HomeMy WebLinkAbout2013-082 DSS - IFC Emergency Solutions Grant Program Award Grant #2012-016 Signed Contract Contract#68-5000
Inter-Faith Council for Social Service,Inc.
Xt
Contract#68-5000 Contract Period Begins: October 1,2012 Ends: September 30, 2013
This contract is hereby entered into by and between the Orange County Department of Social Services (the
"County") and Inter-Faith Council for Social Service, Inc. (the "Contractor") (referred to collectively as the
"Parties"). The Contractor's federal tax identification number or Social Securijy Number is 59-1224041.
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)Vorkplace (Attachment C)
(5) Conflict of Interest(Attachment D)
(6) No Overdue Taxes(Attachment E)
(7) Federal Certification Regarding Lobbying(Attachment G)
(8) Federal Certification Regarding Debarment(Attachment H)
(9) IRS federal tax exempt letter or 501(c)(3) (Attachment K)
(10)Budget(Attachment M)
(11)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 October 1, 2012 and shall terminate on September 30,
2013.
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 Attachment M,Budget,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
$60,590. This amount consists of$60,590 in Federal (CFDA 9 State and County funds, $0
(source of other funds if applicable).
] a. There are no matching requirements from the Contractor.
X] b. The Contractor's matching requirement is$168,467,which shall consist of:
In-kind ] Cash
Cash and In-kind X] 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 $229,057.
Contract-General (06/04) Page 1 of 3
Contract#68-5000
Inter-Faith Council for Social Service,Inc.
6. Reporting Requirements:
Contractor shall comply with audit requirements as described in N.C.G.S. § 143-6.2 and OMB Circular A-133.
7. Payment Provisions:
Payment shall be made in accordance with the Contract Documents as described in the Scope of Work,
Attachment B.
8. Contract Administrators: All notices pennitted 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, Human Services Manager Sharron Hinton,Human 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@orangecountync.gov
For the Contractor:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS
Chris Moran,Executive Director Chris Moran, Executive Director
Inter-Faith Council for Social Service, Inc. Inter-Faith Council for Social Service, Inc.
110 W. Main Street 110 W. Main Street
Carrboro,NC 27510 Carrboro,NC 27510
(919) 929-6380 ext. 26
cmoran@ifcmailbox.org
Contract-General (06/04) Page 2 of 3
Contract 468-5000
Inter-Faith Council for Social Service,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.
INTER-FAATACOUNCIL FOR SOCIAL SERVICE,INC.
Signature Date
t
Printed Name Title
ORANGE COUNTY,,
- /3
Signature, County Nia—hQer Date
Printed Name Title/
Signature Direct 4 Orange County Department of Social Services Date
Printed Name ' Title
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act.
-
Signature of County Finance Officer Date
p
act en approved This c ftr roved as to form and legal sufficiency. (2-0 '1!,
Signatdre of County Attorney Dat
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Contract#68-5000
Inter-Faith Council for Social Service,Inc.
ATTACHMENT A
GENERAL TERMS AND CONDITIONS
Orange County Department of Social Services
Relationships of the Parties respective successors. It is expressly understood and
agreed that the enforcement of the terms and
Independent Contractor: The Contractor is and conditions of this contract, and all rights of action
shall be deemed to be an independent contractor in the relating to such enforcement,shall be strictly reserved
performance of this contract and as such shall be to the County and the named Contractor. Nothing
wholly responsible for the work to be performed and contained in this document shall give or allow any
for the supervision of its employees. The Contractor claim or right of action whatsoever by any other third
represents that it has, or shall secure at its own person. It is the express intention of the County and
expense, all personnel required in performing the Contractor that any such person or entity, other than
services under this agreement. Such employees shall the County or the Contractor, receiving services or
not be employees of, or have any individual benefits under this contract shall be deemed an
contractual relationship with the County. incidental beneficiary only.
Subcontracting: The Contractor shall not
subcontract any of the work contemplated under this Indemnity and Insurance
contract without prior written approval from the
County. Any approved subcontract shall be subject to Indemnification: The Contractor agrees to
all conditions of this contract.Only the subcontractors indemnify and hold harmless the County and any of
specified in the contract documents are to be their officers,agents and employees,from any claims
considered approved upon award of the contract. The of third parties arising out or any act or omission of
County shall not be obligated to pay for any work the Contractor in connection with the performance of
performed by any unapproved subcontractor. The this contract.
