Loading...
HomeMy WebLinkAbout2011-149 DSS - The Family Violence Prevention Center of Orange County~~q ~ 5 ~5 Contract #68-1007 The Family Violence Prevention Center of Orange County, Inc. Contract # 68-1007 Fiscal Year Begins_Julyl, 2011 Ends June 30, 2012 This contract is hereby entered into by and between the Orange County Department of Social Services (the "County") and The Family Violence Prevention Center of Orange County, Inc. (the "Contractor") ( . 1. Contract Documents: This Contract consists of the following documents (1) This contract (2) The General Terms and Conditions (Attachment A) (3) The Scope of Work, description of services, and rate (Attachment B) (4) Federal Certification Regarding Drug-Free Workplace & Certification Regarding Nondiscrimination (Attachment C) (5) Conflict of Interest (Attachment D) (6) No Overdue Taxes (Attachment E) (7) Certification of Transportation (Attachment J) (8) IRS Federal Tax Exempt Letter or 501(c)(3) (Attachment K) - (9) Outcomes and Reporting (Attachment N) These documents constitute the entire agreement between the Parties and supersede all prior oral or written statements or agreements. 2. Precedence Among Contract Documents: In the event of a conflict between or among the terms of the Contract Documents, the terms in the Contract Document with the highest relative precedence shall prevail. The order of precedence shall be the order of documents as listed in Paragraph 1, above, with the first-listed document having the highest precedence and the last-listed document having the lowest precedence. If there are multiple Contract Amendments, the most recent amendment shall have the highest precedence and the oldest amendment shall have the lowest precedence. 3. Effective Period: This contract shall be effective on July 1, 2011 and shall terminate on June 30, 2012. This contract must be twelve months or less. 4. Contractor's Duties: The Contractor shall provide the services and in accordance with the approved rate as described in Attachment B, Scope of Work, and shall meet the requirements set forth in Attachment N, Outcomes and Reporting. 5. County's Duties: The County shall pay the Contractor in the manner and in the amounts specified in the Contract Documents. The total amount paid by the County to the Contractor under this contract shall not exceed $8,000. This amount consists of $8,000 in Federal (CFDA # ), State and County funds, $0 (source of other funds if applicable). [X] a. There are no matching requirements from the Contractor. [ ] b. The Contractor's matching requirement is $ ,which shall consist of: [ ] In-kind [ ]Cash [ ]Cash and In-kind [ ]Cash and/or In-kind The contributions from the Contractor shall be sourced from non-federal funds. The total contract amount including any Contractor match shall not exceed $8,000. 6. Reporting Requirements: Contractor shall comply with audit requirements as described in N.C.G.S. § 143C-6-22 & 23 and OMB Circular A-133. 7. Payment Provisions: Contract-C+eneral (07/10) Page 1 of 3 Contract #68-1007 The Family Violence Prevention Center of Orange County, Inc. Payment shall be made in accordance with the Contract Documents as described in the Scope of Work, Attachment B. 8. Contract Administrators: All notices permitted or required to be given by one Party to the other and all questions about the contract from one Party to the other shall be addressed and delivered to the other Party's Contract Administrator. The name, post office address, street address, telephone number, fax number, and email address of the Parties' respective initial Contract Administrators are set out below. Either Party may change the name, post office address, street address, telephone number, fax number, or email address of its Contract Administrator by giving timely written notice to the other Party. For the County: IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS Sharron Hinton, Community Services Manager Sharron Hinton, Community Services Manager Orange County Department of Social Services Orange County Department of Social Services P.O. Box 8181 113 Mayo Street Hillsborough, NC 27278 Hillsborough, NC 27278 (919)245-2840 shinton co.oran e.nc.us Program Contact: Robert Gilmore, Work First Manager Orange County Department of Social Services P.O. Box 8181 300 West Tryon Street Hillsborough, NC 27278 (919)245-2847 For the Contractor: IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS Family Violence Prevention Center Family Violence Prevention Center 201 East Rosemary Street 201 East Rosemary Street P.O. Box 187 Chapel Hill, NC 27514 Chapel Hill, NC 27514 (919)929-3872 Contrast-General (07/10) Page 2 of 3 ~''~ y ~5 Contract #68-1007 The Family Violence Prevention Center of Orange County, Inc. 9. Signature Warranty: The undersigned represent and warrant that they are authorized to bind their principals to the terms of this agreement. The Contractor and the County have executed this contract in duplicate originals, with one original being retained by each party. THE FAMILY CENTER OF ORANGE COUNTY, INC. I ~ I Signature \ 1 ateG~ ~Je~1~ ~P.llr1~14 ~~-C.L:9a-r1C.Te, ~v - ~~F' Printed Name Title ORANGE Director, Departrr3~nt of Social Services Director Date Printed Nam Title This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act. Clarence G. Grier, Financial Services Director Date This contract has~been approved as to form and legal sufficiency. 