 $ 105.63 $ 5,067.59 $ 249.68 $ - $ - $ - $ 7,130.80 DocuSign Envelope ID: 6B91390F-F638-440A-BDDF-3B917B61B061 Family Violence Program Budget FY22 Other Contractor: Crisis Center of the Plains A B C D E Description Justification Cost Percent Applied to them HHSC Contract Amount Budgeted to HHSC Contract 1 Copier Lease Printing of intakes, protective orders, presentation materials, bookkeeping reports and grant copies. 265.08 x 12 months=3180.96 HHSC=15.75%, SAPCS=30.93%, OVAG=11.35%, BIPP=7.86%, Unrestricted=34.14% $ 3,177.45 15.75% $ 500.45 2 Fire and Security System at Safe Home Safe home security camera and fire alarm and entry alarm to keep clients secure. 90 x 12 months = 1080.00 HHSC= 46.3%, Unrestricted=53.7% $ 1,079.91 46.30% $ 500.00 3 Van- Vehicle Lease This vehicle is used to transport clients to appointments, job interviews and dr appointments. Advocates use the vehicle to travel to out lying counties to present presentations and to attend court hearings. The mileage in HHS Uniform Terms the vehicle is approximately 10,500 miles annually. 365.00 x 12 months = 4380.00 $ 4,380.00 100.00% $ 4,380.00 4 Directors and ConditionsOfficers Insurance Required for the directors and officers. HHSC=33.5%, Attachment C.Unrestricted=66.5% $ 1,791.00 33.50% $ 599.99 5 Property Liability Professional Insurance Property, general and professional liability coverage. HHSC=34.55%, SAPCS=1.33%, OVAG=6.42%, Unrestricted=57.71% $ 11,286.00 34.55% $ 3,899.31 6 Office Utilities Electricity, water, trash, sewer, gas. HHSC=20.09%, VOCA=23.64%, SAPCS=29.01%, OVAG=10%, BIPP=12.41%, Unrestricted=4.85% $ 8,461.92 20.09% $ 1,700.00 7 Office Telephone Hotline calls & staff use for communications. HHSC=14.79%, VOCA=24.66%, SAPCS=42.31%, OVAG=8.38%, BIPP=8.22%, Unrestricted=1.64% $ 3,042.60 14.79% $ 450.00 8 Office Internet Communication on grants and with law enforcement and the judicial system. HHSC=50.01%, VOCA=41.67%, BIPP=5%, Unrestricted=3.32% $ 899.82 50.01% $ 450.00 9 Office Maintenance Maintaining property / building repairs of plumbing, electrical, air conditioning and heating. HHSC=18.06%, SAPSC=50.02%, OVAG=14.45%, BIPP=5.42%, Unrestricted=12.05% $ 2,768.55 18.06% $ 500.00 10 Client Assistance OTC medications, bus tickets, birth certificates, drivers license, state ID and public transportation passes for clients. HHSC=34.12%, Unrestricted 65.88% $ 6,365.00 34.12% $ 2,171.74 DocuSign Envelope ID: 6B91390F-F638-440A-BDDF-3B917B61B061 Family Violence Program Budget FY22 Supplemental Justification Contractor: Crisis Center of the Plains Cost Category Item # Justification 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 DocuSign Envelope ID: 6B91390F-F638-440A-BDDF-3B917B61B061 Family Violence Program Budget FY23 Salaries Contractor: Crisis Center of the Plains A B C D E F G Staff Position Justification Monthly Salary No. of Months Annual Salary Percent applied to HHSC contract Amount budgeted to HHSC contract 1 Executive Director Oversees all operations and administration and Safe Home services and recommends to Board of Directors on all matters requiring action $ 3,640.00 12 $ 43,680.00 34.23% $ 14,951.66 2 Assistant Director Assist Executive Director in all operations and administration, direct supervision of Advocacy and Safe Home services and recommends to Board of Directors on all matters requiring action $ 3,206.67 12 $ 38,480.04 37.49% $ 14,426.17 3 Financial Director Maintains Accounts Receivable/Payables, Bank Statements/Quarterly Reports $ 3,293.33 12 $ 39,519.96 15.62% $ 6,173.02 4 Advocacy Director Oversees advocates in administration and Safe Home, works with survivors/ assists with Legal advocacy with clients. $ 3,033.33 12 $ 36,399.96 19.69% $ 7,167.15 5 Senior Advocate Coordinate Primary presentations work, Advocacy with individuals and recruits and trains volunteers. $ 2,600.00 12 $ 31,200.00 20.92% $ 6,527.04 6 Victims Advocate Coordinate Primary presentations work. Advocacy work with individuals survivors, recuits and trains volunteers through out the year. $ 2,166.67 12 $ 26,000.04 13.22% $ 3,437.21 7 Data Entry-Part Time Data entry clerk on all work with resident and non-resident clients in the Osnium system. $ 866.67 12 $ 10,400.04 76.92% $ 7,999.71 8 Safe Home Director Oversees advocates at Safe Home, reviews all safe home clients files and operations of the safe home. Full time position. Making sure the safe home has maintained compliance with the cleaning and safety of clients during the COVID-19. $ 2,080.00 12 $ 24,960.00 68.29% $ 17,045.18 9 Safe Home Advocate/ Shift