HomeMy WebLinkAbout2012-209 Housing - Day Day for Karen Interpreter $2,000 •
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ORANGE COUNTY
COUNTYWIDE INTERPRETER CONTRACT
NORTH CAROLINA (15,000 OR LESS)
THIS AGREEMENT, made and entered into this 1st day of July, 2012, ("Effective Date")by and
between Orange County, North Carolina, a body politic and corporate organized under the laws of the State
of North Carolina,(the "County"),and Day Day(the "Provider");
WITNESSETH:
For the purpose and subject to the following terms and conditions hereinafter set forth, the County
hereby contracts for the services of the Provider, and the Provider agrees to provide the following
Interpretation Services (hereinafter referred to as "Services")to the County in accordance with the terms of
this Agreement,time being of the essence.
1. Contract. This Contract consists of this document and additional documents checked below:
a. For Health Department:
i. ® Health Department Additional Terms and Conditions
ii. ./ Business Associates Agreement
iii. ® Condition of Contract Statement
b. For Department of Social Services:
i. ❑ The General Terms and Conditions(Attachment A);
The Scope of Work,description of services,and rate(Attachment B);
iii. ® Federal Certification Regarding Drug-Free Workplace(Attachment C);
iv. ® Conflict of Interest(Attachment D);
v. ®No Overdue Taxes(Attachment E);
vi. ❑ 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. Provider's Responsibilities:
a. The Provider shall be qualified to interpret between English and Karen with the client and
County staff.
b. Professional Conduct. The Provider shall adhere to the standards of professional conduct of
an interpreter while conducting the services to include the following:
i. The Provider shall relate to all County clients and staff in a respectful and
professional manner.
ii. The Provider will interpret the information being shared between client/family and
staff as clearly as possible, without additional personal comments or biases on the
topic being discussed.
iii. The provider when providing interpretation services will interpret the information as
clearly as possible without changing the meaning and the intent of the conversation.
Revised June 2011 1
iv. The Provider will interpret the information to the best of his/her ability.
c. Client Confidentiality.
i. The Provider acknowledges that she/he may have access to information that is
confidential and provided by state and federal laws and agrees to comply with all
privacy policies, regulations, and laws as well as the Health Insurance Portability
and Accountability Act(HIPAA)of 1996(P.L.104-191).
ii. The Provider agrees to protect confidential information (e.g., client name,
appointment type,telephone number, health information) that he/she may receive in
doing business with County. The Provider should ensure proper, safe storage and
protection of client information during use, and shredding/deletion of such
information when it is no longer necessary for business purposes.
iii. Breaches of client confidentiality will result in automatic termination of this
Agreement.
d. Scope of Services.
i. Procedures and Guidelines Upon Acceptance of an Interpretation Assignment:
1. The Provider agrees to give at least 24 hour notice if he/she is unable to
participate in a scheduled client contact.
2. The Provider will be expected to make confirmation phone calls to clients in
advance of an assigned appointment, when feasible, and when the Provider
is provided the information by County staff. The Provider should notify
County staff as soon as possible if the client has told the Provider that he/she
will not be able to make the appointment and/or if he/she needs to
reschedule. These confirmation calls will not be paid for separately, but are
considered part of the service when the Provider accepts an assignment for
an appointment.
3. The Provider shall not have contact with County clients without County
staff being present, unless specifically asked by staff to call clients to
confirm or schedule appointments. It is not acceptable for the Provider to
give out his/her home telephone number or cell phone number for later
contact between the family and Provider.
3. County's Responsibilities. County will compensate Provider as provided in subsection 4 for
interpretation services at the rate prescribed. Per hour reimbursement will begin at the time the
Provider meets with County staff for the appointment and ends at the time the staff and
interpreter contact is completed. There will be a minimum of one (1) hour of service for an
appointment. There will be a minimum of one (1) hour of service for an appointment. County
will reimburse the Provider for one(1) hour of interpretation service in the event of a same day
cancelled appointment. That includes appointments for clients who do not show up for an
appointment, and for those who cancel an appointment with less than 24 hour notice.