6~~~ /~, Moore, Staff Attorney Contract-General (07/10) Date Page 3 of 3 Contract #68-1007 The Family Violence Prevention Center of Orange County, Inc. ATTACHMENT A GENERAL TERMS AND CONDITIONS Orange County Department of Social Services Relationships of the Parties Independent Contractor: The Contractor is and shall be deemed to be an independent contractor in the performance of this contract and as such shall be wholly responsible for the work to be performed and for the supervision of its employees. The Contractor represents that it has, or shall secure at its own expense, all personnel required in performing the services under this agreement. Such employees shall not be employees of, or have any individual contractual relationship with the County. the County or the Contractor, receiving services or benefits under this contract shall be deemed an incidental beneficiary only. Indemnity and Insurance Indemnification: The Contractor agrees to indemnify and hold harmless the County and any of their officers, agents and employees, from any claims of third parties arising out or any act or omission of the Contractor in connection with the performance of this contract. Subcontracting: The Contractor shall not subcontract any of the work contemplated under this contract without prior written approval from the County. Any approved subcontract shall be subject to all conditions of this contract. Only the subcontractors specified in the contract documents are to be considered approved upon award of the contract. The County shall not be obligated to pay for any work performed by any unapproved subcontractor. The Contractor shall be responsible for the performance of all of its subcontractors. Assignment: No assignment of the Contractor's obligations or the Contractor's right to receive payment hereunder shall be permitted. However, upon written request approved by the issuing purchasing authority, the County may: (a) Forward the Contractor's payment check(s) directly to any person or entity designated by the Contractor, or (b) Include any person or entity designated by Contractor as a joint payee on the Contractor's payment check(s). In no event shall such approval and action obligate the County to anyone other than the Contractor and the Contractor shall remain responsible for fulfillment of all contract obligations. Beneficiaries: Except as herein specifically provided otherwise, this contract shall inure to the benefit of and be binding upon the parties hereto and their respective successors. It is expressly understood and agreed that the enforcement of the terms and conditions of this contract, and all rights of action relating to such enforcement, shall be strictly reserved to the County and the named Contractor. Nothing contained in this document shall give or allow any claim or right of action whatsoever by any other third person. It is the express intention of the County and Contractor that any such person or entity, other than Insurance: During the term of the contract, the Contractor at its sole cost and expense shall provide commercial insurance of such type and with such terms and limits as may be reasonably associated with the contract. As a minimum, the Contractor shall provide and maintain the following coverage and limits: (a) Worker's Compensation -The contractor shall provide and maintain Worker's Compensation Insurance as required by the laws of North Carolina, as well as employer's liability coverage with minimum limits of $500,000.00, covering all of Contractor's employees who are engaged in any work under the contract. If any work is sublet, the Contractor shall require the subcontractor to provide the same coverage for any of his employees engaged in any work under the contract. (b) Commercial General Liability - General Liability Coverage on a Comprehensive Broad Form on an occurrence basis in the minimum amount of $1,000,000.00 Combined Single Limit. (Defense cost shall be in excess of the limit of liability.) (c) Automobile -Automobile Liability Insurance, to include liability coverage, covering all owned, hired and non-owned vehicles used in performance of the contract. The minimum combined single limit shall be $500,000.00 bodily injury and property damage; $500,000.00 uninsured/underfnsured motorist; and $25,000.00 medical payment. The Contractor shall provide this insurance for all automobiles that are: a. owned by the Contractor and used in the performance of this contract; b. hired by the Contractor and used in the performance of this contract; and General Terms and Conditions - (07/10) Page 1 of 5 c. owned by Contractor's employees and used in performance of this contract ("non-owned vehicle insurance"). Non- owned vehicle insurance protects employers when employees use their personal vehicles for work purposes. Non- ownedvehicle insurance supplements, but does not replace, the car-owner's liability insurance. The Contractor is not required to provide and maintain automobile liability insurance on any vehicle-owned, hired, or non-owned-unless the vehicle is used in the performance ofthis contract. (d) The insurance coverage minimums specified in subparagraph (a) are exclusive of defense costs. (e) The Contractor understands and agrees that the insurance coverage minimums specified in subparagraph (a) are not limits, or caps, on the Contractor's liability or obligations under this contract. (f) The Contractor may obtain a waiver of any one or more of the requirements in subparagraph (a) by demonstrating that it has insurance that provides protection that is equal to or greater than the coverage and limits specified in subparagraph (a). The County shall be the sole judge of whether such a waiver should be granted. (g) The Contractor may obtain a waiver of any one or more of the requirements in paragraph (a) by demonstrating that it is self-insured and that its self-insurance provides protection that is equal to or greater than the coverage and limits specified in subparagraph (a). The County shall be the sole judge of whether such a waiver should be granted. (h) Providing and maintaining the types and amounts of insurance or self-insurance specified in this paragraph is a material obligation of the Contractor and is of the essence ofthis contract. (i) The Contractor shall only obtain insurance from companies that are authorized to provide such coverage and that are authorized by the Commissioner of Insurance to do business in the State of North Carolina. All such insurance shall meet all laws of the State of North Carolina. (j) The Contractor shall comply at all times with all lawful terms and conditions of its insurance policies and all lawful requirements of its insurer. (k) The Contractor shall require its subcontractors to comply with the requirements ofthis paragraph. (1) The Contractor shall demonstrate its compliance with the requirements of this paragraph by submitting certificates of insurance to the County before the Contractor begins work under this contract. Contract #68-1007 The Family Violence Prevention Center of Orange County, Inc. Default and Termination Termination Without Cause: The County mayterminate this contract without cause by giving 30 days written notice to the Contractor. In