Contractor shall be responsible for the performance of
all of its subcontractors. Insurance: During the term of the contract, the
Contractor at its sole cost and expense shall provide
Assignment: No assignment of the Contractor's commercial insurance of such type and with such
obligations or the Contractor's right to receive terms and limits as may be reasonably associated with
payment hereunder shall be permitted.However,upon the contract. As a minimum, the Contractor shall
written request approved by the issuing purchasing provide and maintain the following coverage and
authority,the County may: limits:
(a) Forward the Contractor's payment check(s) (a) Worker's Compensation - The contractor
directly to any person or entity designated by shall provide and maintain Worker's
the Contractor, or Compensation Insurance as required by the
(b) Include any person or entity designated by laws ofNorth Carolina,as well as employer's
Contractor as ajoint payee on the Contractor's liability coverage with minimum limits of
payment check(s). $500,000.00, covering all of Contractor's
In no event shall such approval and action obligate the employees who are engaged in any work
County to anyone other than the Contractor and the under the contract. If any work is sublet,the
Contractor shall remain responsible for fulfillment of Contractor shall require the subcontractor to
all contract obligations. provide the same coverage for any of his
employees engaged in any work under the
Beneficiaries: Except as herein specifically provided contract.
otherwise, this contract shall inure to the benefit of (b) Commercial General Liability - General
and be binding upon the parties hereto and their Liability Coverage on a Comprehensive Broad
General Terms and Conditions—(06/04) Page I of 5
Contract#68-5000
Inter-Faith Council for Social Service,Inc.
Form on an occurrence basis in the minimum contract in a timely and proper manner, the County
amount of $1,000,000.00 Combined Single shall have the right to terminate this contract by
Limit. (Defense cost shall be in excess of the giving written notice to the Contractor and specifying
limit of liability.) the effective date thereof. In that event,all finished or
(c) Automobile-Automobile Liability Insurance, unfinished deliverable items prepared by the
to include liability coverage, covering all Contractor under this contract shall, at the option of
owned,hired and non-owned vehicles used in the County, become its property and the Contractor
performance of the contract. The minimum shall be entitled to receive just and equitable
combined single limit shall be $500,000.00 compensation for any satisfactory work completed on
bodily injury and property damage; such materials,minus any payment or compensation
$500,000.00 uninsured/under insured previously made. Notwithstanding the foregoing
motorist; and $25,000.00 medical payment. provision, the Contractor shall not be relieved of
Providing and maintaining adequate insurance liability to the County for damages sustained by the
coverage is a material obligation of the Contractor County by virtue of the Contractor's breach of this
and is of the essence of this contract. The Contractor agreement, and the County may withhold any
may meet its requirements of maintaining specified payment due the Contractor for the purpose of setoff
coverage and limits by demonstrating to the County until such time as the exact amount of damages due
that there is in force insurance with equivalent the County from such breach can be determined. In
coverage and limits that will offer at least the same case of default by the Contractor,without limiting any
protection to the County. All such insurance shall other remedies for breach available to it,the County
meet all laws of the State of North Carolina. Such may procure the contract services from other sources
insurance coverage shall be obtained from companies and hold the Contractor responsible for any excess
that are authorized to provide such coverage and that cost occasioned thereby. The filing of a petition for
are authorized by the Commissioner of Insurance to bankruptcy by the Contractor shall be an act of default
do business in North Carolina. The Contractor shall under this contract.
at all times comply with the terms of such insurance
policies,and all requirements of the insurer under any Waiver of Default: Waiver by the County of any
such insurance policies, except as they may conflict default or breach in compliance with the terms of this
with existing North Carolina laws or this contract, contract by the Provider shall not be deemed a waiver
The limits of coverage under each insurance policy of any subsequent default or breach and shall not be
maintained by the Contractor shall not be interpreted construed to be modification of the terms of this
as limiting the contractor's liability and obligations contract unless stated to be such in writing,signed by
under the contract. an authorized representative of the County and the
Contractor and attached to the contract.
Default and Termination
Availability of Funds: The parties to this contract
Termination Without Cause: The County may agree and understand that the payment of the sums
terminate this contract without cause by giving 10 specified in this contract is dependent and contingent
days written notice to the Contractor. In that event, upon and subject to the appropriation,allocation,and
all finished or unfinished deliverable items prepared availability of funds for this purpose to the County.
by the Contractor under this contract shall, at the
option of the County, become its property and the Force Majeure:Neither party shall be deemed to be
Contractor shall be entitled to receive just and in default of its obligations hereunder if and so long
equitable compensation for any satisfactory work as it is prevented from performing such obligations by
completed on such materials, minus any payment or any act of war, hostile foreign action, nuclear
compensation previously made. explosion,riot,strikes,civil insurrection,earthquake,
hurricane,tornado,or other catastrophic natural event
Termination for Cause: If,through any cause,the or act of God.
