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STATE OF NORTH CAROLINA
DIVISION OF SOCIAL SERVICES
PURCHASE CONTRACT
ID # 68E01
This Contract is entered into between the Department of Social Services and The
Employment Security Commission(referred to as Provider) identified on Attachment A. This
contract shall consist of form DSS-2497, Attachment A(DSS-1292) and Budget(DSS-6844).
This contract shall be in effect from 7/1/2002 to 6/30/2003.
The Department will purchase specific services from the Provider as set forth in the
Contract in order to make optimal use of the facilities, staff and programs of the Provider.
This Contract is subject to the provisions of all applicable Federal regulations and State
policies.
Subject to its other provisions, the terms of this contract shall be in effect to and from
the dates specified on Attachment A.
SECTION I: RESPONSIBILITIES
A. The Department will:
1. Determine client eligibility for service(s) in accordance with Federal and
State regulations; and
2. Inform the Provider on Form DSS-1360 concerning the eligibility of each
individual for the service, the period of time for which services are authorized,
and any changes in the individual's eligibility status; and
3. Reimburse the Provider for service(s)purchased as described in Attachment A
of this Contract for eligible clients; and
4. Keep the Provider informed of any alterations in and/or to the regulations
governing the service program; and
5.'Accept fiscal responsibility for deviations from the terms of this Contract as a
result of acts of the Department or any of its officers, employees, agents or
representatives.
B. The Provider will:
1. Provide service(s) as specified in Attachment A of this Contract in accordance
with applicable standards for the service(s); and
2. Furnish information to the Department as required to support the full cost of
service(s)provided pursuant to this Contract; and
I
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3. Comply with all State licensing standards, all applicable accrediting standards and
any other standards or criteria established by the Division of Social Services to
assure quality of services; and
4. Restrict the use or disclosure of information obtained in connection with the
administration of North Carolina's programs for the provision of services
concerning applicants for and recipients of those services to purpose directly
connected with the administration of the service program; and
5. Comply with the terms of Section 504 of the Rehabilitation Act of 1973 and all
requirements imposed by or pursuant to the regulations of the Department of
Health and Human Services issued pursuant to that Section,which prohibit
discrimination against handicapped persons in employment and in the operation
of programs and activities receiving Federal funds; and
6. Comply with Title VI and VII of the Civil Rights Act of 1964 and all requirements
imposed by or pursuant to the regulations of the Department of Health and Human
Services issued pursuant to that Title; and
7. Accept fiscal responsibility for deviations from the terms of this Contract as a
result
of acts of the Provider or any of its officers, employees, agents or representatives.
SECTION II: RESPONSIBILITY FOR LIABILITIES
Each party hereto agrees to be responsible for its own liabilities and that of its officers,
employees, agents, or representative arising out of this Contract.
SECTION III: TREATMENT OF ASSETS
Treatment of assets acquired under this Contract shall be subject to the following:
A. Ownership of property purchased by the Provider under the terms of this Contract or
which reimbursement by the Department is based upon the actual purchase cost of the
property shall immediately vest with the Department of Human Resources upon such
reimbursement.
B. The North Carolina Department of Human Resources shall have no claim to property
purchased by the Provider under the terms of this Contract for which reimbursement by
the Department is based upon approved depreciation schedule or use allowance.
C. The Provider shall maintain and administer in accordance with sound business practice a
program for the maintenance, repair,protection and preservation of property purchased
under the terms of this Contract to assure its continued availability.
D. Property purchase under the terms of this Contract shall be used only for the performance
of this Contract.
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SECTION IV: RECORDS AND REPORTS
A. The Provider agrees to maintain client records which date and document, in accordance
with established policy, the service delivered for the individual, a valid authorization for
service, programs records,documents and other evidence which reflect program
operations.
B. The Provider agrees to furnish information to the Department, 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, in this Contract, Attachment A or approved
supporting information for review and approval by the Department.