Revised June 2011 2
4. Payment for Services: The County agrees to pay at the rates specified for Services satisfactorily
performed in accord with this Agreement. The amount to be paid by the County shall not exceed
$2,000 ($35/hour for Interpretation Services). Payment shall be made within thirty(30) days of
an invoice properly submitted to County. Should Provider fail to perform its duties under the
terms of this Agreement,County may,without fault or penalty,withhold any payment associated
with the work to be performed until such time as said work is completed. The procedures for
payment of services rendered shall be as follows:
a. The Provider. The Provider will complete and submit the County Invoice for Payment of
Interpretation Services form to County staff at the time the service is rendered. County staff
will verify the information,sign and forward the form for payment of services.
b. For interpretation services:
i. The Provider will record the start and finish time worked to the minute. After the
first hour of service,payment will be calculated and paid per minute.
ii. The Provider shall submit one invoice per client, unless there is a block of
appointments without interruption. Without interruption means that there were no
cancelled appointments and no lunch hour included. This is appropriate for a group
of clients who are served for the same type of appointment, at the same location.
For question,contact the departmental contact.
iii. In the event of a cancelled appointment, the Provider is required to stay until
relieved of duty by the individual in charge. County staff may require other
interpreter-related services in place of the scheduled appointment. As stated above,
the Provider may submit an invoice in the event of a broken appointment(with less
than 24 hour notice).
iv. If the Provider is assisting County staff with a large volume of phone calls outside of
a scheduled appointment time, the Provider should complete a Call Log to submit
along with an invoice describing the services performed. This type of service is paid
by the minute,without a one hour minute requirement for payment.
v. In the case of an unexpected closing or delayed opening(e.g., inclement weather) of
the County Offices when providing interpretation services, the Provider shall not be
paid for missed appointments. When in doubt,the Provider can call 732-8181 to see
if county offices are open or are on a delayed schedule. When possible, the Provider
is also asked to help call his/her scheduled clients to inform them of the delay or
closing.
5. Term. The term of this Agreement shall be from July 1,2012 to June 30, 2013.
6. Errors and Omissions. Provider represents and agrees that Provider is qualified to perform and
fully capable of performing and providing the services required or necessary under this
Agreement in a fully competent, professional and timely manner to the satisfaction of the
County. Provider shall be responsible for all errors or omissions, in the performance of the
Agreement. Provider shall correct any and all errors, omissions, discrepancies, ambiguities,
mistakes or conflicts at no additional cost to the County.
7. Additional Terms and Condition. The County may have additional terms and condition that
shall be provided as Attachment 1, and shall be attached and are hereby incorporated by
reference.
Revised June 2011 3
W. 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 document as listed in
Paragraph 1, above, with this contract document having the highest precedence then the first
listed document 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.
A. Non—waiver: Failure by County at any time to require the performance by Provider of any of the
provisions hereof shall in no way waive or affect the County's right hereunder to enforce the
same, nor shall any waiver by the County of any breach be held to be a waiver of any succeeding
breach or a waiver of this Non-Waiver Clause.
10. Independent Contractor: The Provider shall operate as an independent Provider, and the County
shall not be responsible for any of the Provider's acts or omissions. The Provider shall not be
treated as an employee with respect to the Services performed hereunder for federal or state tax,
unemployment or workers' compensation purposes. The Provider understands that neither
federal, nor state, nor shall payroll tax of any kind be withheld or paid by the County on behalf
of the Provider or the employees of the Provider.
ll. Insurance: The Provider shall obtain, at its sole expense, all insurance needed to adequately
insure itself during the performance of these services.
12. Indemnity: The Provider agrees to defend, indemnify,and hold harmless Orange County from all
losses, liabilities, claims, demands, suits, costs, damages or expenses (including reasonable
attorney's fees) arising from bodily injury, including death, to any person or persons or damage
to or destruction of any property caused in whole or in part by any negligent or intentional act or
omission on the part of the Provider.
13. Termination: This Agreement may be terminated at any time by mutual written agreement of the
parties or by the County upon written notice to the Provider.
14. Entire Agreement: The parties have read this Agreement and agree to be bound by all of its
terms, and further agree that it constitutes the complete and exclusive statement of the
Agreement between the parties unless and until modified in writing and signed by the parties.