that event, all finished or unfinished deliverable items prepared by the Contractor under this contract shall, at the option of the County, become its property and the Contractor shall be entitled to receive just and equitable compensation for any satisfactory work completed on such materials, minus any payment or compensation previously made. Termination for Cause: If, through any cause, the Contractor shall fail to fulfill its obligations under this contract in a timely and proper manner, the County shall have the right to terminate this contract by giving written notice to the Contractor and specifying the effective date thereof. In that event, all finished or unfinished deliverable items prepared by the Contractor under this contract shall, at the option of the County, become its property and the Contractor shall be entitled to receive just and equitable compensation for any satisfactory work completed on such materials, minus any payment or compensation previously made. Notwithstanding the foregoing provision, the Contractor shall not be relieved of liability to the County for damages sustained by the County by virtue of the Contractor's breach ofthis agreement, and the County may withhold any payment due the Contractor for the purpose of setoff until such time as the exact amount of damages due the County from such breach can be determined. In case of default by the Contractor, without limiting any other remedies for breach available to it, the County may procure the contract services from other sources and hold the Contractor responsible for any excess cost occasioned thereby. The filing of a petition for bankruptcy by the Contractor shall be an act of default under this contract. Waiver of Default: Waiver by the County of any default or breach in compliance with the terms ofthis contract by the Provider shall not be deemed a waiver of any subsequent default or breach and shall not be construed to be modification of the terms ofthis contract unless stated to be such in writing, signed by an authorized representative of the County and the Contractor and attached to the contract. Availability of Funds: The parties to this contract agree and understand that the payment of the sums specified in this contract is dependent and contingent upon and subject to the appropriation, allocation, and availability of funds for this purpose to the County. Force Majeure: Neither party shall be deemed to be in default of its obligations hereunder if and so long as it is prevented from performing such obligations by any act of General Tenns and Conditions - (07/10) Page 2 of 5 Contract #68-1007 The Family Violence Prevention Center of Orange County, Inc. war, hostile foreign action, nuclear explosion, riot, strikes, civil insurrection, earthquake, hurricane, tornado, or other catastrophic natural event or act of God. Survival of Promises: All promises, requirements, terms, conditions, provisions, representations, guarantees, and warranties contained herein shall survive the contract expiration or termination date unless specifically provided otherwise herein, or unless superseded by applicable Federal or State statutes of limitation. Intellectual Property Rights Copyrights and Ownership of Deliverables: All deliverable items produced pursuant to this contract are the exclusive property of the County. The Contractor shall not assert a claim of copyright or other property interest in such deliverables. Federal Intellectual Property Bankruptcy Protection Act: The Parties agree that the County shall be entitled to all rights and benefits of the Federal Intellectual Property Bankruptcy Protection Act, Public Law 100-506, codified at 11 U.S.C. 365 (n) and any amendments thereto. Compliance with Applicable Laws Compliance with Laws: The Contractor shall comply with all laws, ordinances, codes, rules, regulations, and licensing requirements that are applicable to the conduct of its business, including those of federal, state, and local agencies having jurisdiction and/or authority. Title VI, Civil Rights Compliance: In accordance with Federal law and U.S. Department of Agriculture (USDA) and U.S. Department of Health and Human Services (HHS) policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age or disability. Under the Food Stamp Act and USDA policy, discrimination is prohibited also on the basis of religion or political beliefs. Equal Employment Opportunity: The Contractor shall comply with all federal and State laws relating to equal employment opportunity. Health Insurance Portability and Accountability Act (HIPAA): The Contractor agrees that, if the County determines that some or all of the activities within the scope of this contract are subject to the Health Insurance Portability and Accountability Act of 1996, P.L. 104-91, as amended ("HIPAA"), or its implementing regulations, it will comply with the HIPAA requirements and will execute such agreements and practices as the County may require to ensure compliance. Confidentiality Confidentiality: Any information, data, instnunents, documents, studies or reports given to or prepared or assembled by the Contractor under this agreement shall be kept as confidential and not divulged or made available to any individual or organization without the prior written approval of the County. The Contractor acknowledges that in receiving, storing, processing or otherwise dealing with any confidential information it will safeguard and not further disclose the information except as otherwise provided in this contract. Oversight Access to Persons and Records: The State Auditor shall have access to persons and records as a result of all contracts or grants entered into by State agencies or political subdivisions in accordance with General Statute 147-64.7. Additionally, as the State funding authority, the Department of Health and Human Services shall have access to persons and records as a result of all contracts or grants entered into by State agencies or political subdivisions. Record Retention: Records shall not be destroyed, purged or disposed of without the express written consent of the County. The Department of Health and Human Services' basic records retention policy requires all records to be retained for a minimum of three years following completion or termination of the contract. If the contract