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4) 98°Io of participants who indicate during the enrollment process of DSHS WIC Program <br />that they have no source of health care shall be referred to at least one (1) source of health <br />care at certification of eligibility. <br />Contractor shall submit the WIC Local Agency Performance Measure Report which describes <br />Contractor's efforts towards meeting assigned annual targets as described in items 1-4 of the <br />performance measures. The report shall be in an approved format as provided by DSHS, and <br />shall be completed and submitted to DSHS within fifteen (15) calendar days after the end of each <br />month. <br />SECTION III. SOLICITATION DOCUMENT: N/A <br />SECTION IV. RENEWALS: DSHS may renew this contract for one renewal period if funds are <br />available. <br />SECTION V. PAYMENT METHOD: Cost Reimbursement <br />SECTION VI. BILLING INSTRUCTIONS: <br />Contractor shall request payment using the State of Texas Purchase Voucher (Form B-13) and <br />FSR's and submit by electronic mail to Contract Development and Support Branch <br />WicVouchers@dshs.state.tx.us <br />SECTION.VII. BUDGET: <br />SOURCE OF FL'Iv'DS: CFDA # 10.57 <br />All categories of costs billed to DSHS WIC Program, and allocation of such costs, shall be in <br />accordance with the "Plan to Allocate Direct Costs" (PADC) submitted by Contractor and <br />approved by DSHS WIC Program. This document is incorporated herein by reference and made <br />a part of this contract Attachment. <br />SECTION VIII. SPECIAL PROVISIONS: <br />General Provisions, Compliance and Reporting Article, Section 1.07, Statutes and Standards <br />of General Applicability, is hereby amended to include the following: <br />All provisions required by implementing the regulations of the Department of <br />Agriculture, 7 CFR Part 246, 248; Department of Justice Guidelines for Enforcement of <br />Title VI, Civil Rights Act of 1964; 28 CFR § 50.3 and 28 CFR Part 42; and Food & <br />Nutrition Service (FNS) directives and guidelines, to the effect that no person will, on the <br />grounds of race, color, national origin, sex, age, or disability be excluded from <br />participation under any program or activity for which Contractor receives federal <br />financial assistance from FNS; and hereby gives assurance that it shall immediately take <br />measures necessary to implement this contract Attachment. <br />PROGRAM ATTACHMENT -Page 5 <br />