Worker/#1 Maintains safety of the survivors living in the Safe home. Develops Safety Plans and service plans with survivors. Check on clients, makes sure no fever and all requirements. Part time position. $ 1,733.33 12 $ 20,799.96 97.00% $ 20,175.96 10 Safe Home Advocate/ Shift Worker/#2 Maintains safety of the survivors living in the Safe home. Develops Safety Plans and service plans with survivors. Check on clients, makes sure no fever and all requirements. Part time position. $ 1,733.33 12 $ 20,799.96 97.00% $ 20,175.96 DocuSign Envelope ID: 6B91390F-F638-440A-BDDF-3B917B61B061 Family Violence Program Budget FY23 Fringe Benefits - Employer Paid Portion Contractor: Crisis Center of the Plains A B C D E F G H I J K Staff Position FICA & Medicare Workers' Compensation State Unemployment Insurance Health Insurance Life Insurance Dental Insurance Retirement Other - See Supplemental Justification Page Subtotals 1 Executive Director Gross $ 3,341.52 $ 169.53 $ 108.90 $ 5,224.32 $ 466.80 $ - $ - $ - $ 9,311.07 34.23% $ 1,143.80 $ 58.03 $ 37.28 $ 1,788.28 $ 159.79 $ - $ - $ - $ 3,187.18 2 Assistant Director Gross $ 2,943.72 $ 169.53 $ 108.90 $ 5,224.32 $ 466.80 $ - $ - $ - $ 8,913.27 37.49% $ 1,103.60 $ 63.56 $ 40.83 $ 1,958.60 $ 175.00 $ - $ - $ - $ 3,341.59 3 Financial Director Gross $ 3,023.28 $ 169.53 $ 108.90 $ 5,224.32 $ 466.80 $ - $ - $ - $ 8,992.83 15.62% $ 472.24 $ 26.48 $ 17.01 $ 816.04 $ 72.91 $ - $ - $ - $ 1,404.68 4 Advocacy Director Gross $ 2,784.60 $ 169.53 $ 108.90 $ 5,224.32 $ 292.20 $ - $ - $ - $ 8,579.55 19.69% $ 548.29 $ 33.38 $ 21.44 $ 1,028.67 $ 57.53 $ - $ - $ - $ 1,689.31 5 Senior Advocate Gross $ 2,386.80 $ 169.53 $ 108.90 $ 5,224.32 $ 238.92 $ - $ - $ - $ 8,128.47 20.92% $ 499.32 $ 35.47 $ 22.78 $ 1,092.93 $ 49.98 $ - $ - $ - $ 1,700.48 6 Victims Advocate Gross $ 1,989.00 $ 169.53 $ 108.90 $ 5,224.32 $ 277.88 $ - $ - $ - $ 7,769.63 13.22% $ 262.95 $ 22.41 $ 14.40 $ 690.66 $ 36.74 $ - $ - $ - $ 1,027.16 7 Data Entry-Part Time Gross $ 795.60 $ 169.53 $ 108.90 $ - $ - $ - $ 1,074.03 76.92% $ 611.98 $ 130.40 $ 83.77 $ - $ - $ - $ - $ - $ 826.15 8 Safe Home Director Gross $ 1,909.44 $ 169.53 $ 108.90 $ - $ - $ - $ - $ 2,187.87 68.29% $ 1,303.96 $ 115.77 $ 74.37 $ - $ - $ - $ - $ - $ 1,494.10 9 Safe Home Advocate/ Shift Worker/#1 Gross $ 1,591.20 $ 169.53 $ 108.90 $ 5,224.32 $ 257.40 $ - $ - $ - $ 7,351.35 97.00% $ 1,543.46 $ 164.44 $ 105.63 $ 5,067.59 $ 249.68 $ - $ - $ - $ 7,130.80 10 Safe Home Advocate/ Shift Worker/#2 Gross $ 1,591.20 $ 169.53 $ 108.90 $ 5,224.32 $ 257.40 $ - $ - $ - $ 7,351.35 97.00% $ 1,543.46 $ 164.44 $ 105.63 $ 5,067.59 $ 249.68 $ - $ - $ - $ 7,130.80 DocuSign Envelope ID: 6B91390F-F638-440A-BDDF-3B917B61B061 Family Violence Program Budget FY23 Other Contractor: Crisis Center of the Plains A B C D E Description Justification Cost Percent Applied to HHSC Contract Amount Budgeted to HHSC Contract 1 Copier Lease Printing of intakes, protective orders, presentation materials, bookkeeping reports and grant copies. 265.08 x 12 months=3180.96 HHSC=15.75%, SAPCS=30.93%, OVAG=11.35%, BIPP=7.86%, Unrestricted=34.14% $ 3,177.45 15.75% $ 500.45 2 Fire and Security System at Safe Home Safe home security camera and fire alarm and entry alarm to keep clients secure. 90 x 12 months = 1080.00 HHSC= 46.3%, Unrestricted=53.7% $ 1,079.91 46.30% $ 500.00 3 Van- Vehicle Lease This vehicle is used to transport clients to appointments, job interviews and dr appointments. Advocates use the vehicle to travel to out lying counties to present presentations and to attend court hearings. The mileage in the vehicle is approximately 10,500 miles annually. 365.00 x 12 months = 4380.00 $ 4,380.00 100.00% $ 4,380.00 4 Directors and Officers Insurance Required for the directors and officers. HHSC=33.5%, Unrestricted=66.5% $ 1,791.00 33.50% $ 599.99 5 Property Liability Professional Insurance Property, general and professional liability coverage. HHSC=34.55%, SAPCS=1.33%, OVAG=6.42%, Unrestricted=57.71% $ 11,286.00 34.55% $ 3,899.31 6 Office Utilities Electricity, water, trash, sewer, gas. HHSC=20.09%, VOCA=23.64%, SAPCS=29.01%, OVAG=10%, BIPP=12.41%, Unrestricted=4.85% $ 8,461.92 20.09% $ 1,700.00 7 Office Telephone Hotline calls & staff use for communications. HHSC=14.79%, VOCA=24.66%, SAPCS=42.31%, OVAG=8.38%, BIPP=8.22%, Unrestricted=1.64% $ 3,042.60 14.79% $ 450.00 8 Office Internet Communication on grants and with law enforcement and the judicial system. HHSC=50.01%, VOCA=41.67%, BIPP=5%, Unrestricted=3.32% $ 899.82 50.01% $ 450.00 9 Office Maintenance Maintaining property / building repairs of plumbing, electrical, air conditioning and heating. HHSC=18.06%, SAPSC=50.02%, OVAG=14.45%, BIPP=5.42%, Unrestricted=12.05% $ 2,768.55 18.06% $ 500.00 10 Client Assistance OTC medications, bus tickets, birth certificates, drivers license, state ID and public transportation passes for clients. HHSC=34.12%, Unrestricted 65.88% $ 6,365.00 34.12% $ 2,171.74 DocuSign Envelope ID: 6B91390F-F638-440A-BDDF-3B917B61B061 Family Violence Program Budget FY23 Supplemental Justification Contractor: Crisis Center of the Plains Cost Category Item # Justification 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Ellis County Coalition for Health Options, Inc. Legal Name of Contractor Comal County Family Violence Shelter Inc. Hope Health Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Xxxxx, Xxxxxxx, Xxxxxxx & Xxxx Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24October 5, 2021 2022 Signature of Authorized Representative Date Signed Xxxxxxx Xxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director CEO Title of Authorized Representative New Braunfels000 X. Xxxxxxxxx Street Waxahachie, TX 78130 75165 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels000 X. Xxxxxxxxx Street Waxahachie, TX 78131 75165 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxx@xxxxxxxxxxxx.xxx 87868653 Email Address DUNS Number 00-0000000 17424406498 0-00-00000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) NA 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number Health and Human Services T9SRL6KRFK48 XXX.xxx Unique Entity Identifier (HHSUEI) Additional Provisions y DocuSign Envelope ID: 174E3697-45BA-4893-8CB8-E1C1DD56D65B r Incubator Program – Grant Funding Version 1.0 Effective: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Open Enrollment No. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions are incorporated into and made a part of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.HHS0012233
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxxxxxxxx Legal Name of Contractor Comal Medina County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24September 1, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxxxx County Judge Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director 0000 Xxxxxx X Title of Authorized Representative New Braunfels, Hondo TX 78130 78861 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels0000 Xxxxxx X Xxxxx, TX 78131 XX 00000 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxxxxxx@xxxxxxxxxxxxxxxxx.xxx 080272057 Email Address DUNS Number 00-0000000 17424406498 017460011061 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number Health ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx SAn Xxxxxxxx County Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 ed Representative Signature of Authorized Representative Date Signed Authoriz Judge Xxxxx Xxxx Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director 000 X. Xxxxxx Xx 000 Sinton Texas 78387 August 25, 2021 Date Signed San Xxxxxxxx County Title of Authorized Representative New Braunfels, TX 78130 400 w Xxxxxx XX 109 Xxxxxx Tx.78387 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, 400W. Xxxxxx Xx 000 Sinton Tx. 798387 000 X. Xxxxxx Xx 000 Xxxxxx TX 78131 78387 Mailing Address, if different City, State, Zip Code 000-000-0000 000361364-000-0000 6118 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxx@xxxxxxxxxxxxxxxxxxx.xxx 0784490547 Email Address DUNS Number 00-0000000 17424406498 174662307006 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 00000 1746002307006 Texas Franchise Tax Number Texas Secretary of State Filing Number Health ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx The University of Texas at Arlington Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24September 1, 2021 2023 Signature of Authorized Representative Date Signed Xxxxx Xxxx X Xxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Senior Director, OGCS Title of Authorized Representative New Braunfels000 X. Xxxxxxxxx Drive Arlington, TX 78130 76019 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000Phone Number Fax Number xxxxx.xxxxxxxxx@xxx.xxx 00-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Email Address DUNS Number 00-0000000 17424406498 37147147146 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) n/a n/a Texas Franchise Tax Number Texas Secretary of State Filing Number LMLUKUPJJ9N3 XXX.xxx Unique Entity Identifier (UEI) ATTACHMENT D Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxxxxxx Living LLC Legal Name of Contractor Comal County Family Violence Shelter Inc. Xxxxxxx Living LLC Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Harris county Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 247, 2021 2022 Signature of Authorized Representative Date Signed Xxxxx X Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Title of Authorized Representative New Braunfels0000 Xxxxxxxxx Xx Xxxxxxx, TX 78130 XX. 