Modifications may be evidenced by telefacsimile signature.
15. Governing Law: Both parties agree that this Agreement shall be governed by the laws of the
State of North Carolina. Should either party initiate litigation to settle any dispute involving the
terms of this Agreement such litigation shall be initiated in the General Court of Justice of North
Carolina seated in Orange County,North Carolina.
16. Non Appropriation: Provider acknowledges that County is a governmental entity, and the
validity of this Agreement is based upon the availability of public funding under the authority of
its statutory mandate. In the event that public funds are unavailable and not appropriated for the
performance of County's obligations under this Agreement, then this Agreement shall
automatically expire without penalty to County immediately upon written notice to Provider of
the unavailability and non-appropriation of public funds.
Revised June 2011 4
IN WITNESS WHEREOF,Orange County and the Provider have signed this Agreement, effective
as of the day first written above.
ORANGE OUNTY PROVIDE' • :'ay Day
f / /, ....
Paw
By: A .. .21‘../ By:
Co or Manage, Title: YiSil AL.J7v.---At-c '
200 S. Cameron St. 1105 Highway 54 Bypass Apt Y-1
P.O. Box 8181 Chapel Hill,NC 27516
Hillsborough,NC 27278
This i trument has been approved as to technical content.
Ilir. . L. Fi , ousing,Housing and
Community Development Department Director
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal
Control Act.
44... ii .
Clarence G. Grier, Finance Director
Th.. ' , me Lfir s een approved as to form and legal sufficiency.
1
\■ IF
II
Ann e M.Mo, e, Staff Atto ey
Revised June 2011 5
IMINIMEIMINIMIIIMMI11.1.11.1.11.1.1.1.1MMill
Orange County Health Department(hereinafter referred to as "OCHD")
Additional Terms and Conditions
These are additional terms and conditions to the Agreement between Orange County and the
(PROVIDER)to the Countywide Interpreter/Translator Contract of$15,000 or less. The additional
terms and conditions shall supersede any terms in the original contract and are hereby incorporated
as follows:
Add to Section 2.b.
v. The Provider will follow the National Code of Ethics and Standards of Practice
outlined by the National Council on Interpreting in Health Care which can be
found at www.ncihc.org and is hereby incorporated by reference.
vi. The Provider is required to sign the OCHD Conditions of Contract Statement
containing the confidentiality, Title X and public health activities in emergency
situations information which is hereby incorporated by reference.
Add to Section 2.d.i.3 the following sentence:
The Provider should generally instruct clients to call the Health Department
front desk staff or the Spanish voicemail line at 644-3350 (when language
appropriate)to schedule an appointment or to inquire about services.
Add Section 2.e.
e. Medical Documentation.
i. The Provider is required to provide proof of immunity to varicella, measles,
mumps and rubella prior to inception of contract work. Proof of immunity
must be one of the following: medical records diagnosing the disease,
laboratory records confirming the disease, laboratory records documenting
positive disease titers, or medical records documenting receipt of 2 doses of
each vaccine. (Exception: If the Provider has documentation of only one
dose of vaccine, the Provider must provide documentation of a second dose
within 60 days of the first day of contract work.) The Provider is
responsible for covering all costs associated with acquiring any necessary
titers, medical diagnosis or laboratory confirmation of disease or
vaccinations.
ii.The Provider is required to get a TB screening and provide those results to
OCHD prior to beginning contract work. The Provider is responsible for the
costs associated with acquiring such screening. The screening can be one of
the following:
1. Receipt of a TB skin test(TST) if the Provider has no history of TB
infection/disease or of a positive TST(Note: If the Provider has not
had an additional TST within the previous 12 months,a second TST
Revised June 2011 6
will be required one week after the first to establish an accurate
baseline.)
2. Completion of a TB Screening Form by a medical provider if the
Provider has a history of TB disease or of having a positive TST.
