HomeMy WebLinkAboutAgenda - 04-06-1999 - 8fORANGE COUNTY
Board of Commissioners
Action Agenda
Item No. S -+
Action Agenda Item Abstract
Meeting Date: April 6,1999
Subject: 1999 -00 Contract between the NC Department of Health and Human Services and
Orange Health Department.
Department: HEALTH
Attachments(s):
Contract
Public Hearing Yes X No
Information Contact:
Health Director's Office X2411
Telephone Number
Hillsborough - 732 -8181
Chapel Hill - 968 -4501
Mebane - 227 -2031
Durham - 688 -7331
Purpose:
To approve the annual consolidated contract between the NC Department of Health and Human
Services and the Orange County Health Department, which provides State and Federal funds to
the Health Department to partially support mandated services.
Background:
The attached contract stipulates the state contract support in the amount of $552,629 for the
programs listed below. This is a reduction of $9,385. The reduction is primarily due to a cut in
school health funds. School health funds were cut due to the inception of NC Health Choice.
School health funds in prior years were used to provide vision care and dental health for children
who did not qualify for Medicaid but were eligible for the reduced school lunch program. The
dental health program in Orange County has utilized the majority of these funds in previous
years.
General
Maternal Health
AIDS (Federal)
Family Planning
Immunization Action Plan
CSHS Orthopedic
Child Health
Child Service Coordination
Breast & Cervical Cancer
Intensive Home Visiting
Environmental Health Food and Lodging
Block Grant that includes Communicable Disease, Adult Health and Health Promotion
Each year the State contracts with the Health Department to render specified services. The
attached contract outlines the terms in dollar amounts for each program activity as well as local
allocations and revenues which support these mandated services.
Financial Impact: The state consolidated contract provides $552,629 federal and state dollars
to the county to provide specific services. The contract is awarded on an annual basis and will
be included in the department's 1999 -2000 budget. This represents approximately 13% of the
overall health department budget. This does not include Medicaid revenue which is earned
separately for services provided.
Recommendation:
The Manager recommends that the Board approve the contract, subject to the endorsement of the
County Attorney and County Purchasing Director and authorize the Chair to sign the contracts
and assurances.
0
M
_ RETURN THIS COPY TO THE CLERK'S _
OFFICE FOR THE PERMANENT AGENDA FILE
Page 1 of 11
CONSOLIDATED CONTRACT
BETWEEN
THE STATE OF NORTH CAROLINA
AS REPRESENTED BY
THE STATE HEALTH DIRECTOR
(Hereinafter called the "State ")
W
Orange County Health Department
(Local Health Department -- Hereinafter called the "Department ")
FOR THE PURPOSE OF
MAINTAINING AND PROMOTING THE ADVANCEMENT OF
HEALTH IN NORTH CAROLINA
This Contract Shall Cover a Period From
July 01, 1999 to June 30, 2000
NOW, THEREFORE, the State and the Department agree that the provisions and clauses
herein set forth shall be incorporated in and constitute the terms and conditions applicable
for the following activities involving State funding. (State funding or funds means state,
federal, and /or special funding or funds throughout this contract.)
Page 2 of 11
A. WORK TO BE PERFORMED
1. The Department shall perform activities in compliance with applicable program
rules contained in the North Carolina Administrative Code as well as all applicable
Federal and State laws and regulations.
2. The Department shall perform the activities specified in the Program Contract
Addenda for State funded budgets.
3. The Department shall administer and enforce all rules which have been adopted
by the Commission for Health Services or approved by the State and adopted by
the Local Board of Health.
4. The Department shall provide to the State copies of rules adopted by the Local
Board of Health pursuant to G.S. 130A -39 and Public Health Ordinances adopted
by the County Commissioners, within 30 days of adoption.
5. The Department shall provide to the State a Community Diagnosis Prioritization of
Problems every biennium. The Department shall also provide a Community
Diagnosis narrative, if completed.
B. FUNDING STIPULATIONS
1. Funding for this contract is subject to the availability of State, Federal, and special
funds for the purpose set forth in this Contract.
2. During the period of this Contract, the Department shall not use State, Federal or
Special Project funds received under this Contract to reduce locally appropriated
funds as reflected in the Local Health Department Budgets.