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxx@xxxxxxxxxxxxx.xxx 065852210 Email Address DUNS Number 00-0000000 17424406498 32060716332 1487107801 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 32060716332 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number N/A XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions – Grant Funding Version 1.0 Effective: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions are incorporated into and made a part of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.Conditions - Vendor Version 3.2 Effective: April 2021 Responsible Office: Chief Counsel Table of Contents
Appears in 1 contract
Samples: HHSC Contract
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Collin County Legal Name of Contractor Comal County Family Violence Shelter Inc. N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24December 2, 2021 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxx, County Judge Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director County Judge Title of Authorized Representative New Braunfels, TX 78130 XXXXX XXXX COUNTY JUDGE Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels0000 XXXXXXXXX XX XXXXXXXX, TX 78131 75071 Mailing Address, if different City, State, Zip Code N/A N/A Phone Number Fax Number 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Email Address DUNS Number 00-0000000 17424406498 XXXXX@XX.XXXXXX.XX.XX 074873449 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 00-0000000 17560008736 Texas Franchise Tax Number Texas Secretary of State Filing Number S1ETLA9BNCC5 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx N/A Legal Name of Contractor Comal County Family Violence Shelter Inc. N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature ature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. August 29, 2022 Sign Representative Date Signed Executive Director Director, Interim Title of Authorized Representative New Braunfels0000 Xxx Xxxxxxx Xxxxxx, TX 78130 Xxxxx 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Same Same Mailing Address, if different City, State, Zip Code Same Same Phone Number Fax Number 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 n/A Email Address DUNS Number 00-0000000 17424406498 xxxxxx.xxxxxx@xxxx.xxxxx.xxx 078354556 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 00-0000000 36446446449 000 Texas Franchise Tax Number Texas Secretary of State Filing Number L667SNCL4135 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.1 Published and Effective – Grant Funding Version 1.0 EffectiveApril 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxxxxx Xxxxxxx Legal Name of Contractor Comal County Family Violence Shelter Inc. Xxxxxxx Center Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24October 21, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director 8/24/2021 Title of Authorized Representative New Braunfels, TX 78130 Xxxxxx Xxxxxxx Chief Executive Officer Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels0000 Xxxx Xxxxx Tyler, TX 78131 Tx 75702 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 P O Box 4730 Tyler, Tx 75712 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 000 000-0000 000 000-0000 Email Address DUNS Number 00-0000000 17424406498 xxxxxxxx@xxxxxxxxxxxxx.xxx 182925958 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 175128141108005 1-75-1281410-8 Texas Franchise Tax Number Texas Secretary of State Filing Number Health ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx The University of TExas at EL Paso Legal Name of Contractor Comal County Family Violence Shelter Inc. N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County El Paso Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24February 11, 2021 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxx X Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director 000 X. Xxxxxxxxxx Xxxxxx Vice President for Research Title of Authorized Representative New BraunfelsEl Paso, TX 78130 Texas 79968 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 N/A N/A Mailing Address, if different City, State, Zip Code (000-) 000-0000 000-000-0000 