C. The Provider agrees to maintain books,records, documents and other evidence and
accounting procedures which 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.
D. The Provider agrees to retain all books,records and other documents relevant to this
Contract for three years after final payment or until all audits continued beyond this period
are completed. Federal auditors and any persons authorized by the Division of Social
Services or the Department shall have the right to examine any of these materials. In
records produced under this Contract will be turned over to the Department.
SECTION V: SUBCONTRACTING
The Provider shall not subcontract any of the work contemplated under this Contract without
obtaining prior written approval from the Department. Any approved subcontract shall be
subject to all conditions of this Contract. The Provider shall be responsible for the
performance of any subcontractor.
SECTION VI: MAINTENANCE OF EFFORT
The Provider certifies that the funds to be used under this Contract do not replace or supplant,
in any way, Federal, State or local funds for already existing services..
SECTION VII: MONITORING AND EVALUATION
A. The Provider agrees to participate in program, fiscal and administrative monitoring or
audits, making records an staff time available to Federal, State and county staff.
B. The Provider 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 and State
laws, regulations, standards and/or terms of this Contract.
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SECTION VIII: AMENDING THE CONTRACT
This contract in whole or in any part may be amended at any time:
A. By the Department in the event that such amendment is necessary to comply with
applicable laws, regulations,policies and standards; and by mutual consent of both parties.
B. Each party to this contract will notify the other immediately in writing if an amendment
becomes necessary due to alterations in the activities described in Attachment A or for
any
other reason.
SECTION IX: TERMINATION
A. This contract,in whole or in any part,may be canceled at any time:
1. By any party,with cause,upon at least 30 days notice, in writing, and delivered by
registered mail with return receipt requested or in person, or
2. By the Department in the event reimbursement to the Department is not available
and/or continued at an aggregate level sufficient to allow for the purchase of the
indicated quantity of service. The obligations of each party shall be terminated to the
extent specified in the notice of termination, immediately upon receipt of the notice of
termination from the Department,or
3. By the Department in the event that the Division of Social Services/Department
determines that the Provider is in violation of any or all of the terms of this Contract.
The obligations of each party shall be terminated to the extent specified in the notice
of termination immediately upon receipt of the notice from the Department,or
4. By mutual consent of all parties.
B. In the event of termination in part, all parties shall continue the performance of this
Contract to the extent not terminated.
C. If this Contract is terminated, in whole or in part,the Provider may be required to deliver
and transfer Title or assignment of interest to the Division of Social Services or dispose of
any property specifically produced or acquired for the performance of such part of this
Contract as has been terminated,and the Provider shall,upon the direction of the Division
of Social Services,protect and preserve property in the possession of the Provider in
which the Division of Social Services has an interest.
D. After receipt of a notice of termination, and except as otherwise directed by the
Department, the Provider shall cease work under the Contract on the date, an to the
extent specified,in the notice of termination. The Department shall pay the Provider the
agreed upon amount for the delivery of services under the terms of this Contract up to the
effective date of termination. Reimbursement shall not be made for equipment or supplies
purchased after the notice of termination is received except as approved by the
Department.
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E. Waiver of any default shall not be deemed to be a waiver of any subsequent default.
Waiver of breach of any provision of the Contract shall not be deemed to be a waiver of
any other subsequent breach and shall not be construed to be a modification of the terms
of this Contract unless stated to be such in writing, signed by an authorized representative
of the Department and attached to the Contract.
SECTION X: CONCLUSION
It is expressly understood an agreed that the services provided to eligible clients pursuant to
this Contract shall consist exclusively of those services specified in the attached program
description incorporated into this Contract as Attachment A.
It is further understood and agreed that the provision of services pursuant to this Contract
shall be subject to the limitations and conditions contained in the laws. regulations,
guidelines and plans cited in this Contact, and that this Contract is subject to renegotiations of
revision to meet any new or revised rules, regulations, or policies that may be issued by the
Department of Health and Human Services, or the North Carolina Social Services
Commission, or the Department of Human Resources and that are communicated to the
Provider.