3. The Department shall not use personal health program funds to support
environmental health personnel nor use environmental health program funds to
support personal health programs.
4. Fees generated by the Food and Lodging fees collection program may only be
used to support Environmental Health activities.
5. Funds for Childhood Lead Poisoning Prevention may be used to support both
environmental health and child health activities.
6. The Department shall comply with Standards for Mandated Public Health
Services, 15A NCAC 25, Section .0200; and Administrative Procedures Manual
for Federal Block Grant Funds, 1 NCAC 33, Sections .0100 - .1502.
7. The Department shall maintain employee time records to document employee
salaries and fringe benefits charged to state funds. The percentage of time each
employee spends in each activity shall be converted to dollars based upon the
employees' salary and benefits
8. The Department participating in Medicaid Reimbursement shall:
a. Comply with the terms of the Medicaid Interagency Agreement and the
Provider Participation Agreement effective October 1, 1992 and any
subsequent approved addenda or new Agreement approved and
established during the period of this contract.
Page 3 of 11
b. Make every reasonable effort to collect its cost in providing services, for
which Medicaid reimbursement is sought, through public or private third
party payors except where prohibited by Federal regulations or State law.
No one shall be refused services solely because of an inability to pay.
9. Subject to the approval of the appropriate Division, a local health department may
seek reimbursement for services covered by a program operating under 15A
NCAC 24A rules when those services are not supported by other state or federal
funds. All payment program rules and procedures as specified in the Purchase of
Medical Care Services manual must be followed.
10. Programs and services supported in whole or in part with federal funds must
provide interpreter services at no charge to non - English speaking clients. Only
those programs and services funded entirely with state and /or local funds, unless
prohibited by State law or rule, may charge non - English speaking clients for
interpreter services.
11. Subject to the availability of funds and approval of the Office of Public Health
Nursing, a local health department may request reimbursement for:
a. Nursing service personnel participating in the Introduction to Principles
and Practices of Public Health and Public Health Nursing
course. Reimbursement is limited to no more than $400.00 per participant
upon successful completion of the course:
b. Nursing service personnel participating in the the Public Health Nurse
Supervisors Training Course. Reimbursement is limited to no more than
$600.00 per participant upon successful completion of the course.
C. Community Health Assistants and Public Health Nurses attending certain
pre- approved Continuing Education courses offered by the Office of Public
Health Nursing. Reimbursement is limited to $25.00 per participant per
event.
12. The Department shall have an annual audit performed in accordance with The
Single Audit Act of 1984 as implemented by OMB Circular A- 133.The audit report
should be submitted to the Controller's Office within (six) 6 months following the
close of the contract. Audit findings and resolution of said findings shall be
handled by the Controller's Office.
13. Equipment is a type of fixed asset consisting of specific items of property that: (1)
are tangible in nature; (2) have a life longer than one year; and (3) have a
significant value.
a. For Inventory Purposes
1. Equipment must be accounted for in accordance with Local
Government Accounting System Procedure No. 15.
2. Women, Infants and Children Program
All equipment with an acquisition cost of $500.00 or more must be
inventoried with the Division of Women's and Children's Health.
b. For Prior Approval Purposes
Page 4 of 11
1. All equipment purchased or leased where there is an option to
purchase with State /Federal funds must receive prior written
approval from the appropriate Division when the acquisition cost
exceeds $500.00.
2. Women, Infants and Children Program
All medical equipment and computer equipment, regardless of cost
and all other equipment with an acquisition cost of $500.00 or
more must receive prior approval from the program office.
3. The use of Maternal and Child Health Medicaid fees for capital
improvements requires prior written approval from the Division of
Women's and Children's Health.
C. FISCAL CONTROL
The Department shall comply with the Local Government Budget and Fiscal
Control Act, North Carolina General Statute Chapter 159, Article 3.
a. The Department shall maintain a purchasing and procurement system in
accordance with generally accepted accounting practices and procedures
set forth by the Local Government Commission.
b. The Department shall execute written agreements with all parties who
invoice the Department for payment for the provision of services to
patients.
C. When subcontracting, the following conditions must be met:
1. The Department is not relieved of any of the duties and
responsibilities provided in this contract.