N/A Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxx@xxxx.xxx 132051285 Email Address DUNS Number 00-0000000 17424406498 740006813 N/A Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number Health XXX.xxx Unique Entity Identifier (UEI) ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx City of Lubbock Legal Name of Contractor Comal County Family Violence Shelter Inc. City of Lubbock Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center City of Comal County Lubbock Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed A Xxxx Xxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director May 19, 2023 uthorized Representative Date Signed Mayor Title of Authorized Representative New Braunfels0000 xxx. K Lubbock, TX 78130 Texas 79401 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 N/A N/A Mailing Address, if different City, State, Zip Code 000-000(000)-000-0000 000-000(000)-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxxxx@xxxxxxxxx.xx 058213893 Email Address DUNS Number 00-0000000 17424406498 7560005906 00017560005906 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number LXDNEKWRVKJ6 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Permian Basin Community Centers for Mental Health & Mental Retardation Legal Name of Contractor Comal County Family Violence Shelter Inc. PermiaCare Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County PermiaCare Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24July 1, 2021 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Chief Executive Director Officer Title of Authorized Representative New Braunfels000 X Xxxxxxxx Xxxxxxx, TX 78130 Xx, 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Same Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 0000000000 0000000000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 XXXXXxxxxxxx@xxxxxxxxxx.xxx 074145561 Email Address DUNS Number 00-0000000 17424406498 XXXxxxxxxxxx@xxxxxxxxxx.xxx 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 000000000 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number KQBSRH72A6P1 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.0 Published and Effective – Grant Funding Version 1.0 EffectiveAugust 2021 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxxxxxxxxxx-Xxx Legal Name of Contractor Comal County Family Violence Shelter Inc. Xxxxxx Services Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed December 19, 2023 Xxxxx Xxxx Xxxxxxxxxxx-Xxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director President/CEO Title of Authorized Representative New Braunfels0000 Xxxxxxx Xxxxxx, TX 78130 Xxxxx 000 Xxxxxxx, XX 00000-1341 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code (000-000-0000 000-) 000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxx@xxxxxxxxxxxxxx.xxx 170044572 Email Address DUNS Number 00-0000000 17424406498 19424019495 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) Not applicable 0004536907 Texas Franchise Tax Number Texas Secretary of State Filing Number SZLZHM4FJCX5 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – Grant Funding Version 1.0 EffectiveNovember 2023 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxxxxx Xxxxxxxxx Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24October 5, 2021 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxx Xxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Directive Title of Authorized Representative New Braunfels0000 Xxxxxxxxx Xxxxxx, TX 78130 Xxxxx, 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000 000 0000 (000-000-0000 000-) 000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxx@xxxxxxxxxx.xxx 148007429 Email Address DUNS Number 00-0000000 17424406498 xxx@xxxxxxxxxx.xxx 17513681514 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 32072007563 17513681514 Texas Franchise Tax Number Texas Secretary of State Filing Number NZCFBZKEA6W8 XXX.xxx Unique Entity Identifier (UEI) Attachment D Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Legal Name of Contractor Comal County Family Violence Shelter Inc. Alamo Area Council of Governments Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24March 14, 2021 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Title of Authorized Representative New Braunfels, TX 78130 Xxxxx Xxxx Executive Director Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels0000 XX Xxxx 000 San ANtonio, TX 78131 78217 Mailing Address, if different City, State, Zip Code 0000 XX Xxxx 000 San ANtonio, TX 78217 Phone Number Fax Number xxxxxxx-xxxxxx@xxxxx.xxx 