Replace Section 3 with the following paragraph:
3. County's Responsibilities. County will compensate Provider as provided in subsection 4
for interpretation and translation services at the rate prescribed. Per hour reimbursement
will begin at the time the Provider meets with County staff for the appointment and ends
at the time the staff and interpreter contact is completed. There will be a minimum of
one (1) hour of service for an appointment. OCHD will reimburse the Provider for one
(1)hour of interpretation service in the event of a same day cancelled appointment. That
includes appointments for clients who do not show up for an appointment,and for those
who cancel an appointment with less than 24 hour notice. Exception: "Family"Refugee
Health Assessment (communicable disease and/or physical exam) appointments with 3
or more family members will only be reimbursed for a total of two (2)hours in the case
of same day cancelled appointments. OCHD will not reimburse the Provider if an
appointment is cancelled with more than 24 hour notice.
Add to Section 4.b.iii the following sentence:
ii. In the event of a cancelled appointment,the Provider is required to stay until
relieved of duty by the nurse supervisor or the individual in charge of
clinical operations. OCHD staff may require other interpreter-related
services in place of the scheduled appointment. As stated above, the
Provider may submit an invoice in the event of a broken appointment(with
less than 24 hour notice).
Revised June 2011 7
•
BUSINESS ASSOCIATE AGREEMENT
This Agreement is made effective the 1st of July, 2012, by and between Orange County on
behalf of the Orange County Health Department, hereinafter referred to as "Covered Entity", and Day
Day, hereinafter referred to as "Business Associate," (individually, a "Party" and collectively, the
"Parties").
WITNESSETH:
WHEREAS, Sections 261 through 264 of the federal Health Insurance Portability and
Accountability Act of 1996, Public Law 104-191, known as "the Administrative Simplification provisions,"
direct the Department of Health and Human Services to develop standards to protect the security,
confidentiality and integrity of health information; and
WHEREAS, pursuant to the Administrative Simplification provisions, the Secretary of Health and
Human Services has issued regulations modifying 45 CFR Parts 160 and 164 (the "HIPAA Security and
Privacy Rule"); and
WHEREAS, the Parties wish to enter into or have entered into an arrangement whereby
Business Associate will provide certain services to Covered Entity, and, pursuant to such arrangement,
Business Associate may be considered a "business associate" of Covered Entity as defined in the
HIPAA Security and Privacy Rule (the agreement evidencing such arrangement is entitled Countywide
Interpreter Agreement ($15,000 or less) , dated July 1, 2012, and is hereby referred to as the
"Arrangement Agreement"); and
WHEREAS, Business Associate may have access to Protected Health Information (as defined
below) in fulfilling its responsibilities under such arrangement;
THEREFORE, in consideration of the Parties' continuing obligations under the Arrangement
Agreement, the Parties agree to the provisions of this Agreement in order to address the requirements
of the HIPAA Security and Privacy Rule and to protect the interests of both Parties.
I. DEFINITIONS
Except as otherwise defined herein, terms used in this Agreement shall have the same meaning
as those terms set forth in the HIPAA Security and Privacy Rule.
II. CONFIDENTIALITY REQUIREMENTS
(a) Business Associate shall:
(i) use or disclose any protected health information solely as permitted or
required by this Agreement, the Arrangement Agreement (if consistent
with this Agreement and the HIPAA Security and Privacy Rule), or as
required by law.
(ii) ensure that its agents, including a subcontractor, to whom it provides
protected health information received from or created by Business
Associate on behalf of Covered Entity, agrees to the same restrictions
and conditions that apply to Business Associate with respect to such
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information. In addition, Business Associate agrees to take reasonable
steps to ensure that its employees' actions or omissions do not cause
Business Associate to breach the terms of this Agreement;
(iii) implement appropriate safeguards to prevent use or disclosure of
protected health information other than as permitted or required by this
Agreement;
(iv) permit the Secretary of Health and Human Services to audit Business
Associate's records and practices related to use and disclosure of
protected health information to ensure Covered Entity's compliance with
the terms of the HIPAA Security and Privacy Rule;
(v) report to Covered Entity any use or disclosure of protected health
information which is not in compliance with the terms of this Agreement of
which it becomes aware;
(vi) report to Covered Entity any Security Incident of which it becomes
aware. For purposes of this Agreement, "Security Incident" means the
attempted or successful unauthorized access, use disclosure,
modification, or destruction of information or interference with system
operations in an information system; and
(vii) mitigate, to the extent practicable, any harmful effect that is known to
Business Associate of a use or disclosure of protected health information
by Business Associate in violation of the requirements of this Agreement.