2. The subcontractor will agree to abide by the standards contained
herein or to provide such information as to allow the Department to
comply with these standards.
3. The subcontractor will agree to allow state and federal authorized
representatives access to any records pertinent to its role as a
subcontractor of the Department.
4. The Department will make available to the State upon request a
copy of subcontracts supported with State /Federal funds.
d. The Department must receive prior approval from the state to subcontract
when any of the following conditions exist:
1. The Department proposes to subcontract to a single entity
fifty percent(50 %) or more of the total state and federal
funds made available through this contract.
2. The Department proposes to subcontract fifty percent
(50 %) or more, or $50,000 which ever is greater, of the
total state and federal funds made available through this
contract for a single public health service or program.
3. The Department proposes to subcontract for services in the
Women, Infants and Children Program.
Page 5 of 11
e. The Department shall retain all budgets, budget revisions, contracts,
contract addenda, and financial records in accordance with the current
Records Disposition Schedule for County and District Health Departments
issued by the Division of Archives and History, Department of Cultural
Resources.
2. The Department shall prepare and maintain a budget for each activity covered by
this contract in a manner consistent with instructions provided with Local Health
Department Budget - WIC Form 3370 and Local Health Department Budget Form
2948.
a. The Department shall prepare budget revisions for prior approval of the
State when State funds will be increased or decreased.
b. The Department shall submit all revisions prior to the end of the term
specified in this Contract. Budget revisions received by the State after the
end of the contract period will be returned without action.
3. The Department shall observe the following conditions when budgeting and
reporting earned revenues:
a. All payments from persons, and public or private third party payors, shall
be utilized for the activity that generated the revenue and shall not reduce
or replace locally appropriated funds during the period of this contract.
The Department may use revenues from any Division of Women's and
Children's Health supported activity in any other activity supported by the
Division.
b. All earned income must be budgeted in the program where earned, except
that income earned by a program which has no activity budget can be
budgeted in a program approved by the State. With regard to revenue
generated by maternal and child health related services, program is
defined as any activity supported by the Division of Women's and
Children's Health.
C. All fees collected shall be used in the current year or succeeding fiscal
years.
d. Use of program income generated by the expenditure of Federal
categorical funds will be governed by applicable Federal regulations,
including but not limited to 45 CFR 74.
e. When budgeting:
Line item 9000 on the program budget must be used to budget the .
total of line items 101, 102 and 103.
ii. Line item 102 on the program budget must be used to budget TXIX
earned revenues.
iii. Line item 103 on the program budget must be used to budget
other earned revenues.
f. When reporting expenditures:
i. Line item 9000 on the Local Expenditure Report must be used to
report the total of line items 101, 102, 103.
Page 6 of 11
ii. Line item 102 on the Local Expenditure Report must be used to
report TXIX earned revenues that were expended.
iii. Line item 103 on the Local Expenditure Report must be used to
report other earned revenues that were expended.
g. A local account shall be maintained for unexpended TXIX fees. Accounts
shall be maintained in sufficient detail to identify the program source
generating the fees.
h. The amount of Title XIX fees budgeted in FY 1999 -2000 must equal or
exceed the amount of Title XIX revenues earned during FY 1997 -98. The
state will not approve program activity budgets that do not include an
amount of Title XIX fees sufficient to meet the requirements of this section.
The state may waive this requirement if the Department provides sufficient
justification.
4. The Department shall submit a quarterly report of actual receipts and
expenditures of the Department according to instructions provided with Local
Expenditure Reports, Form 2949 and Form 2950.
a. The Department shall submit quarterly expenditure reports to the State
within 45 days from the end of the reporting quarter. Failure to meet the
reporting deadline will result in an immediate suspension of payments until
the overdue report is received.
b. The Department shall submit the final Expenditure Report to the State
within 45 days after the end of the contract period. Report is due by
August 14.