PROVIDER DEPARTMENT
Employment Security Commission Orange County Department of Social Services
By By: ice G
Title: Manager Title: Director
Date: '1���0a Date: 7��L
This Agreement has been preaudited in the manner required by the local Government Budget
and Fiscal Control Act.
ATTEST:
Orange County Finance Officer
Signature..i�� �G �
Date:
Chair Oranee—Countv Board of County Commissioners
Signatur -
Date: 1
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SECTION XI: CERTIFICATON
The Orange County Board of Social Services supports this performance based contract with
the Employment Security Commission to provide on site First Stop registration, vocational
assessment,job development and placement, and follow-up services.
S t1 Z
Dorothy Gamble, C air /
Orange County Board of Social Services
ATTACHMENT A
State of North Carolina
Division of Social Services
Contract Application Page 1 of_ 7
I Contract Summary -
A. This agreement is between the Orange County Department of Social Services
(hereinafter referred to as the"Department") and the Employment Security Commission
(heretofore and hereinafter referred to as the "Provider").
B. This agreement shall be in effect from July 1,2002 to June 30,2003
C. Services to be Provided:
(1) (2) (3) (4) (5)
Number of Number of Units Definition of
Service Service Code Persons Served of Service Unit of Service
Job Development
And Placement 546 200 200 One Partici ant
Job Readiness/
Job Search 547 250 250 One Participant
Any additional services should be listed in III. - Service Program Description
D. Area to be Served: Orange County
State of North Carolina
Division of Social Services
Contract Application Page 2 of 7
E. Contract Identification:
1. Provider
a. Name of Contract Administrator Dorothy Pennell
Tel. # : (919) 644-1051
b. Name of Program Contact Person: Jimmy Modlin
Tel. #:
c. Program Name, Location and Mailing Address: Employment Security Commission
601 VAleg Forge Rd
Hillsborough,NC 27278
d. Additional Service Delivery Sites: Skills Development/JobLink Center
e. Status : (X) Public O Private,non-profit
( )Private, for Profit( ) Individual
f. Provider Contract ID#: 68FO1
2. County Department of Social Services
a. Name of Contract Administrator: Nancy Coston
Tel. # : (919) 245-2800
b. Name of Services Program Contact Person: Gwendolyn Price
Tel. #: (919)245-2800
c. Address of County Department of Social Services:
P. O. Box 8181
300 W. Tryon St.
Hillsborough,NC 27278
State of North Carolina
Division of Social Services
Contract Application Page 3 of 7
II. Fiscal Provisions
A. Amount of Reimbursement:
Reimbursement under the terms of this agreement will be limited to a maximum of
$ 27,627 TOTAL=$ SSBG+$ IV-B+$ RAP+
$ State +$ County+$ Other(identify) : Federal,State
and Local TANF Dollars
(Optional : County funds consist of$ for and$
(funding source)
for )
B. Method of Reimbursement:
1. For Purchase Contract(DSS-2497) Total and Unit Cost:
(X) a. Reimbursement will be made in accordance with the current budget approved by
the Department and on file with both parties. The amount of reimbursement will be
based on allowable expenditures made in behalf of eligible clients, determined in a
accordance with acceptable cost allocation methods. The Provider will report all
expenditures made under the terms of the contract.
( ) b. Reimbursement will be made at a unit cost rate of$ per unit of
reimbursement delivered to eligible clients for an estimated number of
units. The Provider will document total expenditures made under the terms of the
contract to the Department within thirty days after the termination of this contract,
or as instructed by the Department. Reimbursement which exceeds actual allowable
cost will be adjusted to actual allowable cost.
2. For Vendor Agreements (DSS-2252)Fixed Rate
Reimbursement will be based on:
( ) a. a standard fixed rate or
( ) b. an individual fixed rate.
c. Reimbursement will be made at a fixed rate of$ per unit of
(define) for as estimated number of units.