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Email Address DUNS Number 00-0000000 17424406498 xxxxx@xxxxx.xxx 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 00-0000000 0-00-00000000 Texas Franchise Tax Number Texas Secretary of State Filing Number Health M8MHKZAERQN6 XXX.xxx Unique Entity Identifier (UEI) ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 01/31/2019 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Xxxxxxx Xxxxxxxxx Xxxxxxxxxx Legal Name of Contractor Comal County Family Violence Shelter Inc. Xxxxxxx Xxxxxxxxx Xxxxxxxxxx Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Xxxxxxxxxx, LLC Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 2415, 2021 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxxx X. Xxxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director 0000 XXXXXXXX XXXXX Administrator Title of Authorized Representative New BraunfelsGRAND PRAIRIE, TX 78130 75054 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxx.xx 079259832 Email Address DUNS Number 00-0000000 17424406498 18109753626 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 32058528285 0802310510 Texas Franchise Tax Number Texas Secretary of State Filing Number T8C9GKHLYD33 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions – Grant Funding Version 1.0 Effective: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions are incorporated into and made a part of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.Conditions - Vendor Version 3.2 Effective: April 2021 Responsible Office: Chief Counsel Table of Contents
Appears in 1 contract
Samples: HHSC Contract
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Lubbock Regional MHMR Center Legal Name of Contractor Comal County Family Violence Shelter Inc. DBA StarCare Specialty Health System Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal Lubbock County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24December 27, 2021 2023 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Chief Executive Director Officer Title of Authorized Representative New Braunfels000 Xxx X Xxxxxxx, TX 78130 XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 0000000000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxxx@xxxxxxxxxxxxxxx.xxx 098786460 Email Address DUNS Number 00-0000000 17424406498 17512976915000 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 000000000 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number TEKNZFR8LLK4 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Wichita Falls - Wichita County Public Health District Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Wichita Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Xxx Xxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive April 16, 2024 Authorized Representative Date Signed Director of Health Title of Authorized Representative New Braunfels0000 Xxxxx Xx. Xxxxxxx Xxxxx, TX 78130 XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels0000 Xxxxx Xx. Wichita Falls, TX 78131 76301 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxx.xxxxx@xxxxxxxxxxxxxx.xxx 059463133 Email Address DUNS Number 00-0000000 17424406498 0000000-0 17560007142 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) Governmental Entity Governmental Entity Texas Franchise Tax Number Texas Secretary of State Filing Number R737LBFW8T13 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – Grant Funding Version 1.0 EffectiveNovember 2023 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Bandera County Legal Name of Contractor Comal County Family Violence Shelter Inc. n/a Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County n/a Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24April 25, 2021 2023 Signature of Authorized Representative Date Signed Xxxxxxx X. Xxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director County Judge Title of Authorized Representative New Braunfels000 Xxxx Xx. Xxxxxxx, TX 78130 Xxxxx 00000 Physical Street Address City, State, Zip Code PO P.O. Box 310344 New Braunfels877 Bandera, TX 78131 Texas 78003 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 830.796.3781 000.000.0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxxxxxxx@xxxxxxxxxxxxx.xxx 159390939 Email Address DUNS Number 00-0000000 17424406498 00-0000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) n/a n/a Texas Franchise Tax Number Texas Secretary of State Filing Number SDM3ZTEF7MK5 XXX.xxx Unique Entity Identifier (UEI) ATTACHMENT E Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Denton County Public Health Legal Name of Contractor Comal