C. The Department shall submit amended or corrected expenditure reports
within four (4) months after the end of the contract period. Any such
reports must be prepared for the specific quarter to be amended or
corrected. Reports received after October 31 will be returned without
action.
d. The Department shall refund to the State all unexpended State funds
within 45 days after notification of overpayment. When payment is not
received by the State within 45 days, future payments to the Department
may be reduced by the amount due or payments may be suspended until
the refund is received by the State.
e. The Department shall submit monthly WIC expenditure reports to the State
no later than the 8th of the following month. Final expenditure report is
due by August 14.
f. Reimbursement of WIC approved expenditures for July, August, and
September cannot exceed one -fourth of the total budget for the contract
period.
g. The Department shall submit monthly Minority Infant Mortality Reduction
and Healthy Start expenditure reports to the state no later than the 15th of
the following month.
h. The Department shall submit expenditure reports for Mosquito Control
activity in accordance with 15A NCAC 18B, Sections .0104 and .0107.
Page 7 of 11
I. The Department shall submit request for payment for services provided
under 15A NCAC 24 A rules to the Claims Processing Unit, Purchase of
Medical Care Services, DHHS.
j. The Department shall submit request for reimbursement for nurse training
to the Office of Public Health Nursing. Form 3300 - Public Health Nurse
Training Activity must be used as the invoice for payment.
5. The Department shall submit on an annual basis Staff Time Activity Report, 3389,
Environmental Health Report, 3738, and Food and Lodging Report, 3888. The
reports shall accompany the final expenditure report and must be received by the
State within 45 days after the end of the contract period.
D. PERSONNEL POLICIES
The Department shall adhere to and fully comply with State personnel policies as found in
North Carolina General Statute, Chapter 126, and 1 NCAC 8. Such policies include, but
are not limited to, the following:
1. Equal employment opportunity;
2. Affirmative action;
3. Policies for local government employment subject to the State Personnel Act;
4. "Local Classification and Salary Range';
5. "Compensation Policy for Local Competitive Services Employees'; and
6. "Recruitment and Selection Policy and Procedures';
7. Environmental Health Specialists employed by the Department shall be delegated
authority by the State to administer and enforce State environmental health rules
and laws as directed by the State pursuant to G.S. 130A -4(b). This delegation
shall be done according to 15A NCAC 10.0100.
a. Local health departments are responsible for sending their newly -
employed environmental health specialists (intems) to centralized training
within 180 days from date of employment.
b. Arrangements for centralized training for newly-employed environmental
health specialists will be handled by the Education and Training Staff,
Division of Environmental Health.
A
C. A local health department which is contracting with an environmental
health specialist employed by another department shall be responsible for
assuring that all original documents, correspondence, and other public
records be maintained in the health department using the contractor and
the contract shall stipulate that the contractor shall be available for
consultation to the public being served.
8. The Department shall comply with Minimum Standard Health Department Staffing
15A NCAC Section .0301(c), and shall assure that all nursing staff who provide
public health services funded by this contract comply with this rule.
Page 8 of 11
E. CONFIDENTIALITY
All information as to personal facts and circumstances obtained by Department personnel
in connection with the provision of services or other activity under this Contract shall be
privileged communication, shall be held confidential, and shall not be divulged without the
responsible person's written consent except as may be otherwise required by applicable
law or regulation. Such information may be disclosed in summary, statistical, or other
form which does not directly or indirectly identify particular individuals.
F. CIVIL RIGHTS
1. The Department shall assure that no person, on the grounds of race, color, age,
religion, sex, marital status, immigration status, or national origin (unless
otherwise medically indicated) or otherwise qualified handicapped individual solely
by reason of his/her handicap be excluded from participation in, be denied the
benefits of, or be subjected to discrimination under any program or activity
covered by this Contract.
2. The Department shall complete HHS Form 690, Assurance of Compliance with
Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of
1973; Title IX of the Education Amendments of 1972, and the Age Discrimination
Act of 1975; for the Women, Infants and Children Program, FNS -64, Assurance
of Compliance with the Department of Agriculture Food and Nutrition Service,
under Title VI of the civil Rights Act of 1964;
3. The American with Disabilities Act 1990 (ADA) makes it unlawful to discriminate in
employment against a qualified individual with a disability and outlaws
discrimination against individuals with disabilities in State and local government
services and public accommodations. The Department certifies that it and its
principals and subcontractors will comply with regulations in A.D.A. Title I
(Employment), Title II (Public Services), and Title 111 (Public Accommodations) in
fulfilling the obligations under this agreement.