is subject to Federal policy and regulations, record retention will normally be longer than three years since records must be retained for a period of three years following submission of the final Federal Financial Status Report, if applicable, or three years following the submission of a revised final Federal Financial Status Report. Also, if any litigation, claim, negotiation, audit, disallowance action, or other action involving this contract has been started before expiration of the three year retention period described above, the records must be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular three year period described above, whichever is later. Warranties and Certifications Date and Time Warranty: The Contractor warrants that the product(s) and service(s) furnished pursuant to this contract ("product" includes, without limitation, any piece of equipment, hardware, firmware, middleware, custom or General Terms and Conditions - (07/ 10) Page 3 of 5 commercial software, or internal components, subroutines, and interfaces therein) that perform any date and/or time data recognition function, calculation, or sequencing will support a four digit year format and will provide accurate date/time data and leap year calculations. This warranty shall survive the termination or expiration of this contract. Certification Regarding Collection of Taxes: G.S. 143- 59.1 bars the Secretary of Administration from entering into contracts with vendors that meet one of the conditions of G. S. 105-164.8(b) and yet refuse to collect use taxes on sales of tangible personal property to purchasers in North Carolina. The conditions include: (a) maintenance of a retail establishment or office; (b) presence of representatives in the State that solicit sales or transact business on behalf of the vendor; and (c) systematic exploitation of the market by media-assisted, media- facilitated, or media-solicited means. The Contractor certifies that it and all of its affiliates (if any) collect all required taxes. Miscellaneous Choice of Law: The validity of this contract and any of its terms or provisions, as well as the rights and duties of the parties to this contract, are governed by the laws of North Carolina. The Contractor, by signing this contract, agrees and submits, solely for matters concerning this Contract, to the exclusive jurisdiction of the courts of North Carolina and agrees, solely for such purpose, that the exclusive venue for any legal proceedings shall be Orange County, North Carolina. The place of this contract and all transactions and agreements relating to it, and their situs and forum, shall be Orange County, North Carolina, where all matters, whether sounding in contract or tort, relating to the validity, construction, interpretation, and enforcement shall be determined. Amendment: This contract may not be amended orally or by performance. Any amendment must be made in written form and executed by duly authorized representatives of the County and the Contractor. Severability: In the event that a court of competent jurisdiction holds that a provision or requirement of this contract violates any applicable law, each such provision or requirement shall continue to be enforced to the extent it is not in violation of law or is not otherwise unenforceable and all other provisions and requirements of this contract shall remain in full force and effect. Headings: The Section and Paragraph headings in these General Terms and Conditions are not material parts ofthe agreement and should not be used to construe the meaning thereof. Contract #68-1007 The Family Violence Prevention Center of Orange County, Inc. Time of the Essence: Time is of the essence in the performance of this contract. Executive Order # 24: "By Executive Order 24, issued by Governor Perdue, and N.C. G.S. § 133-32, it is unlawful for any vendor or contractor (i.e. architect, bidder, contractor, construction manager, design professional, engineer, landlord, offeror, seller, subcontractor, supplier, or vendor), to make gifts or to give favors to any State employee of the Governor's Cabinet Agencies (i.e., Administration, Commerce, Correction, Crime Control and Public Safety, Cultural Resources, Environment and Natural Resources, Health and Human Services, Juvenile Justice and Delinquency Prevention, Revenue, Transportation, and the Office of the Governor). This prohibition covers those vendors and contractors who have a contract with a governmental agency; or have performed under such a contract within the past year; or anticipate bidding on such a contract in the future. For additional information regarding the specific requirements and exemptions, vendors and contractors are encouraged to review Executive Order 24 and G.S. Sec. 133-32. Executive Order 24 also encouraged and invited other State Agencies to implement the requirements and prohibitions of the Executive Order to their agencies. Vendors and contractors should contact other State Agencies to determine if those agencies have adopted Executive Order 24." Key Personnel: The Contractor shall not replace any of the key personnel assigned to the performance of this contract without the prior written approval of the County. The term "key personnel" includes any and all persons identified as such in the contract documents and any other persons subsequently identified as key personnel by the written agreement of the parties. Care of Property: The Contractor agrees that it shall be responsible for the proper custody and care ofanyproperty furnished to it for use in connection with the performance of this contract and will reimburse the County for loss of, or damage to, such property. At the termination of this contract, the Contractor shall contact the County for instructions as to the disposition of such property and shall comply with these instructions. Travel Expenses: Reimbursement to the Contractor for travel mileage, meals, lodging and other travel expenses incurred in the performance of this contract shall not exceed the rates established in County policy. General Terms and Conditions - (07/10) Page 4 of 5 Sales/Use Tax Refunds: If eligible, the Contractor and all subcontractors shall: (a) ask the North Carolina Department of Revenue for a refund of all sales and use taxes paid by them in the performance of