Contractor shall fail to fulfill its obligations under this
General Terms and Conditions—(06/04) Page 2 of 5
Contract#68-5000
Inter-Faith Council for Social Service,Inc.
Survival of Promises: All promises, requirements, Confidentiality: Any information,data,instruments,
terms, conditions, provisions, representations, documents, studies or reports given to or prepared or
guarantees, and warranties contained herein shall assembled by the Contractor under this agreement
survive the contract expiration or termination date shall be kept as confidential and not divulged or made
unless specifically provided otherwise herein, or available to any individual or organization without the
unless superseded by applicable Federal or State prior written approval of the County. The Contractor
statutes of limitation. acknowledges that in receiving,storing,processing or
otherwise dealing with any confidential information it
Intellectual Property Rights will safeguard and not further disclose the information
except as otherwise provided in this contract.
Copyrights and Ownership of Deliverables: All
deliverable items produced pursuant to this contract Oversight
are the exclusive property of the County. The
Contractor shall not assert a claim of copyright or Access to Persons and Records: The State Auditor
other property interest in such deliverables. shall have access to persons and records as a result of
all contracts or grants entered into by State agencies
Federal Intellectual Property Bankruptcy or political subdivisions in accordance with General
Protection Act: The Parties agree that the County Statute 147-64.7. Additionally, as the State funding
shall be entitled to all rights and benefits of the authority, the Department of Health and Human
Federal Intellectual Property Bankruptcy Protection Services shall have access to persons and records as a
Act, Public Law 100-506, codified at 11 U.S.C. 365 result of all contracts or grants entered into by State
(n)and any amendments thereto. agencies or political subdivisions.
Compliance with Applicable Laws Record Retention: Records shall not be destroyed,
purged or disposed of without the express written
Compliance with Laws: The Contractor shall consent of the County.The Department of Health and
comply with all laws, ordinances, codes, rules, Human Services' basic records retention policy
regulations, and licensing requirements that are requires all records to be retained for a minimum of
applicable to the conduct of its business, including three years following completion or termination ofthe
those of federal, state, and local agencies having contract. If the contract is subject to Federal policy
jurisdiction and/or authority. and regulations, record retention will normally be
longer than three years since records must be retained
Equal Employment Opportunity: The Contractor for a period of three years following submission of the
shall comply with all federal and State laws relating to final Federal Financial Status Report,if applicable,or
equal employment opportunity. three years following the submission of a revised final
Federal Financial Status Report. Also, if any
Health Insurance Portability and Accountability litigation, claim, negotiation, audit, disallowance
Act(HIPAA): The Contractor agrees that, if the action,or other action involving this contract has been
County determines that some or all of the activities started before expiration of the three year retention
within the scope of this contract are subject to the period described above,the records must be retained
Health Insurance Portability and Accountability Act until completion of the action and resolution of all
of 1996,P.L. 104-91, as amended("HIPAX'),or its issues which arise from it, or until the end of the
implementing regulations,it will comply with the regular three year period described above,whichever
HIPAA requirements and will execute such is later.
agreements and practices as the County may require
to ensure compliance. Warranties and Certifications
Confidentiality Date and Time Warranty: The Contractor warrants
that the product(s) and service(s) furnished pursuant
General Terms and Conditions—(06104) Page 3 of 5
Contract#68-5000
Inter-Faith Council for Social Service,Inc.
to this contract ("product'' includes, without Severability: In the event that a court of competent
limitation, any piece of equipment, hardware, jurisdiction holds that a provision or requirement of
firmware, middleware, custom or commercial this contract violates any applicable law, each such
software, or internal components, subroutines, and provision or requirement shall continue to be enforced
interfaces therein)that perform any date and/or time to the extent it is not in violation of law or is not
data recognition function,calculation, or sequencing otherwise unenforceable and all other provisions and
Will support a four digit year format and will provide requirements of this contract shall remain in full force
accurate date/time data and leap year calculations. and effect.