G. 1 RESPONSIBILITIES OF THE STATE
1.
The State shall provide to the Department upon request technical assistance in
the preparation of the Consolidated Contract, Activity Budgets and Contract
Addenda.
2.
The State shall specify those administrative forms /reports and their respective
revision dates that are required by particular activities pertaining to the
Department's budget with the State in Listing of Required Fiscal and Statistical
Reports (Addendum 1) for the contract period. New forms/reports not listed in
Required Fiscal and Statistical Reports shall be implemented during a contract
period only with the approval of the State Health Director.
3.
The State shall provide to the Department within thirty (30) days after receiving an
acceptable activity budget from the Department an approved signed copy of the
budget.
4.
The State shall provide funds to the Department upon approval of the Contract
Addenda, activity budgets, and signing of this contract.
5.
The State shall assist the Department to comply with all applicable laws,
regulations, and standards relating to the activities covered in this contract.
6.
The State reserves the right to conduct reviews to determine compliance with the
terms of this contract.
H: \WP61 \CONTRACT \CONSOLID \99- OOCC.FRM
Page 9 of 11
7. The State shall be assured that the Department maintains expenditure of locally
appropriated funds for maternal health, child health, and family planning activities
equal to or greater than that reported on the Staff Time Activity Report for the
period beginning July 1, 1984, and ending June 30, 1985. This maintenance of
effort shall be measured by salary equivalencies which are to lac maintained in
accordance with Section B. 7. of this contract.
H. DISBURSEMENT OF FUNDS
The State shall disburse funds to the Department as follows:
Provided the Consolidated Contract is properly executed and all quarterly
expenditure reports are filed within the established time frames, payments equal
to 1/12 of the total program approved budget shall be made in the following
months:
July August September October November January February
April May
Based on expenditures reported for the first, second, and third quarters, payments
shall be adjusted either upward or downward, in payments made in the following
months:
December March June
2. For departments selecting quarterly reimbursement option, payments shall be
made when the quarterly expenditure report is received. Quarterly payment for
reported expenditures shall be limited to one -fourth of the budgeted amount
3. For departments receiving Rural Obstetrical Care Incentive funds, payment of
such funds shall be made in one lump sum the month following receipt and
approval of the activity budget.
4. For departments receiving Healthy Start or Minority Infant Mortality Reduction
project funds, payment will be based on actual reported expenditures. Monthly
payments will be made provided that expenditure reports are received as required
in C. 4. g.
5. Food and lodging fees will be disbursed to the department in one sum the month
following receipt and approval of the activity budget and any subsequent budget
revisions.
6. Funds for Childhood Lead Poisoning Prevention will be disbursed once per year.
The amount will be determined by the number of confirmed cases identified in
each county. A separate contract addendum must be submitted with budget
page in order to receive these funds. Funds for training will be disbursed upon
request.
7. Increased or decreased payments necessitated by changes in the total budgeted
amount will be reflected in the monthly payments subsequent to approval of the
budget revision.
8 Payments shall be suspended when expenditure reports are not received by the
time specified in C. 4. a,b, a and g. Payments will resume in the months
subsequent to receipt of the expenditure reports.
9. Payment is limited to the total amount of the budget by line item as reported on
Expenditure Report 2949.
H: \WP61 \CONTRACT \CONSOLID \99- OOCC.FRM
Page 10 of 11
10. Final payments will be made based on the 4th quarter expenditure report. Final
payments will be equal to the difference between approved reported expenditures
and the sum of previous payments. Final payments should be made not later than
September provided that an original signed copy of an expenditure report for each
quarter has been received by the Office of the Controller. Final payment will be
made only after the Staff Time Activity Report, 3389, Environmental Health
Report, 3788, and Food and Lodging, 3888 are received by the State.
AMENDMENT OF CONTRACT
Amendments, modifications, or waivers of this contract may be made at any time by
mutual agreement of all parties. Amendments shall be in writing and signed by
appropriate authorities.
PROVISION OF TERMINATION
This contract may be terminated for reasons other than non - compliance upon sixty (60)
days written notice by either party. If termination should occur, the Department shall
receive payment only for allowable expenditures.