this contract, pursuant to G.S. 105-164.14; and (b) exclude all refundable sales and use taxes from all reportable expenditures before the expenses are entered in their reimbursement reports. Advertising: The Contractor shall not use the award of this contract as a part of any news release or commercial advertising. Contract #68-1007 The Family Violence Prevention Center of Orange County, Inc. Orange County Living Wage: Orange County is committed to providing its employees with a living wage and encourages agencies to which it provides funding to pursue the same goal. The County's living wage hourly standard, as adopted by the Orange County Board of County Commissioners annually, can be found in the Orange County Budget Ordinance. To the extent possible, Orange County recommends that the Contractor and all subcontractors provide a living wage, as defined in this section, to their employees. General Terms and Conditions - (07/10) Page 5 of 5 Contract #68-1007 The Family Violence Prevention Center of Orange County, Inc. ATTACHMENT B SCOPE OF WORK Orange County Department of Social Services Federal Tax Id. or SSN Contract # 68-1007 A. CONTRACTOR INFORMATION 1. Contractor Agency Name: The Familv Violence Prevention Center of Orange Countv Inc 2. If different from Contract Administrator Information in General Contract: Address Telephone Number: Fax Number: Email: 3. Name of Program (s): Familv Violence Prevention 4. Status: ( )Public (X) Private, Not for Profit ()Private, For Profit 5. Contractor's Financial Reporting Year Julv 1, 2011 through June 30. 2012 B. Explanation of Services to be provided and to whom (include SIS Service Code): The Contractor will assess clients referred by the Countv to determine need for domestic violence services and provide counseling services. Services may include but are not limited to crisis counseline, individual assessments support group court advocacv rental assistance utilities and attornev fees. The Contractor is required to meet all goals and outcomes listed in Attachment N C. Rate per unit of Service (define the unit): 1. If Standard Fixed Rate, Maximum Allowable, (See Rates for Services Chart) 45.00/hour 2. Negotiated County Rate. D. Number of units to be provided: E. Details of Billing process and Time Frames; The Countv will reimburse the Contractor for services described in this contract up to the budgetary limits of the contract allotment The Countv will reimburse the Contractor at a rate of $45.00/hour for approved services provided For reimbursement. the Contractor must submit an original and two copies of an invoice by the fifth of the month for the preceding month's expenditures to the designated Countv Administrator The Countv will reimburse the Contractor monthly upon receipt of a complete and correctly filed report. Contract-Scope of Work (06/04) Page 1 of 2 Contract #68-1007 The Family Violence Prevention Center of Orange County, Inc. F. Area to be served/Delivery site(s): Oran¢e Coun ~~ (Si~nature County Authorized Person) (Signature of ontractor) (Date Submitted) (Date Sub itte ) Contract-Scope of Work (06/04) Page 2of 2 Contract #68-1007 The Family Violence Prevention Center of Orange County, Inc. ATTACHMENT C CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS AND CERTIFICATION REGARDING NONDISCRIMINATION Orange County Department of Social Services I. By execution of this Agreement the Contractor certifies that it will provide adrug-free workplace by: A. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the Contractor's workplace and specifying the actions that will be taken against employees for violation of such prohibition; B. Establishing adrug-free awareness program to inform employees about: (1) The dangers of drug abuse in the workplace; (2) The Contractor's policy of maintaining adrug-free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; C. Making it a requirement that each employee be engaged in the performance of the agreement be given a copy of the statement required by paragraph (A); D. Notifying the employee in the statement required by paragraph (A) that, as a condition of employment under the agreement, the employee will: (1) Abide by the terms of the statement; and (2) Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction; E. Notifying the County within ten days after receiving notice under subparagraph (D)(2) from an employee or otherwise receiving actual notice of such conviction; F. Taking one of the following actions, within 30 days of receiving notice under subparagraph (D)(2), with respect to any employee who is so convicted: (1) Taking appropriate personnel action against such an employee, up to and including termination; or (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; and Making a good faith effort to continue to maintain adrug-free workplace through implementation of paragraphs (A), (B), (C), (D), (E), and (F). Federal Certification -Drug-Free Workplace (07/10) Page 1 of 2 Contract #68-1007 The Family Violence Prevention Center of Orange County, Inc. II. The site(s) for the performance of work done in connection with the specific agreement are listed below: 1. ao t ~. ~s e., c 5-E-. (Street address) (City, county, state, ztp code) (Street address) (City, county, state, zip code) Contractor will inform the County of any additional sites for performance of work under this agreement. False certification or violation of the certification shall be grounds for suspension of payment, suspension or termination of grants, or government-wide Federal suspension or debarment (45 C.F.R. Section 82.510. Section 4 CFR Part 85, Section 85.615 and 86.620). CERTIFICATION REGARDING NONDISCRIMINATION The Vendor certifies that it will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§ 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (h) the Food Stamp Act and USDA policy, which prohibit discrimination on the basis of religion and political beliefs; and (i) the requirements of any other nondiscrimination statutes which may apply to this Agreement. i~ Signature Fi~.1c~~ v io~elu.C 1TCV~IC~'-0~1 C~. °f~ A ency/Organization e~ , O~~g Title ~ < <I Date (Certification signature should be same as Contract signature.) Federal Certification -Drug-Free Workplace (07/10) Page 2 of 2 Contract #68-1007 The Family Violence Prevention Center of Orange