Reimbursement will be based on the actual number of units delivered whether over
or under the estimated number. If multiple components are being purchased,
additional rates and units can be identified as follows:
State of North Carolina
Division of Social Services
Contract Application Page 4 of 7
C. Reimbursement Reporting:
1. Expenditures
The Provider will report expenditures monthly in accordance with policy set forth by
the Controller's Offices,Division of Social Services, issued via the Fiscal Manual.
Expenditures are to be reported on the DSS Administrative Cost Report(Form DSS-
1571, Part III). Reports are to be submitted to the Department by the fifth working
day of the month following the month in which services were delivered. The
Department will reimburse the Provider monthly,usually by check,upon receipt of a
completed and correctly filed report.
2. Reporting for the Statewide Services Information System(SIS)
In addition to the Administrative Cost Report(DSS-1571, Part III),the Provider will
submit to the Department the Monthly Report of Service Delivery(DSS Form 1571,
Part IV). This should be submitted along with the Administrative Cost Report by the
fifth working day of the month following the month in which services were delivered.
The units reported in Column 12 of the 1571 Part IV are the units of service defined in
Column 5 of I.C. of this Attachment. Service definition and reporting instructions are
found in Family Services Manual,Volume VI, Chapter IV.
D. Audit Requirements
The Provider shall be responsible for compliance with the audit requirements of
Department of Health and Human Services federal regulation 45 CFR Part 74,
Administration of Grants,or State Administrative Procedures Manual for Federal Block
Grant Funds,whichever is applicable. These regulations stipulate that an annual audit be
performed for the fiscal year in which contract funds were received.
( )
1. NA
Private,non-profit if amount of reimbursement received is under$ 1,000;private,
for profit or individual
( ) 2. (Applicable to Private,Non-Profit Providers if reimb. $1,000 or over)
An annual audit is to be performed in accordance with OMB Circular A-110 by an
"independent auditor." Independent auditor"means either: (a)a state government
auditor from the Department of Human Resources or the Department of
Administration, Office to the State Auditor; or(b) a certified public accountant.
Upon completion of the audit, a copy of the audit report must be forwarded to the
county department of social services.
State of North Carolina
Division of Social Services
Contract Application Page 5 of 7
( ) 3. (Applicable to Public Hospitals, Colleges, and Universities)
The annual audit must be performed in accordance with OMB Circular A-110.
It is not necessary for the institution to program audits performed separately
from an all-inclusive single audit which entails all revenues and expenditures
of the public agency. However,it is the responsibility of the contractor to
insure that the contract program is included in the institution's single annual
audit.
A copy of the audit report must be provided to the County department of.
Social Services upon completion of the annual audit.
(X) 4. (Applicable to State or Local Government Agencies)
An annual audit is to be performed in accordance with OMB Circular A-128
by an independent auditor. Upon completion of the audit, a copy of the audit
report must be forwarded to the county Department of Social Services.
E. Client Fees for Service
(X) 1. No fees will be charged to individuals determined to be eligible for services by
the department of social services.
( ) 2. The service(s)under contract with the Provider are services for which a client
fee may be assessed. Policy regarding the assessment and collection of fees is
contained in Family Services Manual,Volume VI, Chapter III. If a client is to
to be chugged a fee,the department will inform the Provider of the amount of
fee to be charged and of any subsequent changes by way of the Purchase of
Service Referral and Authorization(DSS Form 1360). The Provider will
establish a plan with the client for collecting the fee on at least a monthly basis;
and when fees are not paid within ten days of the due date, will bill the client
in writing and send a copy of the bill to the Department. NO OTHER FEES
FOR SERVICES MAY BE CHARGED TO THE CLIENT. Client fees are to
be reported on the Monthly Report of Service Delivery(DSS Form 1571,Part
IV).
F. Management of the Funding/Matching Share Requirement
O 1. A cash transfer of the matching share will be made to the county department of
social services in accordance with the terms specified in the Donation
Agreement(DSS-1319).
