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FY August 1, 2021/ September 30, 2022

Meals On Wheels, Inc. of Tarrant County

______ Completed Direct Purchase of Service Application

______ Signed Vendor Agreement

______ Copy of current license/bond as applicable

______ Completed Request for Taxpayer Identification Number and Certification (form W-9)

______ Copy of current liability insurance policy identifying Meals On Wheels, Inc. of Tarrant County as co-insured.

NOTE: If approved, Vendor will be contacted and must attend a mandatory orientation with Meals On Wheels Program Coordinator prior to commencement of the Agreement and coordination of new referrals. This Agreement is contingent upon the approval of the President & CEO of Meals On Wheels.

Please return your completed Vendor Agreement to:

Marcus Rockwell
VP of Adult Activity Centers
Meals On Wheels, Inc. of Tarrant County
5740 Airport Freeway
Fort Worth, Texas 76117
817-258-6482 – Marcus direct line

Meals On Wheels, Inc. of Tarrant County
Direct Purchase of Services Application FY 2021/22

Vendor Information
Legal Name of Agency/Company:

Mailing Address:

Telephone Number (Area Code):
Fax Number (Area Code):

Authorizing Official:
Email: Phone:
Billing Contact Person:
Email: Phone:
Type of Agency – (choose one): 0 Public 0 Private Non-Profit 0 Private for Profit

Preferred method of receiving referrals: Fax _____________or E-mail: ________________________

Certification / License:
State or federal agencies that license and/or regulate your services:

Please attach a copy of any applicable certifications and license.

Does your agency have liability insurance? 0 Yes 0 No

Please attach a copy of the insurance policy.
Conflicts of Interest:
Please indicate all family relationships the officers of your company may have to Meals On Wheels, Inc. of Tarrant County, the Area Agency on Aging of Tarrant County, or the City of Fort Worth.



a. Purpose: The purpose is to request applications for the provision of services on a Direct Purchase of Service (DPS) basis to qualified participants eligible to receive services under Title III of the Older Americans Act of 1965, as amended, and state general revenue funds.

b. Eligibility to apply: Organizations eligible to apply are private non-profit, private for profit, and local city-county governmental entities, which have the capacity to meet the requirements of service delivery under DPS procedures.

A. For profit applicants: private for-profit entities applying for funding will not require approval by the Texas Department of Health and Human Services (HHSC) prior to beginning of service delivery.
B. Vendor must provide proof of liability insurance in the amount of $1,000,000 or more before transporting participants. The insurance must list Meals On Wheels, Inc. of Tarrant County as an additional insured, and the insurance must be primary as to its coverage of Meals On Wheels, Inc. of Tarrant County.
C. Vendors must have a working fax machine available, with send and receive capabilities.
D. Debarred/Suspended Parties: Debarred or suspended parties are ineligible to apply for funding and are excluded for participation in this program.

c. Definition of Direct Purchase of Service (DPS): DPS is a contracting methodology for the purchase of services on client-by-client basis in lieu of annualized contracting, or a fixed sum basis. It is a procurement methodology, which provides flexibility in the purchasing of services for participants in Title III Programs.

d. Application Process: Interested parties may apply for consideration for participation in the vendor pool by submitting a completed and signed direct purchase application, vendor agreement.

e. Maintenance of Records: The Vendor shall document all riders and attach documentation with their billing to verify rider count.

f. Evaluation: Meals On Wheels, Inc. of Tarrant County will conduct periodic program evaluations of vendors in accordance with the letter of agreement.

g. Confidentiality: Vendors shall have procedures to ensure that no information about an older person, or obtained from an older person, is disclosed in a form that identifies the person.

h. Code of Conduct: The Vendor will establish safeguards to prohibit employees from soliciting and/or accepting gratuities, favors, or anything of monetary value from the participants.


a. Billing must be submitted no later than Monday by 4:00 p.m. of the following week using billing forms approved by Meals On Wheels, Inc. of Tarrant County. At month-end, the billing must be submitted mid-week so all billing for the month is received no later than the 3rd day of the following month. Vendor must also provide a monthly billing report using forms approved by Meals on Wheels, Inc. of Tarrant County.

b. In the event the billing is not accurate there may be a delay in payment of at least five (5) business days from the time the billing is reconciled.

c. Quality customer service must always be provided to participants and the Adult Activity Center Program Coordinator, and phone calls must be returned in a timely manner. (24 hours)

d. Vendor must designate a contact person who will be accessible to resolve issues.

e. Vendors must also have the ability to provide an approved substitute provider when the regular provider is unable to work.