The State may withhold payment to the Department until the State can determine whether
the Department is entitled to further payment or whether the State is entitled to a refund.
K. COMPLIANCE
1. The State shall assure compliance with all terms of this contract.
a. Upon determination of non - compliance, the State shall give the
Department sixty (60) days written notice to come into compliance. If the
deficiency is corrected, the Department shall submit a written report to the
State which sets forth the corrective action taken.
b. If the above deficiencies should not be corrected to the satisfaction of the
State after the sixty (60) day period, disbursement of funds for the
particular activity may be temporarily suspended pending negotiation of a
plan of corrective action.
C. If the deficiency is still not corrected within the next thirty (30) days
following temporary suspension of funding, program funds may be
permanently suspended until the Department can provide evidence that
the deficiencies have been corrected.
d. In the event of the Department's non - compliance with clauses of this
contract, the State may cancel, terminate, or suspend this contract in
whole or in part and the Department may be declared ineligible for further
State contracts or agreements. Such terminations for non - compliance
shall not occur until: (1) the provisions of Section K-1 (a -c) have been
followed, documented, and have failed to provide a resolution, (2) all other
reasonable administrative remedies have been exhausted.
2. If the Department or the State should be determined out of compliance with the
provisions of the contract, either party may file a formal appeal with the Office of
Administrative Hearings.
Page 11 of 11
IN WITNESS WHEREOF, the Department and the State have executed this
agreement in duplicate originals, one of which is retained by each of the parties.
LOCAL SIGNATURES
Health Directo ate`
Finan6 fficer Date
Chairmw of County Commissioners Date
(when required)
STATE OF NORTH CAROLINA
State Health D#6ctor
or Authorized Agent
ASSURANCE OF COMPLIANCE
ASSURANCE OF COMPLIANCE WITH TITLE VI OF THE CIVIL RIGHTS ACT OF 1964, SECTION 504 OF THE REHABILITATION ACT OF
1973, TITLE IX OF THE EDUCATION AMENDMENTS OF 1972, AND THE AGE DISCRIMINATION ACT OF 1975
The Applicant provides this assurance in consideration of and for the purpose of obtaining Federal grants, loans, contracts, property, discounts
or other Federal financial assistance from the Department of Health and Human Services.
THE APPLICANT HEREBY AGREES THAT IT WILL COMPLY WITH:
1. Title VI of the Civil Rights Act of 1964 (Pub. L 88- 352), as amended, and all requirements Imposed by or pursuant to the Regulation
of the Department of Health and Human Services (45 C.F.R. Part 80), to the end that, in accordance with Title VI of that Act. and the
Regulation, no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be
denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant receives
Federal financial assistance from the Department.
2. Section 504 of the Rehabilitation Act of 1973 (Pub. L 93- 112), as amended, and all requirements imposed by or pursuant to the
'Regulation of the Department of Health and Human Services (45 C.F.R. Part 84), to the end that, in accordance with Section 504 of
that Act and the Regulation, no otherwise qualified handicapped individual in the United States shall, solely by reason of his handicap,
be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity
for which the Applicant receives Federal financial assistance from the Department
3. Title IX of the Educational Amendments of 1972 (Pub. L 92- 318), as amended, and all requirements imposed by or pursuant to the
Regulation of the Department of Health and Human Services (45 C.F.R. Part 86), to the end that, in accordance with Title IX and the
Regulation, no person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or
be otherwise subjected to discrimination under any education program or activity for which the Applicant receives Federal financial
assistance from the Department.
4. The Age Discrimination Act of 1975 (Pub. L 94 -135), as amended, and all requirements imposed by or pursuant to the Regulation of
the Department of Health and Human Services (45 C.F.R. Part 91), to the end that, in accordance with the Act and the Regulation, no
person in the United States shall, on the basis of age, be denied the benefits of, be excluded from participation in, or be subjected to
discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department.