State of North Carolina
Division of Social Services
Contract Application Page 6 of 7
( ) 2. The provider certifies through the contract budget attached to this contract that
the matching share in available. Further, it is agreed that the provider will
report all program costs incurred each month relating to this contract on the
DSS-1571. However,reimbursement will be limited to the federal/state
financial participation rate.
(X) 3. The county department of social services is providing the match.
G. Provider Fees (For Purchase Contracts Only)
(N/A) 1. The Provider agrees to pay the Department/Division up to
Administrative Fee as payment in full for the.administration of the contract.
The amount of the fee is five percent of the matching share contributed by
the Provider.
(N/A) 2. The Provider agrees to pay the Department up to $ Certification Fee
as payment in full for the determination and certification of client
eligibility. The amount of the fee is five percent of the matching share
contributed by the Provider.
Monitoring and Certification Fees,when applicable, will be deducted from the
amount to be reimbursed.
State of North Carolina
Division of Social Services
Contract Application
Page 7 of 7
III. Service Program Description
Orange County Department of Social Services (DSS) is purchasing the services of a Job
Development Specialist from the Employment Security Commission of North Carolina. The
General Assembly considers the Employment Security Commission the state's primary job
placement authority. The Job Development Specialist will be stationed at the DSS and will be
providing services to Work First participants. The following services are included in this
contract:
• Vocational Assessment and Employment Counseling,
• Job Readiness Training and Job Club,
• First Stop Registration,
• Process Unemployment Insurance Claims,
• Job Development and Placement(placements include direct placements and entered
employment),
• Follow-up Services
Job Development Specialist Duties
The Job Development Specialist will assess and counsel Work First participants who are
referred with an objective of locating employment. Job readiness and job club activities will
include but are not limited to information about employer expectations, appropriate*dress and
grooming,resume preparation, goal setting, and networking.
Other duties of Job Development Specialist are as follows:
• Interview applicants/participants to determine work history, education, training and skills,
• Conduct file searches of suitable job openings,
• Refer applicant to employers,
• Perform job development contacts with employers to obtain job orders,
• Provide labor market information to employers, applicants and other agencies,
• Determine eligibility for unemployment insurance,and
• Follow-up with applicants and employers in an effort to impact job retention.
Performance Measures
North Carolina's Work First Program, implemented in July 1995, is one of the most
comprehensive welfare reform efforts in the nation. The guiding principles of Work First
requires parents to take personal responsibility for their children, limits the receipt of Work
First Cash Assistance(temporary and short-term), and requires parents to work.
The Orange County Department of Social Services, in conjunction with the Employment
Security Commission have identified the following performance measures.
• Locate full-time employment for 200 Work First eligible participants.
g p p
• Provide labor market information to employers, applicants, and other agencies.
• Complete First Stop registration for Work First participants.
• Maintain contact with participants and employers for three months after placement.
• Perform job development activities.