County Family Violence Shelter Inc. Same Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Same Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative March 28, 2023 Date Signed Xxxxx County Judge Xxxx Xxxx Xxxxxx County Judge Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Title of Authorized Representative New Braunfels, TX 78130 000 X Xxxx 000 Xxxxx 0000 Xxxxxx XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Same N/A Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 000.000.0000 000.000.0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxx.xxxx@xxxxxxxxxxxx.xxx 074863127 Email Address DUNS Number N/A 00-0000000 17424406498 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number HDKNE4T1LXG7 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Health and Human Services Contract Affirmations v. 2.2 Effective May 2022 Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Mercris Home Health, Inc. Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘'doing business as’') Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘'doing business as’') Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxxx Xxxxxxx-Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive 0000 Xxxxxxxxxx Xx, Physical Street Address Same Mailing Address, if different 000-000-0000 Phone Number xxxxxxx000Xxxxxxxxxxx@xxxxx.xxx Email Address 000000000 Federal Employer Identification Number 32040164280 Texas Franchise Tax Number NIA XXX.xxx Unique Entity Identifier (UEI) 05/16/2023 Date Signed Director Title of Authorized Representative New Braunfels, Richmond TX 78130 Physical Street Address 77469-5815 City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different Same City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 Email Address NIA DUNS Number 00-0000000 17424406498 Federal Employer 12715179607 Texas Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Texas Franchise Tax Number (TIN) 0801156215 Texas Secretary of State Filing Number Health and Human Services (HHS) Additional Provisions – Grant Funding Version 1.0 Effective: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS Contract Affinnations v. 2.2 Effective May 2022 ATTACHMENT 1. TURNOVER PLAN 3 2SUBCONTRACTOR AGREEMENT FORM HHS CONTRACT NUMBER The DUA between HHS and Contractor establishes the permitted and required uses and disclosures of Confidential Information by Contractor. TURNOVER ASSISTANCE 3 3Contractor has subcontracted with (Subcontractor) for performance of duties on behalf of CONTRACTOR which are subject to the DUA. TRADEMARK LICENSE 3 4Subcontractor acknowledges, understands and agrees to be bound by the same terms and conditions applicable to Contractor under the DUA, incorporated by reference in this Agreement, with respect to HHS Confidential Information. TRADEMARK OWNERSHIP 4 5Contractor and Subcontractor agree that HHS is a third-party beneficiary to applicable provisions of the subcontract. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICALHHS has the right, DENTALbut not the obligation, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The to review or approve the terms and conditions of these Additional Provisions are incorporated into the subcontract by virtue of this Subcontractor Agreement Form. Contractor and made Subcontractor assure HHS that any Breach as defined by the DUA that Subcontractor Discovers shall be reported to HHS by Contractor in the time, manner and content required by the DUA. If Contractor knows or should have known in the exercise of reasonable diligence of a part pattern of activity or practice by Subcontractor that constitutes a material breach or violation of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have DUA or the meanings assigned to them in HHS Uniform Terms and ConditionsSubcontractor's obligations, Attachment C.Contractor shall:
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx San Ankonio C1ubhouse, Inc Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a D.B.A. or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Sepkember 23, 2020 Date Signed Xxxxx Xxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Execukive Direckor Title of Authorized Representative New Braunfels0000 Xxxxxxxx Xxxx Xxx Xxxxxxx, TX 78130 XX 00000 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels, TX 78131 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxx§xxx0xxxxxxx.xxx 2101111111 Email Address DUNS Number 00-0000000 17424406498 18205599402 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 18205599402 0800036194 Texas Franchise Tax Number Texas Secretary of State Filing Number Health ATTACHMENT E ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 01/31/2019 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Additional Provisions – Grant Funding Version 1.0 Effective0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: February 2021 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions Certain of these Additional Provisions are incorporated into and made a part assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have applicant, I certify that the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.applicant:
Appears in 1 contract
Samples: contracts.hhs.texas.gov
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Kaufman County Legal Name of Contractor Comal County Family Violence Shelter Inc. N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director 000 X Xxxxxxxx Xx. April 6, 2023 Signature of Authorized Representative Date Signed County judge Title of Authorized Representative New BraunfelsKaufman, TX 78130 Texas 75142 Physical Street Address City, State, Zip Code PO Box 310344 New BraunfelsN/A Kaufman, TX 78131 Texas 75142 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 N/A Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxx.xxxxx@kaufmancounty net 08-3879759 Email Address DUNS Number 00-0000000 17424406498 00-0000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) 756001036 N/A Texas Franchise Tax Number Texas Secretary of State Filing M6EKFHS5NLT3 Number XXX.xxx Unique Entity Identifier (UEI) ATTACHMENT E Health and Human Services (HHS) Additional Provisions Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – Grant Funding Version 1.0 EffectiveJuly 2022 Responsible Office: February 2021 Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Additional Provisions V.1.0 – Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Funding Effective: February 2021 TABLE OF CONTENTS 1Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions in this document are incorporated into in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and made a part state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant Contractand Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. Terms included HHS, in these Additional Provisions and not otherwise defined have its sole discretion, reserves the meanings assigned right to them in HHS Uniform Terms and Conditionsadd requirements, Attachment C.terms, or conditions. TABLE OF CONTENTS
Appears in 1 contract
Samples: Grant Agreement
Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxx Fort Bend County Legal Name of Contractor Comal County Family Violence Shelter Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Crisis Center of Comal County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. August 24, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxx XX Xxxxxx County Judge Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1547 Common St. Executive Director Title of Authorized Representative New Braunfels000 Xxxxxxx Xx. Richmond, TX 78130 TX, 77469 Physical Street Address City, State, Zip Code PO Box 310344 New Braunfels000 Xxxxxxx Xx. Richmond, TX 78131 TX, 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxx@xxxxxxxxxxxxxx.xxx 826288904 xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Email Address DUNS Number 00-0000000 17424406498 746001969 17460019692 Federal Employer Identification Number Texas Payee ID No. – 11 digits 30009958981 100396101 Identification Number (TIN) N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number N/A XXX.xxx Unique Entity Identifier (UEI) ATTACHMENT E HHS Data Use Agreement This Data Use Agreement (“DUA”), effective as of the date the Base Contract into which it is incorporated is signed (“Effective Date”), is entered into by and between a Texas Health and Human Services Enterprise agency (“HHS) Additional Provisions – Grant Funding Version 1.0 Effective: February 2021 Health ”), and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICALthe Contractor identified in the Base Contract, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and Human Services Additional Provisions V.1.0 – Grant Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions of these Additional Provisions are incorporated into and made a part political subdivision of the Grant Contract. Terms included in these Additional Provisions and not otherwise defined have the meanings assigned to them in HHS Uniform Terms and Conditions, Attachment C.State of Texas (“CONTRACTOR”).
Appears in 1 contract
Samples: Interlocal Cooperation Contract