(b) Notwithstanding the prohibitions set forth in this Agreement or the Arrangement
Agreement, Business Associate may use and disclose protected health information as
follows:
(i) if necessary, for the proper management and administration of Business
Associate or to carry out the legal responsibilities of Business Associate,
provided that as to any such disclosure, the following requirements are
met:
(A) the disclosure is required by law; or
(B) Business Associate obtains reasonable assurances from the
person to whom the information is disclosed that it will be held
confidentially and used or further disclosed only as required by
law or for the purpose for which it was disclosed to the person,
and the person notifies Business Associate of any instances of
which it is aware in which the confidentiality of the information has
been breached;
(ii) for data aggregation services, if such services are to be provided by
Business Associate for the health care operations of Covered Entity
pursuant to any agreements between the Parties evidencing their
business relationship.
III. AVAILABILITY OF PROTECTED HEALTH INFORMATION
Business Associate shall:
(a) at the request of Covered Entity, provide access to protected health information in a
designated record set to Covered Entity or, as directed by Covered Entity, to an
individual, in a time and manner sufficient to permit Covered Entity to comply with the
requirements of 45 CFR 164.524.
3
(b) at the request of Covered Entity or an individual, make any amendment(s) to protected
health information in a designated record set that are directed by or agreed to by
Covered Entity, in a time and manner sufficient to permit Covered Entity to comply with
the requirements of 45 CFR 164.526.
(c) document disclosures of protected health information and information related to such
disclosures in a manner sufficient to permit Covered Entity to respond to a request by an
individual for an accounting of disclosures of protected health information in accordance
with 45 CFR 164.528 and provide such documentation to Covered Entity or an individual
as directed by Covered Entity.
IV. TERMINATION
(a) Term: This Agreement terminates when the Arrangement Agreement terminates or as
provided in Paragraph IV.b. below(termination for cause).
(b) Termination for cause: Upon Covered Entity's knowledge of a material breach by
Business Associate, Covered Entity shall either:
(i) provide an opportunity for Business Associate to cure the breach or end
the violation or, if Business Associate does not cure the breach or end the
violation within the time specified by Covered Entity, terminate this
Agreement and the Arrangement Agreement; or
(ii) immediately terminate this Agreement and the Arrangement Agreement if
Business Associate has breached a material term of this Agreement and
cure is not possible.
(c) Return or destruction of protected health information: At termination of this Agreement,
the Arrangement Agreement(or any similar documentation of the business relationship
of the Parties), or upon request of Covered Entity, whichever occurs first, Business
Associate shall:
(i) if feasible, return or destroy all protected health information received from
or created or received by Business Associate on behalf of Covered Entity
that Business Associate still maintains in any form. Business Associate
shall only destroy protected health information with the written approval of
Covered Entity. After return or destruction, Business Associate shall
retain no copies of such information.
(ii) if return or destruction is not feasible, Business Associate will provide
Covered Entity with documentation explaining the reason that it is not
feasible. If the protected health information is not returned or destroyed,
Business Associate will extend the protections of this Agreement to the
information and limit further uses and disclosures to those purposes that
make the return or destruction of the information not feasible.
(d) Survival: The obligations of Business Associate under this Agreement shall survive the
expiration, termination, or cancellation of this Agreement, the Arrangement Agreement
and/or the business relationship of the parties, and shall continue to bind Business
Associate, its agents, employees, contractors, successors, and assigns as set forth
herein.
V. MISCELLANEOUS
4
(a) All protected health information that is created or received by Covered Entity and
disclosed or made available in any form, including paper record, oral communication,
audio recording, and electronic display by Covered Entity or its operating units to
Business Associate or is created or received by Business Associate on Covered Entity's
behalf shall be subject to this Agreement.
(b) A reference in this Agreement to a section in the HIPAA Security and Privacy Rule
means the section as in effect or as amended.
(c) In the event of an inconsistency between the provisions of this Agreement (including
definitions) and mandatory provisions of the HIPAA Security and Privacy Rule, as
amended, the HIPAA Security and Privacy Rule shall control. Where provisions of this
Agreement are different than those mandated in the HIPAA Security and Privacy Rule,
but are nonetheless permitted by the HIPAA Security and Privacy Rule, the provisions of
this Agreement shall control.