The contacts for Meals On Wheels, Inc. of Tarrant County is:

Marcus Rockwell
V.P. of Adult Activity Centers
Meals On Wheels, Inc. of Tarrant County
5740 Airport Freeway
Fort Worth, Texas 76117
817-258-6482 Direct Line

Mikita McNeal
Adult Activity Center
Transportation Coordinator & Scheduler

This agreement shall be for a period of one calendar year, commencing beginning on the ___ day of ____________ (the “Start Date”), and shall continue through the ___ day of __________________ (the “End Date”) or until it has been terminated by either party by giving thirty days written notice to the other party (the “Agreement”). Further, in the event the Agreement is not executed by both parties on and before the expiration date the Agreement shall remain in effect on a month-to-month basis until resigned by both parties.

_____________________, hereinafter referred to as Vendor, hereby agrees to provide services effective beginning on the Start Date in accordance with the Older Americans Act of 1965 (OAA), as amended, Texas Department of Aging and Disability Services (DADS), the AAA Direct Purchase of Services program and the stated Scope of Services.
The AAA Direct Purchase of Services program is designed to promote the development of a comprehensive and coordinated service delivery system to meet the needs of older individuals (age 60 and older). This Agreement provides a mechanism for the creation of an individualized network of community resources on a client-by-client basis through the Older Americans Act, as amended, and the Texas Department of Aging and Disability Services’ AAA Access and Assistance guidelines.
The purpose of this system of Access and Assistance is to develop cooperative working relationships with other service providers to build an integrated service delivery system that ensures broad access to and information about community services, maximizes the use of existing resources, avoids duplication of effort, gaps in services, and facilitates the ability of people who need services to easily find the most appropriate Vendor.
A. The Vendor agrees to provide the following service to participants authorized by Meals On Wheels, Inc. of Tarrant County



Taking an approved participant from one location to another but does not include any other activity. Meals On Wheels, Inc. of Tarrant County will reimburse the vendor at a rate of $12.50 per passenger per one-way eligible trip. This is a grant funded program service; therefore, dates may be reduced or altered due to budgetary restraints.
Adult Activity Centers included in this Agreement include:
Roosevelt Center; 2117 Roosevelt STE. F Pantego Drive
Northside Senior Center; 1100 N.W. 18th Street Fort Worth, Texas 76164
Como Senior Center; 4900 Horne Street Fort Worth, Texas 76107
Fellowship Corner; 959 E Rosedale St., Fort Worth, 76104
Worth Heights; 3551 New York Ave Fort Worth, Texas 76110
North Tri Ethnic; 2950 Roosevelt Fort Worth, Texas 76106
Eugene McCray; 4932 Wilbarger St. Fort Worth, Texas 76119
Handley Meadowbrook; 6201 Beaty Street Fort Worth, Texas 76112
Diamond Hill 1701 NE 36th St. Fort Worth, Texas 76106
Additional centers may be added as agreed upon by both parties.
In performing this Agreement, Vendor will comply with all Texas Administrative Code standards which may be accessed at the Texas Secretary of State website:

Vendor will also comply with all applicable Older American Act and other required rules and regulations which may be accessed at the following website:

Targeting: Services are designed to identify eligible clients, with an emphasis on high-risk clients and serving older individuals with greatest economic and social need, low-income minorities and those residing in rural areas, as identified in the Older American Act.