STATE OF NORTH CAROLINA
DIVISION OF SOCIAL SERVICES
PURCHASE CONTRACT BUDGET
SUMMARY Effective
Provider Fm ln=ent Security C:nmmiccinn ID#68F.01 Period 7/1/2002 through 6/30/2003
Part I- Estimated Expenditures
Object of Expenditure Total Non-Matchable Total Matchable
Program Costs Costs Costs
1 2 (3
A. Salaries $20,244
B. Fringe Benefits 4,203
C. Staff Development-Services
D. Travel 550
E. Equipment Purchase-Tangible
Property
F. Transportation-Recipient
G. Medical Supplies and Expense
H. Cost of Space-Non-Residential
I. Room& Board-Residential Treatment
J. Service Payments
K. Other
L. Indirect Costs 2,630
M. Totals 27,627
Part Il -Computation of Unit Cost or Individual Fixed Rate
A. 1. Total Matchable Costs $
2. Less: Earned Income for Unit Cost Method $
3. Net Matchable Costs $
B. 1. Total Service Unit Capacity, or
2. Total Anticipated Utilization Capacity
Method of Computation or Source of Data
D. Estimated Unit Cost or Individual Fixed Rate: $ per
Part III-Distribution of Estimated Revenue for Total Cost Reimbursement Method
(a) (b)
A. Estimated Eligible and Matchable Costs Number Ratio
1. Estimated Eligible Clients 250 100%
2. Estimated ineligible Clients 0 0%
3. Total Clients 250 100%
B. Eligible Costs
(1) Matchable (2) Less (3) Net (4) (5)Costs Eligible
Costs Earned Matchable Estimated% for Financial
[Part 1,Line M, Income Costs of Eligible Participation
col.(3) B. 1 Less 2 A. 1. B. 3 x 4
$ $ $ $ $
A. Program Costs Amount Source of Funds
1. Federal/State Funds $ Work First
2. Local Matching Share $ County
3. Other Budgeted Funds $
4. TOTAL REVENUE $ 27.627
B. Fees(If Applicable)
1. Administrative Fee $
2. Certification Fee $
3. TOTAL FEES $
Part V-Reimbursement Projections(For Title XX Providers Only)
Annual Projection July- September October-June
Projection Projection
A. $ B. $ C. $
Signed: Date:
Pr der/Authorize Official
Date:
ounty Director or Designee
Purchase Contract Budget
Supporting Budget Schedules
A. Salary Schedule
(1) (2) (3) (4) (5) (6) (7)
Number Pay %of No. of Months Annual Total
of Persons Position or Title Grade Time Em Toyed Salary Cost
1 Job Development Specialist N/A 50% 12 $40,488 $20,244
Total - Salaries $20,244
B. Fringe Benefits
(1) (2) (3)
Total
Type Method of Computation Cost
FICA $20,244 x 7.65% 1549
Health Ins. 175.66 x 12 x 50% 1054
Retirement $20,244 x 7.13% 1443
Worker's Compensation $20,244 x .60% 121
Unemployment Insurance $20,244 x.18% 36
Total - Fringe Benefits $4,203
C. Staff Development- Service Funds Schedule
(1) (2)
Item Total
Cost
Total Staff Development - Service Funds
D. Travel Schedule
(1) (2) (3) (4) (5) Daily Subsistence (8)
No. of No. of Rate per No. of (6) (7) Total
Persons Position or Title Miles/Days Mile Days Rate Days Cost
i Job 1,594 .345 $550
Development
Specialist
Total - Travel $550
E. Equip ment - Tangible Property Schedule
(1) (2) (3) (4)
No. of Total Cost
Units Item Cost p er Unit
N/A
Total Equipment - Tangible Property
I
F. Recipient Transportation Schedule
(1) (2) (3)
Item Method of Computation Total
Cost
N/A
la. Salaries
#of Position or Title Pay % of # of Months Annual
Persons Grade Time Em to ed Salary
N/A
lb. Frin a Benefits
N/A
Total Recipient Transportation
G. Medical Supplies and Expenses Schedule
�1) (2)
Total
Item Cost
N/A
Total - Medical Supplies and Expense
H. Cost of Space - Non-Residential Schedule
(1) (2)
Total
Item Cost
N/A
Total Cost of Space - Non-Residential
I. Room and Board Costs - Residential Treatment
(1) (2) (3)
Total
Item Method of Computation Cost
N/A
Total Room and Board Costs - Residential Treatment
J. Service Payment Schedule
(1) (2) (3) (4)
No. of
Units Item Cost per Unit Total
N/A
Total - Service Payment
K. Other Expense Schedule
(1) (2)
Total
Item Cost
N/A
Total - Other Expense
L. Indirect Cost Schedule
(1) (2) (3) (4)
Rate Rate Applied To: Amount Rate Applied To: Total
12.99% Salary $20,244 $2,630
Total - Indirect Cost $2,630