This warranty shall survive the termination or
expiration of this contract. Headings: The Section and Paragraph headings in
these General Terms and Conditions are not material
Certification Regarding Collection of Taxes: G.S. parts of the agreement and should not be used to
143-59.1 bars the Secretary of Administration from construe the meaning thereof.
entering into contracts with vendors that meet one of
the conditions of G.S. 105-164.8(b)and yet refuse to Time of the Essence: Time is of the essence in the
collect use taxes on sales of tangible personal performance of this contract.
property to purchasers in North Carolina. The
conditions include: (a) maintenance of a retail Key Personnel: The Contractor shall not replace any
establishment or office; (b) presence of of the key personnel assigned to the performance of
representatives in the State that solicit sales or this contract without the prior written approval of the
transact business on behalf of the vendor; and (c) County. The term"key personnel"includes any and
systematic exploitation of the market by media- all persons identified as such in the contract
assisted,media-facilitated,or media-solicited means. documents and any other persons subsequently
The Contractor certifies that it and all of its affiliates identified as key personnel by the written agreement
(if any) collect all required taxes. of the parties.
Miscellaneous Care of Property: The Contractor agrees that it shall
be responsible for the proper custody and care of any
Choice of Law: The validity of this contract and any property furnished to it for use in connection with the
of its terms or provisions, as well as the rights and performance of this contract and will reimburse the
duties of the parties to this contract, are governed by County for loss of, or damage to, such property. At
the laws of North Carolina. The Contractor, by the termination of this contract, the Contractor shall
signing this contract, agrees and submits, solely for contact the County for instructions as to the
matters concerning this Contract, to the exclusive disposition of such property and shall comply with
jurisdiction of the courts of North Carolina and these instructions.
agrees, solely for such purpose, that the exclusive
venue for any legal proceedings shall be Orange Travel Expenses: Reimbursement to the Contractor
County, North Carolina. The place of this contract for travel mileage, meals, lodging and other travel
and all transactions and agreements relating to it,and expenses incurred in the performance of this contract
their situs and forum, shall be Orange County,North shall not exceed the rates established in County
Carolina, where all matters, whether sounding in policy.
contract or tort, relating to the validity, construction,
interpretation, and enforcement shall be determined. Sales/Use Tax Refunds: If eligible, the Contractor
and all subcontractors shall: (a) ask the North
Amendment: This contract may not be amended Carolina Department of Revenue for a refund of all
orally or by performance. Any amendment must be sales and use taxes paid by them in the performance
made in written form and executed by duly authorized of this contract,pursuant to G.S. 105-164.14;and(b)
representatives of the County and the Contractor. exclude all refundable sales and use taxes from all
General Terms and Conditions-(06/04) Page 4 of 5
Contract#68-5000
Inter-Faith Council for Social Service,Inc.
reportable expenditures before the expenses are wage and encourages agencies to which it provides
entered in their reimbursement reports. funding to pursue the same goal. The County's living
wage hourly standard, as adopted by the Orange
Advertising: The Contractor shall not use the award County Board of County Commissioners annually,
of this contract as a part of any news release or can be found in the Orange County Budget
commercial advertising. Ordinance. To the extent possible, Orange County
recommends that the Contractor and all
Orange County Living Wage: Orange County is subcontractors provide a living wage, as defined in
committed to providing its employees with a living this section,to their employees.
General Terms and Conditions—(06/04) Page of
Contract#68-5000
Inter-Faith Council for Social Service,Inc.
ATTACHMENT B
SCOPE OF WORK
Orange County Department of Social Services
Federal Tax Id. or SSN
Contract#68-5000
A. CONTRACTOR INFORMATION
1. Contractor Agency Name:Inter-Faith Council for Social Service, Inc.
2. If different from Contract Administrator Information in General Contract:
Address
Telephone Number: 919-929-6380 Fax Number: 919-929-3353 Email: cmoran&ifcmailbox.org
3. Name of Program (s): Emergency Solutions Grant
4. Status: ( )Public (X-) Private,Not for Profit ) Private, For Profit
5. Contractor's Financial Reporting Year: October 1,2012 through September 30,2013
B. Explanation of Services to be provided and to whom(include SIS Service Code):
The Contractor will provide approved Emergency Shelter services as provided in the Emergengy
Solutions Grant Contract(#00027858),Attachment B, which is hereby incorporated by reference. The
Contractor is also required to meet all requirements 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)
2.Negotiated County Rate.
$60,585 allocated as provided in Attachment M and reimbursed as provided in Attachment N,
Section IV.
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 Lip to the budgetary limits of the contract allotment. See Attachment N for
reimbursement guidelines and timeframes.
F. Area to be served/Delivery site(s): Orange County
{Signature
of County Authorized Person) (Signature of Contractor)
6
(Date Submitted) (Date Submitted
Contract-Scope of Work(06104) Page I of I
Contract#68-5000
Inter-Faith Council for Social Service,Inc.