The Applicant agrees that compliance with this assurance constitutes a condition of continued receipt of Federal financial assistance, and that it
is binding upon the Applicant, its successors, transferees and assignees for the period during which such assistance is provided. If any real
property or structure thereon is provided or improved with the aid of Federal financial assistance extended to the Applicant by the Department,
this assurance shall obligate the Applicant, or in the case of any transfer of such property, any transferee, for the period during which the real
property or structure is used for a purpose for which the Federal financial assistance is extended or for another purpose involving the provision
of similar services or benefits. If any personal property is so provided, this assurance shall obligate the Applicant for the period during which it
retains ownership or possession of the property. The Applicant further recognizes and agrees that the United States shall have the right to seek
judicial enforcement of this assurance.
The person or persons whose signature(s) appear(s) below Ware authorized to sign this assurance, and commit the Applicant to the above
provisions.
COX �4A
Date Signature and Title of Authorized Official
0C31W Canty Health Department
Name of Applicant or Recipient
300 W. Lyon Street
Street
Hillsbarotiga, VIC 27278
City, State, Zip Code
Form HHS -690
5/97
two ra6+6 U.S. Z=AXTM -T OF ACRICUirj%Z a«.......ea o.....a.�,�
C67e1 Food and Nutrition Service .a
ASSURANCE OF COMPLIANCE WITH THE DEPARTMENT OF AGRICULTURE.
FOOD AND NUTRITION SERVICE. UNDER TITLE VI OF THE CIVIL RIGHTS ACT OF 1964
CRANz aum HFAM IMAI 7MM
%Naas of Applicant)
Unreiaaftar called the "Applicant. ")
W=T AC= MUT it w211 comply with Title VI
Of the Civil lights Act of 1961- (?.L. i8 -352)
and all requisesents imposed by the Regulations
Of the Department of Agriculture (7 CFR part 13),
Departs *nt of Justice (23 CFR !arts 42 i SO),
and FNS directives or regulstioas issued
pursuant to that Act and the Regulations. to the
effect that, no person In the United States shall,
on the ground of race, color, or national origin,
be excluded from participation In, be denied the
beaefits of. or be otherwise subject to disc.•• =1-
na.!an under any progra: or activity for vhich the
Applicant received Federal financial assistance
from the Depsrnant; and 23.rRr! CITES ASSZ7 %jCZ
THAT it will icediataly Lake any seasures A.
necessary to effec:=zg this &Crecent.
IRIS ASSURA`iCr is given In considers -won of and
for the purpose of obtaining any and all Federal
financial assistance. grants and loans of Federal
funds. reimbursable expenditures, grant or
donation of Federal property and interest in
property, the deta_1 of Federal personnel. the
sale and lease of. and the perslsslon to use.
Federal property or Interest in such property or
the furnishing of Services without eaosideration
or at a nominal consideration, or at a consider-
ation which is reduced for the purpose of assist-
ing the recipient, ar in recognition of the
Public interest to be served by such sale, Isis&.
or furnishing of services to the recipient. c
Dated
300 W. Ikyoa St.
Hillsborough, NC 27278
(Address of Applicant)
any improvements sad* vith Federal financial
assistance extended to the Applicant by the
Department. 7ALs includes any Federal agreement,
arrangement. or other contract which has as one
of its purposes the provision of assistance such
as food, food stamps. cash assistance for the
purchase of food. and cash assistance for purchase
or rental of food service equipsent or any other
financial assistance extended in reliance on the
representations and agreements Bade in this
assurance.
ET ACWTINC THIS ASSURAh+CE, the ayplicar.: agrees
to cos:;ils data, maintain records and submit
reports as required, to pewit effective enforce -
seat of Title VI and per_it authorized USDA
Personnel during normal working hours to review
such records. books and accounts as needed to
ascertain compliance with Title VI. 21 there are
any violations of this assurance, the Department
of Agri culture.. Food and Nutrition Service, shall
have the right to seek judicial enforcasent of
this assurance.
This assurance is binding on the applicant, its
successors. transferees. and assignees as long as
It receives assistance or retains possession of
any assistance from the Department. The person
or persons whose signatures appear below are
authorized to sign this assurance an the behalf of
the applicant.
U�
(Applicant)
By Chair, f7zauge County 03®d.SB1C r
MUG of authorized official)
No further sonies or other benefits say be paid out under Food and Nutrltlon Service Federal assistance
programs unless ch:s Assurance L con *lased mad filed as required by existing regulations (7 CTR 15).'
op• .n 004