I. The VENDOR agrees to:


a. Americans with Disabilities Act of 1990-
The VENDOR shall comply with the requirements established under the Americans with Disabilities Act in meeting statutory deadlines established under the Act as they pertain to operations for employment, public accommodations, transportation, state and local government operations and telecommunications.

b. Drug Free Workplace-
The VENDOR shall comply with the Drug-Free Workplace Act of 1988, and Texas Senate Bill 1- 1991, as applicable.

c. Random Drug Screens-
The VENDOR shall conduct random drug screens at least annually and provide proof of completion.

d. Certification Regarding Debarment 45CFR 92.35
The VENDOR must provide information required to verify status and may not be listed among those who are debarred or suspended parties. This status is required annually while this Agreement is in affect.

e. Employee Background Checks-
The VENDOR shall conduct criminal background checks at least annually and provide statement to the affect with all employees under the agreement included.

f. Equal Employment Opportunity-
VENDOR agrees to provide equal opportunity to all employees and applicants for employment. No person is to be discriminated against in employment opportunities or practices on any basis protected by applicable federal, state, or local law including race, religion, color, sex, national origin, age, genetic information, veteran, or disability status. This policy applies to all terms, conditions and privileges of employment including, but not limited to, hiring, transfer, promotion, termination, layoff, retirement, training, compensation, and benefits.


(Includes all documents completed prior to the commencement of this Agreement)

a. Vendor Application and all other required documents (e.g., licenses, insurance policies, etc)
b. Signed and completed Certification Regarding Debarment

Vendor agrees, consents, and stipulates that Meals On Wheels, Inc. of Tarrant County may terminate this Agreement at any time and for any reason or no reason by delivery of a notice of termination by email, USPS, FedEx, or UPS at least 30 days prior to the intended termination date. Possible grounds for termination of the Agreement include, but are not limited to:

a) Not starting newly authorized services in a timely manner.
b) Ongoing failure to return phone calls or e-mails from MOW staff within 24 hours;
c) “No call/ no show” on scheduled appointments with consumers;
d) Failure to accurately complete trip logs. All trip logs must be signed and dated by the client/family caregiver and agency employee, and dated appropriately, if applicable;
e) Consistently denying referrals;
f) Consistently denying referrals based on no staff availability;
g) Consistent billing errors or billing consistently turned in late;
h) Arrests other than a Class c misdemeanor;
i) Failure to disclose any and all traffic violations, criminal arrests, criminal convictions;
j) Operation of a vehicle not preapproved. All vehicle operated under the DPOS agreement must be included in the vehicle inventory document with documentation of TxDOT inspection; or
k) Vendor taking any action which Meals on Wheels, Inc. of Tarrant County reasonably determine to threaten, harm, or endanger the health or welfare of clients.

It is further agreed between the parties that the designated representative of Meals On Wheels, Inc. of Tarrant County will meet with the designated representative of Vendor to review current operations and any necessary amendments when called upon. Any amendment to this Agreement must be agreed upon in writing between the parties.

It is further agreed between the parties that in case any one or more provisions contained in this Agreement shall for any reason be held to be invalid, illegal, or unenforceable, in any respect, such invalidity, illegality or unenforceability shall not affect any other provisions thereof and this Agreement shall be construed as if such invalid, illegal or unenforceable provision had never been contained herein.

It is further agreed that the Vendor shall indemnify, and hold harmless Meals On Wheels, Inc. of Tarrant County, its officers, agents, and employees harmless from any and all liability, demands, claims, actions losses, interests, costs of defense and expenses, including reasonable attorney fees arising from and in connection with the performance of this Agreement if such liability, demands, claims, actions, losses, interests, cost of defense and expenses, including reasonable attorney fees are founded in whole or in part upon the negligence, gross negligence, or intentional act of the Vendor, its employees, servants, or agents.

This Agreement shall be constructed in accordance with the laws of the State of Texas. Exclusive venue for any lawsuits or actions of law or in equity arising here under shall be in Tarrant County, Texas.

EXECUTED this _______ day of _________________, ________


For the faithful performance of the terms of this Agreement, the parties affix their signatures and bind themselves effective _________________.

Authorized Signatures


Company Name: ____________________________________________

Authorized Signature:  ________________________________________

Printed Name of Authorized Signer: _______________________________

Date: ____________________________________________________



Meals On Wheels, Inc. of Tarrant County

Authorized Signature:  ________________________________________

Carla Jutson, President & CEO

Date: ____________________________________________________


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