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).
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Contract#68-5000
Inter-Faith Council for Social Service,Inc.
H. The site(s)for the performance of work done in connection with the specific agreement are
listed below:
1.100 W. Rosemary Street
(Street address)
_Chanel Hill NC 27514
(City, county, state, zip code)
2. 110 W. Main Street
(Street address)
Carrboro NC 27510
(City,county, state,zip code)
3. 2505 Homestead Road
(Street address)
Chapel Hill NC 27514
(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).
Signature Title
Agency/Organization Date
(Certification signature should be same as Contract signature.)
Federal Certification-Drug-Free Workplace(06/04) Page 2 of 2
Contract#68-5000
Inter-Faith Council for Social Service,Inc.
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 I of 3
Contract#68-5000
Inter-Faith Council for Social Service,Inc.
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
1, !E1 i Zf,,�C�k fl . Gi (_ _PU Notary Public for said County
and State, certify that
y (,� e_cco� Acct Mok personally appeared before
me this day and acknowledged
that he/she is—?(-e-,5 Id t of
F Ntk r Y)'c e-
-in�cr- c,, Cooncil -� r- �Oc '
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
Conflict of Interest Policy(06104) Page 2 of 3
Contract#68-5000
Inter-Faith Council for Social Service,Inc.
Sworn to and subscribed before me this W�' day of /-y-w`r G h ,
ELIZABETH A. GARFUNKEL
Notary Public, North Carolina
- Orange County
My Commission Expires
.tune 1 1 , 2014
(O cial Seal)
Notary Public
My Commission expires _ f nt 1 20 A/
■rrrrrrarrrrrrrrrrrrrsrrrrrrrrrrrrrrirrr■■■a rrrrrrrrrr�rrrrrrrrrrrrrrru
Attached is reonflict of Interest Policy for Inter-Faith Council for Social Service,Inc.
Signa of Corporation Official
Conflict of Interest Policy(06/04) Page 3 of 3
i lj'ii
AV
0
Inter-Faith Council for Social Service
5"Ild Of Vireetws
Rebecca McCulloh March 12,2013
President
To: Orange County Department of Social Services
Chris Harlos
Vlce-Aia!ident
+ Certification:
Jenna Meints
Treasurer We certify that the Inter-Foith Council for Sociol Service 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
Mae McLendon 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).
Herb Paul
Past PreshYe7t Sworn Statement:
Don BoUltDn Rebecca McCulloh and Chris Moran being duly sworn,say that we are the Board Chair and
William sultan Executive Director, respectively,of Inter-Faith Council for Social Service of Carrboro in the
State of North Carolina;and that the foregoing certification is true,accurate and complete
Evelyn Craig 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
Richard Edens authorities for further action.
Clarke French
4
Kathleen Herr
Rebecca McCulloh, Board Chair
Randy Kabrick
Mary Beth Koza
�L
Beth Martin Chris Moran, Executive Director
Sallie Moore
Carol R
Sworn to and subscribed before me on the day of the date of said certification.
oss
Maggie Silton
Keith Taylor rAA1 y Commission Expires:Z�YV-ill
Debra Watkins (Notari Signature'and Seal)
Michael Wood
Hon army Lffe ELIZABETH A. GAR F URK E L
omrdmewber Notary Public, North Carolina
Orange County
Robert Seymour My Commission Expires
• I June 11,2014
Execz&ve Afrector
Chris Moran
1910l
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.1 th.Z%W,TrW.W.
110 W.Main Street•Carrboro,NC 27510•Phone 919-929-6380•Fax 919-929-3353•www.ifcweb.org
Contract#68-5000
Inter-Faith Council for Social Service,Inc.
ATTACHMENT G
CERTIFICATION REGARDING LOBBYING
Orange County Department of Social Services
The undersigned certifies,to the best of his or her knowledge,and belief,that:
1.No Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned,
to any person for influencing or attempting to influence an officer or employee of any agency,a
Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with the awarding of any Federal contract,continuation, renewal,
amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.
2. If any funds other than Federal appropriated funds have been paid or will be paid to any person
for influencing or attempting to influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with this Federally funded contract,grant, loan,or cooperative agreement,the
undersigned shall complete and submit Standard Form SF-LLL, "Disclosure of
Lobbying Activities," in accordance with its instructions.