(d) Except as expressly stated herein or the HIPAA Security and Privacy Rule, the parties to
this Agreement do not intend to create any rights in any third parties.
(e) This Agreement may be amended or modified only in a writing signed by the Parties. No
Party may assign its respective rights and obligations under this Agreement without the
prior written consent of the other Party. None of the provisions of this Agreement are
intended to create, nor will they be deemed to create any relationship between the
Parties other than that of independent parties contracting with each other solely for the
purposes of effecting the provisions of this Agreement and any other agreements
between the Parties evidencing their business relationship.
(f) This Agreement will be governed by the laws of the State of North Carolina.
(g) No change, waiver or discharge of any liability or obligation hereunder on any one or
more occasions shall be deemed a waiver of performance of any continuing or other
obligation, or shall prohibit enforcement of any obligation, on any other occasion.
(h) The parties agree that, in the event that any documentation of the arrangement pursuant
to which Business Associate provides services to Covered Entity contains provisions
relating to the use or disclosure of protected health information that are more restrictive
than the provisions of this Agreement, the provisions of the more restrictive
documentation will control.
(i) In the event that any provision of this Agreement is held by a court of competent
jurisdiction to be invalid or unenforceable, the remainder of the provisions of this
Agreement will remain in full force and effect.
(j) The headings in this Agreement are for convenience of reference only and shall not
define or limit any of the terms or provisions hereof.
5
IN WITNESS WHEREOF, the Parties have executed this Agreement as of the day and year
written above.
COVERED ENTITY: BUSINESS ASSOCIATE:
•
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6
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ORANGE COUNTY HEALTH DEPARTMENT
Contracted Interpreters
Conditions of Contract Statement
Confidentiality
As a Contract Interpreter for Orange County Health Department(OCHD), I acknowledge that I may have
access to information that is confidential as mandated by state and federal law, HIPAA regulation and/or
Orange County policy. I recognize my legal obligation as a Contractor to maintain the confidentiality of
information about former and current recipients of OCHD services.
I understand that release of information determined to be confidential by law to unauthorized persons may
result in criminal prosecution. I further understand that the failure to maintain legally required confidentiality
of information constitutes"misconduct"within the meaning of the Orange County Personnel Ordinance and
may lead to disciplinary action, including termination of contract.
If a question arises regarding whether a release of information may be public record vs. confidential client
information, I will seek assistance from an OCHD Clinic Manager.
Title X Information Requirement
OCHD provides services solely on a voluntary basis. A client's acceptance of service is not a prerequisite to
eligibility or receipt of a non-Title X service (Family Planning).
As an OCHD Contract Interpreter, you may be subject to prosecution under Federal law if you coerce or
endeavor to coerce any person to undergo an abortion or a sterilization procedure.
As an Interpreter,your responsibility is to convey the message from the provider to the client to the best of
your ability,without prejudice or personal bias. If you are present when an OCHD employee attempts to
coerce a person to undergo an abortion or a sterilization procedure, discontinue interpreting, and report this to
the Clinic Manager.
Public Health Activities in Emergency Situations
In order to fulfill the responsibilities of the department in emergency situations or in training, and due to our
limited number of bilingual staff,you may be asked to work at emergency shelters or other locations
designated by the Health Director or emergency operations. You may also be asked to participate in
emergency drills and exercises. As a Contractor, you do have the right to decline any of these special
requests.
I certify that I have read and understand the conditions stated above. I have had an opportunity to discuss the
conditions and requirements of my contract with a designated agency representative.
Contractor Name: // Al Date: D 6 /2.. g /2o,2
Contractor Signature: Date: v O
b l X12
OCHD Representative: Date: l.3 i 1'2-
Contract
Day Day
ATTACHMENT B
SCOPE OF WORK
Orange County Department of Social Services
Federal Tax Id. or SSN 3 - /L - Y
Contract#
A. CONTRACTOR INFORMATION
1. Contractor Agency Name: Day Day
2. If different from Contract Administrator Information in General Contract:
Address
Telephone Number: Fax Number: Email:
3. Name of Program(s): Interpreter Services
4. Status: ( ) Public ( )Private,Not for Profit (X)Private, For Profit
5. Contractor's Financial Reporting Year July 1, 2012 through June 30, 2013
B. Explanation of Services to be provided and to whom(include SIS Service Code):
The Contractor will provide language interpretation services to the County.