County, Inc. ATTACHMENT D CONFLICT OF INTEREST POLICY Orange County Department of Social Services Instructions: This document is intended as an aid to assist non-State entities in establishing a conflict of interest policy. It is not intended to be used verbatim, but rather to serve as a template for nongovernmental organizations as they craft their individual conflict of interest policy. This example includes definitions of what is considered unacceptable, and the consequences of any breaches thereof. Each organization that chooses to use this template should take care to make changes that reflect the individual organization. Conflict of Interest Defined: A conflict of interest is defined as an actual or perceived interest by a (Contractor/staff member/Board member) in an action that results in, or has the appearance of resulting in, personal, organizational, or professional gain. A conflict of interest occurs when an employee/Contractor/Board member has a direct or fiduciary interest in another relationship. A conflict of interest could include: - Ownership with a member of the Board of Directors/Trustees or an employee where one or the other has supervisory authority over the other or with a client who receives services. - Employment of or by a member of the Board of Directors/Trustees or an employee where one or the other has supervisory authority over the other or with a client who receives services. - Contractual relationship with a member of the Board of Directors/Trustees or an employee where one or the other has supervisory authority over the other or with a client who receives services. - Creditor or debtor to a member of the Board of Directors/Trustees or an employee where one or the other has supervisory authority over the other or with a client who receives services. - Consultative or consumer relationship with a member of the Board of Directors/Trustees or an employee where one or the other has supervisory authority over the other or with a client who receives services. The definition of conflict of interest includes any bias or the appearance of bias in a decision-making process that would reflect a dual role played by a member of the organization or group. An example, for instance, might involve a person who is an employee and a Board member, or a person who is an employee and who hires family members as consultants. Employee/Contractor/Board Member Responsibilities: It is in the interest of the organization, individual staff, and Board members to strengthen trust and confidence in each other, to expedite resolution of problems, to mitigate the effect and to minimize organizational and individual stress that can be caused by a conflict of interest. Employees are to avoid any conflict of interest, even the appearance of a conflict of interest. This organization serves the community as a whole rather than only serving a special interest group. The appearance of a conflict of interest can cause embarrassment to the organization and jeopardize the credibility of the organization. Any conflict of interest, potential conflict of Conflict of Interest Policy (06/04) Page 1 of 3 Contract #68-1007 The Family Violence Prevention Center of Orange County, Inc. interest, or the appearance of a conflict of interest is to be reported to your supervisor immediately. Employees are to maintain independence and objectivity with clients, the community, and organization. Employees are called to maintain a sense of fairness, civility, ethics and personal integrity even though law, regulation, or custom does not require them. Acceptance of Gifts: Employees, members of employee's immediate family, and members of the Board are prohibited from accepting gifts, money or gratuities from the following: a. Persons receiving benefits or services from the organization; b. Any person or organization performing or seeking to perform services under contract with the organization; and c. Persons who are otherwise in a position to benefit from the actions of any employee of the organization. Employees may, with the prior written approval of their supervisor, receive honoraria for lectures and other such activities while on personal days, compensatory time, annual leave, or leave without pay. If the employee is acting in any official capacity, honoraria received by an employee in connection with activities relating to employment with the organization are to be paid to the organization. NOTARIZED CONFLICT OF INTEREST POLICY State of North Carolina County of Orange and State, certify that Notary Public for said County personally appeared before me this day and acknowledged that he he ~XQ ~ ~+ i ~ ~ ~ ~ ~ e c ~- o ~ of and by that authority duly given and as the act of the corporation, affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors in a meeting held on the ~ ~~~ day of r--l a r c 1-., oZ O l l s-~ Sworn to and subscribed before me this ~ day of ~ ~ ~+ ~ a~~ Conflict of Interest Policy (06/04) Page 2 of 3 Contract #68-1007 The Family Violence Pr `\\n~~i flr~ ~el~~~/of Orange County, Inc. `\~~~ ~ r1UD3p~ /~~~ ~y/,~ 1 • • \ ~ j • NOTARY : m _ •~= (Official Seal) ~ ', PUBLIC Notary Public %~• ~' My Commission expires /°~ , ~il ~~)~~~~ ao-3 Attached is the Conflict of Interest Policy for: The Family Violence Prevention Center of Orange County, Inc. ~~ l Signature of Co oration Official Conflict of Interest Policy (06/04) Page 3 of 3 FAMILY VIOLENCE PREVENTION CENTER OF ORANGE COUNTY, INC. CONFLICT OF INTEREST POLICY Conflicts of Interest A conflict of interest means a conflict, or the appearance of a conflict, between the private interests and official responsibilities of a person in a position of trust. Examples of possible conflicts of interest include, but are not limited to the following: 1. A member of the FVPC's Board of Directors, a staff member, a volunteer or a relative (a relative is defined as a parent, spouse, sibling, child, domestic partner, or spouses of parents, spouses of siblings, or children) of any of the aforementioned receives or is likely to receive financial gain from the receipt of funds from FVPC or a client of FVPC. 2. A member of the Board of Directors, a staff member, or a volunteer is a member of the governing board of a contributor to FVPC. 3. A member of the Board of Directors, a staff member, a volunteer or a relative (a relative is defined as a parent, spouse, sibling, child, domestic partner, or spouses of parents, spouses of siblings, or children) of any of the aforementioned has a personal, financial, professional or political gain at the expense of FVPC or one of FVPC's clients. 