3. The undersigned shall require that the language of this certification be included in the award
document for subawards at all tiers (including subcontracts, subgrants, and contracts under grants,
loans,and cooperative agreements)who receive federal funds of$100,000.00 or more and that all
subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making
or entering into this transaction imposed by Section 1352, Title 31,U.S. Code. Any person who
fails to file the required certification shall be subject to a civil penalty of not less than$10,000.00
and not more than$100,000.00 for each such failure.
'r,VN )Q,
Signature Title
Agency/Organization Date
(Certification signature should be same as Contract signature.)
Federal Certification-Lobbying(06104) Page I of I
Contract#68-5000
Inter-Faith Council for Social Service,Inc.
ATTACHMENT H
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARY EXCLUSION-LOWER TIER COVERED TRANSACTIONS
Orange County Department of Social Services
Instructions for Certification
1. By signing and submitting this proposal,the prospective lower tier participant is
providing the certification set out below.
2. The certification in this clause is a material representation of the fact upon which
reliance was placed when this transaction was entered into. If it is later determined that
the prospective lower tier participant knowingly rendered an erroneous certification, in
addition to other remedies available to the Federal Government, the department or agency
with which this transaction originated may pursue available remedies, including
suspension and/or debarment.
3. The prospective lower tier participant will provide immediate written notice to the
person to which the proposal is submitted if at any time the prospective lower tier
participant learns that its certification was erroneous when submitted or has become
erroneous by reason of changed circumstances.
4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier
covered transaction," "participant," "person," "primary covered transaction," "principal,"
"proposal," and"voluntarily excluded," as used in this clause,have the meanings set out
in the Definitions and Coverage sections of rules implementing Executive Order 12549.
You may contact the person to which this proposal is submitted for assistance in
obtaining a copy of those regulations.
5. The prospective lower tier participant agrees by submitting this proposal that, should
the proposed covered transaction be entered into, it shall not knowingly enter any lower
tier covered transaction with a person who is debarred, suspended, determined ineligible
or voluntarily excluded from participation in this covered transaction unless authorized by
the department or agency with which this transaction originated.
6. The prospective lower tier participant further agrees by submitting this proposal that
it will include this clause titled"Certification Regarding Debarment, Suspension,
Ineligibility and Voluntary Exclusion-Lower Tier Covered Transaction," without
modification, in all lower tier covered transactions and in all solicitations for lower tier
covered transactions.
7. A participant in a covered transaction may rely upon a certification of a prospective
participant in a lower tier covered transaction that it is not debarred, suspended,
ineligible, or voluntarily excluded from covered transaction,unless it knows that the
certification is erroneous. A participant may decide the method and frequency of which it
Federal Certification-Debarment(06/04) Page 1 of 2
Contract#68-5000
Inter-Faith Council for Social Service,Inc.
determines the eligibility of its principals. Each participant may,but is not required to,
check the Nonprocurement List.
8. Nothing contained in the foregoing shall be construed to require establishment of a
system of records in order to render in good faith the certification required by this clause.
The knowledge and information of a participant is not required to exceed that which is
normally possessed by a prudent person in the ordinary course of business dealings.
9. Except for transactions authorized in paragraph 5 of these instructions, if a
participant in a covered transaction knowingly enters into a lower tier covered transaction
with a person who is suspended, debarred, ineligible, or voluntarily excluded from
participation in this transaction, in addition to other remedies available to the Federal
Government,the department or agency with which this transaction originated may pursue
available remedies, including suspension, and/or debarment.
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-
Lower Tier Covered Transactions
(1) The prospective lower tier participant certifies, by submission of this proposal,that
neither it nor its principals is presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from participation in this transaction by any
Federal department or agency.
(2) Where the prospective lower tier participant is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation to
this proposal.
Signature Title
Agency/Organization Date
(Certification signature should be same as Contract signature.)
Federal Certification-Debarment(06/04) Page 2 of 2
Contract#68-5000
Inter-Faith Council for Social Service,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 for a 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 of tax-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 learn more about non profits,visit www.irs.gov, 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
Department of the Treasury
Date: September 28, 2004 P. O. Box 2508
Cincinnati, OH 45201
Inter-Faith Council for Social Service Person to Contact:
110 W. Main Street Mrs. Jones 31-03886
Carrboro, NC 27510-2085 Customer Service Specialist
Toll Free Telephone Number:
8:00 a.m.to 6:30 p.m. EST
877-829-5500
Fax Number.
513-263-3756
Federal Identification Number.
Dear Sir or Madam:
This is in response to your request of September 28, 2004, regarding your organization's tax-
exempt status.