C. Rate per unit of Service(define the unit):
1. If Standard Fixed Rate, Maximum Allowable, (See Rates for Services Chart)
2.Negotiated County Rate.
$35.00/hour—inte .retation
D.Number of units to be provided:
E. Details of Billing process and Time Frames; The County will reimburse the Contractor
for services described in this contract up to the budgetary limits of the contract allotment.
The County will reimburse the Contractor at a rate of$35.00/hour for approved services
provided and travel at the county rate. For reimbursement,the Contractor must submit the
Orange County Department of Social Services Invoice for Payment of Interpreting
Services form to the County staff at the time services are rendered. County staff will
verify the information, sign the form, and forward the form to the designated County
Administrator. The County will reimburse the Contractor monthly upon receipt of a
complete and correctly filed report.
Contract-Scope of Work(06/04) Page l of 2
Contract
Day Day
Per hour reimbursement will begin at the time the Contractor meets with County staff for
the appointment and ends when the County staff and Contractor contact is completed.
There will be a minimum of 1 hour of service for an appointment. Mileage
reimbursement will be for round trip from the Contractor's home or work site to the
prearranged appointment site.
F. Area to be served/Delivery site(s): Orange County
(Signature of Coun uthorized Person) ( ignature of Contractor)
7-76 -/ (26/2 g/Zoi 2,
(Date Submitted) (Date Submitted)
Contract-Scope of Work(06/04) Page 2of 2
ATTACHMENT C
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS
Orange County Department of Social Services
I. By execution of this Agreement the Contractor certifies that it will provide a drug-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 a drug-free awareness program to inform employees about:
(1) The dangers of drug abuse in the workplace;
(2)The Contractor's policy of maintaining a drug-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 a drug-free workplace through implementation
of paragraphs (A), (B), (C), (D), (E), and(F).
Federal Certification-Drug-Free Workplace(06/04) Page 1 of 2
II. The site(s) for the performance of work done in connection with the specific agreement are
listed below:
1. 113 Mayo Street
(Street address)
Hillsborough, Orange,NC, 27278
(City, county, state,zip code)
2. 2501 Homestead Road
(Street address)
Chapel Hill, Orange,NC, 27516
(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
(Section 4 CFR Part 85, Section 85.615 and 86.620).
K2. I�a re., erp►,ei
Signature Title
06/2 2/112
Agency/Organization Date
(Certification signature should be same as Contract signature.)
Federal Certification-Drug-Free Workplace(06/04) Page 2 of 2
ATTACHMENT D
CONFLICT OF INTEREST POLICY
Orange County Department of Social Services
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 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
Conflict of Interest Policy(06/04) Page 1 of 2
. •
•
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
I, L. , certify that I have read the forgoing
information, understand it, and that no conflict of interest exists in the execution of this
contr .
Signature
Sworn to and subscribed before me on thec9C., day of 3 i-i--4-;2012.
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Conflict of Interest Policy(06/04) Page 2 of 2
Exhibit E
Day Day
1105 Highway 54 Bypass Apt. Yl l
Chapel Hill,NC 27516
To: Orange County Department of Social Services
Certification:
I certify that I do not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at
the federal, State, or local level. I further understand that any person who makes a false
statement in violation of N.C.G.S. 143-6.2(b2) is guilty of a criminal offense punishable
as provided by N.C.G.S. 143-34(b).
Sworn Statement:
I, being duly sworn, say that I am Day Day; and that the foregoing certification is true,
accurate and complete to the best of my knowledge and was made and subscribed by me.
I also acknowledge and understand that any misuse of State funds will be reported to the
appropriate authorities for further action.
Signature
C
Sworn to and subscribed before me on the C day of S '-
-_II _ 41 My Commission Expires: 161 ci 2 c�c S
!-' Signature and Se.,
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