4. A member of the Board of Directors, a staff member, or a volunteer is offered or given a favor or gift (valued at $25.00 or more) from anyone who does business with FVPC, including clients of FVPC. 5. A member of the Board of Directors, a staff member, or a volunteer is involved in a romantic relationship with another member of the Board of Directors, a staff member, a volunteer or a client. Where the possible conflict of interest involves a volunteer or staff person other than the Executive Director, full disclosure, by notice in writing, shall be made immediately by the staff member of volunteer to the Executive Director. The Executive Director shall determine whether a conflict exists, and if so, whether the conflict should be permitted to continue. The Executive Director shall document the conflict and the resolution in writing and shall add it to the employee's or volunteer's personnel file. Where the possible conflict of interest involves a board member or the Executive Director, full disclosure, by notice in writing, shall be made immediately by the board member, staff member, or volunteer of FVPC to the full Board of Directors-Following full disclosure of a possible conflict of interest, the Board of Directors shall determine whether a conflict of interest exists, and if so, the Board shall vote to authorize or reject the transaction and/or condition. No Board member shall vote on any matter in which she or he has disclosed a possible conflict of interest. Similarly, no member of the Board of Directors, staff person or volunteer shall participate in any discussion or debate of the Board of Directors, or any committee thereof, in which the subject of the discussion is a contract, transaction, or situation in which there may be a conflict of interest. Adopted by the Board of Directors on June 11, 2010 as part of the Personnel Policies Reapproved by the Board of Directors on March 10, 2011 Attachment E Overdue Taxes Orange County Department of Social Services Family Violence Prevention Center of Orange County P.O. Box 187 Chapel Hill, NC 27514 Tel: (919) 929-3872 Fax: (919) 929-9925 June 1, 2011 To: Orange County Department of Social Services Certification: We certify that the Familv Violence Prevention Center of Orange County does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. We further understand that any person who makes a false statement in violation of N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable as provided by N.C.G.S. 143C-10-1. Sworn Statement: Michelle Williams Hamilton and DeWarren Brandon Watson being duly sworn, say that we are the Board President and Treasurer, respectively, of Familv Violence Prevention Center of Orange County in Chapel Hill in the State of North Carolina; and that the foregoing certification is true, accurate and complete to the best of our knowledge and was de and subscribed by us. We also acknowledge and understand that any misuse of State swill a reported to the appropriate authorities for further action \\~~~ttll lI t~~~~~/ \~~~\P.NUDSO~ ii~~ •' P sident _= ~• NARY ' ~ -_ '" *** ;~_ O •• PUBLIC = e e ~~iicF COU 1~\\\\\~~ Sworn to and subscribed before me on the day of the date of said certification. (Notary ignature and Seal) My Commission Expires: I °Z/3 ~ / ~ 3 Overdue Taxes - (07/08) Page 1 of 1 Contract #68-1007 The Family Violence Prevention Center of Orange County, Inc. ATTACHMENT E OVERDUE TAXES Orange County Department of Social Services Instructions: Grantee should complete this certification for all funds received. Entity should enter appropriate data in the yellow highlighted areas. The completed and signed form must be provided to the County Department of Social Services. Entity's Letterhead [Date of Certification (mmddyyyy)] To: Orange County Department of Social Services Certification: We certify that the [insert orgaftizarion's name) does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. We further understand that any person who makes a false statement in violation of N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable as provided by N.C.G.S. 143C-10-1. Sworn Statement: [Name of Board Chair] and [Name of Second Authorizing Official] being duly sworn, say that we are the Board Chair and [Title of the Second Authorizing Official], respectively, of [insert name of organization] of [City] in the State of [Name of State]; and that the foregoing certification is true, accurate and complete to the best of our knowledge and was made and subscribed by us. We also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Board Chair [Title of Second Authorizing Official] Sworn to and subscribed before me on the day of the date of said certification. (Notary Signature and Seal) My Commission Expires: Overdue Taxes - (07/08) Page 1 of 1 Contract #68-1007 The Family Violence Prevention Center of Orange County, Inc. ATTACHMENT J CERTIFICATION REGARDING TRANSPORTATION Orange County Department of Social Services By execution of this Agreement the Contractor certifies that it will provide safe client transportation by: 1. Insuring that all drivers (including employees, contractors, contractor's employees, and volunteers) shall be at least 18 years of age; 2. Insuring that all drivers (including employees, contractors, contractor's employees, and volunteers) shall be licensed to operate the specific vehicle used in transporting clients in accordance with Chapter 20-7 of the General Statutes of North Carolina and the Division of Motor Vehicle requirements; 3. Insuring that all vehicles used to transport clients shall have valid vehicle registration notices (verify both license tag and inspection expiration dates); 4. Insuring that all vehicles transporting clients shall have at least the minimum level of liability insurance appropriate for the type of vehicle; 5. Insuring that the contractor shall have written policies and procedures regarding how drivers handle and report client emergencies and/or vehicle crashes involving clients to contractor and how contractor notifies the Orange County