In November 1970 we Issued a determination letter that recognized your organization as
exempt from federal income tax. Our records indicate that your organization Is currently
exempt under section 501(c)(3) of the Internal Revenue Code.
Our records indicate that your organization is also classified as a public charity under
sections 509(a)(1)and 170(bX1)(A)(vi)of the Internal Revenue Code.
Our records indicate that contributions to your organization are deductible under section 170
of the Code, and that you are qualified to receive tax deductible bequests, devises, transfers
or gifts under section 2055, 2106 or 2522 of the Internal Revenue Code.
If you have any questions, please call us at the telephone number shown in the heading of
this letter.
Sincerely,
A ;YAj&-)
Janna K. Skufca, Director, TE/GE
Customer Account Servic.#s
Contract#68-5000
Inter-Faith Council for Social Service,Inc.
ATTACHMENT M
BUDGET
Orange County Department of Social Services
October 1,2012 - September 30, 2013
Cost Type Total
EMERENCY RESPONSE
Emergency Shelter Rent $ 14,902
Emergency Shelter Utilities $ 14,902
Emergency Shelter Supplies $ 29,806
Subtotal $ 59,610
SYSTEM COORDINATION
HMIS/CHIN User Fees $ 975
• Subtotal $ 975
MATCH
Cash and/or In-Kind $168,467
Subtotal $168,467
Total $229,052
Page 1 of 1
Contract#68-5000
Inter-Faith Council for Social Service,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:
BACKGROUND:
The Emergency Solutions Grant(ESG)was created in the HEARTH Act by combining the
previous Emergency Shelter Grant and previous Homelessness Prevention and Rapid Re-Housing
programs. The ESG program is intended to assist people in preventing or ending their
homelessness through its support of homeless emergency services (primarily homeless shelters)
and community housing stability programs. The program is designed to emphasize placement in
permanent housing as the desired outcome. On any given night in North Carolina there are over
10,000 homeless people eligible for this assistance.
PURPOSE:
ESG Grantees are responsible for completing tasks from a menu of federally eligible services. The
ESG grant will support operating expenses for homeless shelters, including but not limited to
facility rent and utility payments, insurance, and supplies.
The Contractor's approved budget includes:
• Serving an estimated 500 individuals/households at an expected cost of approximately$119
per individual/household
• CHIN data entry at a cost of$975 for User Fees
• Providing matching funds in the amount of$168,467.00
SCOPE OF WORK:
I. Training
All core ESG project staff, including housing stability managers, case management supervisors,
grant managers, Emergency Services case managers, CHIN data entry, and financial processors
must attend ESG training provided by the State within 45 days of contract execution.
Type of Position Type of Required Training
Housing Stability Case Manager and Supervisors Face to Face
Grant Managers Webinar/Conference Call
CHIN data entry Face to Face
Financial Processing/Fiscal Webinar/Conference Call
Emergency Services Case Manager Webinar/Conference Call
Documentation: Copy of certification of training completion or training sign-in sheets.
II. Eligibility Screening and Intake
Contractor will engage in ESG intake and eligibility process to comply with US Department of
Housing and Urban Development(HUD) and state guidance documenting all federally required
eligibility criteria, including but not limited to homeless status. Contract will only provide ESG
Outcomes (06/04) Page 1 of 5
Contract#68-5000
Inter-Faith Council for Social Service,Inc.
funded services to eligible participants. If Contractor provides services to ineligible participants
using ESG funds or ESG matching funds the Contractor will reimburse the County for those funds
from a non-ESG funding source.
Documentation: Participant files and appropriate data entered into CHIN.
111. Carolina Homeless Information Network(CHIN)
Contractor will be responsible for ensuring that all staff involved in CHIN data entry or CHIN data
monitoring shall participate in ESG CHIN training. Staff responsible for CHIN data entry or
monitoring is expected to take advantage of available technical assistance in an assertive,proactive
manner to ensure their ability to meet the requirements for accurate data entry. Contractor will
input,regularly review, and correct,if necessary, 100%of required data fields into CHIN within
two weeks of client contact and/or service. Data fields include,but are not limited to: eligibility,
demographic,and risk factor data for participant households, services provided to households,
Financial Assistance (dollar amounts for individual)and salaried staff time spent directly on work
with ESG households. In addition, CHIN will provide monthly data quality reports to Contractor
and the Housing and Homelessness Unit.
Domestic Violence programs are prohibited from entering data into CHIN. They are required,
however,to collect all of the same data in a separate system and to report aggregate information to
the State as needed for State and federal reports.
Documentation: CHIN reports and Participant files.
IV. Eligible Expenditures
Emergency Shelter Operations
• Maintenance
• Rent
• Security
• Fuel
• Equipment
• Insurance
• Utilities
• Food
• Furnishings
• Supplies necessary for the operation of the emergency shelter
Systems Coordination
• HMIS (Staffing,Equipment)
PERFORMANCE MONITORING/QUALITY ASSURANCE PLAN
1. Spending Rates
Contractor must expend 100%of funds and 100%of the matching funds by September 30,2013.
Contractor is allowed to spend 100%of funds before June 30,2013.
Documentation: Fiscal reports.
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Contract#68-5000
Inter-Faith Council for Social Service,Inc.
11. Monitoring
Contractor will participate in all monitoring activities,programmatic and/or fiscal, state and/or
federal, field and/or desk monitoring(materials mailed/emailed in to the state offices).
A. At a minimum,participant file monitoring will include review of households that were not
enrolled into the program, households that are currently enrolled in the program, and
households that have exited the program(unless no households have yet exited).
B. Fiscal monitoring will include monitoring of fiscal processes, financial documentation of
expenses, and eligibility documentation in client files.
C. Programmatic monitoring will also include review of CHIN data entry and monitoring
practices.
Frequency of monitoring visits may be based on performance as documented in CHIN and
additional risk factors as identified in previous grantee performance, grant application forms, and
monitoring reports from other state and federal agencies.
Documentation: Monitoring reports and participant files.
III. Reporting
A. Contractor will be responsible for accurate and complete CHIN data entry(comparable data
for Domestic Violence programs) and reimbursements requests. All CHIN data entry for
the quarter must be entered into CHIN by the end of the third month of the quarter.
B. Contractor will be responsible for all other information required for federal reporting.
Contractor will be notified of these reporting requirements as federal guidance is provided.
C. Contractor will be responsible for submission of semi-annual reports to the State.
Documentation: CHIN reports,Annual reports, Semi-Annual reports.
IV. Reimbursement
The Contractor shall submit to Orange County Department of Social Services by the 5h of each
month, a monthly reimbursement request for services rendered the previous month. Contractor will
submit reimbursement requests using forms supplied by the State with required
documentation/proof of payment and maintaining additional required documentation in household
(participant) files and in the CHIN system. Reimbursement requests may be verified against data in
CHIN before payment is made. The Contractor shall reimburse the County for any funds that are
misused. When reimbursements are made in a timely and complete manner, Emergency Services
reimbursements will be paid on a monthly basis.
Documentation: Reimbursement forms,reimbursement documentation, CHIN reports,participant
files,timesheets or documentation of indirect cost rates, cost allocation plans and paid invoices.
V
Signature Title
Outcomes (06104) Page 3 of 5
Contract#68-5000
Inter-Faith Council for Social Service,Inc.
Agency/Organization Date
(Certification signature should be same as Contract signature.)
PERFORMANCE MEASURES CHART
The County uses performance measures rubrics as a tool to determine the success of a project and
how well services and products are being delivered. Together they enable the County to gauge
efficiency, determine progress toward desired results and assess whether the program is on track
with meeting its goals. The Contractors shall adhere to all of the performance
requirements/standards in the scope of work, including performance measures in the chart below.
Measure Outcome Frequency Semi-Annual
Type
_
Measure Increase the percentage of households that exit to permanent housing
Year 2013 Preferred Increase
Trend
Target Value 30%
Data Source CHIN,the statewide Homeless Management Information
System
Collection Staff enter data into the CHIN system
Process and
Calculation
Collection Daily
Frequency
Measure Quality Frequency Semi-Annual
Type I
Measure Maintain HMIS bed coverage for the region
Year 2013 Preferred Maintain
I Trend
Target Value 90-100%
Data Source The HUD required ERIC, electronic housing inventory chart
Collection Contractor provides CoC Lead Agency with data to be
Process and entered into the ERIC
Calculation
Collection Annually
Frequency I
Measure Quality Frequency Semi-Annual
Type I
Measure Decrease the percentage of households that exit to unknown destinations
Outcomes (06/04) Page 4 of 5
Contract#68-5000
Inter-Faith Council for Social Service,Inc.
ecrease
Year 2013 Preferred D
Trend
Target Value 50%
Data Source CHIN,the statewide Homeless Management Information
System
Collection Staff enter client level data into the CHIN system
Process and
Calculation
Collection Daily
Frequency
Outcomes (06/04) Page 5 of 5