Department of Social Services Signature ' ` Fa,,,,,~ ly V alerce -Pieven~i ax ~i- Agency/Organization ~n9e , Title ~ t l1 Date (Certification signature should be same as Contract signature.) Transportation Certification (05/09) Page 1 of 1 Contract #68-1007 The Family Violence Prevention Center of Orange County, Inc. ATTACHMENT K 501(c)(3) and TAX EXEMPT STATUS Orange County Department of Social Services What is a Private Non Profit Agency? Answer: A private non profit is an organization that is incorporated under State law and whose purpose is not to make a profit, but rather to further a charitable, civic, religious, scientific, or other lawful purpose. The Secretary of State's office grants corporate status to organizations in North Carolina. What is a 501(c)(3) designation? Answer: When the agency becomes a state private non profit corporation, it can then apply for 501(c)(3) designation through the IRS. Once the IRS grants 501(c)(3) status, the organization is exempt from certain taxes and any donations to the charitable organization are tax deductible. Many individuals and organizations prefer to make donations to 501(c)(3) private non profits. Who can obtain a 501(c)(3) designation? Answer: Any organization or group can apply for 501(c)(3) status, provided their charter or mission focuses on the non profit's objective. Another option is to apply fora 509(a)(1) status which falls under the 501(c)(3) umbrella. Being a 509(a)(1) designates an organization as a tax-free public charity that receives most of its support from a governmental unit or from the general public. Becoming a 509(a)(1) provides public recognition oftax-exempt status, advance assurance to donors of deductibility of contributions, exemption from certain State and federal taxes, and non profit mailing privileges. Organizations that typically qualify are churches, educational institutions, hospitals, and governmental units. To Team more about non profits, visit www.irs.~ov, or call the tax-exempt helpline at 877-829- 4933. How does a Private Non Profit obtain Tax Exempt Status? A private non profit must apply to the IRS for tax exempt status. To qualify, applicants must complete and submit to the IRS Form 1023. Once federal tax exempt status is granted, the private non profit applies for State tax exempt status by completing Form CD-435 and submitting it to the N. C. Department of Revenue. Please attach proof of 501(c)(3) or IRS tax-exempt status to this page. INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 Date ~ :- ~s,~ ~i FAMILY VIOLENCE PREVENTION CENTER OF ORANGE COUNTY INC PO BOX 187 CHAPEL HILL, NC 27514-0000 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 31-1720053 DLN: 17053043784075 Contact Person: STEPHEN D SEOK ID# 31125 Contact Telephone Number: (877) 829-5500 Public Charity Status: 170 (b) (1) (A) (vi) Our letter dated AUGUST 2000, stated you would be exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code, and you would be treated as a public charity, rather than as a private foundation, during an advance ruling period. Based on the information you submitted, you are classified as a public charity under the Code section listed in the heading of this letter. Since your exempt status was not under consideration, you continue to be classified as an organization exempt from Federal income tax under section 501(c)(3) of the Code. Publication 557, Tax-Exempt Status for Your Organization, provides detailed information about your rights and responsibilities as an exempt organization. You malr request a copy by calling the toll-free number for forms, (800) 829-3676. Information is also available on our Internet Web Site at www.irs.gov. If you have general questions about exempt organizations, please call our toll-free number shown in the heading between 8:30 a.m. - 5:30 p.m. Eastern time. Please keep this letter in ~~our permanent records. Sincerel~r yours , Lois G. L er Director, Exempt Organizations Rulings and Agreements Letter 1050 (DO/CG) Contract #68-1007 The Family Violence Prevention Center of Orange County, Inc. ATTACHMENT N OUTCOMES AND REPORTING Orange County Department of Social Services By signing and submitting this document, the Contractor certifies that it agrees to the following: 1. The Contractor agrees to participate in program, fiscal and administrative monitoring and/or audits, making records and staff time available to Federal, State and County staff. 2. The Contractor agrees to take necessary steps for corrective action, as negotiated within a corrective action plan, for any items found to be out of compliance with Federal, State, and County laws, regulations, standards and/or terms of the Contract. 3. The Contractor agrees that continuation of and/or renewal of this Contract is contingent on meeting the following requirements. The Contractor agrees to: A. Refer clients to the County for eligibility determination. B. Get Release of Information forms signed to allow communication between the County and the Contractor about specific clients. C. Assess clients and determine needs. D. Maintain client records that date and document the service delivered to the individual, a valid authorization for service, program records, and documents and other evidence that reflect program operattons. E. Furnish information to the County, as requested, to support provision of service(s) pursuant to this Contract and the full cost of the service; and submit changes, as needed or required for review and approval by the County. F. Maintain books, records, documents and other evidence and accounting procedures that reflect all direct and indirect costs expended under this Contract. A current, complete inventory of all equipment purchased under the terms of this Contract must be kept. G. Retain all financial and program records for a period of three years from the date of final payment under this agreement or until all audits continued beyond this period are completed. Federal auditors and any persons authorized by the Division of Social Services or the County shall have the right to examine any of these materials. ~n ul.,~ Signature ~on;~y ~id~et~C.e ~ie~ea~~or.C-k. Agency/Organization /~.,.,,,, o~ 1~ , ~x~~~ ~~ ~ ~.~o ~ Title ~ ( (~ Date (Certification signature should be same as Contract signature.) Outcomes (06/04) Page 1 of 1